Body Dysmorphia: Diana's Secret
"As soon as she disclosed to us the sexual abuse, Diana started having problems with her appearance," Guadalupe shares.
"I can rationalize that it's not my fault. But I think in the back of my mind, where there's a level of conditioning that I still have not dealt with, that it's my fault that things happened, that the family separation happened. I sometimes think, â€˜Maybe if I had not told, then it wouldn't have happened,'" she says through sobs.
"What do you say about that, Mom?" Dr. Phil asks Guadalupe.
"Did you believe her?" Dr. Phil probes.
"I believe Diana," she replies.
Dr. Phil turns to Diana. "How do you feel about your sister saying, â€˜I don't have sympathy for this. Come on, get over it. I've got kids and a life, and I get up and get going in 20 minutes, and you spend three hours in a mirror'?" he asks.
"I understand her frustration because she doesn't live in my mind. She has not experienced my experiences," she responds. "However, she was never sexually abused, nor did she have to face what I faced as an adolescent, disclosing to my family that this is what had happened to me, and they protected him at the expense of me."
"Do you realize that, at an intellectual level, most people would look at you and say that you are a beautiful woman?" Dr. Phil asks.
"What is the payoff for standing in front of the mirror for two or three hours?" he inquires.
"Absolutely no payoff," Diana replies.
Dr. Phil takes her to task. "You wouldn't do it if there wasn't some payoff," he says. "Do you feel like, â€˜If I watch it closely, I can control it? I can manage it?"
"Yes, I do," she says.
"Well, Diana has her moments where she'll start screaming, crying. She'll tell my mom and dad if they love her, they'll do this procedure for her, that this is the only way that she's going to get better, and the procedure gets done," she replies.
Dr. Phil addresses Guadalupe. "Do you give in?" he asks.
"We try not to give in," she replies. "But at the end we do because her promise to us is, â€˜One more time.'"
Guadalupe explains, "Every time we feel that, â€˜Maybe this time. Maybe now Diana can go forward.'"
Dr. Phil wants Liz and Guadalupe to understand the severity of Diana's disorder. "This isn't just her being vain," he tells them.
"I think it stems from my mom and dad not going and getting the therapy after the abuse that she had," Liz concedes.
"At age 16, you made a serious attempt to kill yourself with an overdose of Prozac," Dr. Phil points out.
"Yeah, correct," Diana says softly.
"In 2005, and again in 2006, you made a serious attempt to hang yourself, to take your own life."
"At the end of '06, you overdosed again, trying to end your life. True?"
Dr. Phil gives Liz and Guadalupe a grave stare. "Statistics are pretty clear; people with body dysmorphic disorder are about 45 times more likely than normal to commit suicide. So the point here is, she's going to get this right. She's made four attempts. This girl is going to kill herself, Mom, Sis. It's going to happen," he warns.
"Diana has a classic case of body dysmorphic disorder," Arie replies.
Dr. Phil introduces Dr. Esteban Gonzalez, a licensed psychiatrist of the South Texas Behavioral Health Center, who has agreed to work with Diana. "You believe she is a threat to herself, correct?" he asks.
"It appears to me that this is a very layered and convoluted situation that has manifested itself in this particular manner," Dr. Phil observes. He tells Diana, "You do have a history that has to be dealt with. You are dealing with depression, and anxiety, and agoraphobia, and all types of things."
Addressing Arie, Dr. Phil says, "Your experience has been that this requires a pretty intensive and long-term intervention."
"The first thing I would recommend is stopping the cosmetic procedures. They do not work; they never work for body dysmorphic disorder. In fact, they always exacerbate BDD. In terms of treatment, I'd highly recommend to Diana a combination of cognitive behavioral therapy and medication management," he advises. "I'd recommend a minimum of two years of therapy."
"Will you immerse yourself in this [therapy], and really start, not just living with this, but working through this?" Dr. Phil asks Diana.
"Absolutely. If it's going to save my life," she replies.