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Dear Nighat Ara,
I have an uncanny obsession for clothes. I don't know why. Everytime there is a party- a birthday, an anniversary- anything, I just worry myself sick over what to wear. So I just end up going on a shopping spree. This happens three to four times every week. To make the situation worse I cannot bargain. My cash flow is in a serious ebb mode and I cannot save up my month's salary. Lately, I have even been going into debt.

I know I need to start putting checks on my clothes shopping. But I do not know how. Please tell me a way to get around this problem.

Ans: Any kind of obsessive thought can generate anxiety/worry (negative energy in the body) and can lead to a compulsive urge to act in a particular fashion, in order to release that tension from the body. You have revealed that your obsessive thoughts about “what to wear” lead to compulsive shopping spree, which is causing financial debts. Grooming ourselves in an appropriate way is a social requirement as well as self-care practice. However, when it goes over the edge, there is an obvious absurdity in it and hence raises the question of sanity. This has become a self-destructive behavior, which needs to be addressed in order to prevent further damage to your life. Body image problem, social phobia resulting from distorted self-image or other low self-esteem issues (e.g. any underlying thoughts like- “I'm a misfit”, “I don't belong here” etc.), Assertiveness problem (e.g. “I cannot bargain”), depression or other associated psychiatric condition needs to be further explored.

Shopping addiction is a condition where people buy things unnecessarily for short-term gratification overlooking the long-term negative consequences. Buying new items can alter the mood level (e.g. new clothes feel good) and this internal reward system (good feeling as opposed to anxiety feelings prior to shopping) tends to set up a cycle of repetition despite the awareness of its negative consequences (financial debt, no savings etc.). The psychopathology is similar to drug addiction (e.g. heroin, cocaine, alcohol etc.) and can be treated by taking different approaches.

Although you haven't disclosed your gender here, I'm assuming you are a female (after all the obsession is over clothes and not over mobile phone, computer or car!!). One of the underlying issues of women's addiction is body-image distortion. Contributory social factors are- gender role assignment (e.g. women attract men by their physical beauty), media promotes a particular body shape and size as an idealized standard through commercials, modeling, fashion shows, beauty contests etc., anything less than that, is “not good enough”, resulting in a sense of shame and inferiority. Women who are not comfortable with the size and shape of their body are also at a higher risk of developing eating disorders like bulimia (bouts of excessive eating followed by induced throwing up or purging) and anorexia (under eating leading to severe weight loss). People try to cope with conflicting feelings about body image by obsessing on body weight, looks and clothing.

Psychotherapy sessions can offer healthier coping strategies to deal with these internal conflicts. This is an experiential learning process that requires a safe therapeutic environment based on the client- therapist relationship. Body image problem can be the result of failure of an important developmental task in childhood where every child needs to feel special, wonderful and welcome. If this normal, healthy, narcissistic need remains unfulfilled, it can give rise to grandiose exhibitionist need in later life. I just can't resist referring those famous lines from fairy tale “Snow White” that has captured this human anguish so brilliantly - “Mirror! Mirror on the wall, who is the fairest of them all?”

This real world requires us to learn to live with not just the absence of good (e.g. love, appreciation, encouragement etc.) but also with the presence of bad (e.g. put downs, teasing, tormenting etc.). Therapy sessions try to give the client a chance to build the internal structures that weren't built as a child and can also focus on compensating for other old deficits causing delay/arrest/failure in complex interplay of body-mind-spirit. People who have good self-reflective power can benefit from this approach.

Keeping a reasonable collection of nice and comfortable clothes, budgeting well and keeping a fixed amount to spend on clothes are important ways of dealing with this situation. Getting rid of credit card or extra cash, involving a support person in monitoring the progress, using reminders about the consequences (debt, embarrassment, guilt after buying the cloth etc.), avoiding shopping malls etc. might also work. Plan the week ahead of time, a basically introverted person might need to replace some party time with other recreational and productive activities like exercise, cooking, reading, gardening etc. to ensure enough personal space in life. Choosing activities with friends, which doesn't require one to be formal and uptight (e.g. swimming, movie night etc.) might be good idea for a “people” person.

Why do you go to parties? Think it through- are you there to impress someone, please others or to enjoy your time? Are you there to play the “mockery mock” game of competition- who is the prettiest/ cutest/ richest? Rationalize your action; identify your goals and then work towards it. Eliminate the discrepancies between action and goal. Imagine and discover how you really would like to feel in and about your body. Challenge the old tape of critical comments (if it is still playing in your head) and replace it with positive statements.

