Steroids: Seductive Today, Sinister Tomorrow
An Appointment and Cautionary Tale
I got a new patient who came into my office- we’ll call him Rocky- and he said to me, “Ya know, I’m here because I’ve been having trouble with rage.” And then he just looks at me expectantly. After eleven words, he’s waiting for me to open my desk drawer and take out my magic wand. Bing! You’re cured! He’s clearly never been to a shrink. We talk here.
In all honesty, I didn’t even need a magic wand at that point, because between those eleven words and my eyes, I had already diagnosed him. I should’ve waved my pen at him like a wand and said “Stop using steroids. You’re cured.” Instead, I said, “Let’s explore this a bit.”
He says “I’m worried, I might be bipolar….” How did I just know he was going to say that? It is so typical. At 32 years of age, Rocky’s a big boy, unnaturally bulky, looks like he’s been lifting a lot of weights. Compared to his trunk, his head looks like somebody washed it in hot water. His face is oily, pock-marked with acne and scars. I’m noting all these things, jotting them down on my pad, jot jot, as he goes on. “…and I like to go to the gym to blow off some steam…” Rages jot. Acne jot. Oily skin jot jot. Bacne jot. Receding hairline jot jot. “…and lately everybody just pisses me off and I can’t…” Angry jot jot.“…I mean, I can bench a lot. So the other day, I was with my buddy and I finally figured it out; I realized that he’s jealous; that’s his problem with me…” Paranoia jot jot. “…and I know I’m his competition. I undercut him all the time. He would love to see me fail and close up shop, but…” Ah ha. Psychotic? jot jot. All of this is very typical with steroid use and abuse. “…so anyway, I can push harder, lift more, ya know? I work at it! The steroids help, but the work is all me.” Bingo! Finally! Now we’re getting somewhere.
So tell me about that…the steroids. Who’s prescribing? “Oh no, I am buying it at the gym.” Well, how much are you using? “I’m doing 200mg every two days.” Injecting testosterone cypionate, 200mg Q 2 days jot jot jot jot jot. Buys at gym jot jot. And how long have you been using them? “Uhh, maybe about three years?” Times 3+ years jot jot jot. Do you think maybe you have a problem? “Oh, no. No.” Denies problem jot jot. I explain that he’s at a max dose for someone who has virtually no gonad function. Confusion jot. I explain that means someone who produces no natural testosterone. I spell it out. You’re taking the max dose that a person with no gonad function, zero testosterone would take, and that’s on top of your normal testosterone levels. Or I should say your natural testosterone levels. So you would be way above normal- ten times normal levels or more. And you’re wondering why you’ve been having these rages? Losing control? Loses control jot jot. Banging on s÷=%t at home jot jot jot. Screaming at wife jot jot. Have you ever hit her? “No. I haven’t hit her. But I’ve wanted to hit something. My fists are clenched and I want to tear something apart with my bare hands.” Denies hitting wife jot jot. Clenched fists jot jot jot. Believes he’s bipolar jot jot. I tell him that he’s not bipolar. Steroids are the problem here. He says, “No, it’s not. Can’t be.” No. It’s the steroids, I’m sure. Rocky says, “Ya know, I’ve been reading, and I’m saying it’s probably bipolar.” He’s just holding on to the bipolar excuse. Addicted jot jot. I mean, he would rather be bipolar- actually fight to be bipolar- than admit that his precious steroids are the sole root of his many issues. Denial jot. Steroids don’t cause a typical high, it’s more of an exhilarating positive feeling, an energized, almost super power feeling. For dudes like Rocky, with his temperment, he is all about that musclebound feeling of power.
Have you noticed your hairline is receding. “Oh. You can tell?” Umm, yeah, I can tell- it’s like three inches back from where it should be- that’s why I mentioned it. That’s what steroids do. “Really?” Really. Bipolar doesn’t do that. Have you noticed your oily skin and acne on your back? “Yeah, I have.” Yeah. Bipolar doesn’t do that either. Guess what does. You get really argumentative and pissy. Some people actually become psychotic. “Oh, I’m not psychotic, man.” Really? But, you know, in our conversation, you said you’re always worried about people at the gym being jealous and giving you side eye and you said people are trying to destroy your business. You know, maybe you’re getting a little paranoid. “Oh, I am not paranoid.” Uh huh, yeah. I tried to explain. When you’re getting paranoid, you don’t know you’re getting paranoid. He saw all these deep meanings and he was making these deep connections, why people would be tracking him and why government agencies would be interested in monitoring his business. Rocky is in the nursing home business. He’s not even actually running a nursing home, he just provides services to nursing homes. It’s not like he’s involved with any government agencies. He’s contracted to bring in ancillary services to nursing homes. It’s a fairly big business and he’s been pretty successful financially, but there was no root in reality for the paranoia he was demonstrating.
