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Home / Thoughts / Sean's Thoughts / BIID, Psychiatrists, Psychologists, Therapy, and Medication

BIID, Psychiatrists, Psychologists, Therapy, and Medication

Written by Sean on Saturday, April 25, 2009

After a rather long wait for an appointment with a psychiatrist, I finally saw someone last week. There were in fact two someones in the meeting, a psychiatrist and a psychologist. End result: Two suggestions - therapy and medication.

It was interesting that not only a psychiatrist, but also a psychologist attended this meeting. It makes sense to me, and I was pleasantly surprised. The psychatrist was the one to speak, mostly.

They seemed a bit disaproving that this was my 3rd visit in less than a year. A bit as if it was my fault it hadn’t worked out before. Never mind that the first visit was just with a locum, the guy’s contract finished and he was gone after two relatively pointless visits. The second guy was a complete, total and utter loss.

He pointed out that as I’d been in contact with Dr. First, Dr. Ryan, Dr. McGeoch and several other specialists in the field of Body Identity Integrity Disorder, it was unlikely that he could bring anything new to the table. I appreciated his honesty on that, and I think it was good that it was said. I wasn’t there for them to fix BIID anyway.

The psychiatrist made me laugh. He pointed out that BIID is a very rare, interesting and fascinating condition. As such, it is tempting for him to look at the condition rather than look at me as a patient in need of assistance. I appreciated that he was honest about the fact he had difficulties with it but was doing his best to ignore his bias. He said that BIID is a bit like a rare pink bottomed baboon! "You want to study it", he said.

In any case, we spoke quite a while. He asked a lot of questions about my depressive episodes. He asked me to tell him about them, and when I did, he said not to tell him what I did (loss of enthusiasm, staying in couch all day not wanting to move, etc), but how I felt. I described despair of knowing I’m unlikely to ever be in the body I need to be in, and talked about that some more. He seems to think that the depression is more a factor of BIID than anything else.

In the end, two things were suggested to me:

1. Antipsychotics (Quetiapine)
2. Acceptance Compliance Therapy (ACT)

Antipsychotics

The suggestion of using antipsychotics to help with BIID isn’t new. I believe it’s been used by others, and on my first visit at the community mental health the locum I saw also suggested it. I am not comfortable at all with the idea. Not at all.

It’s not because the drug is an "antipsychotic". That doesn’t bother me. It’s not because it is usualy used to treat psychosis. But it is because of secondary effects, and possible long term impact on me, even if I stop the drugs. Even though Quetiapine is an atypical "2nd generation" type of antipsychotic, it’s still is scary shit. Among other things: Weight gain, drowsiness, headaches, dry mouth, sexual dysfunction, increased paranoia. I’ve been told by someone on Quetiapine that the drowsiness goes after a few weeks, and so does the increased paranoia. Dry mouth, I’m already living with as a side effect to my antidepressant. Same with sexual dysfunction (I don’t mind so much being impotent, because I would be if I were paralysed, but the lack of libido is getting to me). The weight gain is enough of an issue for a psychiatrist familiar with BIID tell me it would be a possible problem especially since I’m a wheelchair user.

But there is another side effect that is scary: Tachycardia. Apparently up to 7% of people on Quetiapine can develop this. It’s a sufficient risk that the psychiatrist who suggested it told me I’d be having ECGs every couple weeks.

Acceptance Compliance Therapy

ACT, is a form of psychotherapy that derived from Cognitive Behavioural Therapy (CBT). It is apparently quite successful in helping people with obssessive or compulsive conditions. I’m somewhat sceptical. It’s not the first time someone wants to treat BIID like Obsessive Compulsive Disorder (OCD). Although the psychologist wasn’t saying that she wanted to treat BIID like OCD, just that ACT had been successful with these types of conditions.

The thing is, I’m not the same person I was when I tried CBT. My life circumstances have changed a lot. This therapy is different than CBT, even if derived from it.

What Now?

That is the question, isn’t it? What now? I have decisions to make.

I sought opinions from a few people about the medication option. I got some very good feedback (thanks to those of you who gave me your opinion, BTW). One person suggested I "run, not walk" to get on Quetiapine, because the effect on them was so good. It doesn’t remove BIID, they said, but it turns the volume down some. I must admit, their testimony was convincing. Still, I’m *really* concerned about side effects, particularly long term impact.

One doctor I spoke to was not particularly positive about using Quetiapine for BIID. They also pointed out that if I was both on the drugs and doing the therapy at the same time, and something improved, I woudln’t know which one had made the difference! Great point, I thought.

And so, my decision is to hold off on Quetiapine for now. Try ACT. If ACT doesn’t work, the medicatio will still be there for me to try.

Parting Thought

I think that the biggest difference at this point, for me, is that I’m not trying to treat or cure BIID. The only way I think I can resolve BIID is through becoming paralysed, somehow. I am, however, hoping to find a way to reduce the impact of the BIID anguish on me. This is what I hope ACT might do for me.

There’s no word yet about who will provide this, nor how though…

Tags: BIID, Body Integrity Identity Disorder, Medication, Pharmacotherapy, Psychiatrist, Psychologist, Psychotherapy, Therapy

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