Body dysmorphic disorder puts ugly in the brain of the beholder (Ben Buchanan)

 

People with body dysmorphic disorder have an excessive fear of looking ugly or disfigured. DeeAshley/Flickr

     

When people think of mental problems related to body image, often the first thing that comes to mind is the thin figure associated with anorexia. Body dysmorphic disorder is less well known, but has around five times the prevalence of anorexia (about 2% of the population), and a high level of psychological impairment.

 

It’s a mental disorder where the main symptom is excessive fear of looking ugly or disfigured. Central to the diagnosis is the fact that the person actually looks normal.

Neither vanity nor dissatisfaction alone

People with body dysmorphic disorder think there’s a particular feature of their face (such as nose, lips or ears) or another body part (such as arms, legs or buttocks) that’s unbearably ugly. Many seek unnecessary cosmetic surgery or skin treatments – but sadly only a few receive appropriate psychological support.

In general, people with the disorder are very shy and some choose to stay home out of fear of being judged or laughed at because of the way they look.

Body dysmorphic disorder should never be dismissed as body dissatisfaction or vanity. Suzy Forcella

Many people with the disorder spend hours every day looking at themselves in the mirror. Others have unusual grooming habits to try and cover up their perceived flaw.

These people have significant difficulties with their social lives and experience high levels of anxiety and depression. Body dysmorphic disorder is clearly a serious problem and should never be dismissed as body dissatisfaction or vanity.

But distinguishing between these can be difficult, so the following questions are often used as a guide:

• do you think about a certain part of your body for more than two hours a day?
• does it upset you so much that it regularly stops you from doing things?
• has your worry about your body part affected your relationships with family or friends?

If someone answers yes to these questions, further professional evaluation is needed. A full assessment would entail a few sessions with a mental health clinician to talk about these worries and an assessment of grooming behaviours.

Brain research

My research using brain imaging has shown there are clear differences in the brains of people with body dysmorphic disorder that lead to changes in the way they process information. We found that people with the disorder had inefficient communication between different brain areas.

 

In particular, the connections between areas of the brain associated with detailed visual analysis and a holistic representation of an image were weak. This could explain the fixation on just one aspect of appearance.

 

There was also a weak connection between the the amygdala (the brain’s emotion centre) and the orbitofrontal cortex, the “rational” part of the brain that helps regulate and calm down emotional arousal.

 

Once they become emotionally distressed, it can be difficult for someone with body dysmorphic disorder to wind down because the “emotional” and “rational” parts of the brain simply aren’t communicating effectively.

 

People usually develop body dysmorphic disorder during their teenage years, which happens to be an important time for brain development. They also often report childhood teasing about their looks, which may act as a trigger that rewires the brain to focus attention on physical appearance.

One-on-one psychological therapy should be first-line treatment for body dysmorphic disorder. benbuchanan.com.au

Cosmetic procedures

Many people with body dysmorphic disorder seek cosmetic procedures such as nose jobs, breast implants or botox injections. The problem is that the vast majority (83% in some research) experience either no improvement or a worsening of symptoms after it. And most are dissatisfied with the procedure.

 

This differs from people without body dysmorphic disorder who are generally satisfied with cosmetic procedures and even report psychological benefits on follow-up.

 

Researchers estimate about 14% of people who receive cosmetic treatments have diagnosable body dysmorphic disorder, indicating that psychological screening practises are inadequate. Given the likelihood of causing psychological harm, it may be wise for cosmetic surgeons to assess all potential clients before operating.

Psychological treatment

It can be difficult to persuade someone with the disorder to accept psychological help given the belief in their physical defect is likely to be very strong. But once someone receives psychological therapy, symptoms are likely to reduce.

 

The first-line of treatment is cognitive behavioural therapy (CBT), focusing on exposure and response prevention with the option of antidepressant medication. This helps patients modify unhelpful daily rituals and safety behaviours, such as mirror checking or camouflaging the perceived defect with make-up.

 

Body dysmorphic disorder is under-diagnosed because those with it persistently deny they have a psychological problem, preferring to opt for physical treatments instead. Evidence suggests that symptoms are underpinned by differences in the way the brain processes information and that psychological therapy can help people overcome the preoccupation their with appearance.

