A life with nearly no BDD

 What's on?

Mirrors, even in harsh light, are not a problem anymore. A few days ago, I could scrutinise my face in strong light, notice signs of ageing, and stay relaxed about them, an incredible feeling! I could also appreciate the friendly and pleasant-looking person I was facing.

zoom sessions have become a habit, I even propose them, and I am amazed that what I considered the weird shape under my mouth is sometimes not visible anymore. That makes me realise how much our vision can trick us. I'd rather be tricked this new way!

I have now started a summer project for finally being able to make close-up photos. The reason is, I need them for my different projects. I am always asked for a photo alongside my biographical details. And I have now enough of sending photos which are four to eleven years old! The project is thus: each time we go for a walk, my husband takes a photo of me, with the idea that it will gradually be closer and closer.

I have another milestone to face in the autumn: being filmed for a music documentary. I am still frightened. Meanwhile though, my vision of actors in TV series has become more and more tolerant. There is in particular a very popular French crime series where six of the eight main characters have crooked noses, like me. And I find them attractive. I also enjoy very much Geraldine McEwan in the Marple series. So there is hope.

I practice daily the series of exercises I listed in my third post. The series takes only two minutes, and I try to do it at least ten times a day, actually not such a feat. It has now created something totally new and quite wonderful:

- My breathing has changed, has become super easy, a pleasure each time I concentrate on it. My rib cage is extraordinarily supple and I have a feeling of a delicious space at the back of the nose, together with an also delicious feeling of deep relaxation of my upper face, in particular my eyes. This state makes thinking easy, anxiety is gone, I am in the here and now.

- If I lose this wonderful state, it is very easy to find again, I can recover it in a few moments of body consciousness. And it has changed my facial expression to the better: smiling is totally associated with this state.

My conclusion is that the series brings me to an ideal balance of my autonomous nervous system. If it helps my BDD, fair enough, but it is in any case a by-product of my research that I shall not abandon!

A life without BDD?

 On December 8th 2020, I had my last therapy session. The therapist and I decided that we did not need to ask the health insurance for more sessions. I seem to be cured of BDD. I say "seem", as I can well imagine relapses. But I experience such positive changes that we shall at least pause for a while.

How far have I gone from October 2019 when, seeing myself inadvertently on the screen of my laptop, I ran sobbing to the bedroom shouting "No, this cannot be me, it is too horrible, I cannot bear it!" That same morning, I got in touch with a special unit for BDD at the University of Münster, not far from where I live. They directed me to the University of Wuppertal, the town I live in, where an online therapy study was starting, and I was lucky to be able to embark on it from November 2019 until March 2020, when I continued with a dozen of individual sessions with the person who had designed the online therapy.

The main sign of being (nearly) cured is that I am now able to look at myself on the screen of my laptop. Hating to be filmed and photographed has always been the main sign of my BDD. I have increased the size of the image and I was able to participate in a virtual musicological conference at the end of November, four days of seeing my face on the screen, getting more and more used to it, even at some point liking it. I was using my "Monna Lisa" smile a lot: it is the expression that I now have as soon as my eyes, thanks to peripheral vision, are relaxed. I like it very much. It feels good. And yesterday and today, I could prepare a zoom meeting with a singing pupil, giving myself time to look at myself and not running away sobbing to the bedroom.

I am discovering new ideas and feelings. As I said in my last post, the idea of accepting oneself was horrific to me. I had to be amazingly beautiful or nothing. As was unpleasant the idea that I could work at improving my appearance. A friend, whom I was confiding in two years ago, had told me: well, you can "make the best of yourself" in order to look better on photos. I tried it of course on the rare occasions when I was being photographed, but it was always with an uneasy feeling, it was something unpleasant, it felt illegitimate. Now that I can look calmly and benevolently at myself, I can understand her point. I can see positive aspects of my appearance, along with things that I do not like that much but which do not horrify me anymore, and things that I can change, like having a better haircut, taking more care of my eyebrows and maybe having the crowns of my two front teeth renewed, as their colour is slightly different from the others'. To sum it up, I am more and more accepting what I look like, and then I can "go from there". This is now an option, I have a choice.

