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What Is Body Dysmorphic Disorder?

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What Is Body Dysmorphic Disorder?

Mandy Rosenberg, 35, from Brookfield, Wisc., has always drawn attention because of her looks. With her long blonde hair, athletic build and large blue eyes, she was called Barbie by some of her high school peers.

But even though people often told her that she was pretty, she didn’t view herself the same way.

She’d spend hours staring at a tiny blemish on her forehead that was barely visible to others. In her mind, it was a large and unsightly scar, and she would climb on top of her bathroom sink to get as close to the mirror as possible while examining it.

“If I couldn’t make that go away, I didn’t want to live anymore,” she said.

Ms. Rosenberg didn’t know it at the time, but she had both obsessive-compulsive disorder and body dysmorphic disorder, or B.D.D., a mental health condition that causes people to spend an inordinate amount of time worrying about their appearance — to the point where they may isolate themselves from others and feel imprisoned in their own bodies.

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People with B.D.D. not only think they look unattractive but can become convinced that others will reject them because of their flaws.

“They often feel they’re unlovable,” said Dr. Katharine Phillips, an expert in B.D.D. and a psychiatrist at Weill Cornell Medicine and NewYork-Presbyterian.

Those with B.D.D. fixate on perceived cosmetic problems that to others appear unnoticeable or minor. But it’s not about vanity; instead, people with B.D.D. feel extreme anguish that impairs their functioning.

The disorder typically emerges during adolescence and is estimated to affect 2 to 3 percent of the general population, but these numbers may be conservative because the disorder is underdiagnosed.

Studies have shown differences in the brains of people with B.D.D., said Dr. Jamie Feusner, a professor of psychiatry at the University of Toronto Temerty Faculty of Medicine. Some of his research has found that in those who have the condition areas of the brain that help us view things holistically are underactive.

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This might be part of the reason that people with B.D.D. have trouble viewing their imperfections as small relative to their entire face or body. It’s akin to looking at a window with a smudge on it, then “thinking that the whole window is ruined,” Dr. Feusner said.

Patients with B.D.D. aren’t always aware that their concerns stem from a mental health problem. Instead, they often believe wholeheartedly that they have physical defects.

Because of this, someone might suffer for a decade or more before seeking help from a mental health provider, said Hilary Weingarden, a psychologist in Massachusetts who studies O.C.D. and related conditions.

Instead, “they’re going to their dermatologist and a plastic surgeon and the dentist and the aesthetician,” she said.

But trying to “fix” their appearance only serves to maintain and exacerbate their anxiety in the long run.

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People with B.D.D. may withdraw from relationships, avoid attending work or school, and spend an excessive amount of time on repetitive behaviors like examining themselves in the mirror, attempting to camouflage their appearance or seeking reassurance from others.

Chris Trondsen, a therapist in Costa Mesa, Calif., who diagnosed Ms. Rosenberg with B.D.D., said his patients admit to spending hours chatting with artificially intelligent bots, both seeking affirmation and asking what they ought to fix.

“If you ask a human, people are going to get fed up answering the questions,” Mr. Trondsen said.

Mr. Trondsen was inspired to study psychotherapy because of his own struggle with B.D.D. He used to fixate on his complexion and other parts of his body, too. He worried that his nose was too large for his face and that his body wasn’t muscular enough, a form of B.D.D. called muscle dysmorphia.

“I kept thinking I was getting uglier,” Mr. Trondsen said.

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Like many patients with B.D.D., he also spent hours checking his body in mirrors and rarely left his apartment. At 21 years old, Mr. Trondsen became so isolated and consumed by his appearance that he attempted suicide, and might have died had his roommate not discovered him. After that, he sought help and was diagnosed with O.C.D. and B.D.D.

It’s common for those with B.D.D. to also have conditions like O.C.D., major depressive disorder, social phobia and substance use disorder. Studies indicate that people with B.D.D. have high rates of suicidal ideation and behavior, too. One meta-analysis found that, across a patient’s life span, about 66 percent of those with B.D.D. will have thoughts of suicide and around 35 percent will attempt it.

Cognitive behavioral therapy for B.D.D. has been shown to lead to remission in more than half of patients. It includes exposure and response prevention, which is meant to help patients gradually confront the things that they have been avoiding or the rituals they have become dependent upon, like hiding parts of their body with clothing or makeup.

Therapists try to help patients view themselves more holistically, emphasizing that there’s more to them than the specific parts of their bodies they scrutinize.

The disorder can also be treated with serotonin reuptake inhibitors, or S.R.I.s., often at high doses. For those with severe B.D.D., both medication and C.B.T. are recommended, Dr. Phillips said.

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For Ms. Rosenberg, cognitive behavioral therapy with her former therapist, Mr. Trondsen, gradually helped her condition.

