An excerpt from Frans Vermeulen's:
"Spectrum Materia Medica Volume 1 - Monera, Kingdom Bacteria & Viruses"
BORRELIA BURGDORFERI
Latin name: Borrelia burgdorferi.
Family: Spirochaetaceae.
Homoeopathy: Borrelia nosode.
FEATURES
· Named after W. Burgdorfer, the physician who isolated the spirochete from a deer tick in 1981.
· Flexible, spiral-shaped, Gram-negative spirochete propelled by an internal arrangement of flagella, bundled together, that runs the length of the bacteria from tip to tip.
· Microaerophilic, i.e. requires oxygen but less than is present in the air.
· Parasitic on many forms of animal life; found on mucous membranes.
· Transmitted by tick bites.
· The lipid components of Borrelia are unusual in that they include cholesterol, a substance found in only one other bacterial genus, Mycoplasma.
· Also one of the very few bacterial species having linear DNA [typical of organisms with nucleated cells] instead of circular DNA.
· B. burgdorferi is a slow growing [division time is estimated to be 12-24 hours], fastidious organism that requires a complex liquid medium and an optimal temperature of 33-35° C for growth, due to which it is extremely difficult to culture in vitro.
· Glucose provides its major energy source and lactic acid is the predominant metabolic end product.
· Readily adapts to various hosts and “can enter the tissue that is optimal for its survival, and it may evade the immune system and antibiotics by hiding inside certain types of cells. … It is for certain that its ability to kill B-lymphocytes evolved as part of a defence mechanism to evade its own destruction. The observation that it can use the B-cell’s own membrane as camouflage indicates that it may be able to go undetected by our immune system. The way our immune system is supposed to work is that it recognizes foreign invaders as being different from self, and attacks the infection. … The most intriguing fact about Borrelia spirochetes is their well documented ability to change the shape of their surface antigens when they are attacked by the human immune system. When this occurs, it takes several weeks for the immune system to produce new antibodies. During this time the infection continues to divide and hide.” [Grier]
· “Like other spirochetes, such as those that cause syphilis, the Lyme spirochete can remain in the human body for years in a non-metabolic state. It is essentially in suspended animation, and since it does not metabolise in this state, antibiotics are not absorbed or effective. When the conditions are right, those bacteria that survive can seed back into the blood stream and initiate a relapse.” [Grier]
NOTE: While it was first thought that B. burgdorferi was the only species causing Lyme disease, it has since been determined that any number of the different species in the genus Borrelia might be capable of this feat.
The different manifestations of LB do not show an even geographical distribution. This is partly due to the uneven distribution of the different genospecies of B. burgdorferi sensu lato, some of which seem to be associated with particular symptoms. Only one of them, B. burgdorferi sensu stricto, has been implicated as the cause of disease in North America, mainly causing arthritis [60%], but in Europe three genospecies, B. afzelii, B. garinii and B. burgdorferi sensu stricto, are known to be pathogenic. … B. afzelii seems to be associated with a degenerative skin condition, acrodermatitis chronica atrophicans, and B. garinii with neurological symptoms. However, these associations are not clear-cut and there is considerable overlap. B. garinii seems to predominate in western Europe and B. afzelii becomes more prevalent in northern, central and eastern regions, while there is some evidence that B. burgdorferi s.s. has been introduced from the west.
[European Union Concerted Action on Lyme Borreliosis, 1997-2003]
LYME BORRELIOSIS
Borreliosis or Lyme disease occurs in the north temperate zone. It is the most commonly reported tick-borne infection in Europe and North America. A multi-system disorder, borreliosis can affect a complex range of tissues including the skin, nervous and musculoskeletal systems, and to a lesser extent the eyes, kidneys, and liver. [Predilection for the latter three organ systems is more specific for Leptospira.]
The term Lyme disease was first used following investigation into a geographical cluster of juvenile rheumatoid arthritis in the town of Old Lyme, Connecticut, USA, in the mid 1970s. Subsequent studies led to the isolation from the deer tick, Ixodes scapularis [dammini] of a gram-negative spirochete, which was named Borrelia burgdorferi. The disease has, however, been known in Europe under a variety of names [including erythema migrans, acrodermatitis chronica atrophicans, Bannwarth syndrome*] since the 1880s. In 1909, Afzelius had associated a red rash [erythema migrans] with the tick, Ixodes ricinus.
