I have OCD and ruminate about doubts and what-ifs such as what if I lose my mind or what if I develop the early onset of dementia. When I go shopping or eat out at a restaurant it feels like I’m watching myself in a film where the quality of real life seems to have become lost in the slow rhythm of the “movie”.

This sensation is often referred to as a dissociative state, often brought on through stress or extreme anxiety.

What can I do?

Well first, let me explain how imagined possibilities in OCD are focused 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 happen simply because they thought about it. This is despite knowing the idea is irrational. Now add to the experience a dissociative state and you’ll see how TAF is very similar. That is, you think the likelihood of developing the early onset of dementia or losing your mind during an intense dissociated episode outweighs the higher possibility that you won’t. The overwhelming sensation overrides sensible reasoning, similar to the imagined possibilities seen in OCD – e.g., what if my lack of concentration really means I’m losing my memory.

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 do some shopping and your usual response is to avoid/escape that situation then you would learn to cope differently. That is, you would go to the supermarket and put into practice emotion management techniques during your exposure.

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

The best thing to do is identify and note down the situations that trigger your panic attacks? 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. Using mindful techniques means using some or all of your senses. For example, sucking a boiled sweet and thinking about the taste as you work your way down the shopping aisles is mindful; also, focusing on the smells when you pass the freshly baked bread counter; 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 are other mindful ideas. Tuning into all of your 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?

There are different types of stress-induced dissociative states. These include derealisation, depersonalisation, identify confusion and dissociative amnesia. While these states are unpleasant, you can learn to live with them.

How?

By following the self-affirmations below you can train yourself to become less threatened by your symptoms whilst building on your emotion-management skills – realistic self-statements can help you adjust your senses for coping with 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 other wise – 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.”

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

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Disclaimer: this article is written from my own experience of dissociative states and the accounts of others experiencing similar sensations. Please consult with your doctor if you experience these symptoms and to rule out other possible causes.

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