2009年7月31日金曜日

web bots vol zero issue 1

TheCassandraReview
July 22, 2009
www.halfpasthuman.com

take this report with a grain of salt and even through this report Cliff is often saying that he could be way of course. Let's hope he is. Based on the reports I have purchased in the past and what has come true I expect about 10-25% of this actually happening..but even that amount is worthy of at least preparing.

coblat-60 research it

bbc surviour and discovery colony..along with the road. interesting timing. It's either marketing from hollywood or it's that prepping thing. you make up your own minds.

I've listened to the Web Bot guys on Coast to Coast am with George Noory a few days before and also bought the report "The Shape of Things to Come (2010)" that she mentioned, on halfpasthuman.com with only $10. Haven't read it, yet but tomorrow, I will.
My friend also told me that these Web Bot guys are not continuing their appearance on any medias from now on.

2009年7月30日木曜日

On the Edge with Max Keiser - 24 July 2009 (pt1 ~ 3)

MaxKeiserTV
July 24, 2009
http://maxkeiser.com/
On the Edge with Max Keiser - 24 July 2009 (pt1 of 3)

pt.2

pt.3

Feels so great that Max is always saying the truth on TV and throwing money or toilet paper on the floor. Beat it Paulson, stuttering, stummering shi**.

Michael Jackson: 7/29/09 - Tamara on "Prime News" discussing developments

by tamaranoraholder
July 29, 2009
7/29/09 - Attorney Tamara Holder on CNN HLN "Prime News" discussing developments in Michael Jackson death investigation. Including: Conrad Murray, custody issues, etc

Ian Halperin talking MJ on Howard Stern 1~7

Michael Jackson's Fans Can't Face the Fact that they are also Responsible of Killing Him...which is MY OPINION and not Ian's.
Apart from the whole bad comments done on amazon.com or YouTube and so on, to me, Ian Halperin's explanation about Michael actually fits the closest to my view. This man, except with some parts, seems to have the most accurate information among all the critiques....although, I've never met Michael Jackson in person, my opinion is just based on all the information gathered on the internet, books, magazines, radios and analysis from my personal religious, spiritual, or everyday experiences. Totally personal.

Ian Halperin talking MJ on Howard Stern 1~7
shaneomtl1
July 19, 2009

pt.1

Ian Halperin is an investigator, an undercover journalist (obviously, now he's too famous so, he should always put his dark glasses on..) who's been working in this field for 20 odd years, the only guy who info-traded the church of Scientology. He paused as an undercover gay actor in the church, they let him film everything, telling them that he wanted to be cured with his alleged homosexuality, they let them in for months, told them his uncle invented, had all kinds of dough, wanted to invest 50~100 million tax right off... and wrote a book about that. Thats why Michael became interested with Ian. What made you believe that Michael wasn't a child molester? Michael was acquitted on 2005, he thought it was going like an O. J. Simpson trial, and was out to nail him. After 4 years of investigation, unwaveringly thought, Michael Jackson was not a child molester, even if he did look like the classic pedophile profile to the public. You can never judge a book by it's cover here, and the fact is that Michael Jackson never had a proper childhood, Joe Jackson beat the hell out of him, you can ask his high school principal about that. By all accounts, he was a scumbag to Michael. In a video, Joe jackson was just interviewed the other day and told that once in a while he disciplined him but never beat him and said, " Although, Katherin beat the way more than I did", it's horrible. Also pointing out his words that if it wasn't for him, Michael wouldn't have made this successful. All these people are coming out of a woodwork now and rushing to Michael's defense after he's dead. Where were these people all these months when Michael had drug addictions, all kinds of financial problems? Like, La Toya Jackson selling her story on one hand, she's saying "I couldn't get access to Michael, he wouldn't let anyone near him by his handlers durling the last months of his life." on the other hand, she just sells her story to the News of the World, as if she's the closest person to Michael. Joe Jackson's keep saying, too, "I had a perfectly good relationship with my son, his handlers, his security people wouldn't let me near him". Now, everyone knows, if Michael Jackson's paying these security people, HE'S telling them who to keep out. His security people says "Michael told, 'Keep my dad away!'". His old man was an extortionist. Michael was a dough. He says, he loved Michael but the fact is, he burned Michael repeatedly, Michael didn't trust him and Michael was ashamed of how Joe raised him. Never gave him a proper childhood. Back to the Neverland, it looks like a perfect operation to run a pedophile but he wasn't. Michael jackson loved children, he only felt comfortable with children to communicate with, put trust in them. He brought cancer patients, impoverished kids. Michael Jackson wanted to bring people together in this world and he used Neverland as a medium. Michael Jackson is not a child molester. Let's go back to 1993, Jordan Chandler case. I dug up an official court document that says the insurance company forced Michael to settle. They demanded that he'll settle. Michael Jackson broke down in tears, he maintained his innocence and he insisted that he didn't want to settle but the insurance company forced him to settle. In my book, I detail this case. First of all, Jordan Chandler said that Michael Jackson was circumcised, he had blotches, spots on his penis, and there was a raid on Neverland. The cops decended on Jackson's house, this was the most meaning part, the moment of Jackson's life. He had to strip down and be photographed. Was he in fact circumcised? No, uncut. So Jordan Chandler's words didn't match. We all never got to know them all but it's all in the book.
pt.2

On 24, Dec. 2008, Ian said "Michael Jackson has only 6 months to live", by a couple of sources explaining physical and mental (personality disorder like schizophrenia) condition. This was the reason he couldn't publish the book sooner. MJ was a closeted homosexual and usually the black community is homophobia. Also Jehova's Witnesses' faith don't accept that.
pt.3

The marriage with Lisa Marie Presley was arranged by the Scientologists by pushing her, which was what the church members were claiming. They divorced because of their bed issues. Katherin told Ian that she presumed Michael had been a "faggot", so Ian went on like a murder investigation. Michael thought if he came out being gay, everyone would also think he was a pedophile. The other thing that he also said was "It's easier for caucasian entertainer". He was always envious of George Michael, Elton John, Boy George, Freddie Mercury... but because of the race fact, he couldn't.... then, going into more details about Michael's homo-lovers...which I already knew by watching THEM on YouTube somewhere, the other day...
pt.4

In most part of the book, Ian's defending Michael. He'd wrote the whole book based on 5 years research when Michael was still alive. Only the last chapter was added after his death. About Michael's kids' parenting issue, Janet Jackson right now seems to be the closest to the kids among the Jacksons, and she even says that she'll give up her entire career to raise them....which is already gone, BTW. She is also the biggest star of the family, so maybe she can relate on that level. BUT, Ian thinks that the kids should be apart from the Jacksons. Then, why did Michael leave these kids in his 2002 Will, to a woman (Katherin) who didn't protect him, beat him and called him GAY? From Ian's other source, they think another Will exists and people are using the one for convenience. Why is there so much confusion around Michael all the time? With his huge financial entanglement which is actually a business cooperation, the accountant must have had an updated will. Ian's whole point is that you can't trust the people around Michael. Somebody will be brought to justice as a murder case, starting with the doctors. Having Deprovan in your basement is highly illegal. Also the police force investigating the case does not have the best track source when it comes to celebrity cases. Michael's mess, rise and fall of his success attracts people's attention. and then the NAZIs paraphernalia doesn't surprise us at all with his Nation of Islams handling his late years. It started with his Jew bitterness, the control over the music and entertainment industry business. He was an anti-semite. and then the hyperbaric chamber, plastic surgeries,.... Michael knew how to spin the media to reinvent himself apart from the Jacksons. Then with the accusation on pedophile, he wanted to blame somebody or everybody, starting with the issue especially with Tommy Mottola from SONY. Michael tried to isolate him from everything and got himself into blame game... totally unbalancing with also his extravagance with buying the antiques...
pt.5

Michael firstly wanted to concentrate only with his creative works on music, let the others handle the business. Then gradually he became mature enough to do some business with the Beatles (Elvis, Eminem...) catalogs which kept his finance afloat till now. The recent financial situation was very bad, traveling basically as a backpackers with his kids, nomads. Just struggling to put the food on the table, one time he was camping in his friend's basement. He had assets but he was so far in debts that it just couldn't balance out. He was also living in Dubai, Bahrain and that was the reason he started to think about coming back. The only reason for this most famous entertainer of the world to come back was to pay off the creditors. The night Michael Jackson announced his big come back, Ian was at the biggest breakfast show in the UK at GMTV and said "I'm not booking my plane tickets, these concerts will never happen", and urged everyone to take it seriously.... and got everybody's blame after wards. ...then these guys start to argue about Michael's music and starts a dancing party....funny... The entire music scene was created out of black music, which Michael was always crediting on, instead of to himself.... Giving wine to the kids issue (JESUS WINE issue), several times rehab issue, Martin Bashir issue... the reason why Michael let him interview was that he was a big fan of Princess Diana... he was obsessed with her. Michael Jackson made an error of judgment, allowing people in his life who he shouldn't have and he suffered the consequences. He just wanted to invite cancer children to let them have a great time, allowing them to sleep on his bed while Michael himself slept on the floor. Ian interviewed 50 children.
pt.6

Talking with the callers...
From the result of Ian's interview with 50 children, it was obvious that Michael did one thing inappropriate to any of them.
Don't blame the book without reading or watching the film. It is prejudice. When Michael died, the book was already on the press, so Ian had to add a chapter and change the title. Present a concrete evidence with due diligence, then blame me or whatever. Michael Jackson was a doting parent, he lived for those kids which was the last thing that kept him alive. Jackson was a junkie, unfortunately, but let's examine why. This man was gravely ill, without the drugs he would have been dead. He had to become dependent on these drugs, but the doctors went over board. They could have just stabilized or maintained him. When Michael Jackson announced his come back, as he always said, he didn't want to perform less than 100%. He did not want to rip-off his fans, he was an ultimate perfectionist and in less he could delivered the goods, he was unconfortable. That's what made him nervous the last few weeks of his life, he became desponded, he gave up, because he knew he could put off the gig. This outfit AEG that after he died criticize me, still saying the day after he died that he was completely healthy, that shouldn't have happened. Then they released this video because they want to make a lot of dough off his death. They videoed him from the get-go ever since he signed this, they will release the DVD. Michael Jackson is much more wealth than alive to them because he wouldn't done the shows. Jackson's choreographers examined the film, Jackson's experts saying that this was not Michael jackson in fine form, he was out of sink with the rest of the dancers, and they would say after the video was shot, Jackson went on record to say he felt like a marathon runner after crossing the finish line, after doing one song. He couldn't pull this off. Where were all these concerned people who would come out of the woodwork and expressed their deep sympathy to the Jackson family that they were such good friends with Michael? I got to him. Why couldn't they get to him? ... People are saying murder, what's the motive? They would have been bankrupt. Then, Howard standing on the media side and they all argue about the benefit or murder or motives... Ian hopes the authority got the act by now because they are having so many cases like Robert Blake, Phil Spector and O. J., ...hope finally they get it right this time.
pt.7

Why did Michael jackson wanted the elephant man remain so badly? He felt in another life, that he had this whole connection to the elephant man. It is ironic, one of his heroes were Elvis, he fashioned his show after Elvis and yet he ended up like Elvis.... and the Grace Land, the Neverland that became a shrine, certainly will become a tourist spot but Jacksons don't maintain it, though Michael Jackson still retain ownership. He was bailed out by the spokesman he had by the name of Dr. Tohme Tohme which is his real name, got him capital to keep it going, to keep his name part now. This was the guy who was making every decision for Jackson for the last time of his life. I investigated Dr. Tohmw Tohme. First of all, called the American Medical Association but there was no doctor under that name. In fact the last interview that he gave at the memorial with Matt Lauer, he only said Tohme Tohme now. ....You've talked so much that no one's gonna buy your book anymore.... It's only the tip of the iceberg. ...It's unbelievable... Ian Halperin's book, again the name, "Unmasked: The Final Years of Michael Jackson" is in stores now. He put 5 years of investigating this and he has a lot of information and the book is getting a lot of attention now.