In 1948, spirochetes were observed in erythema migrans [EM] biopsies and in 1951 a Swedish clinician, Hollström, successfully treated EM infected patients with penicillin. Also in 1951, it was suggested that EM, with associated meningitis, was probably the result of an infection by a tick- or other insect-borne bacterium. … However, EM was considered a relatively harmless condition with no connection made between the lesion and subsequent symptoms caused by the same bacterium.
[European Union Concerted Action on Lyme Borreliosis, 1997-2003]
The clinical presentation of borreliosis can be divided according to its progress. Borreliosis runs its course in three stages. The early stage presents in up to 70% of cases with erythema migrans, an expanding red maculopapular rash that can reach a large size in diameter and typically clears from the central area [“bulls-eye rash”]. The rash can be circular, triangular, and cover large portions of the body. Vague or pronounced flu-like symptoms and sometimes glandular swelling accompany the rash.
During the second or disseminated stage, which may last for over a year, the spirochete spreads gradually to other tissues via the bloodstream and lymphatics. Manifestations of this stage may include erythematous patches [usually smaller than the initial lesion], fatigue, headache, muscle and joint pains, facial palsy or other cranial nerve lesions, and, rarely, carditis. Progression to the third stage, late borreliosis, involves Lyme arthritis, commonly restricted to the large joints, acrodermatis chronica atrophicans, and neuroborreliosis.
Erythema migrans, the characteristic rash which may appear some days to weeks following infection, is the most common manifestation, next comes arthritis, then neuroborreliosis, while carditis is rare. Some studies report higher disease incidence rates for males, although a recent Swedish study on recurrence of erythema migrans showed the majority of cases to occur in middle-aged women. In addition, acrodermatitis chronica atrophicans [indurated, erythematous plaques, bluish-red, commencing on feet, hands, elbows, or knees, and gradually progressing to epidermal atrophy with thin, shiny, papery appearance of the involved sites] reportedly occurs mainly in elderly women, whereas bilateral facial palsy is a frequent manifestation in children. The number of cases of Lyme disease reported in the United States is about 17,000 per year, but the actual incidence is estimated to be some 10 times higher. According to a WHO report, the number of European cases approaches 60,000 annually.
* Bannwarth syndrome or Garin-Bujadoux syndrome [“paralysie par les tiques,” tick-induced paralysis] is characterised by intense pain, mostly in the lumbar and cervical regions, and radiating to the extremities, accompanied by migrating sensory and motor disorders of the peripheral nerves, including such symptoms as facial paralysis, abducens palsy, paraesthesias, anorexia, fatigue, headache, diplopia, and erythema migrans.
THE IMITATOR’S NEW CLOTHES
Syphilis was known as the “great imitator” because its multiple manifestations mimicked other known diseases. Lyme borreliosis, likewise, has now entered the stage as “the new great imitator.” P.H. Duray concedes: “Initially thought to be a disorder beginning in the skin and progressing to involve the joints, Lyme disease is now ranked as one of the great mimickers of other diseases, in a manner similar to that once ascribed to syphilis.” Sir William Osler remarked that “to know syphilis is to know all of medicine.”
Homoeopathy knows the major syphilitic remedy, Mercurius, as the “great masquerader.” Judging by the close family connection between both spirochetes, it does not come as a surprise that one of very first cases of borreliosis, in 1922 in France, had a weakly positive syphilis test and thus was treated with arsenicals, the then current treatment for syphilis.
There are great differences in how borreliosis manifests in Europe versus in the USA. The major presentation of early neuroborreliosis in the USA is facial palsy, whereas it is encephalomyelitis in Europe. In Europe, the erythema migrans lesion is quite indolent and sometimes hardly noticeable, while US patients have intense inflammatory cutaneous reactions with early dissemination. Acrodermatitis chronica atrophicans is only seen in Europe. Conversely, arthritis is uncommon in Europe, but extremely common in the USA in untreated patients. Neuroborreliosis overall seems to prevail in Europe. These differences are attributed to the distribution of the various Borrelia species.
There are a wide range of symptoms associated with Lyme borreliosis. Symptoms vary greatly, one or more systems may be involved, and new manifestations continue to be described. Like syphilis, Lyme borreliosis may remain latent and asymptomatic for a long period of time; progress for many years through successive stages; or fluctuate dramatically and unpredictably.
