I’m sometimes asked whether BDD can even be diagnosed during adolescence, because this is a time when appearance concerns are so common. The answer is yes, it definitely can! While it may sometimes be difficult to differentiate mild BDD from normal adolescent appearance concerns, more moderate and severe BDD can easily be diagnosed in this age group. In fact, as previously noted, adolescence is when BDD is most likely to develop.
It’s interesting that BDD usually begins during adolescence—a time when appearance concerns are often prominent and bodily changes^ dramatic. It has in fact been suggested that BDD may be a pathological response to the various physical and physiological changes of adolescence. Brain development during adolescence may contribute to the disorder’s onset. For example, at puberty, across species, the brain seems to increasingly attend to indicators of social status, including appearance, as well as cues of social rejection. Sociocultural factors that emphasize the importance of appearance and acceptance by others are also clearly important at this time. The causes of BDD and the mechanisms by which it’s expressed may indeed be linked in some way to the biological, psychological, and social changes that occur during the adolescent years.
As in adults, BDD should be diagnosed when appearance concerns become preoccupying and cause significant emotional distress or interfere with functioning. The adolescent who gets depressed, has problems concentrating in school or whose grades drop, or who misses school, parties, or dates because of appearance worries has concerns in excess of normal, which may be BDD.
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Have you noticed that, even without looking at a watch, we usually wake up at about the same time every morning and feel sleepy and go to bed nearly the same time each night? We do not need to know the time to do all these things. Somehow our body knows the time, as if we have a clock inside. This internal clock is called the biological clock.

Jet lag is a similar example. The traveller who flies from one side of a continent to another is unable to reset his biological clock immediately. The clock is still running at the same time back home; hence there is a feeling of disharmony. Sleeping and eating at a new time disrupt the jet traveller’s old pattern. It may take a few days to get used to the new time. There is one way to reduce the effect of jet lag and that is to reset your biological clock closer to the local time of your destination a few days before travelling. For people travelling westward, you should stay up later and later each night for a few nights before departure. For people travelling eastward, you should go to bed earlier and earlier each night instead. By doing so you may reduce the gap between your biological clock and the new local time of your destination.

Jet lag can become a problem for someone who has to make frequent trips overseas, especially if he has to make important decisions immediately on arrival. The inadequacy of performance after travelling across different time zones has led the military and many large corporations to forbid high level decision-making after a long flight until after a proper resting time. The ‘rest formula’ now used by the International Civil Aviation Organization, developed by Dr L. E. Buley, takes into account the hours of the day the traveller departed and arrived, the number of time zones flown through, and the number of hours travelled:

Rest time (days) – [ 7/2 + (Z - 4) +Cd + Ca ]/10

T is the travel times in hours, Z is the number of time zones, Cd and Ca are coefficients of departure and arrival which introduce gains and losses of time.

If one flies from Melbourne to London, departing Melbourne at 1300 hours (Eastern Standard Time) and arriving London at 0555 (Greenwich Mean Time), the rest period is calculated as follows:

Rest time =[26/2 + (10-4) + 1 + 3]/10 = 2.3 days.

An overseas trip is one of the very few instances in which sleeping pills are to be recommended. A drug that is short acting is preferred so as not to cause drowsiness on arrival.

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Do not be alarmed at the thought of regression. Remember that it is a completely normal phenomenon which all normal people experience in moments of reverie. In fact, it would seem that periods of reverie, like sleep, are necessary for the normal healthy functioning of our mind. In moments of reverie we are no longer concerned with our immediate surroundings, and our mind is left to wander from topic to topic. These moments are extremely relaxing, and the relaxation of the mind remains with us for some time after we have abandoned our reverie, and have returned to our normal way of alert thinking. It seems that in reverie,, just as in sleep, there is an integration of nervous impulses so that we lose some of our tension and anxiety, and as a result feel calmer and more relaxed. In this respect it is interesting to note that the person who suffers from severe tension and anxiety no longer has this normal tendency to moments of reverie. He is alert and on the lookout all the time. He cannot relax and let himself go off guard into a state of reverie. As a result he is without this normal mechanism which helps to save us from anxiety, so his tension is still further increased. The exercises with their consciously induced regression help to make up for the loss of spontaneous reverie, and so work to relieve tension and anxiety.

The common difficulty in allowing ourselves to regress concerns the letting go which is such an important part of it. There is a biological reason for this. Over countless generations we have been conditioned to be on guard. Those that were not on guard fell by the wayside and did not survive. True, we have some reverie, but reverie is characteristically a momentary affair. Now, to regress we have to let go and let ourselves be off guard. But now we can do it because we are safe. We know that we are safe and that nothing will befall us.

We are really rather afraid to let go. This applies to all of us, but especially to those who are tense and anxious. When we suffer from tension we are all the time holding ourselves in, as it were. We keep a hold on ourselves. We keep ourselves in check. We feel that if we did not do this our tension would somehow get out of control, and anything might happen. The difficulty is that the anxious person is continually holding himself in, while in the exercises he is asked to let himself go.

There are two things which help us to overcome this difficulty. The first is that we know that we are completely safe. This simple idea is of the utmost importance. You are safe. It is perfectly safe for you to let yourself relax and go off guard, so that your mind can wander where it will. It is safe because it is the normal thing that all healthy people do in reverie. We must feel safe and secure, because if we feel unsafe and insecure we are automatically on guard, which is the exact opposite of what we are aiming to achieve.

The other way that we get help in allowing ourselves to drift into regression is to become more and more familiar with the sensation of letting go.

I feel the muscles of my legs let go.—The thighs and the calves, they really let go.—My arms let go so that they are just flopped on the sides of the chair.—And the muscles of my face, they let go.—My jaw has let go, I feel it loose.—And my face lets go so that I can feel it smooth out.—I let go my whole body.—I let myself go.—I just drift with it.

Some people experience difficulty in that they remain too alert to everything that is going on around them. Their eyes are closed, but they are still conscious of the furniture and the things around them. If someone in the next room moves, they think that is so-and-so getting ready to prepare the meal. This is not what we want. We aim to let ourselves be oblivious of our immediate surroundings, and if we hear a noise from the next room, it is just a noise, and it has no particular significance for us. We can help ourselves like this:

I am just sitting here relaxing.—While I am doing it nothing else matters, nothing else matters.—I am just here, easy, comfortable, relaxed.—There is just me relaxing.—Me relaxing, that is all that there is.

Occasionally sleep may be a difficulty. Some people, as they start to relax, go straight to sleep. This is to be avoided. Sleep is some help in relieving tension, but it is very, very much less help than this relaxed state of mind. If you have a tendency to fall asleep when you start your exercises, use a more uncomfortable posture, and concentrate on keeping awake. Then when you have finished the exercises, just let yourself drift off to sleep to have a rest.

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