I practice a lot to attain this state. I am now looking at my therapy as the study of a new musical instrument, love to myself. "Übung macht den Meister", the Germans say: only daily practice brings excellence. And it is now clear to me that all the exercises which I practice have one effect: freeing the vagus nerve on its way out of the skull down to the lower abdomen and back. I do it for singing, it works very well (the vagus nerve is an essential nerve of voice production), and I do it now for accepting myself.

Here they are (note that the length is arbitrary, it is a minimum):

1. The most important exercise of all: Freeing the vagus nerve in the upper face by the practice of peripheral vision for thirty seconds

2. Freeing the vagus nerve in the lower face by the practice of this exercise: I smile ten seconds with my mouth shut, teeth together

3. Freeing the vagus nerve at the bottom of the neck in the region of the clavicle and the first ribs, and in the chest with two exercises: I put my hands together at the small of the back, and I thrust my chest up and out ten times, shoulders down; I alternate moving one shoulder forward while moving the other one backward ten times, with the arms hanging relaxed

4. Freeing the vagus nerve at the level of the diaphragm with two exercises: I pull my stomach in ten times while expanding the ribcage sideways; I breathe out and stay up to ten seconds in apnoea

5. Freeing the vagus nerve in the lower abdomen with two exercises: I stand ten to twenty seconds on one leg; sitting on a chair, I press my heels ten times very lightly in the floor

I also practice a moment of body consciousness, eyes closed, when I try to feel intensively my soft palate behind the nose and the eyes, and my pelvic floor and the bottom end of the spine. This often results in a deep breath that comes of its own. I then feel a lovely tingling in the whole body, from head to toe

I practice the series at least ten times a day

NB: At the moment, I only have scientific backing for the exercises 1 and 3.  With the others, I notice specific effects which I associate with parasympathetic activity, but it is still empirical. 

And what is happening now?

It is nearly three months now since I started practicing peripheral vision intensively. Well, I am not looking back (pun intended)! This practice not only relaxes my vision of myself and the world, it is also the most powerful technique that I have found until now to help me attain a state of profound calm, an extremely enjoyable state of fearless energy.

It makes sense. By quitting "tunnel vision", where the sympathetic nervous system is predominant, one reaches a state of balance of the autonomic nervous system where the sympathetic and parasympathetic systems work hand in hand, with neither of them dominating the other.

But also, a relaxed upper face means that the vagus nerve, the main nerve of the parasympathetic nervous system, is not impaired by surrounding tense muscles. The vagus nerve is responsible for the movements of two muscles of the soft palate, the palatoglossus muscle and the levator palatini muscle, placed directly behind the eyes. Logically, a relaxed upper face allows the vagus nerve to function at its best. And in turn, it also favours better breathing: the passage for the air behind the nose is free, an overall bonus for well-being.

As I had already realised as soon as I started practicing peripheral vision at the beginning of August, my vision is becoming benevolent. I can now see the whole picture instead of concentrating on flaws. I mentioned good and bad days in my first post: I am now experiencing only good days. I do not fear my appearance anymore. I do not perceive the elements of my face departing from beauty norms (some irregularity of my features, my drooping eyes, my slightly crooked nose and the weird bulging area under my lower lip) as menacing. I am on the way to accepting what I look like, something that I never imagined I could ever attain, something that even seemed to me to be the apex of resignation and giving up, something that I always thought about with dread each time somebody mentioned its possibility.

And there is an added bonus: the relaxation of the face that the practice of peripheral vision induces has changed my appearance for the better. I realise now that my most hated flaw, the weird shape under the lower lip that I just mentioned, is mostly due to tension in the face. Now that I relax the eyes, a slight smile forms itself, and the flaw nearly disappears. It can be a permanent state, it is what my face looks like when it is relaxed (and it is what happened, I now realise, on the few photos of myself that I like). And the other flaws, which I still see, do not disturb me so much now. The same, curiously enough, for the signs of ageing.

I am now able to look at myself in "foreign" and ungrateful mirrors and I see, with a friendly and warm feeling, a friendly lady who is pleasant enough. And who cares if she is not a beauty? (Can it be me writing this? I was so upset only some months ago at not being admired for my beauty!) I even started doing what I dread the most, looking at myself on my computer screen. I still do it with a small image which I am planning to gradually enlarge, but I already recognise the same lady as in mirrors, with the same nice feeling, and I can even make faces at myself for a laugh!