2009年7月29日水曜日

Body dysmorphic disorder ( & Anorexia nervosa ↓ ) symptoms fit Michael's character 身体醜形障害(日本語)


From Wikipedia, the free encyclopedia (below)
This is clearly a mental disorder where you have been wrongly wired and you can't see what others see.
Basically BDD is about 'imagined' ugliness. Most people who have it are somehow related to the creative arts.
Michael Jackson is a known sufferer with all the known symptoms.
Avoidance of mirrors, self-hate, imagined ugliness that needs to be corrected with plastic surgery, massive usage of beauty-products and etc.

Too ugly for love part 1

Too ugly for love part 2


Body dysmorphic disorder (BDD) (previously known as Dysmorphophobia and sometimes referred to as Body dysmorphia or Dysmorphic syndrome) is a psychological disorder in which the affected person is excessively concerned and preoccupied by a perceived defect in his or her physical features.
The sufferer may complain of several specific features or a single feature, or a vague feature or general appearance, causing psychological distress that impairs occupational and/or social functioning, sometimes to the point of severe depression, severe anxiety, development of other anxiety disorders, social withdrawal or complete social isolation, and more. It is estimated that 1–2% of the world's population meet all the diagnostic criteria for BDD.
The exact cause or causes of BDD differ from person to person, however but most clinicians believe it could be a combination of biological, psychological and environmental factors from their past or present. Abuse can also be a contributing factor.
Onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one's own appearance usually begins. Although cases of BDD onset in children and older adults is not unknown. BDD is often misunderstood to affect mostly women, but research shows that it affects men and women equally.
The disorder is linked to significantly diminished quality of life and co-morbid major depressive disorder and social phobia. With a completed-suicide rate more than double than that of major depression, and a suicidal ideation rate of around 80%, BDD is considered a major risk factor for suicide.
A person with the disorder may be treated with psychotherapy, medication, or both. Research has shown cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) to be effective in treating BDD. BDD is a chronic illness and symptoms are likely to persist, or worsen, if left untreated.


The Diagnostic and Statistical Manual of Mental Disorders defines body dysmorphic disorder as a preoccupation with an imagined or minor defect in appearance which causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The individual's symptoms must not be better accounted for by another disorder; for example weight concern is usually more accurately attributed to an eating disorder.
The disorder generally is diagnosed in those who are extremely critical of their mirror image, physique or self-image even though there may be no noticeable disfigurement or defect. The three most common areas that those suffering from BDD will feel critical of have to do with the face: the hair, the skin, and the nose. Outside opinion will typically disagree, and may protest that there even is a defect. The defect exists in the eyes of the beholder, and one with BDD really does feel as if they see something there that is defective.
People with BDD say that they wish that they could change or improve some aspect of their physical appearance even though they are generally of normal or even highly attractive appearance. Body dysmorphic disorder causes sufferers to believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation about their appearance. This can cause those with this disorder to begin to seclude themselves or have trouble in social situations. They can become secretive and reluctant to seek help because they fear that others will think them vain or because they feel too embarrassed. It has been suggested that fewer men seek help for the disorder than women.
Ironically, BDD is often misunderstood as a vanity-driven obsession, whereas it is quite the opposite; people with BDD do not believe themselves to be beautiful and getting more beautiful with each surgery, but instead feel that their perceived "defect" is irrevocably ugly. People with BDD may compulsively look at themselves in the mirror or, conversely, cover up and avoid mirrors. They may typically think about their appearance for at least one hour a day (and usually more), and in severe cases may drop all social contact and responsibilities as they become a recluse.
A German study has shown that 1–2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder (Psychological Medicine, vol 36, p 877). Chronically low self-esteem is characteristic of those with BDD, because the one's assessment of one's value is so closely linked with one's perception of one's appearance.
BDD is diagnosed equally in men and women, and causes chronic social anxiety for its sufferers.
Phillips & Menard (2006) found the completed-suicide rate in patients with BDD to be 45 times higher than that of the general United States population. This rate is more than double that of those with clinical depression and three times as high as that of those with bipolar disorder. Suicidal ideation is also found in around 80% of people with BDD. There has also been a suggested link between undiagnosed BDD and a higher than average suicide rate among people who have undergone cosmetic surgery.


In 1886, BDD was first documented by the researcher Morselli, who called the condition simply "Dysmorphophobia". BDD was first truly recognized by the American Psychiatric Association in 1987, and in 1997, BDD was first recorded and formally recognized as a disorder in the DSM.
In his practice, Freud eventually had a patient who would today be diagnosed with the disorder: Russian aristocrat Sergei Pankejeff, nicknamed "The Wolf Man" by Freud himself in order to protect Pankejeff's identity, had a preoccupation with his nose to an extent that greatly limited his functioning.


According to the DSM IV, to be diagnosed with BDD, a person must fulfill the following criteria:
"Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present,
the person's concern is markedly excessive."
"The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
"The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)."
In most cases, BDD is under-diagnosed. In a study of 17 patients with BDD, BDD was noted in only five patient charts, and none of the patients received an official diagnosis of BDD despite the fact that it was present. BDD is often under-diagnosed because the disorder was only recently included in DSM IV, therefore clinician knowledge of the disorder, particularly among general practitioners, is not widespread. Also, BDD is often associated with shame and secrecy, therefore patients often fail to reveal their appearance concerns for fear of appearing vain or superficial.
BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia. and so the root of the individual's problems remain unresolved. Many individuals with BDD also do not possess knowledge or insight into Body Dysmorphic Disorder and so regard their problem as one of a physical nature rather than psychiatric, therefore individuals may seek cosmetic treatment rather than mental health treatment.


Studies show that BDD is common in not only nonclinical settings, but clinical settings, as well. A study was done of 200 people with DSM-IV Body Dysmorphic Disorder. These people were of age 12 or older and were available to be interviewed in person. They were obtained from mental health professionals, advertisements, the subject's friends and relatives, and non-psychiatric physicians. Out of the subjects, 53 were receiving medication, 33 were receiving psychological psychotherapy, and 48 were receiving both medication and psychotherapy.
The severity of BDD was assessed using the Yale–Brown Obsessive Compulsive Scale modified for BDD, and symptoms were assessed using the Body Dysmorphic Disorder Examination. Both tests were designed specifically to assess BDD. Results showed that BDD occurs in 0.7–1.1% of community samples and 2–13% of nonclinical samples. 13% of psychiatric inpatients had BDD. Studies also found that some of the patients initially diagnosed with OCD had BDD, as well. 53 patients with OCD and 53 patients with BDD were compared in a study. Clinical features, comorbidity, family history, and demographic features were compared between the two groups. Nine of the 62 subjects (14.5%) of those with OCD also had BDD.


There is a high degree of comorbidity with other psychiatric disorders, often resulting in misdiagnoses by clinicians. Research suggests that around 76% of people with BDD will experience major depressive disorder at some point in their lives, significantly higher than the 10–20% expected in the general population. Around 37% of people with BDD will also experience social phobia and around 32% experience obsessive–compulsive disorder. The most common personality disorders found in individuals with BDD are avoidant personality disorder and dependent personality disorder which conforms to the introverted, shy and neurotic traits usually found in individuals with the disorder.
Eating disorders, such as Anorexia nervosa and Bulimia nervosa, are also sometimes found in people with BDD, usually women, as are trichotillomania, dermatillomania, and sub-type disorders Olfactory Reference Syndrome and muscle dysmorphia.


There are many common symptoms and behaviors associated with BDD. Often these symptoms and behaviours are determined by the nature of the BDD sufferer's perceived defect, for example, use of cosmetics is most common in those with a perceived skin defect, therefore many BDD sufferers will only display a few common symptoms and behaviors.


Common symptoms of BDD include:
Obsessive thoughts about perceived appearance defect.
Obsessive and compulsive behaviors related to perceived appearance defect (see section below).
Major depressive disorder symptoms.
Delusional thoughts and beliefs related to perceived appearance defect.
Social and family withdrawal, social phobia, loneliness and self-imposed social isolation.
Suicidal ideation.
Anxiety; possible panic attacks.
Chronic low self-esteem.
Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect.
Strong feelings of shame.
Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night.
Dependant personality: dependence on others, such as a partner, friend or family.
Inability to work or an inability to focus at work due to preoccupation with appearance.
Decreased academic performance (problems maintaining grades, problems with school/college attendance).
Problems initiating and maintaining relationships (both intimate relationships and friendships).
Alcohol and/or drug abuse (often an attempt to self-medicate).
Repetitive behaviour such as constantly applying make up and often applying it quite heavily.
Seeing slightly varying image of self upon each instance of observal in mirror/reflective surface.
Note: Modification of the body in anyway is a way to change one's appearance. There are many ways to modify the body that do not include surgery/cosmetic surgery. Please take note if any body modification seems compulsive, repetitive, or focused on one area or upon "defects" that person perceives are there.


