When the mirror lies: Body dysmorphic disorder

Note: Orignally written for Tiny Medicine. Click on the link below to watch the animated verison of this blog post.

Most of us are guilty of not being satisfied with the man in the mirror but when this dissatisfaction becomes an obsession it’s highly likely that you’re not just been vain but in reality suffering from body dysmorphic disorder. Keep on watching to find out more about this interesting condition.

What exactly is body dysmorphic disorder?

Body dysmorphic disorder is a mental disorder where one is unhappy with their appearance resulting in an obsession with their flaws thereby hindering their ability to lead a normal life. This flaw could either be a figment of the victim’s imagination or when actually present is less significant than it is perceived by the victim. The obsession can be focused on any part of the body but is more commonly focused on the face, hair, stomach, thighs, or hips. Sufferers of BDD on average may spend around 3-8 hours per day thinking, repeatedly checking and comparing the perceived flaw.  BDD usually starts in adolescence and affects both men and women equally. 

In an attempt to hide their “flaw” victims of BDD may resort to excessive grooming techniques as well as avoid social contact. Some may even seek dermatological treatments or cosmetic surgery which generally doesn’t resolve the distress.  Due to the distress caused by the flaws some victims of BDD experience depression, social anxiety and suicidal thoughts. In addition they may also experience delusions that other people are constantly talking about their flaws.

The cause for BDD is thought to be an amalgamation of genetics, environmental, psychological, biological, social and cultural factors. 

BDD has also been associated with visual processing abnormalities and executive dysfunction. Meaning a victim of BDD has a bias for analyzing fine details rather than looking at the big picture. For example they focus on the flaw in their face (mole) and cannot see beyond it and are unable to see what the face looks like on the whole.

The Goal of treating BDD is to minimize the false beliefs about the defects as well as minimize the compulsive behavior that follows as a result of it. As BDD shares features with Obsessive compulsive disorder the treatment of BDD is similar to OCD and is treated with a combination of medication and cognitive behavior therapy. At present there isn’t an FDA approved drug to treat BDD but antidepressants and antipsychotics are prescribed in order to treat the symptoms of BDD.

BDD is not a quest to increase one’s appearance but a quest to normalize the appearance.

How to deal with Exam stress

Note: Originally written for Tiny Medicine. Click on the link below to watch the animated version of it.

Exams, the dreaded 5 letter word in every student’s vocabulary. Just the mere mention of it is enough to induce stress; every student’s worst enemy. Hold onto your adrenaline and don’t get stressed for we have got you covered.

 So what is the science behind getting stressed?

The amygdala located in the brain senses potentially stressful situations and activates the hypothalamus which carries the message to the pituitary gland. The pituitary gland then in turn activates the adrenal gland which results in secretion of the hormones adrenaline and cortisone. These hormones are responsible for inducing the fight or flight response in the body. When stress levels get too intense it results in negative symptoms.

Keep on watching to find out the best ways to deal with exam stress and how you can transform it from your worst enemy into your friend.

1. Plan ahead

One of the key factors contributing to stress during exams is the massive workload. The best way to tackle this is to start studying well in advance so that the study material can be dealt in small doses instead of one mega dose avoiding the volcano effect. This will not only help in dealing with the stress effectively but also help in retaining more information.

• Take frequent study breaks

Studying for long periods without taking breaks has been proven to be ineffective. Furthermore psychological studies have found out that the average human brain can only concentrate on one task effectively for 45 minutes. Therefore it is important to take frequent breaks not only to optimize studying but also to give the brain it’s much required rest. You can either take small 5 minute breaks every 45 minutes or follow the Pomodoro technique. The pomodoro technique is very effective if you are trying to fight off procrastination as well.

 Of course for many of us a 5 minute break ends up becoming more than 5 minutes and next thing you know it’s time to sleep. This brings us to our next tip which is sure to help you in combating this problem.

• Make a time table and stick to it

Preparing a time table with slots for the study material you are planning to tackle for the day, study breaks and whatever else you have in store for the day not only helps in keeping your breaks in check but also helps in making maximum use of the day. Yes we all know that making a time table is easy but sticking to it is easier said than done. Some tips that will help you in sticking to the timetable you have made for yourself is making the time table the previous day and making it as realistic as possible by setting realistic goals and breaks.

• Get enough sleep

Most of us are guilty when it comes to this one especially during the exam season. But not getting enough sleep actually does more harm than good for your exams. Sleep is an important human function and is instrumental in recharging the brain and body. Decrease in quality and length of sleep leads to increased stress levels. Therefore it is important especially during exam season to not compromise on your sleep. Young adults require a minimum of 8 hours of good quality sleep to function optimally.

• Exercise

Apart from improving your overall health and your sense of well being, exercise has the added benefit of being a stress buster. Exercise pumps up your endorphins, helps relax and calm the body and mind and improves sleep. It is also a great way to break the monotony of the day.