I asked him if he noticed anything else, like maybe breast enlargement? “Ahh, maybe a little bit, but no big deal.” Mmm hmm. + breast development jot jot jot. He says, “You know, my muscles got bigger, I got leaner, and my endurance increased. I felt trimmer, more energetic.” You said your endurance went up, how much cardio do you do, Rocky? He says, “Well, I used to do more, but man, I’ve gotten so much bigger that it’s hard to breathe when I do heavy cardio, you know?” No, I don’t know, because I don’t abuse steroids. Androgenic erythrocytosis jot jot jot. That means that you have increased the number of red blood cells in your blood, so your blood becomes thick and viscous like oil. You have so many red blood cells, it’s tough for your heart to beat, it’s tough for your lungs to get oxygen, because there’s drag from the increased viscosity, so when you do cardio, you can’t breathe. “Yeah, yeah. I can barely run. I used to do triathlons. I can’t do them anymore, but I can lift way more weight.” Yeah, because not only are the steroids making your blood thick like oil with RBCs, the thick blood makes the left heart ventricle- the one that does most of the pumping of the blood- thick. It’s a muscle, so the thick viscous blood overworks it as it tries to pump that thick gross blood through, so it makes that left ventricle wall thick, really thick. So instead of having a thin elastic pump that pumps blood in and out easily, you get this thick, wide left ventricle wall that cannot pump effectively. It enlarges the left ventricle wall, so you can’t pump good oxygen rich blood through. It’s called hypertrophy. With all those factors going on, it’ll cause hypertension. “Oh, yeah, I take medicine for that.” Like no, big deal. Aah, I just take medicine for the damage that I’m causing myself. Duh! + hypertension jot jot jot. + medication jot jot. And did you tell the doctor that prescribes that med that you’re using steroids? “No.” Nice. Prescribing Dr. unaware of illicit steroid use jot jot jot jot jot. Do you know that hypertension leads to kidney disease? “Really? My kidneys work good I think.” I’m thinking ‘maybe for now’ to myself. You think you look good on the outside, although you’re balding, your skin is oily, you have pitted acne scars on your face and acne on your back and you’re growing boobs like a teenage girl and your testicles are microscopic and you have low to no sperm and your penis doesn’t work… and you can’t breathe with any amount of exertion because your blood is thick and gross so your heart is all enlarged and your blood pressure is so high you have to take medication like a man more than twice your age. And you’re causing all of it! Through your steroid addiction. And as if the physical side isn’t bad enough, now it’s affecting you mentally. You’re paranoid, on the verge of psychosis…really you’ve got a toe or two over that line if you want the truth. So no matter how big your muscles are, no matter how good you think you look (and my raised eyebrows were clearly saying that was debatable) you are destroying your body. “Um, like what? How?” Now he’s really listening. I continued. Do you understand what hypertension actually is and does? Cause and effect? How about atherosclerotic plaques. What are those? What do they mean? The arteries in your heart become lined with plaques that are basically made of fat. These fat plaques are sticky, so as your thick gross blood slogs through the arteries, the fat plaques gather and narrow the arteries, so you cannot push blood through the arteries. Eventually, they clog off. It’s like a tunnel being filled with more and more muck, so there’s not enough room for blood to flow through and you get a heart attack and die. But before that happens, you’re incapacitated with high blood pressure because your thick oversized left ventricle is trying to push your thick gross blood through arteries that are filled with fatty muck, athersclerotic plaque filled arteries. “I didn’t know all that.” I’m sure you don’t, but I’m not done educating you yet. It gets better. Well, actually worse.
Education jot. Steroids decrease HDL, which is the good cholesterol that helps keep your arteries open. And it also raises the LDL, which is the bad cholesterol that causes the fatty plaque to build up. So lowers the good while raising the bad. Got that? “Yep. Got it.” So that causes hypertension, and makes you prone to heart attacks and strokes. Did you know that hypertension also makes your kidneys malfunction? I didn’t think so. Right now, your kidneys are trying to pump under hypertension, and that kills them. The gross viscous blood thick with red blood cells kills them. So your kidneys shut down. Do you like to be able to take a piss? To be able to clean your thick slaggy blood of all the toxins you make? He nodded that yes, he rather liked to be able to take a piss and clear his thick slaggy blood of all the toxins he makes. I thought so. Enjoy it while it lasts. Before long, a machine will do that for you: four hour sessions, three times a week…if you’re lucky enough to live that long. If the massive heart attack doesn’t kill you first. Honestly, Rocky looked like he was about to have a heart attack right now. I know I’m hitting him pretty hard with all of this at once, but this guy was in a romantic relationship with his precious steroids, and I need him to break it off, clean and quick like. But wait, there’s more!