Common compulsive behaviors associated with BDD include:
Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.
Alternatively, an inability to look at one's own reflection or photographs of oneself; often the removal of mirrors from the home.
Attempting to camouflage imagined defect: for example, using cosmetic camouflage, wearing baggy clothing, maintaining specific body posture or wearing hats.
Excessive grooming behaviors: skin-picking, combing hair, plucking eyebrows, shaving, etc.
Compulsive skin-touching, especially to measure or feel the perceived defect.
Becoming hostile toward people for no known reason, especially those of the opposite sex
Reassurance-seeking from loved ones.
Excessive dieting / exercise, or work on outside appearance.
Self harm
Comparing appearance/body-parts with that of others, or obsessive viewing of favorite celebrities or models whom the person suffering from BDD wishes to resemble.
Use of distraction techniques: an attempt to divert attention away from the person's perceived defect, e.g. wearing extravagant clothing or excessive jewelry.
Compulsive information seeking: reading books, newspaper articles and websites which relates to the person's perceived defect, e.g. hair loss or dieting and exercise.
Obsession with plastic surgery or dermatology procedures, with little satisfactory results for the patient.
In extreme cases, patients have attempted to perform plastic surgery on themselves,
including liposuction and various implants with disastrous results. Patients have even tried to remove undesired features with a knife or other such tool when the center of the concern is on a point, such as a mole or other such feature in the skin. This can be deadly.
Excessive enema use.
source: The Broken Mirror, Katharine A Philips, Oxford University Press, 2005 ed


In research carried out by Dr. Katharine Philips, involving over 500 patients, the percentage of patients concerned with the most common locations were as follows;
Skin (73%)
Hair (56%)
Nose (37%)
Weight (22%)
Abdomen (22%)
Breasts/chest/nipples (21%)
Eyes (20%)
Thighs (20%)
Teeth (20%)
Legs (overall) (18%)
Body build/bone structure (16%)
facial features (general) (14%)
Face size/shape (12%)
Lips (12%)
Buttocks (12%)
Chin (11%)
Eyebrows (11%)
Hips (11%)
Ears (9%)
Arms/wrists (9%)
Waist (9%)
Genitals (8%)
Cheeks/cheekbones (8%)
Calves (8%)
Height (7%)
Head size/shape (6%)
Forehead (6%)
Feet (6%)
Hands (6%)
Jaw (6%)
Mouth (6%)
Back (6%)
Fingers (5%)
Neck (5%)
Shoulders (3%)
Knees (3%)
Toes (3%)
Ankles (2%)
Facial muscles (1%)
source: The Broken Mirror, Katharine A Philips, Oxford University Press, 2005 ed, p56
People with BDD often have more than one area of concern.


BDD usually develops in adolescence, a time when people are generally most sensitive about their appearance. However, many patients suffer for years before seeking help. An absolute cause of body dysmorphic disorder is unknown. However, research shows that a number of factors may be involved and that they can occur in combination.
Some of the theories regarding the cause of BDD are summarized below:
[edit]Biological/genetic
Chemical imbalance in the brain: An insufficient level of serotonin, one of the brain's neurotransmitters involved in mood and pain, may contribute to body dysmorphic disorder. Although such an imbalance in the brain is unexplained, it may be hereditary.
Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. This neurotransmitter travels from one nerve cell to the next via synapses. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that BDD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential. This theory is supported by the fact that many BDD patients respond positively to selective serotonin reuptake inhibitors (SSRIs) – a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells. There are cases, however, of patient's BDD symptoms worsening from SSRI use. Imbalance of other neurotransmitters, such as Dopamine and Gamma-aminobutyric acid, have also been proposed as contributory factors in the development of BBD.
Genetic predisposition:
It has been suggested that certain genes may make an individual more predisposed to developing BDD. This theory is supported by the fact that approximately 20% of people with BDD have at least one first-degree relative, such as a parent, child or sibling, who also has the disorder. It is not clear, however, whether this is genetic or due to environmental factors (i.e. learned traits rather than inherited genes). Twin studies suggest that the majority, if not all, psychiatric disorders are influenced, at least to some extent, by genetics and neurobiology, although no such studies have been conducted specifically for BDD.
Brain regions:
A further biological-based hypothesis for the development of BDD is possible abnormalities in certain brain regions. Magnetic resonance imaging (MRI)-based studies found that individuals with BDD may have abnormalities in brain regions, similar to those found in OCD.
Visual processing:
While some believe that BDD is caused by an individual's distorted perception of his or her actual appearance, others have hypothesized that people with BDD actually have a problem processing visual information. This theory is supported by the fact individuals who are treated with SSRI's often report that their defect has gone—that they no longer see it. However, this may be due to a change in the individual's perception, rather than a change in the visual processing itself.
Obsessive–compulsive disorder.
BDD often occurs with OCD, where the patient uncontrollably practices ritual behaviors that may literally take over his or her life. A history of, or genetic predisposition to obsessive–compulsive disorder may make people more susceptible to BDD.
Generalized anxiety disorder.
Body dysmorphic disorder may co-exist with generalized anxiety disorder. This condition involves excessive worrying that disrupts the patient's daily life, often causing exaggerated or unrealistic anxiety about life circumstances, such as a perceived flaw or defect in appearance, as in BDD.


Teasing or criticism:
It has been suggested that teasing or criticism regarding appearance could play a contributory role in the onset of BDD. While it's unlikely that teasing causes BDD, since the majority of individuals are teased at some point in their life, it may act as a trigger in individuals who are genetically or environmentally predisposed; likewise, extreme levels of childhood abuse, bullying and even psychological torture, are often rationalized and dismissed as "teasing," sometimes leading to traumatic stress in vulnerable persons. Around 60% of people with BDD report frequent or chronic childhood teasing.

Parenting style:
Similarly to teasing, parenting style may contribute to BBD onset, for example, parents of individuals who place excessive emphasis on aesthetic appearance (i.e. that aesthetic appearance is the most important thing in life) or no emphasis at all may act as a trigger in those genetically predisposed.
Other life experiences:
Many other life experiences may also act as triggers to BDD onset, for example, neglect, physical and/or sexual trauma, insecurity and rejection.


Media:
It has been theorised that media pressures may contribute to BBD onset, for example glamour models and the implied necessity of aesthetic beauty. BDD, however, occurs in all parts of the world, including isolated areas where access to media mediums is limited or non-existent. Media pressures are therefore an unlikely cause of BDD, however they could act as a trigger in those already genetically predisposed or could worsen existing BDD symptoms.
[edit]Personality
Certain personality traits may make someone more susceptible to developing BDD. Personality traits which have been proposed as contributing factors include:
Perfectionism
Introversion / shyness
Neuroticism
Sensitivity to rejection or criticism
Unassertiveness
Avoidant personality
Schizoid personality
Since personality traits among people with BDD vary greatly, it is unlikely that these are the direct cause of BDD. However, like psychological and environmental factors, they may act as triggers in individuals.


BDD can be anywhere from slightly to severely debilitating. It can make normal employment or family life impossible. Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms. The partners and family of sufferers of BDD may also become involved and suffer greatly, sometimes losing their loved one to suicide.
Studies have shown a positive correlation between BDD symptoms and poor quality of life. An indicator of just how seriously this disorder can affect a human being is the fact that the quality of life for individuals with BDD has also been shown to be poorer than those found in major depressive disorder, dysthymia, obsessive–compulsive disorder, social phobia, panic disorder, premenstrual dysphoric disorder and Post traumatic stress disorder.
Because BDD onset typically occurs in adolescence, an individual's academic/social performance may be significantly affected. Depending on the severity of symptoms, an individual may experience great difficulty maintaining grades and attendance or, in severe cases, an individual may drop out of school and therefore not reach the academic level they are capable of. The vast majority of people with BBD (90%) say that their disorder impacts on their academic/occupational functioning, while 99% say that their disorder impacts on their social functioning.
Despite a strong desire for relationships with other people, many BDD sufferers will instead choose to be lonely rather than risk being rejected or humiliated about their appearance by getting involved with people. Many people with BDD also have coexisting social phobia and/or avoidant personality disorder, making the sufferer's ability to establish relationships even more difficult.
Sufferers of BDD may often find themselves getting almost 'stuck' in moping around. That is to say that sufferers, with such a type of depression, can in some cases appear to take a long time to get everything done. However, this is not actually the case, as it is simply that the BDD sufferers will often just sit or lie down for prolonged periods of time, without being able to actually motivate themselves until it becomes completely necessary to get back up. This can often cause little to get done by sufferers, and they can have little self motivation with anything, including relationships with other people. However, contrary to this, when the action is relevant to the person's image, it is more common for the sufferer to exhibit a fanatic and extreme approach, applying attention fully to the tasks at hand and at self-grooming/modification.


Many individuals with BDD have repeatedly sought treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Plastic surgery on those patients can lead to manifest psychosis, suicide or never ending requests for more surgery. Treatment can improve the outcome of the illness for most people. Other patients may function reasonably well for a time and then relapse, while others may remain chronically ill. Research on outcome without therapy is not known but it is thought the symptoms persist unless treated.


Studies have found that Cognitive Behavior Therapy (CBT) has proven effective. In a study of 54 patients with BDD who were randomly assigned to Cognitive Behavior Therapy or no treatment, BDD symptoms decreased significantly in those patients undergoing CBT. BDD was eliminated in 82% of cases at post treatment and 77% at follow-up.
(8) Due to low levels of serotonin in the brain, another commonly used treatment is SSRI drugs (Selective Serotonin Reuptake Inhibitor). 74 subjects were enrolled in a placebo-controlled study group to evaluate the efficiency of Fluoxetine hydrochloride (Prozac), a SSRI drug. Patients were randomized to receive 12-weeks of double-blind treatment with fluoxetine or the placebo. At the end of 12 weeks, 53% of patients responded to the fluoxetine.
Body Dysmorphic Disorder is a chronic disorder that if left untreated can worsen with time. Without treatment, BDD could last a lifetime. In many cases, as illustrated in The Broken Mirror by Katharine Phillips, the social and professional lives of many patients disintegrates because they are so preoccupied with their appearance.