Stimga and Straining the Limits of Perception

"We know that racialized youth face challenges with marginalisation, racism, employment barriers, education setbacks, and social and cultural isolation that can have a negative impact on their development."

Earlier in the month I was at a downtown Toronto event - a typically diverse crowd spanning age, gender, ethnicity, everything.  Towards the beginning of this event I was talking with a Korean-Canadian friend, Mr. Chung; fifties, average height, a little overweight.  A young "white" guy I knew came up to say hi to me and I introduced the two of them.

Towards the end of the night, my Caucasian friend came back to me to say goodbye. He had carefully remembered my Korean friend's name and said bye to the East Asian man I was talking with.

One problem - it wasn't the same guy.

As the night wound down I was speaking to a Chinese-Canadian who'd barely turned forty and was in good shape.

Put my Korean-Canadian friend and my Chinese-Canadian friend side by side, I could easily tell them apart. Given time my white friend would have learned to do the same, but right then and there, he could have been looking at silhouettes.  To him, they looked the same.

You could call that ignorance or a passive form of racism.  Me, I know it as a limitation of cognitive capacity.  It's something I have seen the world over, have experienced from both sides.  People, especially those of limited exposure to diversity are prone to generalizations.

 If I put a set of identical twins in front of you, you'd probably couldn't tell them apart.  Get to know those two individuals, though, and you'll begin to spot subtle differences in freckles, body mass, personality.  With time, you'll learn to clearly and quickly identify which twin is which, even if you don't see them together. Unless, that is, you don't associate any value in developing nuanced perspectives.   if you'd rather see the world as black and white, your brain will literally push back against the cognitive strain in the way muscles ache when they're exercised.

This is a pretty significant thing to understand as it explains stigma, why we fail to design social infrastructure that's inclusive and why we often fail to design services for end-users.  It's why George Bush preferred giving people nicknames instead of bothering to learn their given names and why Rob Ford doesn't think bikes belong on roads "designed for cars."

Bigotry is ignorance and ignorance is natural. We generalize because we need to; new stimuli must be rapidly assessed for potential threat (which is why simple narratives tend to focus on negatives). If we couldn't do that, new stimuli that could harm us wouldn't get properly assessed.  Why do wild animals unexposed to people not feel threatened by them? Because they have no memory file that tells them they should.

Why do people unexposed to other ethnicity tend to stigmatise The Other? Because we have a mental model of what people look like - us.  If something kinda looks like what it should but kinda doesn't, like a person who is unhealthy, we're programed for threat response.

The exact opposite formula explains why beautiful people have less employment challenges that unattractive ones.  We stigmatise in favour of visual cues on how we perceive health first, everything else after.

This might sound alarming to you - after all, the basic message is that we're not in control of how we think. That alarm bell you're feeling is the burn of your cognitive muscle flexing.  Ponder it a while and you'll be comfortable with the notion that humans run more on autopilot than we are in conscious control.
 

The Neurochemistry of Strategic Thinking?

 

Study Appears to Overturn Prevailing View of How the Brain is Wired

 

Posted on June 27, 2013By Neuroscience NewsFeatured, Neuroscience, Neuroscience Videos

 

A series of studies conducted by Randy Bruno, PhD, and Christine Constantinople, PhD, of Columbia University’s Department of Neuroscience, topples convention by showing that sensory information travels to two places at once: not only to the brain’s mid-layer (where most axons lead), but also directly to its deeper layers. The study appears in the June 28, 2013, edition of the journal Science.

 

For decades, scientists have thought that sensory information is relayed from the skin, eyes, and ears to the thalamus and then processed in the six-layered cerebral cortex in serial fashion: first in the middle layer (layer 4), then in the upper layers (2 and 3), and finally in the deeper layers (5 and 6.) This model of signals moving through a layered “column” was largely based on anatomy, following the direction of axons—the wires of the nervous system.

 

“Our findings challenge dogma,” said Dr. Bruno, assistant professor of neuroscience and a faculty member at Columbia’s new Mortimer B. Zuckerman Mind Brain Behavior Institute and the Kavli Institute for Brain Science. “They open up a different way of thinking about how the cerebral cortex does what it does, which includes not only processing sight, sound, and touch but higher functions such as speech, decision-making, and abstract thought.”