Now, with all this bad stuff going on, the little vessels throughout your body do not pump blood as well because they are clogged and they are hypertensive. So all those tissues, joints, and bones are starved of nutrients and oxygen. You get something called avascular necrosis. Avascular means without vasculature- blood vessels- and necrosis means death. It’s everywhere, but especially in the hips, with the ball and socket joint. The little vessels that feed the balls of your hip joints, where the femur meets your hip? Hello, the blood supply gets occluded- it gets starved- and then it gets dead. So you can recognize all the steroid abusers out there: they’re the 40 year olds using wheelchairs and walkers, whining about the pain in their hips. Balding, acne, boobs, erectile dysfunction, heart problems, kidney issues, disability, chronic pain. On and on. Oh yeah, it’s pretty bad, but it gets worse. His face fell. I couldn’t let up now. You enjoy being able to lift weights? You enjoy being physically capable? Like a zombie, he mumbled on a sigh “Yes…” I’m glad you do. But don’t get too used to it. Because if you keep this crap up, keep injecting that garbage, you’ll build your muscles up beyond what your body can handle. You’ll build them up- your muscles will get bigger- but your ligaments and tendons can’t be built up, and they can’t support these unnaturally large muscles. Do you know what muscles without ligaments and tendons do? Not much. Without healthy ligaments and tendons, big muscles are useless for anything but causing pain, debilitating pain. When you’re pumping iron, lifting really heavy weights, your ligaments and tendons get damaged. In no time, the muscle size supercedes the ability of the damaged ligaments and tendons, so you get irreversible chronic muscle pain. Sounds great, right Rocky? Oh, wait, and to top it all off, now you’re having psychological effects. You’re having rages. You want to tear something apart with your bare hands. You said that. What’s scary is that right now, at this moment, you have the physical ability to do that. If somebody pushed you too far on a bad day, you might go there. You could kill someone. I’ve seen it happen to a patient. A guy a lot like you. He came in here young and dumb and I explained everything to him, just like I’ve done with you. For several years, I begged him to stop. He refused to listen; didn’t believe me. Ultimate in denial. He’s in prison now for the next 30 years; that equals a life sentence for him. It’s scary. What’s even scarier is that if you keep this crap up, keep sticking yourself with that needle, you won’t be able to tear somebody apart for long. You might want to, but you’ll be too debilitated. That guy in prison? He’s in a wheelchair now 90% of the time. He uses a walker sometimes- when he can stand the pain- which isn’t often.
I’ll make this very plain. You are addicted to steroids. They are physically wrecking your body, the body you seem to worship. Oily skin, acne, bacne, boobs, receding hairline, balding, teeny tiny testicles, a penis that you can’t get up…and no sperm to come out of it anyway. And that’s just the stuff on the outside that people can see! Your insides get wrecked too. Thick slaggy gross blood, hypertension, atherosclerosis, heart attack, stroke, kidney dysfunction, erectile dysfunction, avascular necrosis, chronic pain. And now you’re raging, scaring the crap out of your wife, you’re paranoid, becoming psychotic. You have nothing positive happening in your life. So it’s your call, Rocky. I can help get you off the train here before it runs your ass over. He was nodding very slowly, but clearly shell-shocked. Look, how about this. Don’t use for two weeks and see me again. You’ll have some time to digest all of this. Can you do it? If you can’t- if you feel like you’re gonna hit that needle- I’ll see you sooner. Here’s my cell number. Call me anytime, but especially if and when you’re tempted to use. Deal? “Deal.” We shook on it.
Dx: steroid addiction, assoc features jot jot jot jot
Pt agrees to d/c use jot jot jot
F/up 2 weeks, will call/ see sooner prn jot jot jot jot jot
Here’s the bottom line on steroids people. Your body just does not like these drugs in excess. There may be some use for them in people with anemia, in people who have wound healing problems, a temporary use in people with HIV or cancer who do not want to eat, and in muscle wasting diseases for short periods of time and in very regulated doses, okay…fine.
But, for my Olympic athlete patients, my professional athlete patients: you all know who you are. All of my Rocky’s out there: cut it out! You’re sterile, can’t get it up, scared everyone’s gonna see your breasts, hello, they are! I know you’re saying ‘but I cycle them on and off, doc!’ I say bullshit. No, it causes permanent damage to heart, kidneys, tendons, and ligaments. Not to mention the cosmetic aspects: the oily skin, the acne on your face and back, the balding, receding hairline… and you say ‘oh, but to minimize the breasts I use an estradiol’ (an anti-estrogen, because testosterone breaks down to estrogen, so if you use an anti-estrogen in someone who is abusing testosterone or testosterone-like drugs, you will not get the breast enlargement) Yes, that’s true. I’ll give you that. But, you still get all that other crap, guys! Hellllo!! All my elite athletes, you all whine like ‘No, no, no, I need it to stay competitive, because everybody else is doping!’ Whatever! You are addicted to the high, the performance, and the cosmetic enhancement. You get big muscles, tiny balls, and tinier brains. You also get limp and sterile, permanent damage to the ventricles, the heart, and the kidneys, hypertension, and its host of other problems. You are predisposing yourself to coronary disease, heart attack, and stroke. You become delusional, and you fly into rages when the wind blows.