身体醜形障害(しんたいしゅうけいしょうがい、Body Dysmorphic Disorder:BDD)とは、自分の身体や美醜に極度にこだわる症状である。実際よりも低い自己の身体的なイメージが原因である。一種の心気症や強迫性障害とされる。重度の場合は統合失調症ともなる。俗に醜形恐怖また醜貌恐怖といわれる。また非常に強い強迫観念から強迫性障害と深い関連性があり、強迫スペクトラム障害にある。その強い強迫観念から身体醜形障害はうつ病も併発する割合もかなり高いとされる。また欧米では身体醜形障害(BDD)と独立だった専門分野として治療されているようだが、本国日本での治療分野では身体醜形障害はまだ独立だって居らず、強迫性障害や統合失調症の前駆症状と診断されているケースが多いようである。当然、強迫スペクトラム障害の伏線上にある純粋な身体醜形障害としての診断もある。

概要
「醜形恐怖」という言葉が19世紀にこの病気について初めて発表したイタリア人医師の名付けた原語を日本語訳したものとして作られ、長らくこの用語が日本では一般的であったが、近年患者が顔だけではなく身体全体を気にしだしたため「身体醜形障害」と呼ばれることも多くなった。近年、アメリカで研究が進んでいる。1995年に発表されたアメリカの調査によると、有病率は1%であるとされているが、患者は自身の身体醜形障害を医師にも言わない傾向が多いため、実際にはより多数の患者がいるのではないかと推測されている。
日本では1990年頃(特に後半)から多くなりだした。この内2割は引きこもりのような状況になるとされる[要出典]。整形をする人も多いが、実際には思い込みに過ぎないため、満足な結果が得られることは少なく、結果的に逆に顔を崩してしまうことさえある。
この障害を持つ場合には、1日に何時間も自身の肉体的な欠陥について考えるようになり、極端に社会から孤立してしまうとされる。その結果として、学校を退学したり、仕事を辞めたりすることがある。また友人を作らなくなったり、離婚をしたりし、最終的には自殺をするに至ることもあるとされる[要出典]。
男性の場合、第二次性徴によって男らしく変化した部分を嫌い、幼児期のままの自分でいたいと思う傾向が強いとされる。また、女性の場合は、母親や姉妹など周囲の身体に対する優劣を意識する傾向が強いとされる。顔自体に限っていえば男性に多いが、身体全体に亘る場合は女性に多いとされる[要出典]。
醜形障害者の割合に男女比の差はあまりないとされるが、とらわれる箇所は男女個々様々で体全体にいたる(頭蓋骨(頭)の大きさ、体型、肌、髪、爪、目、鼻、耳、口、歯並び、顎、体毛、性器、身長、体重など)。
醜形障害者はかなり偏ったボディーイメージを持っている(極端な体重(低体重・モデル体重など)へのこだわりなど)。そういった意味では摂食障害とも関連性はある。もっとも体重だけではなく、一度鏡で見た顔や容姿にいたるイメージへも確固たる真のイメージを持ち難いともされる。それゆえ、何度も鏡を確認するものと思われる。
身体醜形障害の状態があまりにも長く続く場合は、持続性妄想性障害(統合失調症など)にも関連する。その際診断の結果、統合失調症とされる場合も少なくない。それ故、精神科などの比較的大きな医療機関を訪れた際に、対人恐怖や身体醜形障害と診断されることは少なく、強迫性障害や統合失調症となるケースが多い。
醜形障害者の日常生活における困難は、鏡などの反射物(鏡、ガラス、水面、なべのふた、スプーン、ペットボトル、食器類など)に映る顔全体の影形やその姿であり、その対象物を何十分、何時間という単位で目で確認し続けるという強迫性障害でいう強迫確認または強迫行動によって支配される苦しみや苦痛である。また外出した際は他人の視線(顔や容姿全体、こだわっている箇所)を意識しすぎて、ショーウィンドーのガラスや車のガラス、バックミラーなどに自分の顔や容姿を映し様々な角度から自分のこだわっている箇所を確認し続けるという行動をとる。その姿が自分の思っていた顔や容姿とのイメージと合致した場合は、気分が高揚し安心感を持ち、かけ離れていた場合は酷く落ち込み、目的だった事柄や場所に行けず冷や汗を掻いて引き返してくることもある。また外出時は自分の顔・容姿のこだわっている箇所を他人と必死に比べようともする。
また反射物に限らず、写真や映像(カメラやビデオ)に撮られることも嫌い、その自身が映った写真や映像から目を背けたり映りたがらない。写真や映像に写った自身の顔・姿のイメージが自己のイメージと合致すれば上記の様な心理状態になり、違った場合は気落ち落胆しうつになったり、写真の場合は破り捨てることも見受けられる。その結果、履歴書などに載せる証明写真を撮るのに支障を来たす場合がある。
また、醜形障害者は鏡やガラスなどに映った自分を見続ける確認行動がある裏側、必死に鏡やガラスなどの反射対象物を避け、なるべくこだわっている箇所を映らない、映さない、確認しないなどといった極端な反面も持ち合わせていることが多い。なぜ、その両面を持ち合わせているのかは具体的には分からないが、強迫性障害で言う強迫確認の負のループに自身の大事な時間を費やされたくない、その確認しているさまを他人に見られるのが恥ずかしい、奇妙な行為だと思われるのが怖い、またその確認でこだわっている箇所を見てしまったための落ち込みの不安で、恐怖と絶望の渦に陥りたくないという心理的要因が働くのではないかと思われる[要出典]。そしてこの二つの局面を持ち合わせている者もいれば、そうでない者もいるようである[要出典]。
醜形障害者は妄想的に確信を抱いたとらわれのパターンと、元々(生まれつき)の細かい欠陥(例えば、髪の毛が柔らかく細く頭髪が元々薄い傾向や、成人して止ってしまった身長などに対する変えられようのない事実)にとらわれてしまうパターンとがある。後者は投薬治療では中々改善しない場合が多く、10年近く症状で悩まされる場合も多い。いずれにしても、細かい顔や体に対する欠陥や妄想的とらわれが身体醜形障害の特徴である。
自分の容姿にとらわれるあまり、家族にまでそのとらわれ箇所の確認を要求する(どのように思い、感じるか)家族巻き込み型もこの病の典型である。その結果、家族のいい回答が得られずに(正しい返答がない、もしくは家族として思い合ってか言葉に表しにくいため)家庭内暴力にまで至るケースもある。
またこれら反射物による恐怖を発端とする忌避行為により、日常生活に多大なる影響を与える。特に就労に関してこの問題は大きい。例を挙げれば、反射するモニターを使用する光沢液晶やCRTの仕事を忌避したり、サイドミラーを恐れ運転免許が取れなかったり等致命的な支障を就労においてきたす。自分の顔への恐怖は、裏返せば他者の視線への恐怖であり、面を向かってのデスクワークや会議、及び面談等もまともに正対して視線を合わすことさえ困難を極める。結果的に、能力的にできる職種であっても、醜形恐怖が先行するあまり、自ら職業の選択を狭め、最悪何も仕事を選べないという状況になり得る。プライベートにおいてもそのような状態では恋愛はおろか友人関係を築くのも著しい困難を生じる。
原因としては、先天的なこだわりやすい性格や完全志向、強迫神経症に通じる確認行為等の素因も軽視できない一方で、人とのコミュニケーションを上手く取れない自己の内面の脆さを違う形で、つまり外見の劣等へ形を置き換える事で、無意識的にバランスを取っている側面もある。醜形恐怖の人達に、コミュニケーションスキル不足や対人恐怖を含む社会不安症を併発しやすいのもその影響が考えられる。自己へ自己へと意識が集中しすぎ自身で、完璧なこうであれねば、という枠組みを形成してしまうのが根底にある。外界(他人)への意識を拡大させると共に、自分への美醜のこだわりより先に対人スキルを含む内面精神に対する誤った認識の確認、再生、充実が結果的にこれらの強迫観念を解決させる一助になりえる。
マスメディアにおける時代の美醜の価値観も関連する。
容姿だけではなく、社会的に非常に強いコンプレックスを抱く者もある。
自尊心も極端に低い傾向にある。
長期による深刻な悩みの末、自己同一性に欠ける問題もある。
身体表現性障害と大まかに括れる事が出来る。
しばしば、ノイローゼ的になりパニック発作を起こす場合もある。
強迫性障害からの視点では脳内伝達物質のセロトニンの異常と、眼窩皮質という箇所の異常だともいわれる。
身体醜形障害は自己愛とも深い関連があり、自己愛性人格障害にも少なからず関連性がある。
森田療法や暴露反応妨害法なとが有効とされている。
身体醜形障害の自己対処法として、とらわれている箇所を鏡で重視するのではなく、鏡で見てとらわれている箇所から容姿全体へと視点をなぞり移すようにして行き、最後に容姿全体へと視点そのものを変えて行くと良いとされている。
醜形恐怖症は自己臭恐怖症とも深い因果関係があり、しばしば両方を併発する。根底には他者に受け入れられたい迷惑をかけたくないという考えがある。
醜形恐怖は精神病というより元来持つ性格から発している部分が大きい、その際たるものが「完璧主義」である。醜形恐怖が難治といわれるのは、先天的あるいは、長年積み重なった性格・気質によるためでもある。
最近のプチ整形を筆頭として美容整形の浸透が醜形恐怖を更に根深い問題とさせている。
身体醜形障害の治療は心療内科、クリニック、精神科などを受診した場合は向精神薬の(商品名)「一般名」(アナフラニール)「塩酸クロミプラミン」(三環形抗うつ剤)や(デプロメール)・「フルボキサミン」(別名:ルボックス)・(パキシル)「パロキセチン」・(ジェイ・ゾロフト)「セルトラリン」などのSSRI、また抗不安薬(マイナートランキライザー)である(レキソタン)「ブロマゼパム」や、眠りが浅い場合は(ロヒプノール)「フルニトラゼパム」などの睡眠導入剤が処方が主流である。また比較的症状が重い場合は抗精神病薬(メジャートランキライザー)である、(セレネース)(ハロペリドール)・(ルーラン)(非定型抗精神病薬/ペロスピロン)・(セロクエル)「非定型抗精神病薬/クエチアピン」・(エビリファイ)「非定型抗精神病薬/アリピプラゾール」・(リスパダール)「非定型抗精神病薬/リスペリドン」などが処方として挙げられる。

Anorexia nervosa (& Body dysmorphic disorder ↑ ) 神経性食思不振症(日本語)


Michael's death has some similarities to the death of Karen Carpenter (at 32). She was a known aneorexic and died of a heart failure.
Karen suffered heart failure at her parents' home in Downey, California. She was taken to Downey Community Hospital, where she was pronounced dead twenty minutes later. The LA coroner gave the cause of death as "heartbeat irregularities brought on by chemical imbalances associated with anorexia nervosa."

Too Ugly To Live, Body Dysmorphic Disorder - Part 2


From Wikipedia
Anorexia nervosa is a psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia nervosa are known to control body weight commonly through the means of voluntary starvation, excessive exercise, or other weight control measures such as diet pills or diuretic drugs. While the condition primarily affects adolescent females approximately 10% of people with the diagnosis are male. Anorexia nervosa, involving neurobiological, psychological, and sociological components, is a complex condition that can lead to death in the most severe cases.

"Anorexia nervosa" is frequently shortened to "anorexia" in the popular media. This is technically incorrect, as the term "anorexia" used separately refers to the medical symptom of reduced appetite (which therefore is distinguishable from anorexia nervosa in being non-psychiatric).

