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There are some interesting differences between men and women with BDD. I’ve found that women are more likely to have an eating disorder, whereas men are more likely to have a problem with alcohol or drugs. Men are more likely to be single. While the sexes are generally similar in the number and areas of bodily concern, men are more likely to think that their body build is. too small, skinny, or not muscular enough, whereas women are more likely to dislike their weight and hips, thinking they’re too large and fat. While men and women are equally likely to have hair concerns, men are more prone to fear that they’re losing their hair. All of the people who worried about excessive body hair were women, whereas all of those with genital concerns were men. Men are more apt to use a hat for camouflage, whereas women are more likely to turn to cosmetics for cover.
These results are interesting because some of them echo normal appearance concerns and behaviors. Research findings indicate that women generally think their bodies are too large, whereas men tend to worry that theirs are too small. A study of college students, for example, found that 85% of the women wanted to lose weight, whereas only 40% of the men wanted to lose weight and 45% actually wanted to gain it. In the general population, concerns about balding are relatively common among men but not women, and women are more likely to use cosmetics than men.
Several treatment findings are also interesting. I’ve found that men and women are equally likely to seek nonpsychiatric treatment such as surgery or dermatologic treatment for their BDD concerns. They’re also equally likely to receive these kinds of treatment. This finding differs from what we know about the general population, in which women are more likely to receive cosmetic treatments than men.
The only other study that to my knowledge has investigated gender differences in BDD was done in Italy in a smaller series (58 people). This study, like mine, found that BDD was generally similar in women and men. And like my findings, women were more likely to have the eating disorder bulimia nervosa, and men were more likely to be concerned with their genitals. Unlike my results, however, the Italian study found that women were more likely to focus on their breasts/chest and legs, check mirrors, and camouflage, whereas men were more likely to focus on their height and excessive body hair. Certainly, we need more research on gender similarities and differences in BDD, not only in clinical settings but also in the general population and in different cultures.
I’m sometimes asked how many people with BDD are homosexual. I systematically assessed this in my series of 200 people with BDD and found that 5% were homosexual and 3% were bisexual. This percentage is somewhat higher than in the general population, but it indicates that the vast majority of people with BDD are heterosexual.
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Bed-wetting at night during sleep is technically known as nocturnal enuresis. Bed-wetting is a nuisance to parents, and hence toilet training begins at an early age. After the age of four, when they start going to school, most children are dry at night. However there are some that continue to wet their beds at night even to a much older age.

In the past, a lot of people believed that children wet their beds while dreaming. Now, with the advent of the sleep laboratory, we are certain that they wet their beds during NREM sleep, especially in stages three and four of deep sleep. Children who sleep deeply lose control of their bladders in NREM deep sleep. As the children grow older, it is normal for them to sleep less deeply and this increases their bladder control. Ultimately, as these bed-welters become older,

bed-wetting cures itself. Most parents seek medical advice if their children still bed-wet at about school age. The doctor will make sure there is no urine infection or sugar diabetes. Diabetes mellitus, having sugar in the urine, is known to cause excessive urination, although few sufferers of diabetes bed-wet. If the doctor is satisfied that there is no physical illness, normally no treatment is required before the age of eight, as bed-wetting is a self-limiting condition. We are quite sure that the majority of bed-wetters are of normal intelligence and parents need not be worried or concerned about their child’s future development. These children should be rewarded when they have a dry night, and when they have a wet night it should be ignored. Do not punish them, as this will only give them a feeling of guilt which may be harmful to their future personality and may make their bed-wetting worse.

If treatment is required, two methods are commonly used. The first is a medicine called imipramine. This can be given to children when they need to be dry for a night or more as when they stay overnight at a friend’s home or go away to a school camp. It is only a temporary measure, as relapse is common once the medicine is stopped.

A second well-known method is the pad and alarm system. This is an electrical device consisting of two electrical pads separated by a small piece of cloth, and it is placed under the bed sheet. When the child wets the cloth between the pads, a short circuit is created which switches on a battery-run alarm which then wakes the child up. This trains the child to wake up once bed-wetting begins. This training may take anything up to 12 weeks before bed-wetting stops.

Bed-wetting sometimes runs in families and seems to be an inherited characteristic. It has been shown that an identical twin has double the chance of bed-wetting if the other twin bed-wets. Bed-wetting can also be caused by emotional factors; for example the addition of a new baby to the family may be perceived as a threat to the older child. In these cases of stress induced bed-wetting, most of the children have been dry for a period of months or years after toilet training, but bed-wetting begins again when they experience emotional stress. This is called secondary bed-wetting and is commonly stress related. This is less common than primary bed-wetting, in which the child has not gained bladder control at night since birth.

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We have already discussed the very close relationship between the body and the mind, and we have seen that relaxation of the body itself produces some relaxation of the mind. But we can go further than that, and we continue our exercises in this fashion:

Our whole body is relaxed.—We feel it all through us.—It is in our face.—Our face is utterly relaxed.—We feel it in our forehead, and in the sides of our forehead.—We feel it there deeply, deeply in the sides of our forehead.—Deeply, we feel it in our mind.

This sequence follows on easily enough. We feel the relaxation in the muscles of our face, and with this relaxation we feel our face smooth, out in calm. There is a very intimate relationship between the state of our mind and the state of our face. If your mind is calm, so is your face. Conversely if we learn to make our face calm, we experience a feeling of increasing calm of our mind.

With our jaw loose the muscles that work the jaw are fully relaxed. The two temporal muscles extend up to the sides of the forehead. You can feel them by placing the fingertips at the side of the forehead and firmly clenching the jaw. You can feel the muscle contract and then let go as the jaw is relaxed. The feeling of relaxation here gives us the feeling of relaxation deeply within us—in the mind itself.

The whole of our body is relaxed.—We feel the relaxation of all the muscles of our body.

—They are relaxed.—They are relaxed and calm.—We can feel the calm.—We feel the relaxation and we feel the calm.—The relaxation is all through us, and so is the calm that goes with it—The calm of it is part of us.—It is all through us in our body and our mind.

Again, the sequence is logical and straightforward. We feel the relaxation of our muscles. Our relaxed muscles are calm. We can feel the sensation of calm in them, we feel the calm of it all through us. We feel the calm of it in our mind.

Remember that the feeling of relaxation of the mind may at first be variable. It may come and go. There may be a momentary experience of calm of the mind and then it is gone. This is to be expected for the first few attempts. Remember that people who can attain relaxation of the body can all learn to attain relaxation of the mind. If you are able to capture just a moment of calm, it will not be long before you can achieve the full state.

Remember, too, that relaxation of the mind is greatly enhanced by physical relaxation which is attained in relatively uncomfortable circumstances. So as we become more adept at our physical relaxation we do it in increasingly uncomfortable positions.

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