 

 

 

The researchers used the well-understood sensory system of rat whiskers, which operate much like human fingers, providing tactile information about shape and texture. The system is ideal for studying the flow of sensory signals, said Dr. Bruno, because past research has mapped each whisker to a specific barrel-shaped cluster of neurons in the brain. “The wiring of these circuits is similar to those that process senses in other mammals, including humans,” said Dr. Bruno.

 

The study relied on a sensitive technique that allows researchers to monitor how signals move across synapses from one neuron to the next in a live animal. Using a glass micropipette with a tip only 1 micron wide (one-thousandth of a millimeter) filled with fluid that conducts nerve signals, the researchers recorded nerve impulses resulting from whisker stimulation in 176 neurons in the cortex and 76 neurons in the thalamus. The recordings showed that signals are relayed from the thalamus to layers 4 and 5 at the same time. Although 80 percent of the thalamic axons went to layer 4, there was surprisingly robust signaling to the deeper layer.

 

To confirm that the deeper layer receives sensory information directly, the researchers used the local anesthetic lidocaine to block all signals from layer 4. Activity in the deeper layer remained unchanged.

 

“This was very surprising,” said Dr. Constantinople, currently a postdoctoral researcher at Princeton University’s Neuroscience Institute. “We expected activity in the lower layers to be turned off or very much diminished when we blocked layer 4. This raises a whole new set of questions about what the layers actually do.”

 

The study suggests that upper and lower layers of the cerebral cortex form separate circuits and play separate roles in processing sensory information. Researchers think that the deeper layers are evolutionarily older—they are found in reptiles, for example, while the upper and middle layers, appear in more evolved species and are thickest in humans.

 

One possibility, suggests Dr. Bruno, is that basic sensory processing is done in the lower layers: for example, visually tracking a tennis ball to coordinate the movement needed to make contact. Processing that involves integrating context or experience or that involves learning might be done in the upper layers. For example, watching where an opp

onent is hitting the ball and planning where to place the return shot.

“At this point, we still don’t know what, behaviorally, the different layers do,” said Dr. Bruno, whose lab is now focused on finding those answers.

 

A nerve cell in the thalamus (blue) sends its axon (red) into cerebral cortex, where it makes synaptic connections with thousands of neurons. While most of these connections are in a middle layer of the cortex (gray rings), some sparse branches connect to deeper layers.

 

Nobel-prize-winning neurobiologist Bert Sakmann, MD, PhD, of the Max Planck Institute in Germany, describes the study as “very convincing” and a game-changer. “For decades, the field has assumed, based largely on anatomy, that the work of the cortex begins in layer 4. Dr. Bruno has produced a technical masterpiece that firmly establishes two separate input streams to the cortex,” said Dr. Sakmann. “The prevailing view that the cortex is a collection of monolithic columns, handing off information to progressively higher modules, is an idea that will have to go.”2006-06-16 TC axon – high contrast MS1 repeat3-1

 

“Bruno’s work goes a long way toward overturning the conventional wisdom and provides new insight into the functional segregation of sensory input to the mammalian cerebral cortex, the region of the brain that processes our thoughts, decisions, and actions,” said Thomas Jessell, PhD, Claire Tow Professor of Motor Neuron Disorders in Neuroscience and a co-director of the Mortimer B. Zuckerman Mind Brain Behavior Institute and the Kavli Institute for Brain Science. “Developing a more refined understanding of cortical processing will take the combined efforts of anatomists, cell and molecular biologists, and animal behaviorists. The Zuckerman Institute, with its multidisciplinary faculty and broad mission, is ideally suited to building on Bruno’s fascinating work.”

 

Notes about this neuroanatomy and brain mapping research

 

Funding for the study was provided by the National Institute of Neurological Disorders and Stroke (Grant # NS069679), the Rita Allen Foundation, and the Klingenstein Fund.

 

The authors declare no financial or other conflicts of interests.