Irrespective of what you are wearing, feeling comfortable in your skin and being in touch with inner beauty are important preconditions in feeling comfortable around people.

Q.) Dear Dr.
I am a 26year old female. I am getting married in December, I am a bit overweight and have been working out but I don't seem to be able to loose fat around my waist and abdominal area. Also my arms and the area around the back of my shoulders look awful. I have planned my wedding for a long time and would like to look great in a sari, but with this figure I don't think that will happen. Can you help me?

A.)Well yes, we can help you by liposuction, but you must realise that you do have to keep on exercising otherwise you will not lose weight and on the whole, won't look good. Liposuction will help in reshaping your body. First we have to see how overweight you are, then we will decide which areas have to be done first as it might take more than one session to give you a good result. So if you start now you will have a good recovery period before the wedding. Keep on exercising and come see us some time.

Q.)I am a woman in my mid thirties. My husband lives away from me and he will be coming to spend Eid with me after 2 years. I want to look good for this occasion but I have developed wrinkles around my eyes and forehead. Can anything be done in such short time to make me look better? Will I need surgery?

A.)With advancement of technology we can help you in such a short time and that also without involving any surgery. I don't know what your skin is like but it sounds like you don't take much care of it. If your skin is a bit rough, I would suggest Microdermabrasion followed by Botox injection around the eyes and forehead. This is a very safe procedure where botox is injected around the wrinkled areas and the skin becomes smooth. This lasts for about 6 to 9 months, but is definitely worth it as the results are excellent. It only takes about 20 minutes to give the injection and the results appear within 2 to 3 days. I would definitely recommend it for you.

Q.)Dear doctor,
I am 24yr old male. I love to sing and perform with a band. Lately I have noticed that after practising for a while my voice starts cracking. I am getting very worried as it is affecting my singing a lot. What can I do? I am scared to go to a doctor.

A.)In order to get a proper diagnosis you have to go a doctor and that would be an ENT specialist in your case. You may be straining your voice too much, or may have developed polyps on your vocal cord. You need to be examined properly before any treatment option is given.


Under a different sky

Insignificant in-betweens

Iffat Nawaz

You aren't cute… I definitely wasn't attracted to you, nope not even once for even a moment. But I did notice you everyday. Everyday between my short walks to the gym or to grab some lunch, and you stared sitting in your office watching me go by. You were always trapped in your office, in front a big computer screen, and I always felt like you had a bad boss, someone who micromanaged you, called your cell phone if you were 5 minutes late, didn't pay you enough and criticized your work harshly… what were you? A graphic designer perhaps?

You watched me almost everyday, it was a routine, I was almost like a clock for you, because I noticed from the corner of my eye when you saw me walk by you would look away from your computer, look outside and make the motion of getting up probably to grab some lunch yourself. I was the reminder through your fishbowl wall of food, of a break, of some good or bad weather.

I never smiled at you, even when we looked straight into each other's eyes. I didn't feel like it. You didn't either, and it really didn't matter to me. We were like traditions to each other, every day rituals, like old married couples, looking at each other to tell time, to decide moods, reminding each other which day of the week it was, what season it was from my flip flops to boots, we were so disinterested yet creatures of habits and therefore still paying half attention.

And then you disappeared.
I noticed there is someone else sitting on your desk now. She is older, a bit chubby and looks less creative than you. She doesn't look outside much she is squarer, more limited, happier than you were, definitely.

Were you fired? Or did you get a better offer somewhere else? Do you miss your glass walls that stared out into the canal? Water and people on boats, horses going by, people like me, walking along busily for lunch, shopping or nothing at all…are you better off?

No I am not interested, I don't miss you, but I do notice your absence because without you there is one less norm in my life. And no I am not a fan of norms but still... Habits,

you know? They are hard to break…

If I see you outside one day, on the street or at a coffee shop, most probably I won't recognize you, and honestly bumping into you won't mean anything, because our context has changed, our habits too. Your replacement will not play with me our ritualistic game, she won't even look outside to look at the sun or the rain, or nice purses. She brings food from home everyday, I have seen tupperware sitting on her desk, she eats lunch while she works, her lunches look boring, white pasta or graceless salads. She is not you, that's for sure.

You are nobody, really, no one at all…just another temporary minute habit, broken, stares gone, people moving on, I never got your name and it won't matter, we are all walking somewhere, back and forth.




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