Later, as part of her treatment, she created a diagram showcasing all of the things that contribute to her identity: She is a daughter and a faithful Christian, she loves dogs and cats, she is a teacher, she is caring — she is more than just her looks.

My body, she said, “doesn’t get to determine how I go about my day.”

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More middle-class Californians cancel health coverage after losing federal aid

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More middle-class Californians cancel health coverage after losing federal aid

Facing higher premiums and the loss of federal subsidies, 374,000 people with health insurance from the state marketplace known as Covered California canceled their coverage in the first three months of the year, according to government statistics.

The cancellations amount to 19% of those who had renewed their policies on the state marketplace during open enrollment, state officials said. Those cancellations are higher than in the past three years when they ranged from 13% to 15% of those who renewed.

Jessica Altman, executive director of Covered California, attributed the jump in cancellations to the expiration of enhanced federal subsidies that caused the cost of a plan to leap for most middle-class Californians.

“We expect coverage losses to increase through the year,” she said.

Overall, Covered California had 1.8 million enrollees in February, down from 1.94 million the year before — a decline of 7%.

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Altman said monthly enrollment numbers are delayed because consumers have a three-month grace period to resume their premium payments before the insurance carriers end their coverage for nonpayment.

This year, many middle-class Californians who depend on the state-run insurance marketplace created under the Affordable Care Act faced annual costs that were hundreds of dollars higher than last year because of the end of enhanced federal subsidies that began during the COVID-19 pandemic.

In 2021, Congress voted to temporarily boost the amount of subsidies Americans could receive for an ACA plan.

The law also expanded the program to families who had more money. Before that 2021 vote, only Americans with incomes below 400% of the federal poverty level — currently $62,600 a year for a single person or $128,600 for a family of four — were eligible for ACA subsidies. The 2021 vote eliminated the income cap and limited the cost of premiums for those higher-earning families to no more than 8.5% of their income.

On top of the loss of the enhanced federal subsidies, the average premium charged by insurers this year for a Covered California plan rose by more than 10% because of fast-rising medical costs.

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The decline in ACA plan enrollees, however, has been greater in some other states. California has tried to keep people insured by using state tax money to fill in the gap for lower-income families.

This year, the state budgeted $190 million for premium subsidies for people with incomes of up to 165% of the federal poverty level.

In his budget plan, Gov. Gavin Newsom proposed spending $300 million on those state subsidies in 2027. That would expand the subsidies to enrollees with incomes up to 200% of the federal poverty level, or $31,920 for an individual or $66,000 for a family of four.

“We may actually see a number of Covered California enrollees paying less in 2027” because of the additional state subsidies, Altman said.

In May, Newsom also proposed in his budget that an additional $27 million in state money be used to help enrollees pay for the cost of gender-affirming care. That amount is an increase to the $30 million that he earlier proposed be spent this year and next to defray those costs for Covered California enrollees, according to state officials.

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Last year, federal health officials enacted a rule that said the federally subsidized ACA plans could no longer cover gender-affirming care because it was no longer considered an “essential health benefit.”

Newsom’s proposed budget still faces debate in Sacramento and approval by the state Legislature.

The state marketplaces, created by the Affordable Care Act, also known as Obamacare, were meant to help those who don’t have access to an employer’s health insurance plan and have incomes too high to qualify for Medi-Cal, the government-paid insurance for the poor and disabled.

Because of the higher cost this year, more people are choosing the lower-priced Bronze plans. Those plans have higher co-pays and deductibles than the more expensive plans.

“We’re very concerned with the large shift to Bronze,” Altman said. “When you have higher cost-sharing, you’re more likely to defer care.”

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Political play or budget fix? Competition for JPL’s management comes at a fraught moment

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Political play or budget fix? Competition for JPL’s management comes at a fraught moment

Weeks after Trump administration officials announced that management of NASA’s Jet Propulsion Laboratory would open to competitive bidding for the first time, questions remain as to why Caltech could lose control of the lab its researchers founded in 1936.

On one hand, observers note, high-profile delays and cost overruns on significant recent JPL projects earned sharp criticism from NASA even before the 2024 presidential election.

On the other, the second Trump administration’s record of squeezing scientific funding and attacking institutions in Democrat-led states make it difficult to consider any action separate from the charged political atmosphere, analysts say.

“My first instinct is that this [competition] isn’t necessarily a bad thing. It’s not written in stone that Caltech must run JPL, and it wouldn’t be the worst thing to have some competition for running the place,” said Casey Dreier, chief of space policy at the non-profit Planetary Society.

“That said, that requires this contract evaluation to be fair and unbiased, and this administration has no credibility in such things,” he added. “The responsibility is on NASA to earn the trust and ensure such an evaluation is open and free from political meddling. That’s almost impossible.”