This amazing change has led me to think a lot about the therapy I am following. As I said in my first post, I became frustrated, after a few months, by its intellectuality. And I often reflected on the wonderful therapy success that I had in my twenties for bulimia: it involved a close connection with my physical feelings of hunger and satisfaction. With the practice of peripheral vision, I also experience deep physical sensations: relaxation of the eyes and the soft palate, deep breathing, and relaxation in the pelvic floor. This strong physical hold gives me hope that the changes shall be permanent and that I shall not experience a relapse. For bulimia, the healing was complete.

I still wonder at the profound and positive changes on my mental state that these physical feelings have brought in such a quick time. It makes me reflect in particular on subjects like the physiology of benevolence, the physiology of self-love, of acceptance, etc. And I am now using peripheral vision for a number of other problems: for example, if I start to ruminate on a past negative experience, I assume that it is automatically creating tunnel vision, and I try to counter it by relaxing my eyes (easy now, I just have to close the eyes and smile to attain that state). The same for anxiety for future situations.

To finish for now, another "discovery", which explains to me at last why some of the exercises for balancing the autonomic nervous system which I use in my practice as a vocal coach are similar to those for Thoracic Outlet Syndrome. I use one of them regularly for BDD alongside peripheral vision: with the hands placed together at the small of the back, I thrust my chest out and up 5 or 6 times. I was very happy to read this article by Chris Centeno, MD, "The Vagus Nerve, Neck Pain, Anxiety, Headaches, and Depression". It gives precise diagrams of the path followed by the vagus nerve on its way from the head to the chest. Like the brachial plexus nerves, the vagus nerve can get impaired at certain points on its path: by the sternocleidomastoid and the scalene muscles, in the region of the collarbone and the first rib, but also at its exit at the base of the skull, near the first cervical vertebra, the atlas. You can find here some exercises for treating Thoracic Outlet Syndrome.

My discoveries of August 2020

On 14th August 2020, I read an article by Edward C. Godnig published in the Journal of Behavioral Optometry in 2003: "Tunnel Vision - Its Causes and Treatment Strategies". This followed my discovery on 3rd August of a video by Emma McAdam, "Soften the gaze", as part of her series of "anxiety skills". They were eye openers (no pun intended!): they gave me an insight into possible causes and therapeutic paths for Body Dysmorphic Disorder which are not mentioned to this day in the internet pages of the organisations devoted to sufferers of this condition in several countries. They are also absent from the Wikipedia pages on BDD in english, french, german, italian and spanish. When the term "tunnel vision" is used in those pages, it is figurative and not related to the physiological processes which I am going to explain in this post.

BDD is caracterised by the excessive attention a person gives to bodily flaws that appear minor to other people, magnifying them to the extent that normal life can be impaired and unhappiness takes over. This is a serious mental condition that can lead to suicide. You can read more about it here.

The eye opener for me was learning how much our capacity to focus on one visual element, to the exclusion of everything else, has a strong physiological background. When we are anxious, we experience stress reactions, our sympathetic nervous system (schematically, "fight or flight") takes over, and one of the consequences is that our central vision becomes predominant, to the detriment of our peripheral vision.

Although I have been working on the balance of the autonomic nervous system for some years now, as the predominance of the parasympathetic nervous system ("rest and digest") is essential to good singing (several nerves of the vocal apparatus are branches of the vagus nerve), this was new to me. I had never looked into the influence of the sympathetic and parasympathetic nervous systems on vision.

I now quote Edward Godnig: "Tunnel vision, or visual perceptual narrowing, is most commonly associated with the perceptual changes accompanying an intense and sudden assault on an individual. It results in an extensive neurological reaction. These perceptual changes often are reported during combat situation where the body alarm reaction is activated. This reaction can be defined as the neurological, biochemical, hormonal and behavioral changes that occur when the body and mind face "flight or fight encounters". Godnig then quotes Elliott B. Forrest: "Tension increases anxiety and is increased by anxiety. It induces a more narrowed focal, discrete, central processing style and is increased by the exclusion of peripheral stimuli. Tension also fosters selective rigidity in body function and in mental action". And back to Godnig: "This tunneling effect has also showed shape distortions". 

Neither Edward Godnig nor Emma McAdam draw conclusions about BDD in their respective article and video, but the implications of a strong link between stress and vision will be evident to any person suffering from this condition. 