-Diagnosis and clinical features-
To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:

1. Refusal to maintain body weight at or above a minimally normal weight for age and height : Weight loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.
2. Intense fear of gaining weight or becoming fat, even though under weight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. The absence of at least three consecutive menstrual cycles (amenorrhea) in women who have had their first menstrual period but have not yet gone through menopause (postmenarcheal, premenopausal females).

Furthermore, the DSM-IV-TR specifies two subtypes:

* Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, or excessive exercise.
* Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention

1. The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics).
2. Certain physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion".
3. If onset is before puberty, that development is delayed or arrested.


There are a number of features that, although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.

*Physical
Changes in brain structure and function are early signs often to be associated with starvation, and is partially reversed when normal weight is regained. Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation.

Other effects may include the following:
* Extreme weight loss
* Body mass index less than 17.5 in adults, or 85% of expected weight in children
* Stunted growth
* Endocrine disorder, leading to cessation of periods in females (amenorrhoea)
* Decreased libido; impotence in males
* Reduced metabolism, slow heart rate (bradycardia), hypotension, orthostatic hypotension, hypothermia, inappropriate sinus tachycardia and anemia
* Abnormalities of mineral and electrolyte levels in the body
* Thinning of the hair
* Growth of lanugo hair over the body
* Constantly feeling cold
* Constipation
* Abnormalities of mineral and electrolyte levels
* Zinc deficiency
* Potassium deficiency
* Refeeding syndrome
* Reduction in white blood cell count
* Reduced immune system function
* Pallid complexion and sunken eyes
* Patulous eustachian tube
* Creaking joints and bones
* Osteoporosis
* Collection of fluid in ankles during the day and around eyes during the night or peripheral oedema
* Tooth decay
* Dry skin
* Dry or chapped lips
* Poor circulation (cool peripheries), resulting in common attacks of "pins and needles" (Parathesia) and purple extremities
* In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
* Headaches
* Brittle fingernails
* Bruising easily
* Fragile appearance
* Slowing of the growth rate of breasts
* Bed sores and wounds that don't heal timely
* Widespread body pain
* Extreme fatigue
* Vertigo, fainting; usually related to low blood pressure
* Difficulty concentrating, memory deficits


* Distorted body image
* Poor insight
* Self-evaluation largely, or even exclusively, in terms of their shape and weight
* Pre-occupation or obsessive thoughts about food and weight
* Perfectionism
* Obsessive compulsive disorder (OCD)
* Belief that control over food/body is synonymous with being in control of one's life
* Refusal to accept that one's weight is dangerously low even when it could be deadly
* Neuropsychological impairment at very low body weights

*Emotional
* Low self-esteem and self-efficacy
* Phobia of becoming overweight
* Clinical depression or chronically low mood
* Mood swings

*Behavioral
* Excessive exercise, food restriction
* Secretive about eating or exercise behavior
* Fainting
* Social withdraw or being asocial
* Self-harm, substance abuse or suicide attempts
* Very sensitive to references about body weight
* Aggressive when forced to eat "forbidden" foods
* Weighing themselves and constantly checking themselves in the mirror

*Diagnostic issues and controversies
The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. Furthermore, seemingly minor changes in a patient's overall behavior or attitude (such as reported feeling of "control" over any binging behavior) can change a diagnosis from "anorexia: binge-eating type" to bulimia nervosa. It is not unusual for a person with an eating disorder to "move through" various diagnoses as his or her behavior and beliefs change over time.

Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., sub-clinical anorexia nervosa or EDNOS) even if one diagnostic sign or symptom is still present. For example, a substantial number of patients diagnosed with EDNOS meet all criteria for diagnosis of anorexia nervosa, but lack the three consecutive missed menstrual cycles needed for a diagnosis of anorexia.

Feminist writers such as Susie Orbach and Naomi Wolf have criticized the medicalization of extreme dieting and weight-loss as locating the problem within the affected women, rather than in a society that imposes concepts of unreasonable and unhealthy thinness as a measure of female beauty and gaining weight. Other writers have suggested that the disorder relates to issues of self-perception that are deeper than concerns with beauty and public perception.[7]

A vigorous debate exists on the topic of whether eating disorders are a choice or a biological illness. In 2006, Dr. Thomas Insel, director of the US National Institute of Mental Health, wrote an open letter to the National Eating Disorder Association stating "eating disorders are brain disorders."

-Causes and contributory factors-
It is clear that there is no single cause for anorexia and that it stems from a mixture of biological, social, and psychological factors. Current research is commonly focused on explaining existing factors and uncovering new causes. However, there is considerable debate over how much each of the known causes contributes to the development of anorexia. In particular, the contribution of perceived media pressure on women to be thin has been especially contentious.



*Genetic factors
Family and twin studies have suggested that genetic factors contribute to about 50% of the variance for the development of an eating disorder and that anorexia shares a genetic risk with clinical depression. This evidence suggests that genes influencing both eating regulation, and personality and emotion, may be important contributing factors. In one study, variations in the norepinephrine transporter gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia (though the latter may have been due to small sample size).

Several rodent models of anorexia have been developed which largely involve subjecting the animals to various environmental stressors or using gene knockout mice to test hypotheses about the effects of certain genes. These models have suggested that the hypothalamic-pituitary-adrenal axis may be a contributory factor. However, these models have been criticised as food is being limited by the experimenter and not the animal and cannot take into account the complex cultural factors known to affect the development of anorexia nervosa.

*Neurobiological factors
There are strong correlations between the neurotransmitter serotonin and various psychological symptoms such as mood, sleep, emesis (vomiting), sexuality and appetite. A recent review of the scientific literature has suggested that anorexia is linked to a disturbed serotonin system,[13] particularly to high levels at areas in the brain with the 5HT1A receptor - a system particularly linked to anxiety, mood and impulse control. Starvation has been hypothesised to be a response to these effects, as it is known to lower tryptophan and steroid hormone metabolism, which, in turn, might reduce serotonin levels at these critical sites and, hence, ward off anxiety. In contrast, studies of the 5HT2A serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. One difficulty with this work is that it is sometimes difficult to separate cause and effect, in that these disturbances to brain neurochemistry may be as much the result of starvation, than continuously existing traits that might predispose someone to develop anorexia. However, there is evidence that both personality characteristics (such as anxiety and perfectionism) and disturbances to the serotonin system are still apparent after patients have recovered from anorexia. This suggests that these disturbances are likely to be causal risk factors.

Recent studies also suggest anorexia may be linked to an autoimmune response to melanocortin peptides which influence appetite and stress responses.

*Nutritional factors
Zinc deficiency causes a decrease in appetite that can degenerate in anorexia nervosa (AN), appetite disorders and, notably, inadequate zinc nutriture. The use of zinc in the treatment of anorexia nervosa has been advocated since 1979 by Bakan. At least five trials showed that zinc improved weight gain in anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase in the treatment of AN. Deficiency of other nutrients such as tyrosine and tryptophan (precursors of the monoamine neurotransmitters norepinephrine and serotonin, respectively), as well as vitamin B1 (thiamine) could contribute to this phenomenon of malnutrition-induced malnutrition.

-Psychological factors-
There has been a significant amount of study on psychological factors that suggests how biases in thinking and perception help maintain or contribute to the risk of developing anorexia.

Anorexic eating behavior is thought to originate from feelings of fatness and unattractiveness[17] and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating.

One of the most well-known findings is that people with anorexia tend to over-estimate the size or fatness of their own bodies. A recent review of research in this area suggests that this is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person. Recent research suggests people with anorexia nervosa may lack a type of overconfidence bias in which the majority of people feel themselves more attractive than others would rate them. In contrast, people with anorexia nervosa seem to more accurately judge their own attractiveness compared to unaffected people, meaning that they potentially lack this self-esteem boosting bias.

People with anorexia have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsession (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (the pathological pursuit of personal high-standards and the need for control) have been cited as commonly reported factors in research studies.

It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia nervosa in the sufferer. Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders are the most likely conditions to be comorbid with anorexia, and high-levels of anxiety and depression are likely to be present regardless of whether they fulfill diagnostic criteria for a specific syndrome.

Research into the neuropsychology of anorexia has indicated that many of the findings are inconsistent across studies and that it is hard to differentiate the effects of starvation on the brain from any long-standing characteristics. Nevertheless, one reasonably reliable finding is that those with anorexia have poor cognitive flexibility (the ability to change past patterns of thinking, particularly linked to the function of the frontal lobes and executive system).

Other studies have suggested that there are some attention and memory biases that may maintain anorexia. Attentional biases seem to focus particularly on body and body-shape related concepts, making them more salient for those affected by the condition, and some limited studies have found that those with anorexia may be more likely to recall related material than unrelated material.
Fairburn and colleagues psychological model of anorexia

Although there has been quite a lot of research into psychological factors, there are relatively few hypotheses which attempt to explain the condition as a whole.

Professor Chris Fairburn, of the University of Oxford and his colleagues have created a "transdiagnostic" model, in which they aim to explain how anorexia, as well as related disorders such as bulimia nervosa and ED-NOS, are maintained. Their model is developed with psychological therapies, particularly cognitive behavioral therapy, in mind, and so suggests areas where clinicians could provide psychological treatment.

Their model is based on the idea that all major eating disorders (with the exception of obesity) share some core types of psychopathology which help maintain the eating disorder behavior. This includes clinical perfectionism, chronic low self-esteem, mood intolerance (inability to cope appropriately with certain emotional states) and interpersonal difficulties.

*Social and environmental factors
Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media. A recent epidemiological study of 989,871 Swedish residents indicated that gender, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk. A classic study by Garner and Garfinkel demonstrated that those in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.

Although anorexia nervosa is usually associated with Western cultures, exposure to Western media is thought to have led to an increase in cases in non-Western countries. However, it is notable that other cultures may not display the same "fat phobic" worries about becoming fat as those with the condition in the West, and instead may present with low appetite with the other common features.

There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia (up to 50% in those admitted to inpatient wards, with a lesser prevalence among people treated in the community). Although prior sexual abuse is not thought to be a specific risk factor for anorexia, those who have experienced such abuse are more likely to have more serious and chronic symptoms.

The Internet has enabled anorexics and bulimics to contact and communicate with each other outside of a treatment environment, with much lower risks of rejection by mainstream society. A variety of websites exist, some run by sufferers, some by former sufferers, and some by professionals. The majority of such sites support a medical view of anorexia as a disorder to be cured, although some people affected by anorexia have formed online pro-ana communities that reject the medical view and argue that anorexia is a "lifestyle choice", using the internet for mutual support, and to swap weight-loss tips.[30] Such websites were the subject of significant media interest, largely focusing on concerns that these communities could encourage young women to develop or maintain eating disorders, and many were taken offline as a result.