Contact: Karin Eskenazi – Columbia University Medical Center
Source: Columbia University Medical Center press release
Image Source: The anatomical diagram of the cerebral cortex is credited to Gray’s Anatomy and is in the public domain.
Video Source: The video, “A nerve cell in the thalamus (blue) sends its axon (red) into cerebral cortex”, is available on the Columbia University Medical Center YouTube page.
Original Research: Abstract for “Deep Cortical Layers Are Activated Directly by Thalamus” by Christine M. Constantinople and Randy M. Bruno in Science. Published online June 28 2013 DOI:10.1126/science.1236425

Max Landis On Power and Man of Steel

"Having that much power makes you responsible for other people."

 

Yes.

 

First let's clarify what power is, though.  It isn't the mad grab for dominance over others that both capitalism and socialism breed - "I have resources and ego issues so everyone either does what I say or simply don't matter."

 

No.  Power is like driving car on streets where there are pedestrians and bicycles.  You don't try and remove the less-powerful entities, like Rob Ford would do in an attempt to push the weak to the margins and allow cars to rule the world.  What you do, as a driver, is drive responsibly.  As your vehicle has the capacity to kill you are more responsible than the pedestrian or the biker who doesn't have that kind of street clout. 

 

This isn't to say those with less power have no responsibility, only that those with power have more.  Its why those at the top of the social food chain, be they politicians or sports stars or the super-wealthy get held to a higher standard of accountability than regular people do.  Average folk know that they have less influence than those at the top and will seek to knock down or penalize behavior seen as over-the-top.  Elections, talk radio, tabloid newspapers and thanks to Social Media, social murmuration are the tools we use to keep the powerful in line.

 

Of course, this is why it's a slippery slope when politicians try to pull the HOAG (Hell Of A Guy) card.  Back to Rob Ford, who has tried to portray himself as an average bear in the same way George W, Bush did; Ford is not rooted in the same world as the everyman/woman.  He comes from wealth.  He has access to people and resources that a kid from the wrong side of the tracks simply can't connect to without a bridge.  When people like him portray themselves as average bears, they are attempting to remove themselves from the increased scrutiny society places on those we know to be elites.

 

So what if Ford gets drunk at hockey games, doesn't read his Mayoral accountability material or texts while driving?  Any average Joe does that.  Yeah, but not any average Joe is responsible for running a city.

 

With great power, we've been told, comes great responsibility.  We should demand nothing less from our leaders.

 

In fact, true leaders strive to give us nothing less.

It's not about having power.  It's about how you empower others.

Five Leadership Lessons From Christopher Nolan's Batman Trilogy

 

Alex Knapp is getting pretty good at these.  The more examples he pulls from Pop Culture to lay out leadership dos and don't, the more he sells himself as understanding leadership from any angle.  Plus, he draws in a broader audience.  It's quite brilliant, actually.

 

Still waiting for a 5 Leadership Lessons from Loony Tunes; that would be a grand read!

 

 

Five Leadership Lessons From Christopher Nolan's Batman Trilogy

 

Christopher Nolan’s Dark Knight trilogy has been both a critical and commercial success. The entire series is on its way to earning $2 billion, and critics have acclaimed the series of films as the best in the superhero genre. This trilogy has succeeded because of its sheer quality. Nolan’s Batman movies are more than just action-packed extravaganzas – they’re meditations. Meditations on what it means to be a superhero. Meditations on the nature of civil society and its institutions. As a consequence, there’s a lot that we can learn from these three movies that can help us build and lead our own organizations. Here are five such lessons.

 

(Be warned! This discussion includes plot elements from The Dark Knight Rises. If you don’t want to be spoiled, stop here.)

 

1. Organizations Need To Be Built Around Ideas, Not People

 

“People need dramatic examples to shake them out of apathy and I can’t do that as Bruce Wayne. As a man I’m flesh and blood. I can be ignored. I can be destroyed. But as a symbol, as a symbol I can be incorruptible, I can be everlasting.”

