Derealization: Anxiety’s Strangest Symptom

This…thing used to happen to me.  I started noticing in junior high, but it might have been there all my life.  It would start as a moment of intense deja vu.  As the deja vu faded, a dreamy feeling would overtake me.  Then, for a few minutes, I’d feel totally detached from the things I identified as my “self.”  The entire episode would be over in under ten minutes, and it wasn’t exactly unpleasant.  More just…strange.  I tried to explain the symptoms to my parents, but they weren’t sure they understood.  “I think that sort of sounds familiar,” my mom said.  “Maybe I had it when I was a kid.  I can’t remember.”

Later, I noticed a similar phenomenon: a feeling of unreality, of dreaming, of separation from real life and all its trappings.  That feeling could last all day.  After 9/11, I had it on and off for months.  And, though it may sound kind of fun on paper, this feeling was awful.  I knew it related to anxiety, but I didn’t understand it and couldn’t think clearly while experiencing it.

During these episodes, it felt like anything could happen, and not in a good way.  Aliens might invade.  Dinosaurs might wake from beneath the earth and eat us.  During these episodes, nothing could surprise, but everything could terrify.  I suspected that I might be developing schizophrenia.

When I first heard the terms “depersonalization” and “derealization,” I nearly cried.  I wasn’t developing psychosis, I was experiencing a relatively common symptom associated with anxiety disorders.

Depersonalization is the feeling of being attached from one’s self.  Sufferers sometimes feel like robots, going through motions without thought or feeling.  Some feel like they’re watching themselves from a distance.  For me, depersonalization was simpler–just the complete feeling of detachment.

Derealization is almost impossible to explain, I think.  Wikipedia says “[d]erealization… is an alteration in the perception or experience of the external world so that it seems unreal,” but nothing in that description indicates how truly terrible this experience can be.  Derealization is the feeling of dreaming while you’re awake.  Derealization is unshakable deja vu or jamais vu.  Derealization is uncrossable distance between you and the things and people you care about.  In my opinion, derealization is hell on Earth.  Nothing I’ve experienced, except for the apex of a true panic attack, is as awful or crippling.

It’s very common to experience depersonalization and/or derealization during periods of intense stress.  I certainly experienced some degree of both during panic attacks.  In a horrifying situation, the feeling of unreality can be a comfort.  “Spontaneous” derealization, however, offers no benefit.  And, though we know episodes of derealization are related to mental illnesses such as Panic Disorder, doctors don’t know exactly what’s happening in the brain during an episode.  People who suffer from epilepsy also sometimes experience derealization, and derealization does not cause hallucinations or delusions.  I know that I can trigger derealization by sleeping too many hours or being alone for too long.

The best–maybe the only–way to fight an episode of derealization is to practice mindfulness.  Sufferers are encouraged to pay close attention to their surroundings.  When I have an episode, I go outside and just observe.  I touch trees and walls.  I count hats or coats or people who seem happy.  I don’t think about life’s big questions or my place in the world, because I know that I need to be present in order to regain my feeling of reality.

If your child may be suffering from depersonalization or depersonalization, explain that it’s related to anxiety and not psychosis (“going insane”).  Give your child an age-appropriate vocabulary to describe his experience.  Encourage him to stay in the moment by making a game of observation: how many things in this room are purple?  Go outside with your child and make him touch the real world.  

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Please Don’t Make My Students Cry

One of my after-school students recently came home from his school in tears.  His third-grade class had watched a documentary about underwater exploration, and the idea of being stuck in a submarine had given him anxiety.  After the movie, his teacher said something about the class taking a field trip in a submarine; I wasn’t there, but I think she was trying to encourage the students to imagine going in a submarine.  My student misunderstood (probably because he was already anxious) and cried out, “Do we have to go in the submarine?”  His teacher apparently responded with something like, “[student], why are you always so scared of everything? You’re going to ruin the activity for everyone.”  According to my student, the teacher was very annoyed with him.