• Eat healthily and stay hydrated

Your health should always be your number one priority. We usually tend to neglect our physical health during exam season. This is a big mistake. Eating well, drinking lots of water, providing your body with the essentials and a bit more, goes a long way in helping you during exams and keeping stress at bay.

• Talk to someone

Sometimes talking to someone close to you might help you in dealing with exam stress. Maybe it is just hearing their voice or maybe it is their faith in you or even their encouraging words. Either way speaking to a family member or a friend can motivate and empower you to rise above the exam stress.

Exams are a part of life for students. There is simply no way in getting around it. But that doesn’t mean you should let exam stress take over your life.

The desire to be disabled: Body integrity identity disorder

Note: Originally written for Tiny medicine. Click on the link below to view the animated version of this blog post

Ancient Roman Poet Virgil very rightly said “health is the greatest wealth” but did you know that there exists a small fraction of people in this world who desire to be disabled? So intense is their desire that some may even undergo voluntary amputations or try making themselves blind or deaf in a bid to fulfill this desire. Such people are said to be suffering from body integrity identity disorder.

While the Greek myth says that king Oedipus blinded himself as a result of the remorse he was feeling for his past actions, the desire for people with body integrity identity disorder to become disabled stems from a medical condition rather than guilt.

So what exactly is body integrity identity disorder?

Body integrity identity disorder (BIID) also known as  Body integrity dysphoria, amputee identity disorder and xenomelia  is a disorder characterized by a desire to be disabled or simply being uncomfortable with being able bodied. This desire arises due to a mismatch between one’s ideal body image and the actual physical appearance. As a result victims of BIID believe a part of their body does not actually belong to them. This belief often leads to their desire to amputate the offending limb which is healthy and working properly or to become blind or deaf. BIID is kind of similar to Gender dysphoria. While in Gender dyshoria one wishes for a change of gender, those with BIID wish to exchange their normal body with an incomplete one. People with BIID often refer to themselves as transabled just like how people with gender dysphoria refer to themselves as transgender.

 Apart from the intense desire to lose a limb or a sense (sight, hearing) people suffering from BIID often feel anxious and depressed. The anxiety and depression is generally due to the discomfort caused by being able bodied. Although it may seem that BIID is a psychological condition it is actually a neurological condition.

As this condition is an extremely rare disease there isn’t much research available and a definite cause for it hasn’t been identified yet. The most popular theory for the cause of BIID is the theory that the brain isn’t able to provide an accurate plan of the body. As a result of which the brain sees the offending limb as being foreign and not actually a part of the person, hence the desire to have it removed. Research has also shown that those desiring amputations have brain damage in the right hemisphere. Some other plausible causes for BIID put forward by researchers are

• Childhood trauma
• Obsessive compulsive tendencies
• Exposure to amputees at a young age

The wish to become an amputee or to become deaf or blind begins at a very young age, and usually begins between the ages of 8 and 12, although they seek treatment when they are much older.

So how do we treat BIID?

Sadly there is no cure for this condition. Most doctors prescribe cognitive behavioral therapy and antidepressants with the aim of reducing the anxiety, distress and depression caused by living with BIID. Treating the symptoms of obsessions and compulsions has also been proven to be successful in reducing symptoms of BIID.

Even after years of psychotherapy some people still wish to be disabled. Some may act out their desires by pretending that they are amputees using prostheses and other tools like canes in the hopes of easing their desire to be one. Some even resort to self amputation while some damage the limb sufficiently that an amputation becomes necessary. However the latter two are extremely rare.

While the obvious and most logical treatment for BIID may seem like to make the patient disabled. This is not done for many reasons.

• Amputations have only been shown to have a 70% success rate of resolving the symptoms of BIID
• The ethical  concerns related to amputating a healthy limb

 An interesting fact is that most victims of BIID are males, with an association with gender identity disorder, and certain personality disorders like borderline personality disorder. There also doesn’t seem to be a preferred side for the unwanted limb or any history of trauma to the unwanted limb among the prevalent cases.

Although it may seem impossible for us to wrap our head around the idea that someone would want to voluntarily become disabled, BIID or the desire to be disabled is a very real medical condition causing great distress to its victims.