Many Lyme patients were first diagnosed with other illnesses such as arthritis, juvenile arthritis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, lupus, early ALS [amyotrophic lateral sclerosis], early Alzheimer’s disease, Crohn’s disease, irritable bowel syndrome and various other more nondescript illnesses.
So bewildering is the range of symptoms that a borreliosis patient conceded that “while one misguided doctor writes in his book on Lyme that the more widespread and peculiar the symptoms are, the more likely the complaint is psychosomatic, I'd have to say that the more widespread and peculiar the symptoms are, the more likely that the problem is Lyme disease.”
Diagnosis is controversial; some believe the disorder to be “over-diagnosed,” others think it is “under-diagnosed” and again others speak of frequent “misdiagnosis.” The virulence of the spirochete is equally poorly understood. Involvement of immunological host factors have been proposed, whereas the remission of even psychiatric disorders after antimicrobial treatment is deemed proof that it concerns merely a bacterial infection.
Tracking the culprit, the new elusive spirochete, is riddled with problems, considering that there are asymptomatic seropositive patients, seronegative patients with intractable symptoms, patients with persisting symptoms despite the standard two-to-four-week IV antibiotic treatment regimen, seropositivity despite antibiotics, and so on. Patients may have one or all of the stages, or the illness may not become symptomatic until stage 2 or 3. What initially was held for “Lyme Hysteria” turns out to be linked with long-term, chronic problems. Yet, there is, as one author put it, “chronic persistent denial of chronic persistent infection in Lyme Disease.”
TICK-STRICKEN
Borrelia is transmitted by ticks belonging to the genus Ixodes. The two-year life cycle of the tick consists of four stages: egg, larva, nymph, and adult. Between each stage the tick needs a blood meal in order to mature. It usually becomes the host for the Borrelia spirochetes during its larval stage, when it feeds on small animals such as rodents or birds. After its blood meal the tick drops off the host to transform over a period of months into the next instar. Because off-host ticks are vulnerable to desiccation, an environment with high humidity is required to maintain a stable water balance. Temperate deciduous woodland with patches of dense vegetation and little air movement coupled with high humidity constitute ideal conditions. Here Ixodes will be encountered, usually in the spring, the season that warrants sufficient humidity. Animals or humans brushing through the vegetation may pick up ticks, then commonly in their nymphal stage, involuntarily assisting in the completion of their life-cycle. While gorging, ticks increase salivation and with the saliva the spirochetes come along, which resided in the tick’s digestive tract. Ticks are slow feeders, so that spirochetal transmission usually happens after the tick has been feeding for 24 hours. Prompt removal of the attached tick is therefore believed to prevent infection.
Given time, the tick needs to strike only once. That such a relatively short, though unwelcome visit has such devastating long-term effects seems incredible. Although a history of exposure to a tick-endemic area is essential to support the diagnosis of Lyme borreliosis, about one-third of patients do not recall a rash or tick bite “because the nymphal stage of the tick is so tiny and many rashes in body hair and indiscrete areas go undetected.”
The dazzling array of borreliosis symptoms has prompted disbelief. Explanations are offered that the tick with the transmission of spirochetes inoculates other parasites as well, such as Ehrlichia canis [ehrlichiosis], Coxiella [Rickettsia] burnetii [Q fever], other rickettsias, Staphylococcus aureus, and Babesia species [babesiosis].
Rather than using the broad spectrum of symptoms as the main guideline, a medical system that so strictly bases its treatment on diagnosis and identification of causative agents is likely to fail. Psychiatrist Robert Bransfield writes: “There has been a recent trend to incorrectly view so called ‘objective’ signs and symptoms as more valid than those which are ‘subjective.’ Often a machine or lab test is perceived as giving validity to these ‘objective’ signs. Many of these ‘objective’ tests are far less valid and are based on questionable techniques, faulty assumptions, and flawed logic. On the other hand, ‘subjective’ complaints are sometimes viewed with excessive suspicion. … In an effort to create predictability, reliance upon cookbook medicine has given us a recipe for disaster.”
And Thomas Grier: “Too often, I have seen the word cured used in Lyme Disease Studies, only to find that the researchers have redefined the word cure to mean seronegative. Seronegativity is not synonymous with cure. The numerous culture positive cases in recent years should have negated that kind of logic years ago, and yet, in 1997, researchers are still publishing studies that use antibodies and PCR as the end point for cure. It’s time to ask the patients one simple question: How are you feeling?”