Again, I wasn’t there, so it’s possible that my student misinterpreted his teacher’s feelings.  He might be wrong about what she said or how she said it.  I hope he’s wrong, because the idea of an adult–a teacher–speaking that way to one of my students is very upsetting.  The idea of a teacher speaking that way to any anxious student is upsetting.  See, I would hope this teacher would be sensitive to my student’s feelings since she obviously knows that he struggles with his fears.  What she doesn’t know is that he has Generalized Anxiety Disorder (GAD), a condition “characterized by persistent, excessive, and unrealistic worry about everyday things.”  In fact, it’s very likely that this teacher doesn’t even know what GAD is; unlike depression and Obsessive-compulsive Disorder, GAD isn’t typically discussed in pop culture, and most teaching programs do not require training in psychology.

My student’s family has not disclosed his condition to his school.  They have chosen not to pursue accommodations for their son because they worry about stigma and discrimination, very real risks.

This incident inspires several questions.  First, should parents report their children’s mental illnesses to their school?  Second, was my student’s teacher out of line in her criticism of my student?  In considering that question, assume she really said what my student believes she said, and that she exhibited some amount of anger when she made those statements.  Finally, and most importantly, should all teachers be required to complete some amount of training in psychology?  Teachers are increasingly knowledgable about learning disabilities and the Autism spectrum (not knowledgable enough, many parents will say, and I agree), but childhood mental illness is largely ignored in both certification and continuing education programs for teachers.

Please share your feelings in the comments, and stay tuned for posts about disclosing your child’s mental illness and psychology training for teachers.

All stories about my students are shared with permission from the student and her/his family.

Surprising Anxiety Trigger 7: Something That Happened a Long Time Ago

Your daughter watches “Finding Nemo” for the first time and becomes very upset when Nemo’s mother dies at the start of the film. You comfort her appropriately, and she seems to recover. After all, children are surprisingly resilient, and your daughter will surely forget all about the scene soon. Weeks (or even months) later, your daughter starts displaying unusually severe separation anxiety. She’s reticent when questioned, but you assume something very recent has triggered her increased anxiety.

Unfortunately, though children are indeed resilient, they often become haunted by the scary things they see in life, on TV, and even in dreams. Sometimes they dwell on things that frighten them, spending days reliving their fear. In other instances, the scary event only slips into their minds when triggered by unrelated anxiety, random association, or perhaps a relevant song. Either way, children often feel embarrassed by their inability to release scary memories from the past. Encourage your child to share her feelings by listening with interest, respect, and love. Never mock a child for dwelling on old fears; you may be tempted to say “You’re still upset about that?” but it’s important that you display support instead.

If your child expresses lingering or recurrent anxiety about a minor trauma in the past, explain that it’s normal to sometimes feel stuck with a fear, and then help her address the fear directly. Humor can be helpful (“I promise not to get eaten by a fish”) if your child fears supported and respected. If your child cannot release her fear, it may be necessary to discuss the issue with your pediatrician or mental health professional.

If your child has experienced significant trauma in the past, it’s crucial that you speak to an expert as soon as possible.

PRESSED: Jennifer Lawrence criticizes mental illness “stigma” – Movies News – Digital Spy

Published Monday, Feb 25 2013, 6:35am EST | By Catriona Wightman |3 comments

Jennifer Lawrence has revealed that she wants to reduce the stigma surrounding mental illness.

Lawrence picked up the ‘Best Actress’ Oscar for her role as Tiffany in Silver Linings Playbook last night and later said backstage that she hopes the movie has helped to break taboos about mental health.

“I don’t think we’re going to stop until we get rid of the stigma for mental illness,” she said. “I know [director] David O Russell won’t, and I hope that this helps.

“It’s just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it’s such a stigma behind it.”

Lawrence also joked with reporters when one journalist asked if she is worried that she has “peaked too soon” in her career, as she replied: “Well, now I am! God!”

via Jennifer Lawrence criticizes mental illness “stigma” – Movies News – Digital Spy.

Surprising Anxiety Trigger 6: Music

This is the sixth installment of the ongoing series of surprising triggers of childhood anxiety.

