In recent years the term “circadian rhythm” (those rhythms that govern our circadian clock) has been applied to a growing number of metabolic and other patterns found in virtually all creatures. These discoveries led to the creation of the new science of chronobiology.
The first experiments to discover and assess the circadian rhythms in humans were conducted in Europe in the early 1960s. German researchers used the basement of a Munich hospital to isolate volunteers from all external time clues (called Zeitgeber, a German neologism that means “time giver”). There were no windows, nor were the subjects permitted to see newspapers or hear radio or television broadcasts. The participants in the experiment were allowed to establish and follow their own schedules, eating when they were hungry, sleeping when they felt tired. In similar fashion French scientists a few years later used caves in the Alps to isolate their subjects. Among other things, these experiments showed that, left to their own devices, the volunteers tended to go to sleep at twenty-five-hour intervals.
This and subsequent discoveries have established that human circadian rhythms, when allowed to run free with no clues to establish the time of day, tend to operate on a cycle of approximately twenty-five hours. One ramification of this finding is that if our circadian pacemakers were not reset on a daily basis by external factors, the timing of our built-in rhythms would be off by an hour more each day compared with time as measured by the clock.
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When Pamela came to see me, she began by saying, “I’m a picker.” Pamela considered her skin picking the most troubling part of her BDD. “I can’t stop destroying my looks,” she said. “I have this compulsion of picking at my face at any tiny blemish. I try to remove any ugly things on my face…. I feel addicted to this compulsion.”
Pamela was a 25-year-old music student with no obvious skin lesions. She’d picked at her skin for the past eight years, trying to remove small blemishes and imperfections that to her were “hideously ugly.” To decrease her chance of getting pimples, she also picked to remove any dirt that she feared might be under the surface of her skin. Pamela usually picked for several hours a day but sometimes for up to 12 hours at a time. Occasionally, she stayed up all night picking.
I asked Pamela to describe her picking. “The way it usually goes is that first I check a mirror,” she said. “I check in school with a pocket mirror, I check in store mirrors, or I check in my bathroom mirror at home. I hope to find a miracle when I check, but I never do—there’s always something wrong with my skin. I see a tiny blemish, and I start obsessing that my skin looks ugly and that other people will notice it. I think, ‘I see a bump there! People are going to notice it! I have to get rid of it!’ I get very self-conscious and I start. The worst time for me is the morning, when I’m getting ready for the day, and at night before I go to bed. Sometimes I get totally caught up in it, and I don’t even think of anything else.
“When I can’t pick, I get shaky and anxious—I have to do it! I’m drawn by the mirror—I have to look and see how I look, and then I have to start picking when I see anything wrong, even though I know no one else will probably see it. I can’t resist. Then, afterward, I check to see how I look. Usually, I look so terrible that I isolate myself…. I pick hoping to make my skin look better, but I usually make it worse.”
Pamela’s picking caused notable lesions that required dermatologic treatment. “The treatment helped my skin heal, but it didn’t help me stop the picking,” she said. “One dermatologist told me to just stop doing it. If only it was that simple! I’ve tried to stop a hundred times, but I can’t. I’ve tried cutting my fingernails, and then I wore artificial fingernails and bandaids to avoid doing more damage to my face. It really didn’t work.”
Pamela’s boyfriend had recently broken up with her because of her picking. “I could no longer hide my need for privacy to pick—I was much too embarrassed to tell him about what I was doing. And the picking took a lot of time—I ran out of excuses about where I was and why I couldn’t do things with him.”
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Our body reacts to anxiety with a number of physiological responses. Our heart rate is increased, our blood pressure rises, blood is diverted from the organs to the muscles, and the pupils of our eyes are dilated. The body prepares us to meet some emergency. It is really a preparation for action—for fight or flight. This response is a biologically ancient form of reaction, which we have inherited from times past when dangers were usually in the form of some threat of physical attack. The body’s physiological response is well adapted to meet such a threat.
But the warning of anxiety refers to a threat from within—all is not well in our mind. And the body’s traditional response to threats is of little help in this relatively new biological situation. In fact, the beating of our heart and the tensing of our muscles for physical action only tends to increase our anxiety, because there is no outward foe on whom we can vent the physical strength which has been mobilized. In other words our body responds to anxiety according to a biologically outmoded pattern of reaction which can neither rectify the cause nor help us tolerate the discomfort of our anxiety.
The general response of the body to anxiety is modified by a physiological self-regulation device. There are many such self-regulating mechanisms in the body—for instance those which control our body temperature, water balance, and the chemical constituents of the blood. The alerting response which prepares us for action by increasing our heart rate and raising our blood pressure is mediated through the sympathetic nervous system. When this system becomes too active, a self-regulating mechanism calls the parasympathetic system into activity to balance the effect of the overactive sympathetic system. But one of the main functions of the parasympathetic is to increase the mobility of the bowels and the contraction of the bladder. So anxiety in this indirect way may come to cause diarrhoea or frequent urination. This, of course, has quite the opposite effect of the primary response to anxiety, which was to mobilize our bodily resources in preparation for action.
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