Drug Cocktail for heart failure

When your heart is failing

You might think that it’s the end

But if you have the right friends by your side

The end isn’t as near as you might think

All you need are three trusty friends

To help you tide over the difficult times

The first friend you should call over is Diuretics

For a quick visit from him will make you feel better in no time

While thiazide diuretics will help if your heart is failing only mildly

Loop diuretics will help you if your heart is failing moderately or severely

But neither will be of use if you wish to delay you visit to heaven

Next you should give a ring to ACE Inhibitors

Not only does he make you feel better right away

 He can also prolong your life on earth

If being around ACEI infects you with his dry cough

Send him home and call his rich cousin Angiotensin II receptor Blocker over

He is just as good and doesn’t have a dry cough

Lastly only once your heart failure becomes stable

Give a ring to beta blockers

He will surely delay your visit to heaven

Whatever happens do not call

NSAIDS, Corticosteroids or COX 2 inhibitors

Although they were your friends once

They are no longer you friend but your foe

Paradox

I like rock climbing, zip lining and hiking but I also like to just chill in the hotel room reveling in its luxury and posing for pictures. I like watching chick flicks but I also like watching cricket. I love getting dressed up and going out and meeting my friends but I also like cuddling up in bed with a book. I like keeping up with the science world but also the Kadashians. I’m an extrovert but also an introvert.

In short I’m a paradox.

For the longest time this paradox nature of mine was a problem for me. In my short life I had never met anyone like me; a person with such varied interests. I felt like I had to choose one side of the coin in order to fit in. At one point I even thought I had multiple personality disorder and forced myself to pick one side of the coin in a bid to suppress it. I soon realized that something was missing and that I was not happy. At that time I thought I had chosen the wrong side of the coin and chose the other side.

Guess what? I was still unhappy.

That’s when I realized that I didn’t have to choose. There was nothing wrong with being a paradox. For Life is filled with many paradoxes. I am just one of the many.

Types of people in a clinical group

The people in your clinical group can either make or break your clinical experience. Irrespective of whether you are stuck with a good clinical group or a bad clinical group you are guaranteed of having the following people in your group.

The leader

This person carries the weight of the clinical rotation on his/her shoulders. He/she makes it their duty to ensure that the rotation runs smoothly and usually end up being the one who requests for classes from the ward doctors and dividing the patients.

The Savior

This person is the sole reason for the group to pass the clinical rotations as he/she knows the answers to all the questions.

The one who gets picked on

The unluckiest member in the clinical group, either this person’s patient is always discussed or he/she is always picked on by the consultant. It wouldn’t matter if this person’s patient had been discharged and gone to timbuktu because still the consultant would want to ask a question in relation to that patient.

The elusive one

This person is as elusive as Scarlet Pimpernel. He/she never gets picked on by the consultant nor is his patient discussed. While the “one who gets picked on” is the unluckiest member in the group this person is the luckiest member in the group.

The clueless one

Just like the name suggest this person is clueless at all times during the rotation. He/she will attend the orthopedic rotation thinking it is the rheumatology rotation.

 The latecomer

This is the person who gets late for clinical rotations every day. It’s as if this person doesn’t own any watches or clocks.

Did you spot yourself or someone you know?

Types of medical students

4 years into medical school, it’s safe to say that I have seen the good, the bad and the ugly. It has also made me come to the realization that most medical students can be grouped into 5 different types. So read on to find out which group you belong to.

The part time medical students

Contrary to popular belief this species does exist in medical school. They are the medical students who have time for everything other than medical school. They have time to socialize, to workout in the gym and for their side hustle but sadly don’t have time for medical school. Yet they do manage to scrape through all the exams.

The ‘Cool as a Cucumber’ medical students

They are the antithesis of the part time medical students. Some would also go as far as to call them the ideal medical students. They eat, drink and breathe medicine. They have the answers to all the questions at the tip of their tongue. Moreover they are the only group of medical students who are not stressed out for their exams and instead are cool as a cucumber during exam season.

The last minute medical students

These are the medical students who procrastinate all year long but when exams roll over it’s a different story. It’s as if someone pressed the reboot button and ‘abracadabra’ it’s a new person. No longer can a TV series, movie or person distract them. They will pull all nighters and work really hard promising themselves that next time they will start studying earlier knowing deep down that will never happen.

The ‘know it all’ medical students

They are just like Mr. Colin from Pride and Prejudice. They think they know everything and certainly act like they do but in reality they don’t. They even try to teach the consultant!

The “I didn’t study” medical students

These are the medical students who stay up all night long studying yet come to university the next day and lament about not having studied the day before.

At the end of the day it doesn’t matter which type you belong to because the reality is being a medical student is tough.

Liebster Award!!!

Ayubowan!

Hope everyone is safe and practicing social distancing. My dull day was brightened by Rupal who has very kindly nominated me for the Liebster Award. This is my first time being nominated for any kind of blogging award and I’m super excited about it. Thank you Rupal for nominating me.

Rules to the Liebster Blogger awards:

1. Thank the blogger who nominated you and give a link to the blog.
2. Answer the 11 questions given to you
3. Share 11 facts about yourself
4. Nominate between 5-11 other bloggers
5. Ask your nominees 11 questions
6. Notify your nominees once you’ve uploaded your post

Rupal’s Questions for me

• How do you relieve your stress?