SYPHILITIC MIASM
We cannot fail to see the close resemblance between Lyme borreliosis and the syphilitic miasm with Syphilinum as its prototype. The correlations even go beyond the symptomatology, encompassing such elements as controversy, denial, stigmatisation, blame, and banishment. Hardly any other subject creates so much alienation as the syphilitic miasm in all its disguises.
With the exception of a few symptoms, borreliosis appears to be a spitting image of the syphilitic miasm in general and Syphilinum in particular, as is evidenced by Boericke’s and Clarke’s summary of the latter:
Utter prostration and debility in the morning.
Fears the night, and the suffering from exhaustion on awakening.
- Shifting rheumatic pains.
Chronic eruptions and rheumatism.
Alcohol.
Loss of memory [names, dates, etc.]; remembers everything previous to his illness [i.e. short-term memory deficit].
Hopeless; despair of recovery, does not think will ever get better.
Cross, irritable, peevish.
Violent on being opposed.
Feels as if going insane or being paralysed.
The theme of insanity pervades the borreliosis picture. Pains are described as maddening; patients are labelled as crazy by medical practitioners; patients go out of their minds from falling on deaf ears. Descriptions of the mental state induced by Borrelia depict the despair and darkness, the taking away by force of hopes and dreams:
“In this darkness that surrounded me, there was no room left to turn or to run. Only to survive. Days passed like an insect caught in tree sap. Enveloping. A strangely warm, amber struggle in slow motion - a quiet resignation to a world that was filled with nightmare images. Trapped in a mind that knew it had gone insane.”
“I thought I was slowly going crazy, never knowing what the next day would bring.”
“Some days I haven’t a clue what I did two days ago or even that morning. This continues to drive me crazy.”
“After years of being told that I was crazy and then suddenly that I had some type of auto-immune connective tissue disease …”
“I was trying to make sense of it myself, I was grasping at straws for an explanation of what was happening to me. … I felt as if the self I knew was dissolving.”
“Sometimes one can’t hope for better. One can only hope for different. Death is definitely different.”
“When I looked in the mirror I saw someone I didn't recognise.”
“In essence, I was dropping out of life.”
[Citations extracted from the Personal Stories collected on the website Lymealliance.org]
MATERIA MEDICA BORRELIA
Sources
Shifting rheumatic pains.
Chronic eruptions and rheumatism.
Alcohol.
Loss of memory [names, dates, etc.]; remembers everything previous to his illness [i.e. short-term memory deficit].
Hopeless; despair of recovery, does not think will ever get better.
Cross, irritable, peevish.
Violent on being opposed.
Feels as if going insane or being paralysed.
The theme of insanity pervades the borreliosis picture. Pains are described as maddening; patients are labelled as crazy by medical practitioners; patients go out of their minds from falling on deaf ears. Descriptions of the mental state induced by Borrelia depict the despair and darkness, the taking away by force of hopes and dreams:
“In this darkness that surrounded me, there was no room left to turn or to run. Only to survive. Days passed like an insect caught in tree sap. Enveloping. A strangely warm, amber struggle in slow motion - a quiet resignation to a world that was filled with nightmare images. Trapped in a mind that knew it had gone insane.”
“I thought I was slowly going crazy, never knowing what the next day would bring.”
“Some days I haven’t a clue what I did two days ago or even that morning. This continues to drive me crazy.”
“After years of being told that I was crazy and then suddenly that I had some type of auto-immune connective tissue disease …”
“I was trying to make sense of it myself, I was grasping at straws for an explanation of what was happening to me. … I felt as if the self I knew was dissolving.”
“Sometimes one can’t hope for better. One can only hope for different. Death is definitely different.”
“When I looked in the mirror I saw someone I didn't recognise.”
“In essence, I was dropping out of life.”
[Citations extracted from the Personal Stories collected on the website Lymealliance.org]
MATERIA MEDICA BORRELIA
Sources
Non-existent in homoeopathy to date, the extensive literature on Lyme borreliosis provides a fine opportunity for the creation of a provisional symptom picture.
The numbers behind the symptoms refer to the sources below from which the symptoms were collated.