As you are my patients, I’ve probably told you about other patient stories. For those that haven’t heard them: one steroid abuser was very paranoid and psychotic, but of course didn’t know it, because you will not see yourself becoming psychotic. He was stopped at red light. I don’t know what he was doing, but when the light changed green, he didn’t go right away. So the car behind him honked. He started ticking like a time bomb, and the car kept honking, but for whatever reason, he still didn’t go. Instead, with the light still green, he got out of his car. With a golf club. He went off, banging on the guy’s car with the golf club, and he just didn’t stop. Eventually, they called the police. The police came and they had to subdue him with a tazer because he was out of control. When he was transported to the emergency room, he continued there, even continuing to spit and scream, even after being put in four-point restraints. Finally, he had to be pharmacologically restrained with a freaking rhino dart. Unbelievable. I mean, he was all black and blue, like he had been beaten, but he did it by thrashing, all by himself. His whole affect was totally inappropriate. I know that some people are beaten by police for no reason; they don’t deserve it, but this maniac was taking every opportunity to hit the police officers for absolutely no reason. In the hospital, he was arguing with nurses, disturbing the entire emergency department for no reason. His wife finally came in, but even she couldn’t calm him. He just lost it, in every sense. He was (or had been) on the road to being Mr. Olympia or some such title. He was 190 pounds, and bench pressing over 450 pounds. It was just crazy. Eventually, but not long after, he went into kidney failure. But it wasn’t from the steroids. Yeah, right. Denial!! jot jot
You know, it also causes immune suppression, so you don’t fight off pathogens like viruses, like COVID-19, like any bacteria. I had someone who had a heart attack and died. He was 25. Another stroked out in his late 30’s. These patients are Olympians, professional athletes, and really elite level people. They’re so hyper-disciplined about their diets and their training and supplements and sleep patterns and all of that. But they’re abusing steroids. It’s a crazy dichotomy. Some have made it. Big success stories that stopped and then did it the right way. But many don’t. Right now I have a 45-year-old man who is just going into kidney failure. And the one with psychosis that killed the guy that set him off. He’ll die in prison. Now I have Rocky. I hope I opened his eyes.
Remember, people… just because you cannot see what’s going on doesn’t mean the steroids aren’t destroying you. They are. But you can get there without them. And PS, for those that are wondering, there is a steroid withdrawal: headaches, drowsiness, decreased appetite, weight loss, fatigue, depression, dizziness. It’s a mess when I get them off, especially when they do high dose. It takes two to four weeks, and they are miserable, cranky, irritable, and obnoxious people to deal with when they are in withdrawal. I use benzodiazepines, things to help them sleep; I sometimes add anti-psychotics because they can’t see themselves drifting to the psychotic lane, sometimes hearing voices and seeing things. It’s a spectrum. And lots of misreading events in reality… “Those people are talking about me. They’re plotting against me. Those police officers are here to get me, or that group of people talking over there are planning something against me or these workers are not working because they are all in a grand plot against me. They are very faint signs and forms of psychosis. Hearing voices and seeing things, disorganized speech and behavior is the extreme. But there can be the unextreme, the misreading, the over-emotional abnormal response to normal events, thinking people are plotting.
Probably from age 10 to 30 is when most people started and abused the steroids. And too often, it’s a one way trip, once they start, they get lost in it. You know, “I am superman now” and they don’t stop, and then they stroll into my office and then I deal with them when they are 45 to 50 and that’s when their kidneys shut down, when they get a heart attack, when they are debilitated with degenerative disk disease from lifting too heavy weights, their ligaments and tendons go, they become sterile, they cannot have kids, they’re in constant horrible chronic pain. They have heart problems and kidney problems, and that’s what gets them. If they have heart and kidney failure, to the point where the organs have just given up, that’s what kills them.
Hopefully not Rocky jot jot jotLearn More
The 15 Scariest Mental Disorders of All Time
Imagine having a mental disorder that makes you believe that you are a cow; or another that you’ve somehow become the walking dead. Pretty freaking scary, eh? Well, while relatively rare, these disorders are all too real.
Worldwide, 450 million people suffer from mental illness, with one in four families affected in the United States alone. While some mental disorders, like depression and anxiety, can occur organically, others are the result of brain trauma or other degenerative neurological or mental processes. Look, having any mental illness can be scary, but there are some disorders that are especially terrifying. Below, I’ve described the 15 scariest mental disorders of all time.
‘Alice in Wonderland’ Syndrome
In 1865, English author Lewis Carroll wrote the novel Alice’s Adventures in Wonderland, commonly shortened to ‘Alice in Wonderland.’ Considered to be one of the best examples of the literary nonsense genre, (seriously, who knew they even had a nonsense genre?) it is the tale of an unfortunate young girl named Alice, who falls through a rabbit hole into a subterranean fantasy world populated by odd, anthropomorphic creatures. That’s your vocabulary word for the week… anthropormorphic. Popular belief is that Carroll was tripping when he penned it. Regardless if that’s true or not, what is true is that one of Alice’s more bizarre experiences shares its characteristics with a very scary mental disorder. Also known as Todd Syndrome, ‘Alice in Wonderland’ Syndrome causes one’s surroundings to appear distorted. Remember when Alice suddenly grows taller and then finds she’s too tall for the house she’s standing in? In an eerily similar fashion, people with ‘Alice in Wonderland’ Syndrome will hear sounds either quieter or louder than they actually are, see objects larger or smaller than what they are in reality, and even lose sense of accurate velocity or textures they touch. Described as an LSD trip without the euphoria, this terrifying disorder alters one’s perception of their own body image and proportions. Fortunately, this syndrome is extremely rare, and in most cases affects people in their 20’s who have a brain tumor or history of drug use. If you need yet another reason to not do drugs… well, there ya go.