By blogging, watching you tube videos or playing Sudoku

• What’s your favourite timepass?

Binge watching tv series

• Your dream destination

New York City/Greece

• How was your life before coronavirus?

Life before coronavirus was very stressful with clinical training at the hospital in the morning and lectures in the afternoon. Thanks to coronavirus I get to stay at home and spend time with my family and catch up with my friends. I also finally have time for my extracurricular activities and of course blogging.

• Choose one! Is blogging/writing your *profession *hobby *passion * timepass

Blogging is my passion

• Five things you can’t live without at present

My family, my phone, my laptop, WIFI, my headphones

• Any habit you wanna quit but struggling at it

Not being narcissistic but I don’t think I have any bad habits

• Your favourite food/cuisine

Thai food

• The activities you are doing during lockdown

Binge watching tv series, blogging, house work, playing cards with my family

• Choose one (where you would love to go when situation is back on track) *clubbing *beaches *mountains *adventure parks

Mountains

• The quote you would read at the time when life is not going the way you are expecting it to go

“The flower that blooms in adversity is the most rare and beautiful of all”

11 facts about me

1. My first name ends with ‘dri’ hence why my blog is called A spoonful of Dri
2. I am a fourth year medical student from Sri Lanka
3. I still know all the dialogues and lyrics from the Disney animated movie Mulan (1998)
4. My all-time favourite TV series is One Tree Hill
5. I am a Potterhead and a Ravenclaw
6. I can do a darn good imitation of the British accent (At least I like to think so)
7. I am an ambivert
8. My favourite book genre is historical fiction
9. I am a feminist
10. I love baking and icing cakes
11. I enjoy travelling to new places

11 questions for my nominees

1. What decade do you feel you most belong in?
2. If you could identify with one fictional character (from a book, show or movie) who would it be?
3. If you could have dinner with any famous personality (past/present) who would it be?
4. In your opinion what is your best feature?
5. What is your guilty pleasure?
6. What is your all-time favourite movie?
7. Who is your celebrity crush?
8. What is the first thing you are planning on doing once the pandemic ends?
9. What is your favourite colour?
10. What did you want to be when you were a kid?
11. Tea or coffee?

My Nominees

1. The musings of a medico
2. Sinus Rhythm
3. doctor2be2022
4. Confessions of a doctor to be
5. Aarish’s blog
6. The Shubham Stories

A huge thank you to all those who have and continue to support my blog. The comments you leave and the likes really encourage me. Last but certainly not the least a big thank you to my two best friends who encouraged me to start my blog.

Love,

Dri

A different war

The world was engulfed in fear and despair

Curfew imposed and people confined to houses

A shortage of food and food rationed

Many lost their lives

Many lost a son, brother, husband, father, lover

At last after 6 long years it all came to an end

The valiant soldiers who fought in the frontlines

Armed with their weapons were welcomed as heroes

Everyone rejoiced again

Everyone had only one wish in their heart that day

“That the world would not witness such a deadly war ever again”

Thus the great nations came together and made a pledge,

A pledge to never allow Mother Nature to witness a war again

A pledge committing to maintain world peace

Yet no pledge, no organization could prevent the COVID 19 Pandemic

Just like 75 years ago mankind is facing a war again albeit a little different

Fighting in the frontlines are not soldiers armed with guns and explosives but doctors armed with facemasks, gloves and antivirals

Nuclear bombs have been replaced by Hand Sanitizer and disinfectants as lethal weapons

But most importantly instead of the Allies fighting against the Axis we have come together to fight against one

Perhaps the pandemic has been successful in doing what the world has been trying to achieve

Dear COVID -19,

Congratulations for single handedly bringing all of mankind to its knees. Boy you really know how to make a scene don’t you? Honestly girls should take cues from you. You proved to us earthlings that despite walking on the moon and having big plans to send human missions to mars we are still vulnerable as we were when the black plague broke out in the 14^th century. That a wee virus still has the potential to wipe us off the face of the planet.

I remember the time your cousin SARS- CoV visited earth and I thought that you too just like him wouldn’t visit our tiny nation with its tropical climate.  Alas you did decide to pay us a visit albeit late, in keeping with the Sri Lankan habits I suppose.

After being in self quarantine for more than a week I finally have the time to stop and smell the roses, to realize how enjoyable family time can be ( for watching my parents fight over the same spoon while playing spoons is indeed a treat), to be grateful for all that I have been blessed with, to realize how fleeting life can be, to realize that not everything is in my control and that it’s okay and finally realizing that sometimes the best solution is to not do anything.

So although I’m not too pleased about the state of emergency you have thrown my country into, thank you COVID -19 for teaching me these valuable life lessons. I hope you are enjoying your stay here. I’m sure you must be for us Lankans have a practice of treating our guests like god but please do not overstay your welcome.

Love,

An earthling from Sri Lanka