We all know that music can dramatically influence mood, but it’s easy to forget that songs have different effects on different people. Songs are often strongly associated with specific memories: Though I believe the song came out years earlier, “We’re Going to Be Friends” by The White Stripes conjures my senior year in high school so dramatically I get almost giddy when I hear it; 12th grade was one of the best years of my life. Alternately, I can’t listen to Sum41’s first album (and luckily wouldn’t care to anyway) because it brings me back to the anxiety and despair of eighth grade. Children have fewer things to remember, but they may also associate songs with memories. A favorite family lullaby heard while away from parents might trigger separation anxiety, or a song from a scary movie (and remember, children are often scared by seemingly benign movies) might cause sudden unease. These associative memories are too complex for most young children to express, so it’s up to parents, caregivers, and teachers to help anxious children explore their fears.

Even if you’ve never heard a song before or don’t have any strong associations to it, some music just makes you feel bad. Sometimes a piece of a lyric can be scary, or sometimes there’s a scary story being told. I mentioned before that “She’ll Be Coming ‘Round the Mountain” was agonizing for me in preschool because I took the lyrics to mean that the singer’s mother was coming but hadn’t yet arrived–and she never even gets there! Also, don’t underestimate the effects of a “plaintive melody” or a dramatic swell. For most people, the melody of the song is actually more powerful than the lyrics. (Yesterday, my roommate pointed out the story being told in “Sittin’ on the Dock of the Bay.” It’s not as whimsical as you might guess.)

If your child or student becomes distressed during a song, it may be helpful to ask the child whether she’s heard the song before, and where. Next, explain that songs can make you remember something really strongly or even just make you feel a strong emotion. Education, understanding, and training are the best tools to mitigate anxiety, so always use anxiety attacks as “teaching moments.” Then, after the anxiety has been addressed, use distraction to help your child feel normal again. And consider changing the song!

Class Participation Part 3: Introversion, Shyness, and Social Anxiety

This is the third installment in my Class Participation series. Today, I’d like to discuss how forced participation in class discussion affects introverts, shy kids, and students with social anxiety.

Introvert, Shy Kid, or Student with Social Anxiety Disorder?

The term “introvert” is most useful when considered as distinct from “shyness.” Introversion relates to the desire to engage in social interaction, whereas shyness relates to difficulty engaging in social interaction. One of my favorite definitions of introvert is “someone who is energized by being alone.” In this context, an extrovert is someone who is energized by being in a group. I’m an introvert, so I’m easily exhausted by large groups. I often crave time alone. Extroverted friends have expressed confusion about my desire for alone time. I’m similarly confused by these friends’ desire to spend the majority of their time surrounded by others. “If I’m alone, I get depressed,” says the extrovert. “If I’m surrounded by others, I get tired,” says the introvert.

The most important thing to remember about introverts and extroverts is that neither is better that the other. It’s unnecessary and potentially harmful to try to force someone to switch from one to the other.

Shyness or social anxiety can occur in both introverts and extroverts. Shyness can prevent students from expressing themselves and engaging in positive social interaction, so it may actually be beneficial to lovingly encourage shy students to “come out of their shells.”

Social Anxiety Disorder (SAD) is distinct from shyness primarily in that people with SAD experience “fear and avoidance… so severe that they significantly interfere with … daily functioning, school, work, or relationships.” Social Anxiety Disorder is a serious disorder that must be diagnosed by a mental health professional.

Should a teacher allow her students to opt out of class activities just because the student doesn’t like the activity?

All children are born with temperaments and tastes, but it’s important for adults to encourage and allow children to try a variety of activities and personas in order to facilitate emotional growth and self-discovery. Parents know to insist that their children try at least “one bite” of new foods. We know to take children to ballet class and soccer practice and chess club because young children really don’t know what they’ll end up loving. But, when a child clearly expresses an opinion about something that they’ve tried, it’s important to listen. Remember, children are human beings, and they do understand suffering and pleasure. If your child adamantly insists that she hates soccer, you probably shouldn’t sign her up for the team next year. (Obviously issues like these can be somewhat complex, and parents have to use their own judgement. A child who hates vegetables, for example, is likely to benefit from continued exposure.)