Alien Hand Syndrome
While most likely familiar from cheesy horror flicks, Alien Hand Syndrome isn’t limited to the fictional world of drive-in B movies. Those with this very scary, but equally rare mental disorder experience a complete loss of control of a hand or limb. The uncontrollable body part takes on a mind and will of its own, causing sufferers’ “alien” limbs to choke themselves or others, rip clothing off, or to viciously scratch themselves, to the point of drawing blood. Alien Hand Syndrome most often appears in patients suffering from Alzheimer’s Disease or Creutzfeldt-Jakob Disease, a degenerative brain disorder that leads to dementia and death, or as a result of brain surgery separating the brain’s two hemispheres. Unfortunately, no cure exists for Alien Hand Syndrome, and those affected by it are often left to keep their hands constantly occupied or use their other hand to control the alien hand. That last one actually sounds even worse- one unaffected arm fighting against the affected arm that’s trying to tear into the person’s own flesh. Yikes.
Also known as Body Integrity Disorder and Amputee Identity Disorder, Apotemnophilia is a neurological disorder characterized by the overwhelming desire to amputate or damage healthy parts of the body. I recall a woman with Apotemnophilia making worldwide news ages ago when she fought with her HMO to cover the amputation of one of her otherwise healthy legs. Good luck; they don’t even cover flu shots. I remember I was pretty shocked that she found a surgeon to agree to do the amputation in the first place, as it seemed to me that might violate that little thing called the Hippocratic Oath us docs took when we got our medical degrees, specifically that part about ‘do no harm’… and sparked a debate about the ethical dilemma of treating or “curing” a psychiatric disorder by creating what is essentially a physical disability. Though not a whole heck of a lot is known about this strangely terrifying disorder, it is believed to be associated with damage to the right parietal lobe of the brain. Because the vast majority of surgeons will not amputate healthy limbs based purely upon patient request, some sufferers of Apotemnophilia feel forced to amputate on their own, which of course is a horrifying scenario. Of those who have convinced a surgeon to amputate the affected limb, most say they are quite happy with their decision even after the fact.
Those who suffer from the very rare- but very scary- mental disorder Boanthropy believe they are cows, and usually even go so far as to behave as such. Sometimes people with Boanthropy are even found in fields with cows, walking on all fours and chewing grass as if they were a true member of the herd. When found in the company of real cows, and doing what real cows do, people with Boanthropy don’t seem to know what they’re doing when they’re doing it. This apparently universal finding has led researchers in the know to believe that this odd mental disorder is brought on by possible post-hypnotic suggestion, or that it is a consequence of dreaming or a sleep disturbance, sort of kin to somnambulism, aka sleepwalking. I can buy the sleepwalking thing. I have a patient that is a lifelong sleepwalker who sleep-eats, sleep-cleans, sleep-cooks, sleep-destroys, sleep-online-shops, sleep-everythings. Some mornings she wakes up to very unpleasant findings of the house in total disarray, electronics dismantled and improperly and ridiculously fashioned together, every piece of furniture moved or a sink full of dishes and pots and pans with dried up food in them. Before setting up prevention measures, she even had single episodes of adult sleep-driving, and even sleep-biking at (eek!) age 9. In the middle of the night, her mother awoke to what she thought was the big garage door opening, and when she went to check, she saw her coasting out of the driveway on her bright yellow bike, heading right toward a very busy highway. She always has zero recall of the events afterwards. If she can do all of that while essentially sleeping, it would be comparatively easy to wander out to a pasture on all fours and stick around to munch on some grass. Curiously, it is believed that Boanthropy is even referred to in the Bible, as King Nebuchadnezzar is described as being “driven from men and did eat grass as oxen.” Or was it King Nemoochadnezzar? No? Okay, moooving on…
Named after Joseph Capgras, a French psychiatrist who was fascinated by the effective illusion of doubles, Capras Delusion is a debilitating mental disorder in which a person believes that the people around them have been replaced by imposters. As if that’s not bad enough, these imposters are usually thought to be planning to harm the sufferer. It really sounds like a bad Tom Cruise movie. Oh, wait; that’s redundant. Anyhoo, in one case, a 74-year-old woman with Capgras Delusion began to believe that her husband had been replaced with an identical looking imposter who was out to hurt her. Fortunately, Capgras Delusion is relatively rare, and is most often seen after trauma to the brain, or in those who have been diagnosed with dementia, schizophrenia, or severe epilepsy.