SYMPTOMS
MIND
General picture
· “In one U.S. study of 27 patients with late neuroborreliosis, 33% were depressed based on their scores on the Minnesota Multiphasic Personality Inventory. 89% of these 27 patients also had evidence of a mild encephalopathy, characterised by memory loss [81%], excessive daytime sleepiness [30%], extreme irritability [26%], and word finding difficulties [19%]. Controlled studies indicate significantly more depression among patients with late Lyme borreliosis than among normal controls and other chronically ill patients.” [2]
· “A diagnostic tip in favour of Lyme disease as the cause of the depression and irritability might be concomitant memory loss, word finding problems, or a concomitant polyneuropathy.” [2]
Hypersensitivity.
Light.
· Photophobia [keynote]; must wear sunglasses or glacier glasses, even indoors, even at night. [3]
· Feeling of faintness or dizziness form exposure to fluorescent lights, making it difficult to go to supermarkets or other public places. [3]
· Panic attacks triggered by light stimulation, esp. flickering bright lights. [3]
· Nausea from flickering bright lights [fluorescent lights, TV or computer screens, strobe lights during EEG testing or the headlights of cars moving in the opposite line of traffic]. [3]
Sound.
· Ordinary conversation perceived as deafening; wears head phones and puts pillows over his head to block out the sound. [3]
· “To one woman even the sound of another person’s breathing seemed unbearably loud. In her case, the sound sensitivity also included vertigo, nausea and nystagmus in response to sounds. Any sudden sound, like the phone ringing, and certain household sounds, like the running of tap water, could cause her to fall or retch. This peculiar short-circuiting of the inner ear’s auditory and vestibular functions is known as the Tullio phenomenon. This phenomenon has been deemed pathognomonic for syphilis but, as it appears, can occur in Lyme disease as well, and thus provides one more example of the ‘new great imitator,’ Lyme disease, imitating the old ‘great imitator,’ syphilis.” [3]
Smells.
• Smells seem overly intense and noxious. [3]
Taste.
• Foods taste abnormally sour or bitter. [3]
• Or the reverse: loss of taste on left side of tongue. [1]
Touch
· Regional or generalised hyperaesthesia of skin to touch or temperature. [1]
· Sensitivity to touch; “the bed sheet resting lightly on my toe would make the toe ache, like a toothache.” [11]
· “Even the thinness of a sheet was too painful for my legs.” [11]
Vibrations.
· Abnormally heightened vibration sense, eg, thinks car were vibrating with unusual violence. [3]
Emotional lability / mood changes / irritability.
· Accompanied by headache and neck stiffness. [3]
· Sudden, intense irritability from sensory stimulation [sound, touch, light] or occurring unprovoked and inexplicably. [3]
· Sudden, unprecedented fits of violence. [3]
· Uncontrollable outbursts. “A woman, typically reserved and eager to please, became uncontrollably irritable one day at work and found herself yelling at her boss in a most uncharacteristic fashion.” [3]
· Sudden bursting into tears from trifles. [3]
· Fluctuations from marked agitation to severe depression with suicidal threats. [8]
· Rapid mood swings [from grandiosity to sudden tearfulness]. [8]
· Violence; striking children and breaking furniture. [8]
Homicidal ideation, urges, and behaviour occur in some of these patients. Some adult patients describe struggling to not act on these urges. When these patients act on a homicidal urge, more commonly it is a child becoming assaultive to a sibling. Dissociative episodes sometimes occur with these patients, occasionally accompanied by aggressive behaviour and loss of memory. [9]
Cognitive impairment - Lyme Fog
• Short-term memory problems, word-finding difficulties, dyslexia, problems with calculations or inability to concentrate. [1]
Many Lyme patients state “I feel like I have become dyslexic.” Impairment of reading comprehension is an earlier sign with the later addition of auditory comprehension difficulties. Acquired left/right confusion is seen with some of these patients displaying what appears to be an acquired Gerstmann’s syndrome or some variant of this syndrome.* They have problems with calculations and often complain of errors when trying to calculate their check books. Fluency of speech is a very significant problem. When interviewing these patients, this is a clearly evident symptom. Stuttering is seen in many of these patients. [9]
[Boy aet. 5] “I would mix up stories and get cranky. I tried to tell Mom that my brain was ‘sticky’, but she didn't know what I meant. It didn’t hurt, it just wouldn’t work. I would climb up on the sink and put a wet washcloth on my head. On those days, my behaviour was hyperactive and I would stutter.” [11]
“The kicker, though, was the virtually unexplainable difficulty in writing, typing, speaking, and thinking. I'd use the wrong letters, hit the wrong keys, stutter, reverse things, and find myself unable to say the right word. Everyone does this occasionally, but this was consistent and unrelenting. I felt like something poisonous had taken over my brain.” [11]
On interview, patients with Lyme encephalopathy tend to be vague and disorganized in the presentation of the history of their illness. This is despite their close attention to their symptoms and having recounted them many times before. Although in most cases memory of discreet events - tests, dates, diagnoses, responses to medications -- is intact, the patient is unable to recall them spontaneously or organize them in temporal order. They may be unclear as to their chief complaint. They may completely lose track of what they were saying, sometimes repeatedly, or of what the question was. They may get off on a tangent and have trouble re-orienting themselves. Frequent prompting and refocusing will be necessary. beginning the interview with an open-ended question like “Tell me what the problem is” will allow these qualities to become clear.