We all know that classrooms can be overcrowded and teachers can be overtaxed. As I’ve mentioned, class discussion is a relatively easy way to ensure that students are engaging in some way with class material. I dislike class discussion for several reasons, but today I’m focusing on whether it’s appropriate to force introverted, shy, and anxious students to participate in discussion.

Introverted children who are not disordered are unlikely to suffer psychological harm due to forced participation in discussion, but they’re also not particularly likely to benefit from traditional discussion. As an introvert, I learn best working on my own or in a small, intimate group of intelligent peers. Class participation tends to bore and alienate me, and I only speak up when I have something relevant and unique to say. Reducing the grade of students who share selectively is, in my opinion, absurd. However, a dedicated teacher might engage introverted students by directly asking them specific, interesting questions, or by asking whether they agree with the dominant discourse of the discussion.

Shy kids will suffer when forced to participate in class discussion, but they may also benefit from gentle encouragement. A shy extrovert in particular is likely to thrive in a supportive classroom with a teacher who slowly increases the amount of required participation in class discussion.

How much can a teacher help a student with Social Anxiety Disorder?

As with all anxious children, students suffering from Social Anxiety Disorder can greatly benefit from gentle encouragement. Incremental increases in participation in class discussion may help a student with SAD reduce the severity of her disorder. However, a teacher without proper training is NOT a therapist and should not be prescribing a therapy regimen. I can’t stress this enough: a child with Social Anxiety Disorder should be under the care of a mental health professional, and that professional is likely to prescribe exercises designed to help the child manage her anxiety. Teachers of anxious students should educate themselves, treat their students with respect and empathy, and work with the parents and therapists of their anxious students.

Everyone needn’t be the same!

It’s common knowledge that students have different learning preferences, tastes, and strengths. Trying to homogenize students is futile and, more importantly, bad for society! We need students who love limelight and students who work backstage, students who love reading and students who prefer creating, students who obey and students who rebel. Every student deserves the chance to be her best self. Moreover, school should be enjoyable! Hard work and joy are not mutually exclusive. While it’s important for teachers to push children out of their comfort zones, students should never be punished for anxiety, and they should not be expected to become little copies of their teachers.

Coming up: how to make class discussion effective and enjoyable for everyone

Parents of Anxious Kids–Please Join Our FREE, ONLINE Support Group!

In order to meet the needs of parents outside the New York City area, I have moved my support group from Meetup.com and am instead offering free online meetings via Google+’s video conferencing tool (“hangouts”).  To attend a meeting, all you need is access to a free Google+ account.  Setting one up is easy and only takes a minute.  Please consider joining our group, and tell your friends!  More members means more support.

Click here to join!

Don’t be Afraid of the Big Bad Blizzard

You might be worried about losing power. You might be looking forward to gathering around the fireplace. You might be scrambling to reschedule your afternoon meeting or that early Valentine’s dinner date with your spouse. There’s a lot to think about as this blizzard approaches, but don’t forget that your anxious child maybe struggling with irrational and agonizing fears. Follow these tips to help your anxious child through the snowy weekend.

If your anxious child has never experienced a blizzard, be sure to tell her what to expect. Address rational fears like a power outage, but emphasize positives like family time, adventure, and beautiful snow.

Indicate that you and your family will be safe by acting calm and prepared, even if you’re worried about the storm.

Involve your child in your storm preparations. Explain how each action you’re taking will help keep your family safe.

If you lose power, make it an adventure. Play board games in the dark, tell stories by candlelight, or sing songs together.

Shelter your child from sensationalist media.

Avoid using language that indicates or implies that this storm is the worst storm ever or the end of the world or unlike anything we’ve ever seen. Help your anxious child understand that major storms are common and manageable.

If your child was traumatized by Super-Storm Sandy, explicitly explain that this storm will be different.

Ask your child to voice all his fears, and help your child find reasons to dismiss each fear. Be respectful, empathetic, and calm.

Watch for signs of magical thinking. Children who suffer from Obsessive-compulsive Disorder are particularly vulnerable to irrational self-blame regarding catastrophe.

Put safety first. Make sure you have a plan to keep your family warm even if you lose power, and be careful to avoid fires and carbon monoxide poisoning. Follow these blizzard safety rules for kids and parents.

Stay warm this weekend!

