Question: “I’ve been diagnosed with OCD coupled with depersonalisation/derealisation and I ruminate on doubts and what-ifs about losing my mind or getting the early onset of dementia. It feels like I’m watching myself in a movie where the quality of life seems to have become lost in the slow rhythm of that movie. Why does this happen?”

This a sensation that would fit with derealisation brought on through stress or extreme anxiety, including distress associated with obsessive compulsive disorder.

What can I do?

Well first, let me explain how imagined possibilities in OCD focus on faulty reasoning linked to thought–action fusion (TAF). What happens with TAF is that a person thinks as though their obsessive-related fear will be more likely to occur despite knowing this is irrational. Now add to the experience derealisation and you’ll see how TAF is very similar. That is, you think the likelihood of developing the early onset of dementia/Alzheimer’s during an intense derealised or depersonalised state outweighs the higher possibility that you won’t.

But it feels so real.

This is because the sensation is so overwhelming that all reason is lost to the fear associated with the feeling that one’s surroundings are not real (derealisation), similar to the imagined possibilities seen in OCD – e.g., “what if my lack of concentration means I’m losing my memory?” Basically, this is a dissociative condition which is a mental shift in the perception or experience of the external world so that it seems unreal. This shift or alteration in perception does not affect your basic character, it is a symptom of stress remember.

What are the solutions?

Emotion management and attention training can help you manage these dissociative states. What you would do is learn to use techniques that are very similar to facing your fears as you would if you were doing exposure response prevention for OCD.

Can you clarify?

Yes, in graded steps you would face your fears (exposure) while resisting doing your usual “safety” behaviours (response prevention). So if one of your fears is going out of the house to get some shopping and your usual response is to avoid/escape then you would learn to cope differently. That is you would go out shopping and put into practice emotion management techniques during your exposure. When you experience symptoms that make you feel as though your environment is lacking in emotional colour and naturalness and you cannot grasp hold of that crisp and clear awareness in your present surroundings, you would try to ride with it, because everything is natural, you’re just not experiencing it.

But what if I get a panic attack? I can’t do anything once I’m in a state of panic.

One tip is to identify situations that trigger your panic attacks? For example, you could write a list of situations that are stressful for you. Doing this can help you get prepared. By being prepared you can use coping methods like awareness/breathing techniques for managing lower triggering situations first, and then building on intermediate and higher triggering situations with mindfulness techniques. These can include sucking on a boiled sweet and thinking about the fruity or minty taste as you work your way down the shopping aisle; focusing on the smells when you pass by the freshly baked bread; deliberately tuning into the music playing in the background; taking notice of the specific style and size of the text on products and guessing the font (e.g. Arial, Freestyle Script etc.); and taking note of various textures when choosing your items. Tuning into all of your five senses is helpful and keeps you more in control.

When I get this sensation I also feel separated from myself or that I might have changed appearance, and other times I forget certain things, like sometimes I cannot recall what I did the day before. Why is this?

Well, depersonalisation is a state in which one’s thoughts and feelings seem unreal or that they don’t belong to you. There are different types of stress-induced dissociative states. These include the ones previously discussed (derealisation and depersonalisation). Others include identity confusion and dissociative amnesia. While these states are unpleasant, you can learn to live with them.

As well as mindfulness techniques, how else can I learn to live with them?

By following the self-affirmations below you can train yourself to become less threatened by your symptoms whilst building the skills you need to re-adjust and manage these sensations.

Self-affirmations

For derealisation: “I have the sensation that makes me feel that I am not real, that the things around me and what’s happening are not real; yet everything is real, so I can relax and be calm, and continue what I’m doing.”

For depersonalisation: “This is a detached feeling caused by my anxiety (or stress), and will be easier to manage the calmer I remain.”

For identity confusion – I feel like my appearance/voice has changed, or that I’ve forgotten how I look, or who I am; but these are sensations only, therefore I will redirect my attention with mindful distractions.”

For dissociative amnesia: “I am not going insane, neither do I have memory loss linked with dementia/Alzheimer’s, I simply find it difficult to recall certain events or recent information due to stress/anxiety. I will stand back, take a breath, observe my thoughts, put in some perspective, and then mindfully distract.”

Ongoing symptoms: “I have feelings of dissociative states and feel threatened that this indicates the early onset of dementia/Alzheimer’s; that I’m going crazy; or that I might have a brain tumour. However my experiences are showing me otherwise – that is, that my symptoms are proving that these are sensations only and are stress-induced. I will adjust to these sensations and allow them to come and go.”

To summarise, embracing dissociative experiences whilst shopping (or doing something else) is achievable and reduces the chance of fear and panic.

Photo Credit: flickr.com

Disclaimer: this article is written not only through studies for my diploma in CBT but also my experience with dissociative states and the accounts of others experiencing similar sensations. However, as a complementary health therapist, I advise anyone experience these symptoms to consult with their medical practitioner in the first instance, and to rule out other possible causes.

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