What I had just learnt made me reflect on the therapy sessions for BDD that I have been following since December 2019. They have helped me in many ways, I am very grateful to my therapist. Among other elements, they led me to recognise how much the vision of my appearance and of other people's is dominated by an intense fear of the features not conforming to an imagined beauty ideal, in particular signs of ageing. But no linking of this intense fear to the "fight or flight" reaction had been established by my therapist. The therapy is, curiously enough in a situation where the body is so prominent, an essentially intellectual process.

For me, starting to consider my BDD through the angle of the sympathetic reaction of the autonomic nervous system was a revelation. It explained in particular the troubling changes in my condition: there were days where the flaws did not bother me, I accepted them or even did not see them, I was feeling great and felt no impairment in my daily life and interactions with others, apart from when confronted with being photographed or filmed. This could be easily explained, I now recognized, by changes in the balance of my autonomic nervous system. If I was in the "rest and digest" mode, which I practiced very often for my singing, I was deeply calm, not fearful, and my vision reflected this by giving me the large and somewhat benevolent picture of myself and others which people without BDD experience.

In my "bad days", when I dislike my appearance, I am now consciously working to enhance the parasympathetic response in relation to my vision as it has become clear to me that the anxiety caused by the flaws that the focussing is magnifying aggravates in turn the focussing: a typical vicious circle.

 If I look in the mirror or at a photograph and get affected by flaws, I practice exercises to restore the balance of my autonomic nervous system until I attain a central-peripheral continuum in my vision. In particular, if I am practicing the habituation that my therapist taught me while looking at my entire body in a mirror, I interrupt it at regular intervals with exercises on the peripheral vision which develop the parasympathetic state, being very aware of the changes in my sensations, my posture and my breathing. In this sense, I am now integrating into the therapy the bodily components which I felt were missing from it. I have already had the amazing experience of a flaw receding into the background. It was incredible and quick, it happened in a few minutes!

Basically, anything that helps a person relax will favour peripheral vision. But there are some specific exercises. Edward Godnig indicates some techniques for the enhancement of peripheral awareness. Emma McAdam also gives some exercises in her video, as does Chrissy Zwijewski in her article aimed at practitioners of body building.

Here is a description of my own present practice: I hold my hands at different points at the limits of my peripheral vision and move my fingers, while looking at a point in the middle distance and being aware of the movements of my hands through the corners of the eyes. After a short while, I feel my face relax, a light smile starts to spread, my saliva becomes more fluid, my eyes start moistening, a deep and free breath comes of its own, and I feel a strong relaxation in the pelvic floor, as well as down into the legs. All these feelings are sure signs of parasympathetic activity which I have experienced often, but never until now in relation to vision. I feel at the same time deeply calm and full of energy. The process takes from thirty seconds to two minutes. I try to practice this as much as I can every day. I can also just close my eyes and start smiling: I feel an instant relaxation of the upper face and it brings me to the same happy state as the preceding exercise. And I also try to be aware of peripheral vision as often as possible in whatever activity I engage in. A train trip, with the landscape streaming past on both sides, is a wonderful opportunity.

I also practice regularly the following exercise which I use in the frame of my activities as a vocal coach and which brings me to the state of calm associated with the predominance of parasympathetic activity:

- Place your hands together at the small of the back and thrust your chest out 5 or 6 times

In this way I hope to be able to counteract my years of thorough (!) practice of tunnel vision and maybe cure my BDD for good. And I am now aware that any source of anxiety could have an effect on my vision and therefore aggravate my condition.

A short bibliography:

Forrest, E.B., Stress and vision, Santa Ana, CA, Optometric Extension Program Foundation, Inc., 1988.

Godnig, E.C. (2003). Tunnel vision: Its causes and treatment strategies. Journal of Behavioral Optometry, 14(4), 95-99.

Rogers, T. J., & Landers, D. M. (2005). Mediating effects of peripheral vision in the life event stress/athletic injury relationship. Journal of Sport and Exercise Psychology, 27(3), 271-288.

Chu, C., Rosenfield, M., Portello, J.K., et al. (2011). A comparison of symptoms after viewing text on a computer screen and hard copy. Ophthalmic Physiology, 31(1),29-32.