However their experience is different from that of ADD, in that rather than having the experience that there are many thoughts competing for attention, the Lyme patient has difficulty bringing any thought into clear focus. They experience difficulty thinking. One patient described it as the universe ending six inches from his face. He can’t process information that is not immediately apparent, immediately experienced. Another said that when he tries to think about something, or figure something out, all he can do is repeat the question - he can't get to the meaning. One patient, a physician, described it as a “mental intention tremor” -- the more she tries to focus on something the more out of focus it becomes. [14]
· Brain fog. Problems with facial recognition. [1]
· Spaced out, as if in a fog. [2]
· Difficulty remembering details such as names or appointment times. Engaged in new compensatory behaviour, such as daily list-making. [1]
· Compensatory compulsions are common in an effort to compensate for the memory deficits. [9]
These [Lyme disease] patients generally come to the office disorganised [despite a supreme effort to be organized], unable to give a coherent history. They will bring copious notes, which are invariably in the wrong order. [7]
I used to have a quick mind and a good memory, now I was dependent on notes plastered everywhere so I could remember things. [10]
Mistakes in speaking and/or writing
· “Patients with no prior history of dyslexia have found themselves writing letters backwards, reversing numbers or routinely reversing the first and second letters of a word.” [3]
· Mistakes in time: says “tomorrow” instead of “yesterday” and vice versa. [3]
Spatial disorientation - sense of position [“spatial dyslexia”]
· Loses his way in well known streets. [3]
· Difficulty with spatial awareness of where front and back doors are in one’s own house. [9]
· Disturbed sense of position. “Repeatedly bumps into things on the left side of her body, drops things from her left hand despite having no weakness in that hand and occasionally places objects several inches short of a table edge with the result that they fall to the floor.” [3]
· Disturbed sense of position, esp. in hands; grasps the air when reaching for objects. [6]
· “Everything around me looked strange. The people sounded like cackling geese. Everyone looked like they were in fast motion, like someone had sped up the projector. Every time I turned, I was dizzy and disoriented. I was sweating, and completely lost.” [11]
· “I was getting lost driving to places that I had been to hundreds of times.” [11]
· “I was getting lost in my own neighbourhood when I tried to drive.” [11]
· “I forgot where I was on my way home.” [11]
· “Difficulty ‘recognizing’ things when driving - familiar landmarks lost their meaning; I stopped at green lights, made wrong turns or drove past my destination, even in territory close to home.” [11]
Hallucinations
· Musical hallucinations with a sudden onset and taking the form of patriotic or operatic music. [1]
· “I was hallucinating both visually and auditory. I heard phones ring when there were none. I saw shadows twist into menacing shapes. I heard voices talking. At night, I saw flashing lights fill my vision, and my ears were constantly buzzing with static and ringing. I felt for the first time that I might be truly going mad.” [11]
· [Upon awakening in the night] “A skeleton hallucination in black and white, looking at me, grinning a very toothy smile, head cocked, propped up by one arm.” [11]
Intrusive thoughts/images
· Intrusive obsessional thoughts with checking; horrific images of killing others; excessive bathing. [8]
· Intrusive images which are more commonly of an aggressive nature but sometimes can be of a sexual or other nature. Occasionally these images are of a homicidal nature. [9]
· “My mind was a hopeless jumble of uncontrolled thoughts - images and sounds that haunted me. It was as if several minds had been merged into one, and there was no way to sort the images.” [11]
Fears
• Chronic morbid dread of vomiting [without actual emesis]. [6]
• Panic attacks in sleep. [11]
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