 

In Batman Begins, one key aspect of Bruce Wayne’s desire to become Batman is so that he can be a symbol of something. A beacon of hope so that people can aspire to do better. This is a thread that continues through all three films, particularly The Dark Knight Rises, where Batman is honored as the savior of the city, not Bruce Wayne or any one person. Pointedly, Wayne says at the end of the film, “A hero can be anyone.” Indeed, one of the major themes of The Dark Knight Rises is the consequences of the mistake made in The Dark Knight. By holding up Harvey Dent, in particular, as a role model, Batman and Gordon were forced to cover up his crimes committed as Two-Face. That cover-up led to some of the bad things that happened in the third film.

 

What lesson can we take away from this? Well, the people who build great organizations and companies are often larger-than-life. They drive their businesses forward with their energy and passion. But one problem that such organizations face is that when they become completely identified with a single person, their fortunes can rise and fall based on what that one person does.

 

You can see two diametrically opposed versions of this with two companies associated with the late Steve Jobs, Apple and Pixar. Apple is indelibly associated with Steve Jobs. He built the company with Steve Wozniak, and most of the companies products were based on one vision: his. After Steve Jobs was forced out of Apple in 1985, the company did enjoy some success – notably in the late 80s and early 90s, but the company floundered again until Jobs returned to the top spot in 1997. After that, Apple began its ascent to tech industry heights, largely driven by Steve Jobs’ vision for consumer products. As a result, Apple thrived, but also became synonymous with Jobs. Since Jobs passed away last year, many analysts see the company as floundering, with our own Anthony Kosner accusing the once innovative company as “playing it safe.”

 

By contrast, Pixar was also a company largely driven by Steve Jobs, who served as its Chairman of the Board and later its CEO. But while Apple was driven by Jobs’ vision for consumer products, Pixar was driven by an ethos of storytelling. That ethos is strongly held by the animators and writers of Pixar movies, who are committed to the high level of quality that have given the company enormous critical and commercial success. After Jobs’ departure from Pixar, the company remained strong, pushing out some of its best movies such as Up and Wall-E. By building on an ideal of strong storytelling, rather than one man’s vision, Pixar has built an enduring brand.

 

2. Actions Matter More Than Intentions

 

“It’s not who you are underneath, it’s what you do that defines you.”

 

During one memorable scene in Batman Begins, Bruce Wayne is exiting an expensive restaurant, soaking wet with two supermodels in tow. It’s all part of his act to maintain a  ”playboy” image so that nobody suspects he’s Batman. On his way out, he runs across his childhood friend Rachel Dawes, who looks at him condescendingly as Bruce tries to defend himself. “It’s not who I am underneath.” Rachel’s response is pointed: “Deep down you may still be that same great kid you used to be. But it’s not who you are underneath, it’s what you do that defines you.”

 

We often go through life with the best of intentions. One day, we say to ourselves, we’re going to start going to the gym and become a great athlete. One day, we’re going to finish that book. But for whatever reason, we get distracted by the present and lose our focus on the future. We never do go the gym. We never do write that book.

 

In organizations as a leader, we often have the best of intentions for our team. The right hand man that you rely on? You do plan on giving him more responsibility and training. That awesome clerk you hired a year ago? She’s efficient and way overqualified for her work. You plan on expanding her responsibilities and getting her a promotion. That engineer with a great new idea – you’re definitely going to talk to your boss about getting some R&D money to develop it.

 

Then things happen. You’ve got to get that quarterly spreadsheet in. You have a dozen conference calls to attend. You have to do a presentation for your customers. All of it gets in the way, and the next thing you know, your right hand man isn’t working nearly as hard as he used to. That awesome clerk? She moved on to a better paying position in another company. Your engineer? His VC sister-in-law got him some capital and he started his own company. And now you’ve been stuck in the same job for ten years when you had sworn you’d be running the place by now.

 

But nobody remembers what you meant to do. They only remember what you do.

 

3. Trust People With The Truth

 

“You have been supplied with a false idol to stop you from tearing down this corrupt city. Let me tell you the truth about Harvey Dent.” 