Like people with Boanthropy, people suffering from Clinical Lycanthropy also believe they are able to turn into animals; but in this case, cows are typically replaced with wolves and werewolves, though occasionally other types of animals are also included. Along with the belief that they can become wolves and werewolves, people with Clinical Lycanthropy also begin to act like the animal, and are often found living or hiding in forests and other wooded areas. Didn’t Tom Cruise play a werewolf in one of his many (vapid) movies? Or was it a vampire? Werewolf, vampire – tomato, potato.
In a case of life imitating art, or life inspiring art, we have Cotard Delusion. In this case, the ‘art’ is zombies, a la The Walking Dead. Oooh, scary! For ages, people have been fascinated by the walking dead. Cotard Delusion is a frightening mental disorder that causes the sufferer to believe that they are literally the walking dead, or in some cases, that they are a ghost, and that their body is decaying and/or they’ve lost all of their internal organs and blood. The feeling of having a rotting body is generally the most prevalent part of the delusion, so it doesn’t come as much of a surprise that most patients with Cotard Delusion also experience severe depression. In some cases, the delusion actually causes sufferers to starve themselves to death. This terrifying disorder was first described in 1880 by neurologist Jules Cotard, but fortunately, Cotard’s Delusion, like good zombie movies, has proven to be extremely rare. The most well-known case of Cotard Delusion actually occurred in Haiti, circa 1980’s, where a man was absolutely convinced that he had previously died of AIDS and was actually sent to hell, and was then damned to forever walk the earth as a zombie in a sort of pennance to atone for his sins.
Diogenes Syndrome is a very exotic name for the mental disorder commonly referred to as simply “hoarding,” and it is one of the most misunderstood mental disorders. Named after the Greek philosopher Diogenes of Sinope (who was, ironically, a minimalist), this syndrome is usually characterized by the overwhelming desire to collect seemingly random items, to which an emotional attachment is rapidly formed. In addition to uncontrollable hoarding, those with Diogenes Syndrome often exhibit extreme self neglect, apathy towards themselves or others, social withdrawal, and no shame for their habits. It is very common among the elderly, those with dementia, and people who have at some point in their lives been abandoned or who have lacked a stable home environment. This is likely because ‘stuff’ never hurts you or leaves you, though most people with the disorder are unlikely to be able to make that connection. Fortunately or unfortunately, depending on how you look at it, this disorder is much more common than some of the others I’ve mentioned here.
Dissociative Identity Disorder
Dissociative Identity Disorder (DID), is the mental disorder that used to be called Multiple Personality Disorder. Another disorder that has inspired a myriad of novels, movies, and television shows, DID is extremely misunderstood. Generally, people who suffer from DID often have 2-3 different identities, but there are more extreme cases where they have double digit numbers of identities. There was a “reality” show a few years ago that centered on a young mother of two that supposedly had like 32 distinct personalities. All of them had names and ranged from a five-year-old child to an old grandpa; and according to her, a few of them were homosexual while the rest were not, so she was required to be bisexual. She claimed that many of the personalities knew everything about all of the others, and they would get mad at or make fun of the others at various times. What’s more, she would “ask” other personalities to come forward so that producers could ask them questions for the camera’s sake, and her voice and mannerisms changed, depending on the different characteristics of the personalities. It was all pretty difficult to buy to be honest, because I’ve seen a lot of people with DID, and none seemed like they were having as much fun with their illness as she did. In true DID cases, sufferers routinely cycle through their personalities, and can remain as one identity for a matter of hours or for as long as multiple years at a time. They can switch identities at any time and without warning, and it’s often nearly impossible to convince someone with DID that they actually have the disorder, and that they need to take medications for it. For all of these reasons, people with Dissociative Identity Disorder are often unable to function appropriately in society or live typical lives, and therefore, many commonly live in psychiatric institutions, where their condition and their requisite medications can be closely monitored.
Most people cringe at the first sniffle indicating a potential cold or illness, especially these days, but not those with Factitious Disorder. This scary mental disorder is characterized by an obsession with being sick. In fact, most people with Factitious Disorder intentionally make themselves ill in order to receive treatment; and this is what makes it different than hypochondria, a condition where people blow mild symptoms into something they aren’t, kind of like if you cough once and automatically think you have covid-19. Sometimes in Factitious Disorder, people will simply pretend to be ill, a ruse which includes elaborate stories, long lists of symptoms, doctor shopping, and jumping from hospital to hospital. Such an obsession with sickness often stems from past trauma or a previous genuinely serious illness. It affects less than .5% of the general population, and while there’s no cure, psychotherapy is often helpful in limiting the disorder.