Don’t Panic: How Fiction Saves Anxious Kids

All parents (and teachers) know that scary movies can give a child weeks of nightmares. We all remember that one scene that kept us up at night when we were kids. Sometimes the things that scare us aren’t even from horror films: I have a friend who spent second grade terrified of ET.

Scary movies and scary scenes in other movies (like these nightmarish sequences in classic children’s movies) can torment children with anxiety disorders. But, sometimes, a slightly scary piece of fiction can actually provide relief for an anxious kid, especially in older children.

Like many people, I consider junior high to have been the worst time in my life. My anxiety was unmanaged and unpredictable, exacerbated by hormones and life stress. At the time, my biggest fear was, for whatever reason, an alien invasion resulting in the end of the world. So when a good friend suggested I read The Hitchhiker’s Guide to the Galaxy, which basically opens with the Earth being destroyed by aliens, I was reluctant to take her advice. She insisted “H2G2,” as it’s called by fans, was “basically the best book ever,” so I took a risk and started reading.

She was right. The book is smart and witty and adventurous and, most importantly, hilarious. By the time the Earth got destroyed (and, like I said, it happens early), I was laughing too hard to feel scared. I spent the whole summer reading all five books in the “increasingly misnamed” Hitchhiker’s trilogy, and my xenophobia (in the sense of the least common usage) was nearly cured. It’s fitting, therefore, that the fictional version of the Hitchhiker’s Guide is labeled with the words DON’T PANIC.

Humor is healing, and humor typically relies on surprise and the build and release of tension, so fear can easily be a part of humor. After 9/11, the country used humor to heal. Some of that humor was hate-filled. People told awful jokes about Muslims and Arabs. Internet cartoons showed US soldiers leveling Afghan cities. This was revenge humor, and it was anything but healing. Because 9/11 terrified me so deeply, I avoided any reference to the attacks. Then, one day, I saw my brother watching an episode of South Park in which the protagonists visit Afghanistan. The episode balanced empathy with absurdity, presenting Afghan children as virtually identical to their US counterparts except, of course, that the Afghan children had nothing fun to do because their neighborhood kept getting blown up. Bin Laden was turned into a Loony Toons villain, and the jokes at his expense were crude and angry. But the episode was playful! It did help me heal. Other episodes of South Park, like one about SARS, offered similar relief. (If you aren’t familiar with South Park, it’s extremely crude and deliberately controversial, so I’m absolutely not recommending you show it to your young kids. And there are episodes that are simply terrifying, even to adults.)

I’m sharing these anecdotes to illustrate how fiction can sometimes “save” anxious kids. Sometimes laughing about a fear makes it melt away. Humor isn’t even a necessary component; a comforting story that includes your fear and has a happy ending can be just as therapeutic as a great joke. If your student or child is suffering from specific fears, look for books, shows, or movies that address the fears through humor and have a happy ending. Be sure that the media you select is age appropriate, and avoid anything that’s scarier than it is funny; “Mars Attacks” traumatized me so bad I still regret watching it, and it’s been more than ten years.

I’ve included a brief list of works of fiction that I believe may help children deal with specific fears. IMPORTANT: I find these books comforting, but that doesn’t mean everyone else will.

The Hitchhiker’s Guide to the Galaxy, 25th Anniversary Edition
Fears: aliens, end of the world, space; For teens (and adults)

A Swiftly Tilting Planet (Madeleine L’Engle’s Time Quintet)
Fears: nuclear bombs, war, end of the world; Age ten and up

also by Madeleine L’Engle
A Wrinkle in Time [Paperback]
Fears: illness of a parent; Ages ten and up

Coraline
Fears: loss of parents, kidnapping, parents changing, losing eyes; Ages 8 and up
Warning: Coraline is an excellent book with a happy ending, but it’s really creepy!

Holes (A Yearling Book)
Fears: false imprisonment, venomous animals, authority figures, dehydration; Ages 9 and up

If you’ve had a similar experience with a piece of fiction, please post it in the comments.

