If people with BDD see someone who looks as bad as they do, they still don’t feel much better about themselves. Somehow they interpret the situation negatively, thinking such things as “He doesn’t have much hair, but he’s laughing and seems to be enjoying himself. Why can’t I?” Or “She looks as bad as I do, but she has a boyfriend. What’s wrong with me?” A 40-year-old man said, “I stare at peoples’ faces thinking ‘He has freckles and he’s talking to people. Why can’t I do that?’” The situation is interpreted in terms of—and usually ends up reinforcing—the BDD sufferer’s own perceived shortcomings.
“When I’m standing in line at the drug store or the grocery store, I talk to myself, trying to reassure myself that I don’t look so bad and that I should stay in line instead of leaving,” Jason said. “I look at other people and think they’re uglier and worse off than me. But then my thinking takes a negative turn: I think things like ‘It’s true, he’s really ugly, but he doesn’t seem to care. He seems to be doing fine! What’s wrong with me?’ Or I check out all the successful people on TV—a lot of them aren’t attractive, but they’re smiling and seem happy, so I think maybe I can be happy too. But then I get down on myself because I’m not.”
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Cats
The exact incidence of cat allergy has not been established, but in my own practice it is one of the five most common allergens. Allergies to birds, gerbils, hamsters, and rabbits occur, although much less frequently than allergy to cat. Their exact incidence is likewise not clearly established.
If you are a cat-allergic person, you are well aware of the sneezing, nasal congestion, and runny nose that can occur within a few minutes of entering a home inhabited by a house cat. The substance responsible for these symptoms is a protein allergists refer to as Fel d I (this protein is the 1st allergen derived from Felines). Derived primarily from cat salivary glands and sebaceous (oil) glands of hair roots, Fel d I is primarily distributed by cat saliva and dander (material common to the superficial skin). Cat urine and feces contribute little to Fel d I’s load in homes.
Easily airborne, Fel d I appears to remain so for hours, even in an undisturbed house (a house with no one in it). Walking on carpet or sitting on furniture containing this protein causes significant amounts of it to be released into the air. A protein of relatively low molecular weight, it can easily lodge in the nose and eyes or evade nasal entrapment and find its way into the lungs, thus wreaking misery upon cat-allergic family members or guests. It will take months for the cat allergen to abate from your home even after the cat itself has been banished to the outdoors.

Dogs
Like cats, dogs are common causes of perennial allergic rhinitis. The exact nature of the dog’s allergenic proteins responsible for symptoms has not been delineated to the degree that that of cats and house mites has been. We do know that the allergens are proteins and that they are found primarily in the dog’s shed skin and saliva. They also are found in dog hair, blood serum, urine, and feces, but these are not the sources of our primary exposure.
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The design and operation of the human body and the way in which it operates on an automatic level never ceases to astound me. Among the things I find really fascinating is the way the human body knows how to hold to life, to protect its existence. As part of its innate knowledge about how to protect itself, the body tends to prepare itself in ways that I call the as if syndromes. The body changes of these ‘as if patterns of preparedness can cause physical symptoms in stage one stress breakdown. For example:

‘As If I’m fighting for my life
There was an interesting article in one of the medical journals a few years ago about the use of onions and garlic to reduce the risk of thrombosis, that is, the clotting of blood within veins and arteries. It was based on an old French veterinary remedy for thrombosis in horses, and it sparked off some witty letters to the editor about this proposed method of preventing heart attacks. An experiment was described where medical students going into examinations had their blood tested for its clotting ability, some of them having had a meal with onions and some having had a meal without them. The researchers purported to show that the students who had not eaten onions prior to the examination showed an increased tendency for the blood to clot as a result of the stress of the examinations.
What interested me more than the onions or their effects on interpersonal relationships was that the blood of healthy young people should be more ready to clot when they go ‘to do battle’ with the examiners. I have heard that people in hiring and firing jobs have a higher risk of heart attack. (Heart attacks are usually caused by a clot of blood blocking up the coronary artery to the heart – coronary thrombosis.)
It is as if the person going out to face some conflict has his body made ready to respond to a possible loss of blood. It is said that soldiers sustaining severe wounds in battle often don’t bleed much at all, whereas if a person sustains a severe, unexpected wound, as in the case of a butcher severing a femoral artery while boning the ribs of a carcass, there is a real risk of dying immediately from loss of blood. Clearly, readiness for conflict can minimize blood loss.
It is as if the body tones up the blood vessels so they are all ready to shut down the moment they are severed and the blood made ready to clot at a moment’s notice. Unfortunately, if the battle involves a politician under attack from his opposition having to defend himself against a barrage of criticism at question time in the parliament, the toned up blood vessels and quick-clotting blood would be of no good use to him at all. Instead, the increased tone of the blood vessels and the extra clotting ability might cause a clot to form in a vein or artery. I remember how President Nixon suffered from thrombosis of his leg veins when he was in a beleaguered state prior to his resignation.

‘As If I’m hanging on by the skin of my teeth
There are many patterns of preparedness characterized by chronic contraction of specific muscle groups. A common pattern is seen in the person who is expecting the worst and has the teeth clenched and the head held rigidly in anticipation. This may cause severe pain in the temporo-mandibular joint in front of the ear, as well as headaches and neck pain. In general, I find that people who are always psychologically bracing themselves for disaster tend to suffer with stiffness and pain of the extensor muscles of the body. These include not only the muscles at the back of the neck, but those of the shoulders and the lower back.

‘As If I’m starving to death
Diabetes mellitus, or sugar diabetes, used to be considered a psychosomatic disorder, particularly when it was discovered that the extra Cortisol released by the adrenal cortex under conditions of stress tends to increase the body’s blood glucose level and produce symptoms similar to diabetes.
However, there is now no real need to think of diabetes mellitus as a psychosomatic disorder (it doesn’t avail us much), because the treatment for diabetes is by insulin injections and diet, or diet and pills, or diet alone. However, I have been impressed with the number of diabetic patients who have in (their history a significant cause of deep insecurity, an insecurity so profound that they may have feared, at least unconsciously, starving to death.
In diabetes mellitus, the body behaves as if it only has fat from the body stores to live on, as if it is starving to death. The body seems to ignore food coming in to the stomach – with regard to secreting suitable quantities of insulin at least – and occupies itself with breaking down stores of body fat. The result is a combination of excess acid in the blood from breaking down fat, plus an inability to metabolize carbohydrates, with excess glucose flowing out in the urine.
Let me say, however, that while this theory is an interesting one and attention should be paid to deeply-held fears of being abandoned and starving, the correct treatment of diabetes mellitus is by the medically proven methods of diet, hypoglycemic drugs and insulin.

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