Imagine craving the taste of a book or wanting to have sex with a car. That’s reality for those affected by Kluver-Bucy Syndrome, a mental disorder typically characterized by memory loss, the desire to eat inedible objects, and sexual attraction to inanimate objects such as automobiles. I’ve seen a television documentary that featured people with strange fetishes, and they had two British guys that were sexually attracted to their cars. They gave them names and described their curves in the same manner that some men describe women. While one guy (supposedly) limited it to “just” caressing his car, the other actually also made out with his car; I’m talking about tongue and everything. Talk about different strokes! Because of the memory loss, not surprisingly, people with Kluver-Bucy Syndrome often have trouble recognizing objects or people that should be familiar. They also exhibit symptoms of Pica, which is the compulsion to eat inedible objects. The same wierd fetish documentary featured two young women that were “addicted” to eating weird stuff; one routinely ate her sofa cushions. She actually pulled the foam apart into bite sized pieces and ate them, many times a day. She became so used to doing so that she would get anxious if she went too long without eating it, so she started having to bring pieces of her sofa with her to work. I’m guessing she didn’t have to worry about co-workers stealing her food. She had started eating the cusions so long ago that she was actually on her second couch. Her family was so concerned about the potential medical ramifications of eating couch cushions that they made her see a gastro doc, who thought he was being punked when he asked why she was there. After imaging studies, she was in fact diagnosed with some intestinal issues and told to stop eating couch cushions, but the desire was too great for her to cease. She’s probably on her fourth couch by now. The other girl actually loved eating powder laundry detergent. She described the taste in the same dreamily excited way a foodie describes a chef’s special dish du jour. This terrifyingly odd mental disorder is difficult to diagnose, and seems to be the result of severe injury to the brain’s temporal lobe. Unfortunately, there is not a cure for Kluver-Bucy Syndrome and sufferers are typically affected for the rest of their lives.
Obsessive Compulsive Disorder
Though it’s widely heard of and often mocked, Obsessive Compulsive Disorder (OCD) is rarely well understood. OCD manifests itself in a variety of ways, but is most often characterized by immense fear and anxiety, which is accompanied by recurring thoughts of worry. It’s only through the repetition of tasks, including the well-known obsession with cleanliness, that sufferers of OCD are able to find relief from such overwhelming feelings. To make matters worse, those with OCD are often entirely aware that their fears are irrational, but that realization alone actually brings about a new cycle of anxiety. OCD affects approximately 1% of the population, and though scientists are unsure of the exact cause, it is thought that chemicals in the brain are a major contributing factor. I’ve discussed OCD and recounted OCD patient stories many times in this blog and in my book, Tales from the Couch.
Paris Syndrome is an extremely odd but temporary mental disorder that causes one to become completely overwhelmed while visiting the city of Paris. Stranger still, it seems to be most common among Japanese travelers. Of the approximately 6 million Japanese visitors to Paris each year, one to two dozen of them experience the overwhelming anxiety, depersonalization, derealization, persecutory ideas, hallucinations, and acute delusions that characterize Paris Syndrome. Despite the seriousness of the symptoms, doctors can only guess as to what causes this rare and temporary affliction. Because most people who experience Paris Syndrome do not have a history of mental illness, the leading thought is that this scary neurological disorder is triggered by the language barrier, physical and mental exhaustion, and the reality of Paris as compared to the idealized version. Slam! I’ll bet the Paris Tourism Board hates to hear about this one! Huh houn, wee wee monsieur.
The Reduplicative Amnesia diagnosis was first used in 1903 by neurologist Arnold Pick, when he described a patient with a diagnosis of what we know today as Alzheimer’s Disease. It is actually very similar to Capgras Syndrome, in that it involves duplicates, but instead of believing that people are duplicates, people with Reduplicative Amnesia believe that a location has been duplicated. This belief manifests itself in many ways, but always includes the sufferer being convinced that a location exists in two places at the same time. Today, it is most often seen in patients with tumors, dementia, brain injury, or other psychiatric disorders.
Stendahl Syndrome is a very unusual psychosomatic illness; but fortunately, it appears to be only temporary. The syndrome occurs when the sufferer is exposed to a large amount of art in one place, or is spending time immersed in another environment characterized by extreme beauty; probably one of those places that “takes your breath away.” Those who experience this scarily weird mental disorder report sudden onset of rapid heartbeat, overwhelming anxiety, confusion, dizziness, and even hallucinations. It actually sounds a lot like a panic attack to moi. Stendahl Syndrome is named after the 19th century French author who described in detail his experience after an 1817 trip to Florence, which is evidently a beautiful place. I have it on good authority that Stendahl Syndrome has never happened to any visitor to Paris, which, oddly enough is Stendahl’s country of origin.
So, we’ve learned a lot today: that there is a nonsense literary genre, that there are a bunch of freaky and frightening mental disorders out there, that some people might need to look up the word anthropormorphic, that illicit drugs are bad for yet another reason, that a lot of terrible B movies are actually based on some pretty obscure mental disorders, that people with Boanthropy probably get a lot of fiber in their diet, that the lives of people with Capras Delusion sound a lot like a bad Tom Cruise movie, that the term “bad Tom Cruise movie” is redundant, that Tom Cruise probably has Clinical Lycanthropy, that Tom Cruise is a tool, oops, sorry, everyone already knew that. We also learned that there is no longer such thing as Multiple Personality Disorder; it is now called Dissociative Identity Disorder, that Kluver-Bucy Syndrome is threatening to couches, and that if you have Kluver-Bucy Syndrome, co-workers will never steal your lunch. We learned that Japanese tourists hate Paris, and that Stendahl Syndrome never happens there. And we learned lots of other cool stuff, but that if you have so much stuff that you can’t walk through your house you likely have Diogenes Syndrome, probably because you have a deep seated knowledge that stuff never hurts you or leaves you.