-Prognosis-
Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 6% of those who are diagnosed with the disorder eventually die due to related causes. The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.

-Incidence, prevalence and demographics-
The majority of research into the incidence and prevalence of anorexia has been done in Western industrialized countries, so results are generally not applicable outside these areas. However, recent reviews[34][35] of studies on the epidemiology of anorexia have suggested an incidence of between 8 and 13 cases per 100,000 persons per year and an average prevalence of 0.3% using strict criteria for diagnosis. These studies also confirm the view that the condition largely affects young adolescent females, with females between 15 and 19 years old making up 40% of all cases. Furthermore, the majority of cases are unlikely to be in contact with mental health services. As a whole, about 10% of people with anorexia are male and about 90% of people with anorexia are female. Anorexia, however, is not exclusively limited to any age or demographic. In March 2008, a British senior university lecturer with PhD in psychology and a professional background in health, Rosemary Pope, died from anorexia. Anorexia has been reported occurring throughout a patient's life extending into the seventies and eighties. In addition, onset can occur in one's sixties or later. The Italian character actor, Giovanni Rovini, died of onset of symptoms commencing in his early nineties.

神経性無食欲症(しんけいせいむしょくよくしょう、anorexia nervosa: AN)は精神疾患のうち、摂食障害の一種である。一般には拒食症(きょしょくしょう)とも言われる。若年層に好発し、ボディ・イメージの障害(「自分は太っている」と考えること)、食物摂取の不良または拒否、体重減少を特徴とする。神経性食欲不振症、神経性食思不振症、思春期やせ症とも言う。

総論

神経性無食欲症は、心理的要因・社会的要因・生物学的要因によって生じる、摂食行動を主な表現形とする精神疾患である。特に、心理的要因(ストレス)によるところが多く、慢性経過をとることが多い。近年、日本において増加傾向にあり、また経過途中で抑うつを伴ったり身体的疾患を合併することもあり、社会に与える影響も大きい。

典型的なANの患者では、体重を落とすために始めたダイエットで達成感が得られ、体重を落とすことを止められなくなってしまう。低体重であっても自分の体重を多すぎると感じ、さらに体重を減らすことを望む。鏡を見ても「まだまだ痩せられる」と感じるのみであり、体重が低すぎるとは考えない。

宗教上の理由から断食をする場合、政治的目的から断食によるストライキを行う場合、あるいはカロリーを制限することで長寿が達成できるという健康上の信念を持っている場合に、食事を摂らないか極端に食事の摂取量を減らす例があるが、これらはANではない。

時にANは、神経性大食症(過食症)や、その他非定型性の摂食障害へと、病像が変化する場合がある。

疫学

社会的要素を含む疾患であるため、その病態は国によっても異なる。ダイエットが若年層の一大関心事である日本におけるANは、若年層、特に青年期の女性に非常に多いことが特徴である。若年男性でのANの発症も見られることがあるが、男女比はおよそ1対20である。発症年齢が年々低年齢化しており、小学生での発症も増加している。治療は一般に困難であり、長い時間がかかる。合併症や自殺のために経過の途中で死亡する例もある(5%~15%程度)。

一方で、近代的なダイエットとは無縁のアフリカの地方部においてAN様の病像を呈する症例の報告があり、宗教的信念との関連が考えられている。

歴史

日本において、ANが昔から精神の病として存在したことは、文学作品である『源氏物語』に窺い知ることができる。『源氏物語』第三部の宇治十帖で夭折する宇治の大君は、没落した宮家の姫君であり、経済的基盤のある身内がいない。大君の父の宇治八の宮は主人公の薫に娘である二人の姫君の後見(結婚のこと)を託して死亡する。結婚したくない大君は代わりに妹の中君を薫に娶せようとするが、中君は次の東宮と目される匂宮と結婚してしまう。しかし、正妻になる社会的地位を有さない中君と匂宮との結婚生活が苦渋に満ちたものであると思い込んだ大君は、自分が薫と結婚しても同じことになると悟り、ANに罹って衰弱死するのである。(出典:「源氏物語」紫式部)

症状

ANは、精神神経疾患の中では、致死率が最も高い疾患のなかのひとつであり、最終的な致死率は5%-20%程度である。主な死因は、極度の低栄養による感染症や不整脈の併発である。患者は自己の体重が減少することに満足できるため、自殺が死因となることは神経性大食症(過食症)と比較して少ないが、 抑うつ症状を伴うこともあり、自殺企図をきたす症例もある。

* 極度の体重減少
* 女性の場合、無月経
* 活動性の上昇、易興奮性、睡眠障害
* 抑うつ症状
* 食物への興味の上昇…しばしば料理関係の情報を収集する
* 強迫的な思考
* 自傷行為
* 手掌・足底の黄染(高カロテン血症)
* 低血圧
* 低体温
* 徐脈
* 便秘、腹痛
* 電解質代謝異常、特に低カリウム血症
* 骨粗鬆症
* 続発性甲状腺機能低下症
* 色素性痒疹…胸や肩などの痒みの強い発疹が出現する皮膚疾患

電解質代謝異常は、特に利尿剤の乱用が見られる症例では起こりやすく、時に低カリウム血症から致死性の不整脈をきたし、急激に死に至ることがある。

また、これらの個人に属する症状に加えて、極度の体重減少や易刺激性が、周囲との関係不良をもたらすことも大きな問題となる。

診断

DSM-IVの診断基準では、「標準体重の85%の値を維持することを拒否する」「体重が減少しているときでも、現在の体重が増加することに対して恐怖がある」「標準体重に満たない場合も、自分自身の体重を多すぎると感じる」「(初潮後の女性の場合)3周期以上に渡る無月経」の4項目を診断基準としている。

さらに、

* 活動性の亢進があること。体重を落とすため、必要以上の運動・活動を行うこと。
* 現在の病状、深刻性について、認識に乏しいこと。

を組み合わせて診断を行う。診断基準に完全には合致しない場合に、非定型摂食障害(特定不能の摂食障害)の診断になることがある。例えば月経が不順ながら存在し、その他はANの基準を満たす場合、非定型摂食障害と診断される。

摂食障害の患者は時に診療を拒否し、問診の際に症状を隠す傾向にあるため注意が必要。

ANは、以下の2種類のサブタイプに分類される。

* 制限型神経性無食欲症(AN-R)

制限型のAN(restricting type)では、食物を口にすることを重度に制限するが、AN-BPに見られるような行動は行ったことがない。

* 無茶食い-排泄型神経性無食欲症(AN-BP)

無茶食い-排泄型のAN(binge-eating/purging type)では、食物を過量に摂取した後、自分で嘔吐を誘発して、あるいは利尿剤、下剤等を用いて、食物の排泄を試みる、というエピソードを行う。(しかし、下剤や利尿剤では食物の吸収をほとんど妨げることはできない。)排泄する代わりに、無茶食いの後に数日間絶食する場合もある。

2002年の「DSM-IV-TR」の診断基準も同様である。

その他の診断基準として、厚生労働省の診断基準やICD-10の診断基準も存在する。

原因

ANの発生原因については議論があるが、生物学的要因・心理的要因・社会的要因の3つの要素があると考える人が多い。

* 生物学的要因についても様々な研究が報告されている。器質的な脳の病変の存在は明らかにされていないが、二卵性双生児よりも一卵性双生児の方が一致率が高いこと、AN患者の家族にはうつ病、アルコール依存、強迫性障害や摂食障害が多いことから遺伝的要因の関与も考えられている。ANの発病に関連する遺伝子もいくつか見いだされてはいるが、結論は出ていない。視床下部におけるドパミン、ノルアドレナリン活性の異常を指摘する研究もある。出産時の合併症(頭蓋内出血、低体重など)がANの罹患率を増加させるという疫学的研究もある[1]。

* 心理的要因が発病に影響しているのは明らかであり、ANの発病前には、発病に関連する何らかのエピソードが見出されるのが通常である。海外の研究において、摂食障害の患者は健常者よりも高い確率で幼少期に性的虐待を含む虐待を受けた経験をもつという報告もあるが、他の精神疾患においても高い確率で性的虐待の既往が報告されており、摂食障害と性的虐待を直接的な因果関係は不明である[2]。またかつて、1970年代などの初期の研究において、高学歴や家庭の経済状態がよいことなどがANの罹患率と相関するという報告がなされ広く信じられていたが、その後の研究ではこの説を支持しないか、むしろ逆の結果が示されることもある[3]。その他にも精神力動学的に様々な考察がなされている。
o 性的な成熟に対する恐怖・女性であることの否定:女性は第二次性徴を迎えると、皮下脂肪をたくわえ身体が丸みを帯び、乳房がふくらむなど身体が変化する。これらの身体変化に伴い、男性の性的関心の対象となるのを嫌悪・拒絶する心理からANを発症する場合もある。
o 肥満恐怖:肥満への恐怖・嫌悪が存在することが多い。「太っている」などとからかわれることが発症のきっかけとなる場合も多い。また女性の場合、第二次性徴によって皮下脂肪の蓄積するため、前述の性的成熟拒否と肥満恐怖が混合している場合も多い。
o 母親となることの拒絶:摂食拒否によって母親になることを拒絶しているという説。
o 対人関係の障害:原因なのか結果なのかは不明であるが、対人関係に障害を有する症例が多い。
o 失感情症(アレキシサイミア):自らの感情に気づくことができない・できにくいことを「失感情症(アレキシサイミア)」という。ANも失感情症の要素があることが指摘されており、自らのストレスやつらい気持ちに気づかず(否認して)、その代わり身体症状で表現しているという可能性がある。
o 完璧主義・強迫性も、AN患者においてしばしばみられる。
o 嗜癖(依存症)としての要素:ANの初期に、摂食量を制限して体重が減るという結果を得て満足し、更に摂食量制限にふけり、独特の気分高揚を示すことがある。この心性は薬物依存やギャンブル依存などの嗜癖行動との共通点があると言われている。

* 社会的要因もANの発症に関与している。
o メディアにおいてやせた女性、元気で快活な女性が賞賛され、内面よりも外見を重視するような風潮は、ANの発症の大きな要因であろう。実際に、 12~21歳の2862人の思春期少女を18か月間追跡調査したところ、90人が摂食障害を新たに発症したが、発症に関与した因子として一人で食事をすること、少女雑誌をよく読むことやラジオをよく聴くことが挙げられた[4]という研究もあり、メディアの影響がうかがわれる。
o 芸能界やモデル業界などの美を競う業界や、痩せていることが重要だと考えられているスポーツ選手においてANにかかる患者がいることが注目を集めている。