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JPL became part of NASA when the space agency was formed in 1958, and Caltech has been awarded the contract to run the institution outright ever since.

Its current 10-year contract with NASA, which is valued at up to $30 billion, runs through Sept. 30, 2028.

NASA Administrator Jared Isaacman announced the competition on May 22 as part of a slate of sweeping organizational changes at the space agency.

“When you step back, it is worth considering how many additional missions we could have undertaken with the resources lost to program cancellations and cost overruns over the years,” Isaacman wrote in a memo to staff. “That is the problem we must fix, so the American taxpayer and space-loving community can receive the highest scientific return on every dollar we spend at NASA.”

Competing the contract for JPL, the lone Federally Funded Research and Development Center (FFRDC) in NASA’s portfolio, was an effort to address cost-efficiency concerns, Isaacman wrote.

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“This process will take several years, and I do not anticipate it having any impact on the projects underway or the location of the facilities,” he wrote. “It does, however, provide an opportunity to evaluate management costs, overhead burdens, and ideally find ways to get after the science faster and more affordably.”

In a joint statement, Caltech President Thomas F. Rosenbaum and JPL Director Dave Gallagher said the competition was “no surprise” and that a team was already in place “to ensure we are positioned for success.”

In July, NASA’s Office of Procurement held an informational event for companies and institutions interested in the upcoming FFRDC contract.

The dozens of registered attendees included universities like USC, Texas A&M University and Georgia Tech, aerospace companies such as Boeing and Lockheed Martin and nonprofit corporations like MITRE, which manages several FFRDCs, and Universities Space Research Association, a university consortium founded by the National Academy of Sciences in 1969. (SpaceX, which has been awarded more than $13 billion in NASA contracts in the last decade, was not on the list.)

“Lockheed Martin has more than 50 years of deep space exploration success with JPL, supporting landmark missions to Jupiter, Venus, Saturn, Pluto, including nearly a dozen missions to Mars,” said Bob Behnken, VP of Exploration and Technology Strategy. “We look forward to building on that unmatched partnership in the years ahead. We are closely following NASA’s review and will continue to assess how we can best contribute to the agency’s mission.”

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Other attendees contacted by The Times declined to discuss their involvement.

Isaacman indicated that JPL could come under scrutiny even before he took over NASA. The billionaire entrepreneur referenced high costs at the La Cañada Flintridge institution in a memo prepared in advance of his confirmation hearings on his priorities for the space agency.

“Contract structure: Very expensive,” Isaacman wrote of JPL in a table outlining organizational issues at each of NASA’s centers. “Must increase the output and ‘time-to-science’ KPI.”

The institution has recently suffered a number of high-profile management stumbles.

After the JPL-managed Psyche mission to a metal-rich asteroid failed to meet its 2022 launch date, NASA commissioned an independent review that said internal reorganizations and personnel changes created distracted and uninformed managers and burned-out, stretched-thin staffers.

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After a 2023 independent review found there was “near zero probability” of the JPL-managed Mars Sample Return mission making its proposed 2028 launch date, and “no credible” way to bring rocks back from the Red Planet within the stated budget, Isaacman’s predecessor Bill Nelson put out a call for proposals to industry and all other NASA centers, forcing JPL to compete for its own project.

After Trump’s election, Nelson announced that the final decision would be in the next administration’s hands.

The White House pushed for massive cuts to NASA’s 2026 budget that Congress overturned, and has lobbied for similarly steep cuts again this year. JPL has instituted painful cost-cutting measures of its own, reducing staffing from roughly 6,500 employees in 2023 to 4,500 last year through layoffs and attrition.

Its struggles come at a point when NASA is enthusiastically embracing private industry. Last month the agency awarded several key contracts for its upcoming lunar missions to Jeff Bezos’s Blue Origin and other private companies.

Trump has also made no secret of his willingness to punish states that haven’t voted for him through job losses. In announcing his decision to move U.S. Space Command from Colorado to Alabama, Trump acknowledged that his loss in Colorado in three presidential elections played a part in the move.

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It’s impossible to consider any decision on JPL’s future separate from the administration’s track record of politically-motivated decisions, Dreier said.

“At the heart of this is why? Why now? If this is not just some rank political attack on California, what do they hope to gain from this?” Dreier said. “That deserves explanation, because the administration otherwise has no credibility here.”

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Dive Into a Very Noisy Sea With Some Very Rare Whales

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Dive Into a Very Noisy Sea With Some Very Rare Whales

The Gulf of Mexico, which the Trump administration calls the Gulf of America, is one of the noisiest bodies of water in the United States. Air gun blasts are the loudest element there, according to research by scientists who monitor underwater acoustics. Shipping traffic is another major contributor.

The noise could affect the ability of Rice’s whales to find food and mates, scientists say. The chronic stress of living in a loud environment could be detrimental to their health.

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