<s>[INST] i have body dysmorphic disorder , for which i am being treated with fluvoxamin 50mg, twice daily, lonazep..5mg in the nite and .25 in the morning, although my thoughts regarding the body obsession have improved, but i am feeling very lethargic and have lot of pain in the eyes, and is difficult to keep my eyes open and feel like lying down all the time, but dont get rest. please help. well, i am 53 years old male(indian). i have been suffering since last 30 years from thoughts of male inadequacy, although physicaly things are alright, i think that i have a feminine face , hands, and have subnormal genital organs, and these thoughts torment me regularly, i have been on various kinds of anti depressants, ssri also but to no avail. i suffer from E.D. as well and i am not married. please help [/INST] Hello.  Thank you for sharing the details of your problem. Fluoxetine is probably helping you by suppressing the obsessive nature of the thoughts. But the fact is that you may still need to work on your thoughts.  The best addition you can make to the current treatment regime is that of Psychotherapy. Cognitive Therapy is immense potential in treating Body Dysmorphic Disorder. The disorder is eventually nothing but your thoughts about self. And there are probably a lot of irrational beliefs hidden under the surface thoughts of "looking feminine". Going in for Psychotherapy can help you explore those core beliefs and thoughts, modify them so that they do not create the emotional disturbances, and lead a much happier life. It might take care of the other problems such as the ED.  Hope this helps.  Abhijeet Deshmukh, MD </s>