2006年現在、当疾患および神経性過食症をあわせた「中枢性摂食異常症」は厚生労働省の特定疾患に該当し、重点的に研究が進められている。

治療

他の精神疾患がそうであるように、ANも社会的・精神的・肉体的な要素を併せ持つ複雑な疾患である。早期の治療は治療の成功率を高める。

治療法は、入院・外来での疾患教育、認知行動療法や集団療法などの心理療法、薬物療法、家族のカウンセリングなどが中心となる。患者が病気であることを否認する場合や、ANの存在を容認したとしても治療には拒否の姿勢を示す場合はよくみられる。さらには、治療を認める姿勢を見せて、実際には出された食事を隠れて捨てる、などの行為も少なからず見られる。

治療にあたっては、体重増加のみを治療目的とすべきではない。「とにかく食べろ」といった強硬な姿勢を家族や治療者が見せることは、通常逆効果となる。長い間ANと戦っている患者にとって、食物を食べること自体が大変な苦痛・恐怖につながるためである。また体重増加以外にも、患者の主体性を重視し、人間としての成熟、対人関係の充実、実生活での適応などを援助することが重要だからである。以上のように、適切な医師-患者関係、家族-患者関係を築くことが最も大切である。

インターネット等で摂食障害患者、元患者との交流を持つことがよい影響をもたらす場合もある。

治療により軽快した場合、再発や、神経性大食症の発症に注意する必要がある。

厚生労働省の特定疾患に該当し(前述)、治療法についても重点的に研究が進められている。

参考

* オーストリアのエリーザベト皇后も、嫁姑問題を契機にANを発症したといわれている。
* 日本では、ANは一般的には「拒食症」の名前で知られており、その患者の実態は、たびたびドキュメンタリーとしてマスコミに取り上げられることがある。カーペンターズのカレン・カーペンターが拒食症から心臓発作を起こして死亡した際に、本症は日本やアメリカで大きな注目を浴び、注目される疾患となった。
* 東電OL殺人事件の被害者女性も慶應義塾大学を卒業し総合職として東京電力に入社した30代独身のエリート社員であったが、セックス依存症の性癖とANの双方を発症していた。

'I'm better off dead. I'm done': Michael Jackson's fateful prediction just a week before his death By Ian Halperin 29th June 2009

I haven't read Ian Halperin's book so no comments on it, yet.
Although, I'm surely interested in reading it.

amazon.com
Average Customer Review for 'Unmasked: The Final Years of Mickael Jackson'
1.9 out of 5 stars (74 customer reviews)
*************************************

http://www.dailymail.co.uk/news/article-1196009/Im-better-dead-Im-How-Michael-Jackson-predicted-death-months-ago.html;jsessionid=7F4B8AEA3D499DA132EA21D7C7EA41CE

* Genetic condition had ruined his lungs and left him unable to sing
* He became so skeletal, doctors believed he was anorexic
* He had nightmares about being murdered – and wanted to die
* He used swine flu as an excuse to avoid coming to England
* He thought he was agreeing to 10 concerts – it was 50

Whatever the final autopsy results reveal, it was greed that killed Michael Jackson. Had he not been driven – by a cabal of bankers, agents, doctors and advisers – to commit to the gruelling 50 concerts in London’s O2 Arena, I believe he would still be alive today.

During the last weeks and months of his life, Jackson made desperate attempts to prepare for the concert series scheduled for next month – a series that would have earned millions for the singer and his entourage, but which he could never have completed, not mentally, and not physically.

Ailing: Michael Jackson may have worn a mask in public to protect his diseased lungs

Michael knew it and his advisers knew it. Anyone who caught even a fleeting glimpse of the frail old man hiding beneath the costumes and cosmetics would have understood that the London tour was madness. For Michael Jackson, it was fatal.

I had more than a glimpse of the real Michael; as an award-winning freelance journalist and film-maker, I spent more than five years inside his ‘camp’.

Many in his entourage spoke frankly to me – and that made it possible for me to write authoritatively last December that Michael had six months to live, a claim that, at the time, his official spokesman, Dr Tohme Tohme, called a ‘complete fabrication’. The singer, he told the world, was in ‘fine health’. Six months and one day later, Jackson was dead.

Some liked to snigger at his public image, and it is true that flamboyant clothes and bizarre make-up made for a comic grotesque; yet without them, his appearance was distressing; with skin blemishes, thinning hair and discoloured fingernails.

I had established beyond doubt, for example, that Jackson relied on an extensive collection of wigs to hide his greying hair. Shorn of their luxuriance, the Peter Pan of Neverland cut a skeletal figure.
More...

* 24hr 'sober coach' was hired for Michael Jackson as desperate family brought in controversial 'Doc Hollywood' to save star
* Doctor: I saved Jackson from morphine overdose after TV interview in US
* Michael Jackson was due to move into 32-bed Kent manor house this weekend

It was clear that he was in no condition to do a single concert, let alone 50. He could no longer sing, for a start. On some days he could barely talk. He could no longer dance. Disaster was looming in London and, in the opinion of his closest confidantes, he was feeling suicidal.

To understand why a singer of Jackson’s fragility would even think about travelling to London, we need to go back to June 13, 2005, when my involvement in his story began.

As a breaking news alert flashed on CNN announcing that the jury had reached a verdict in Jackson’s trial for allegedly molesting 13-year-old Gavin Arvizo at his Neverland Ranch in California, I knew that history had been made but that Michael Jackson had been broken – irrevocably so, as it proved.

Nor was it the first time that Michael had been accused of impropriety with young boys. Little more than a decade earlier, another 13-year-old, Jordan Chandler, made similar accusations in a case that was eventually settled before trial – but not before the damage had been done to Jackson’s reputation.

Frail: In a wheelchair last year, Michael Jackson looked in no state to perform 50 tough gigs

Michael had not helped his case. Appearing in a documentary with British broadcaster Martin Bashir, he not only admitted that he liked to share a bed with teenagers, mainly boys, in pyjamas, but showed no sign of understanding why anyone might be legitimately concerned.

I had started my investigation convinced that Jackson was guilty. By the end, I no longer believed that.

I could not find a single shred of evidence suggesting that Jackson had molested a child. But I found significant evidence demonstrating that most, if not all, of his accusers lacked credibility and were motivated primarily by money.

Jackson also deserved much of the blame, of course. Continuing to share a bed with children even after the suspicions surfaced bordered on criminal stupidity.

He was also playing a truly dangerous game. It is clear to me that Michael was homosexual and that his taste was for young men, albeit not as young as Jordan Chandler or Gavin Arvizo.

In the course of my investigations, I spoke to two of his gay lovers, one a Hollywood waiter, the other an aspiring actor. The waiter had remained friends, perhaps more, with the singer until his death last week. He had served Jackson at a restaurant, Jackson made his interest plain and the two slept together the following night. According to the waiter, Jackson fell in love.

The actor, who has been given solid but uninspiring film parts, saw Jackson in the middle of 2007. He told me they had spent nearly every night together during their affair – an easy claim to make, you might think. But this lover produced corroboration in the form of photographs of the two of them together, and a witness.

Other witnesses speak of strings of young men visiting his house at all hours, even in the period of his decline. Some stayed overnight.

When Jackson lived in Las Vegas, one of his closest aides told how he would sneak off to a ‘grungy, rat-infested’ motel – often dressed as a woman to disguise his identity – to meet a male construction worker he had fallen in love with.

Jackson was acquitted in the Arvizo case, dramatically so, but the effect on his mental state was ruinous. Sources close to him suggest he was close to complete nervous breakdown.

Death scene: The rented home in Bel Air where Michael Jackson passed away

The ordeal had left him physically shattered, too. One of my sources suggested that he might already have had a genetic condition I had never previously come across, called Alpha-1 antitrypsin deficiency – the lack of a protein that can help protect the lungs.

Although up to 100,000 Americans are severely affected by it, it is an under-recognised condition. Michael was receiving regular injections of Alpha-1 antitrypsin derived from human plasma. The treatment is said to be remarkably effective and can enable the sufferer to lead a normal life.

But the disease can cause respiratory problems and, in severe cases, emphysema. Could this be why Jackson had for years been wearing a surgical mask in public, to protect his lungs from the ravages of the disease? Or why, from time to time, he resorted to a wheelchair? When I returned to my source inside the Jackson camp for confirmation, he said: ‘Yeah, that’s what he’s got. He’s in bad shape. They’re worried that he might need a lung transplant but he may be too weak.

‘Some days he can hardly see and he’s having a lot of trouble walking.’

Even Michael Jackson’s legendary wealth was in sharp decline. Just a few days before he announced his 50-concert comeback at the O2 Arena, one of my sources told me Jackson had been offered £1.8million to perform at a party for a Russian billionaire on the Black Sea.

‘Is he up to it?’ I had asked.

‘He has no choice. He needs the money. His people are pushing him hard,’ said the source.

Could he even stand on a stage for an hour concert?

‘He can stand. The treatments have been successful. He can even dance once he gets in better shape. He just can’t sing,’ said the aide, adding that Jackson would have to lip-synch to get through the performance. ‘Nobody will care, as long as he shows up and moonwalks.’

He also revealed Jackson had been offered well over £60million to play Las Vegas for six months. ‘He said no, but his people are trying to force it on him. He’s that close to losing everything,’ said the source.

Forced: Michael Jackson thought he was agreeing to 10 concerts at London's O2 Arena not 50

Indeed, by all accounts Jackson’s finances were in a shambles. The Arvizo trial itself was a relative bargain, costing a little more than £18million in legal bills.

But the damage to his career, already in trouble before the charges, was incalculable. After the Arvizo trial, a Bahraini sheikh allowed Jackson to stay in his palace, underwriting his lavish lifestyle. But a few years later, the prince sued his former guest, demanding repayment for his hospitality. Jackson claimed he thought it had been a gift.

Roger Friedman, a TV journalist, said: ‘For one year, the prince underwrote Jackson’s life in Bahrain – everything including accommodation, guests, security and transportation. And what did Jackson do? He left for Japan and then Ireland. He took the money and moonwalked right out the door. This is the real Michael Jackson. He has never returned a phone call from the prince since he left Bahrain.’

Although Jackson settled with the sheikh on the eve of the trial that would have aired his financial dirty laundry, the settlement only put him that much deeper into the hole. A hole that kept getting bigger, but that was guaranteed by Jackson’s half ownership of the copyrights to The Beatles catalogue. He owned them in a joint venture with record company Sony, which have kept him from bankruptcy.

‘Jackson is in hock to Sony for hundreds of millions,’ a source told me a couple of months ago. ‘No bank will give him any money so Sony have been paying his bills.

