Many people say that BDD caused the breakup of a relationship, even divorce. You may recall Julie, whose first husband left her because of her BDD. “All I talked about was my nose,” she explained. “All I talked about was wanting surgery. I was so preoccupied I could hardly take care of my kids or the household. We had no relationship.”

Jonathan’s wife left him because of his BDD. “She said that was the reason, and I think it was,” he said. “And I don’t blame her for leaving. I was totally obsessed. I’d spend weekends in bed, and I wouldn’t go out with her because of my pimples. I got so wrapped up in the problem that she really didn’t have a husband anymore. She called BDD ‘the selfish disease.’ “

Many people aren’t in a relationship at all. About two thirds of the people I’ve seen (who on average were in their early 30s) have never been married. Twenty two percent were currently married, and 12% were divorced. Many want to be in a relationship but aren’t for various reasons—self-consciousness, fear of rejection, shyness, or low self-esteem.

Warren had never pursued a relationship with a woman he liked. “All of my relationships have been with women who pursued me,” he said. “I’ve never been in a relationship with someone I liked because of my appearance. I’ve felt undesirable. I’ve stayed single so I don’t inflict myself on anyone else.” “I’d never ask a girl out,” Paul told me. “I’m too shy, and I have the BDD problem. It affects all of my relationships, especially with girls. I totally avoid girls. I don’t even think of being intimate with them. It paralyzes me socially.”

When people avoid dating and social activities so they aren’t rejected, this can create a vicious cycle that makes them more and more isolated. A young man who refused to ask anyone out because of his hair was certain that no woman would ever want to date him, let alone marry him. When I pointed out that in fact he might not ever date if he didn’t ask women out and if he continued to avoid social gatherings where he might meet them, he was surprised. He had assumed the reason he wasn’t dating was because women found him so unappealing. He didn’t realize the extent to which he himself was cremating his dateless situation by avoiding women.

*122\204\8*

The list of problems widely believed to be associated with the menopause makes lengthy and frightening reading. It really makes you wonder if there has been a fear campaign from interested parties to encourage women to take HRT. As you can see the list includes life-threatening problems like osteoporosis, as well as psychological disorders:

•   hot flushes,

•   night sweats,

• irritability,

•   declining libido,

•   osteoporosis,

•   weight gain,

•   vaginal dryness,

•   ageing skin,

•   changes in hair quality,

•   headaches,

•   mood swings including depression,

•   lack of energy,

• joint pains.

The truth is that many of these so called ‘menopausal symptoms’ may have little to do with the menopause at all. Some are just a natural part of the ageing process and affect middle-aged men just as much as they affect women. Others may be related to particular events in our lives that have nothing to do with our hormones. The classic example of this is the ‘empty-nest’ syndrome which many women have to face up to in their late forties or early fifties when children leave home. This can be quite a crisis. You carry on worrying about your children, but you may no longer have daily contact with them. To try to explain away these powerful and legitimate feelings in terms of falling hormone levels is to dismiss many women’s important experience of motherhood. At this time in their lives many women are trying to cope with elderly parents too. It can be very stressful, far more stressful than looking after any number of young children. Few things are more depressing than having to watch a much-loved parent in the final stages of illness. It is quite wrong to blame all these emotional problems on the menopause. When you analyze it there are only a few symptoms that can be truly called menopausal. This is not to say that these symptoms are trivial. Some women suffer severely from them. Others sail through the menopause without any problems at all.

*5/101/5*