Please check out my videos on YouTube- better yet, hit that subscribe button, and share them with folks. And as always, my book, Tales from the Couch has lots more information and patient stories on various psychiatric diagnoses and is available on Amazon and in the office. Be well, everyone!Learn More
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder (e.g. panic disorder). The symptoms that result from a somatoform disorder are due to mental factors. In people who have a somatoform disorder, medical test results are either normal or do not explain the person’s symptoms. Patients with this disorder often become worried about their health because the doctors are unable to find a cause for their health problems. Symptoms are sometimes similar to those of other illnesses and may last for several years.
Somatoform disorders are not the result of conscious malingering (fabricating or exaggerating symptoms for secondary motives) or factitious disorders (deliberately producing, feigning, or exaggerating symptoms) – sufferers perceive their plight as real. Additionally, a somatoform disorder should not be confused with the more specific diagnosis of a somatization disorder.
Disorders in this Category
- Body Dysmorphic Disorder
- Conversion Disorder
- Hypochondriasis Disorder
- Pain Disorder
- Somatization Disorder
Body dysmorphic disorder (BDD) (previously known as dysmorphophobia is sometimes referred to as body dysmorphia or dysmorphic syndrome) is a (psychological) somatoform disorder in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her physical features (body image).
The sufferer may complain of several specific features or a single feature, or a vague feature or general appearance, causing psychological distress that impairs occupational and/or social functioning, sometimes to the point of severe depression and anxiety, development of other anxiety disorders, social withdrawal or complete social isolation, and more. It is estimated that 1–2% of the world’s population meet all the diagnostic criteria for BDD (Psychological Medicine, vol. 36, p. 877).
The exact cause(s) of BDD differ(s) from person to person. However, most clinicians believe it could be a combination of biological,psychological, and environmental factors from their past or present. Abuse and neglect can also be contributing factors.
Onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one’s own appearance usually begins, although cases of BDD onset in children and older adults are not unknown. BDD is often misunderstood to affect mostly women, but research shows that it affects men and women equally.
The disorder is linked to significantly diminished quality of life and can be co-morbid with major depressive disorder and social phobia, also known as chronic social anxiety. With a completed-suicide rate more than double that of major depression (three to four times that of manic depression) and a suicidal ideation rate of around 80%, extreme cases of BDD linked with dissociation can be considered a risk factor for suicide; however, many cases of BDD are treated with medication and counseling.
A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors(SSRIs) to be effective in treating BDD.
BDD is a chronic illness, and symptoms are likely to persist, or worsen, if left untreated.Learn More
Conversion disorder is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fitswithout a neurological cause. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV). Formerly known as “hysteria”, the disorder has arguably been known for millennia, though it came to greatest prominence at the end of the 19th century, when the neurologists Jean-Martin Charcot and Sigmund Freud and psychiatrist Pierre Janet focused their studies on the subject. The term “conversion” has its origins in Freud’s doctrine that anxiety is “converted” into physical symptoms. Though previously thought to have vanished from the west in the 20th century, some research has suggested it is as common as ever.
DSM-IV defines conversion disorder as follows:
- One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.
- Psychological factors are judged, in the clinician’s belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.
- The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
- The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.
- The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
- The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by anothermental disorder.
Pain disorder is when a patient experiences chronic pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and more women than men seem to experience it. This disorder often occurs after an accident or during an illness that has caused pain, which then takes on a ‘life’ of its own.Learn More
Somatization disorder (also Briquet’s disorder or, in antiquity, hysteria) is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin. The disorder must begin before the patient turns 30 years of age and could last for several years, resulting to either medical seeking behavior or significant treatment. One common generaletiological explanation is that internal psychological conflicts are unconsciously expressed as physical signs. Patients with somatization disorder will typically visit many doctors in pursuit of effective treatment.
Examples of manifestations of Pychosomatic disorder are as such: a child itches in response to family issues, and experiencing repressed anger and/or fear. Thus, The child grows and wakes up itching in the same locations, though not aware of the repressed memory causing the suffering in later life, or the patient is engaged in seeking psychotherapy for somatization.
Somatization disorder is a somatoform disorder. The DSM-IV establishes the following five criteria for the diagnosis of this disorder:
- a history of somatic symptoms prior to the age of 30
- pain in at least four different sites on the body
- two gastrointestinal problems other than pain such as vomiting or diarrhea
- one sexual symptom such as lack of interest or erectile dysfunction
- one pseudoneurological symptom similar to those seen in Conversion disorder such as fainting or blindness.