‘The trouble is that he hasn’t been meeting his obligations. Sony have been in a position for more than a year where it can repossess Michael’s share of the [Beatles] catalogue. That’s always been Sony’s dream scenario, full ownership.

‘But they don’t want to do it as they’re afraid of a backlash from his fans. Their nightmare is an organised 'boycott Sony' movement worldwide, which could prove hugely costly. It is the only thing standing between Michael and bankruptcy.’

Pop star Michael Jackson (centre) holds the hands of his two children Paris Michael, four, and son Prince Michael, five, with their faces covered during a visit to Berlin Zoo.
Legacy: Michael Jackson wanted to ensure the future of his children by leaving them 200 unpublished songs

The source aid at the time that the scheduled London concerts wouldn’t clear Jackson’s debts – estimated at almost £242million – but they would allow him to get them under control and get him out of default with Sony.

According to two sources in Jackson’s camp, the singer put in place a contingency plan to ensure his children would be well taken care of in the event of bankruptcy.

‘He has as many as 200 unpublished songs that he is planning to leave behind for his children when he dies. They can’t be touched by the creditors, but they could be worth as much as £60million that will ensure his kids a comfortable existence no matter what happens,’ one of his collaborators revealed.

But for the circle of handlers who surrounded Jackson during his final years, their golden goose could not be allowed to run dry. Bankruptcy was not an option.

These, after all, were not the handlers who had seen him through the aftermath of the Arvizo trial and who had been protecting his fragile emotional health to the best of their ability. They were gone, and a new set of advisers was in place.

The clearout had apparently been engineered by his children’s nanny, Grace Rwaramba, who was gaining considerable influence over Jackson and his affairs and has been described as the ‘queen bee’ by those around Jackson.

Rwaramba had ties to the black militant organisation, the Nation of Islam, and its controversial leader, Louis Farrakhan, whom she enlisted for help in running Jackson’s affairs.

Before long, the Nation was supplying Jackson’s security detail and Farrakhan’s son-in-law, Leonard Muhammad, was appointed as Jackson’s business manager, though his role has lessened significantly in recent years.

In late 2008, a shadowy figure who called himself Dr Tohme Tohme suddenly emerged as Jackson’s ‘official spokesman’.

Tohme has been alternately described as a Saudi Arabian billionaire and an orthopaedic surgeon, but he is actually a Lebanese businessman who does not have a medical licence. At one point, Tohme claimed he was an ambassador at large for Senegal, but the Senegalese embassy said they had never heard of him.

Misguided: Michael Jackson showed no sign of understanding why anyone might be legitimately concerned about him sharing a bed with young boys

Tohme’s own ties to the Nation of Islam came to light in March 2009, when New York auctioneer Darren Julien was conducting an auction of Michael Jackson memorabilia.

Julien filed an affidavit in Los Angeles Superior Court that month in which he described a meeting he had with Tohme’s business partner, James R. Weller. According to Julien’s account, ‘Weller said if we refused to postpone [the auction], we would be in danger from 'Farrakhan and the Nation of Islam; those people are very protective of Michael'.

He told us that Dr Tohme and Michael Jackson wanted to give the message to us that 'our lives are at stake and there will be bloodshed'.’

A month after these alleged threats, Tohme accompanied Jackson to a meeting at a Las Vegas hotel with Randy Phillips, chief executive of the AEG Group, to finalise plans for Jackson’s return to the concert stage.

Jackson’s handlers had twice before said no to Phillips. This time, with Tohme acting as his confidant, Jackson left the room agreeing to perform ten concerts at the O2.

Before long, however, ten concerts had turned into 50 and the potential revenues had skyrocketed. ‘The vultures who were pulling his strings somehow managed to put this concert extravaganza together behind his back, then presented it to him as a fait accompli,’ said one aide.

‘The money was just unbelievable and all his financial people were telling him he was facing bankruptcy. But Michael still resisted. He didn’t think he could pull it off.’

Eventually, they wore him down, the aide explained, but not with the money argument.

‘They told him that this would be the greatest comeback the world had ever known. That’s what convinced him. He thought if he could emerge triumphantly from the success of these concerts, he could be the King again.’

The financial details of the O2 concerts are still murky, though various sources have revealed that Jackson was paid as much as £10million in advance, most of which went to the middlemen. But Jackson could have received as much as £100million had the concerts gone ahead.

It is worth noting that the O2 Arena has the most sophisticated lip synching technology in the world – a particular attraction for a singer who can no longer sing. Had, by some miracle, the concerts gone ahead, Jackson’s personal contribution could have been limited to just 13 minutes for each performance. The rest was to have been choreography and lights.

‘We knew it was a disaster waiting to happen,’ said one aide. ‘I don’t think anybody predicted it would actually kill him but nobody believed he would end up performing.’

Their doubts were underscored when Jackson collapsed during only his second rehearsal.

Hidden life: It was 'clear Michael Jackson was gay' but he married twice, firstly to Lisa Marie Presley, above

‘Collapse might be overstating it,’ said the aide. ‘He needed medical attention and couldn’t go on. I’m not sure what caused it.’

Meanwhile, everybody around him noticed that Jackson had lost an astonishing amount of weight in recent months. His medical team even believed he was anorexic.

‘He goes days at a time hardly eating a thing and at one point his doctor was asking people if he had been throwing up after meals,’ one staff member told me in May.

‘He suspected bulimia but when we said he hardly eats any meals, the doc thought it was probably anorexia. He seemed alarmed and at one point said, 'People die from that all the time. You’ve got to get him to eat.'’

Indeed, one known consequence of anorexia is cardiac arrest.

After spotting him leave one rehearsal, Fox News reported that ‘Michael Jackson’s skeletal physique is so bad that he might not be able to moonwalk any more’.

On May 20 this year, AEG suddenly announced that the first London shows had been delayed for five days while the remainder had been pushed back until March 2010. At the time, they denied that the postponements were health-related, explaining that they needed more time to mount the technically complex production, though scepticism immediately erupted. It was well placed.

Behind the scenes, Jackson was in rapid decline. According to a member of his staff, he was ‘terrified’ at the prospect of the London concerts.

‘He wasn’t eating, he wasn’t sleeping and, when he did sleep, he had nightmares that he was going to be murdered. He was deeply worried that he was going to disappoint his fans. He even said something that made me briefly think he was suicidal. He said he thought he’d die before doing the London concerts.

‘He said he was worried that he was going to end up like Elvis. He was always comparing himself to Elvis, but there was something in his tone that made me think that he wanted to die, he was tired of life. He gave up. His voice and dance moves weren’t there any more. I think maybe he wanted to die rather than embarrass himself on stage.’

The most obvious comparison between the King of Pop and the King of Rock ’n’ Roll was their prescription drug habits, which in Jackson’s case had significantly intensified in his final months.

‘He is surrounded by enablers,’ said one aide. ‘We should be stopping him before he kills himself, but we just sit by and watch him medicate himself into oblivion.’

Jackson could count on an array of doctors to write him prescriptions without asking too many questions if he complained of ‘pain’. He was particularly fond of OxyContin, nicknamed ‘Hillbilly heroin’, which gave an instant high, although he did not take it on a daily basis.

According to the aide, painkillers are not the only drugs Jackson took.

Michael Jackson was unable to dance and sing like he once could due to his illnesses

‘He pops Demerol and morphine, sure, apparently going back to the time in 1984 when he burned himself during the Pepsi commercial, but there’s also some kind of psychiatric medication. One of his brothers once told me he was diagnosed with schizophrenia when he was younger, so it may be to treat that.’

His aides weren’t the only ones who recognised that a 50-concert run was foolhardy. In May, Jackson himself reportedly addressed fans as he left his Burbank rehearsal studio.

‘Thank you for your love and support,’ he told them. ‘I want you guys to know I love you very much.

'I don’t know how I’m going to do 50 shows. I’m not a big eater. I need to put some weight on. I’m really angry with them booking me up to do 50 shows. I only wanted to do ten.’

One of his former employees was particularly struck by Jackson’s wording that day. ‘The way he was talking, it’s like he’s not in control over his own life any more,’ she told me earlier this month. ‘It sounds like somebody else is pulling his strings and telling him what to do. Someone wants him dead.

'They keep feeding him pills like candy. They are trying to push him over the edge. He needs serious help. The people around him will kill him.’

As the London concerts approached, something was clearly wrong. Jackson had vowed to travel to England at least eight weeks before his first shows, but he kept putting it off.

‘To be honest, I never thought Michael would set foot on a concert stage ever again,’ said one aide, choking back tears on the evening of his death.

‘This was not only predictable, this was inevitable.’

On June 21, Jackson told my contact that he wanted to die. He said that he didn’t have what it would take to perform any more because he had lost his voice and dance moves.

‘It’s not working out,’ Jackson said. ‘I’m better off dead. I don’t have anywhere left to turn. I’m done.’

Michael’s closest confidante told me just two hours after he died that ‘Michael was tired of living. He was a complete wreck for years and now he can finally be in a better place. People around him fed him drugs to keep him on their side. They should be held accountable.’

Michael Jackson was undoubtedly a deeply troubled and lonely man. Throughout my investigation, I was torn between compassion and anger, sorrow and empathy.

Even his legacy is problematic. As I have already revealed, he has bequeathed up to 200 original songs to his three children, Prince Michael, aged 12, Paris Katherine, 11, and Prince Michael II (also known as Blanket), seven. It is a wonderful gift.

Yet I can reveal that his will, not as yet made public, demands that the three of them remain with Jackson’s 79-year-old mother Katherine in California. It promises an ugly row.

Ex-wife Deborah Rowe, the mother of the eldest two, has already made it clear to her legal team that she wants her children in her custody, immediately.

The mother of the third child has never been identified. I fully expect that it will emerge that the children had a ‘test tube’ conception, a claim already made by Deborah Rowe.

Michael Jackson may very well have been the most talented performer of his generation, but for 15 years that fact has been lost to a generation who may remember him only as a grotesque caricature who liked to share his bed with little boys. Now that he’s gone, maybe it’s time to shelve the suspicions and appreciate the music.

* Unmasked: The Final Years of Michael Jackson by Ian Halperin is published by Transit Publishing in the UK at £14.99 and Pocket Books in the US at $24. To order your copy at the special price of £13.50 with free p&p, call The Review Bookstore on 0845 155 0713.


Read more: http://www.dailymail.co.uk/news/article-1196009/Im-better-dead-Im-How-Michael-Jackson-predicted-death-months-ago.html;jsessionid=7F4B8AEA3D499DA132EA21D7C7EA41CE#ixzz0McoPXTG1