 

At the end of The Dark Knight, Gotham’s District Attorney, Harvey Dent, had gone on a murderous rampage as the supervillain Two-Face. Confronted with this fact, Commissioner Gordon was concerned that the revelation of Dent’s crimes would lead to the people of Gotham losing hope, which would destroy all that he, Dent and Batman had tried to accomplish during the course of the film. Batman agreed, and quickly offered to tell the people of Gotham a lie. Gordon would tell the City that Batman had committed the murders that Dent had. This would allow Dent’s memory to go untarnished. It was upon that memory that the City built up a new Gotham. But not one that truly dealt with crime – one that merely pushed it underground. In The Dark Knight Rises, the truth about Batman and Dent is revealed to be a lie that corroded the foundation of Gotham’s institutions. At the end of the film, a new Gotham is built on a truth – that Batman is a hero. And that “a hero can be anyone.”

 

As we run our own teams and organizations, it can be tempting to keep the truth to yourself. Especially if things aren’t going well, there’s a fear that telling the truth might incite people to leave or give less than what they’re capable of. Leaders often trick themselves into thinking that people can’t be trusted with the truth, and that if they learn it, bad things will happen. This is a fundamental mistake. If things aren’t going well with your organization, the best thing to do is to put everything out in the open. Trust your team to be adults, capable of handling the truth. What you’ll find, I think, is that the result won’t be panic. The result will be that your team is willing to repay the trust you put in them by redoubling their efforts and creativity into solving the problems at hand.

 

4. You Need To Risk Failure In Order To Succeed

 

“You do not fear death. You think this makes you strong. It makes you weak …  How can you move faster than possible, fight longer than possible without the most powerful impulse of the spirit: the fear of death?”

 

During the mid-point of The Dark Knight Rises, Bruce Wayne is trapped in a hellish prison. It’s a prison made terrible, says his enemy Bane, because it offers hope. There is a pit leading to the surface that the inmates can try to escape from. The only problem? Only one prisoner ever made it – a child. Wayne makes two escape attempts and fails both time at the same point – a point where he has to make a jump that seems impossible for a person to make. In discussing the jump, Wayne reveals to a fellow prisoner that he isn’t afraid of death. His fellow prisoner chastises him for this – pointing out that it’s the fear of death that will drive you to “move faster than possible, fight longer than possible.”

Lesson learned, Bruce Wayne makes a third attempt to escape. Only this time, he had no safety harness to catch him if he fell. And with that, he was able to make the leap and climb to freedom.

 

Human beings are naturally risk-averse. Indeed, a number of psychological studies have show that people are more likely to prevent the chance of loss than the are to chase a reward – even if the end result is identical. So when we start a company, build an organization, or lead a new initiative in our careers, it can be tempting to build safety net after safety net for yourself. The problem is, sometimes when you take so many preparations to avoid losing what you have, you make your organization too slow, restrictive and hidebound to accomplish anything. Sometimes, in order to win, you have a take a risk – even if that means jumping without a safety harness.

 

5. When You Do Fail, Don’t Let It Destroy You

 

“And why do we fall, Bruce? So we can learn to pick ourselves up.”

 

One running theme of Nolan’s Batman trilogy is the idea of failing. It first appears at the beginning of Batman Begins, when a young Bruce Wayne falls into a well full of bats. Upon rescuing him, his father simply notes that the reason we fall is “so we can learn to pick ourselves up.” Something that’s echoed by Alfred to an older Bruce Wayne when he’s nearly killed by the League of Shadows. And of course, it’s the entire story of The Dark Knight Rises after Batman’s defeat at the hands of Bane. Rather than destroy himself, Bruce Wayne escapes from the prison that he’s put in and reclaims the mantle of Batman and vanquishes the threat to Gotham.

 

No matter how hard you try to succeed, it’s inevitable that you’re going to fail at some point in your life. The test of a great leader, though, is how that failure is handled. Some leaders make excuses. Others try to shift the blame. Still others just find organizations that don’t care about past mistakes – just “experience” and make the same mistakes over and over again, failing time and again without learning.

 

True greatness and leadership, though, comes with owning and embracing failure. Because only when you accept responsibility for your mistakes can you learn from them, pick yourself up, and come back stronger and better than before. In his famous speech at Stanford University, Steve Jobs spoke about firing from Apple. He said this, “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life. I’m pretty sure none of this would have happened if I hadn’t been fired from Apple. It was awful-tasting medicine, but I guess the patient needed it.”

 

In other words, Steve Jobs learned to pick himself back up. So did Bruce Wayne. And so can you.