Asthma and Anxiety

We used to go to the emergency room in the middle of the night. I’d wake up to hear the shower running, and I’d know it meant my baby brother couldn’t breathe. At first, when he was a baby, we didn’t know why. It only really happened when he was sick, so my mom sort of figured he just reacted badly to colds. He’d wake up wheezing, and my mom would hold him in a steamy shower. When that didn’t work, we’d jump into the car and drive half an hour to the nearest ER. My mom and dad would keep all the windows open to let in the cold air. At the hospital, the triage nurse would rush my tiny baby brother into a tent filled with steam. Then they’d give him some medicine, and then he’d breathe normally again. Bizarrely, no one at the hospital ever said asthma. They said he was “croupy.” My mom finally read an article about childhood asthma in the paper and asked her pediatrician if that was what caused her son’s breathing troubles. The pediatrician was so shocked he began to laugh. “They didn’t tell you that at the hospital?” he asked. He couldn’t believe the ER doctors would fail to offer that kind of basic information. “Of course it’s asthma! I thought you knew!” (This was, by the way, the kind of pediatrician who happily woke up at midnight to meet us at the ER and tell us all jokes until we calmed down. He took calls at home at any hour and could make my brother laugh while getting a shot, so I’m not surprised he went on to become an expert in child happiness.)

Asthma is scary. It’s genuinely dangerous, and it triggers primal fear in its victims. There are few things as scary as not being able to breathe. My brother, an active, adventurous, and otherwise healthy kid, spent his childhood cursed with severe asthma that necessitated years of ER trips and a variety of unpleasant drugs. I recently asked him if the attacks terrified him, and his answer surprised me: “The fear I felt from having asthma attacks as a young kid was totally manageable, because mom would take care of me and we had all the equipment and stuff.” Wow, check out mister No-Anxiety-Disorder.

However, even my brother has experienced some mild asthma-related anxiety. “I think I subconsciously associate [anxiety] with asthma, probably because asthma attacks are the most consistently stressful/traumatic thing I’ve gone through in my life,” he told me.

For a child with an anxiety disorder, asthma can be absolutely terrifying. Feeling unable to breathe can easily trigger a panic attack, and the panic may make breathing feel even harder. Anxiety medications can speed your heart and cause shaking, so an anxious child who is having an asthma attack is very likely to experience some degree of panic even after using her inhaler, especially if panicked breathlessness prevents her from realizing that the medicine is working. A student shared her experience:

Twice I has asthma attacks while I was hiking with other families. Both times, I ended up having a panic attack. It felt like my inhaler wasn’t working, so I got more panicked. It was like a snowball.

An anxious child who suffers from asthma may also sometimes mistake a panic attack for an asthma attack. My student also described a panic attack that was caused by a stressful life event:

I felt a lot like I couldn’t breathe, and I was really really scared. My inhaler didn’t help at all, and I thought I was going to die. My dad told me to use my relaxation techniques. Once I stopped being scared, my breathing felt totally normal. This makes me think that the feeling of breathlessness was “in my head,” not in my throat.

If your anxious child or student has asthma, talk to him before his next attack. Explain that, unlike asthma, anxiety doesn’t really affect breathing ability, and help him practice distinguishing between panic and asthma. Teach him to take complete, slow breaths. Finally, consider using a peak flow meter to help your child determine whether his anxiety is skewing his perception of his breathing ability.

Of course, it’s extremely important for children and adults to follow their doctors’ orders exactly, especially regarding serious illnesses like asthma. Ask your doctor, but I assume you should instruct your child to use his inhaler or other asthma medication even if he’s not sure whether his breathlessness is caused by asthma or anxiety. Cognitive-Behavioral Therapy and relaxation techniques can be used after medication is administered.

As always, the best thing you can do for your anxious student or child is remain calm. It’s very upsetting to watch someone you care about struggle to breathe, especially when that someone is a young child. However, children look to their caregivers for clues about danger, so it’s important to behave as though you are in control of the situation.

Asthma is a serious and life-threatening disease. Children with asthma need to be in the care of a qualified pediatrician or specialist.

My brother’s asthma has gotten much better, and he’s now able to backpack through forests and float wild rivers and play with his band in front of huge crowds. He’s the coolest person I’ve ever met, and tomorrow is his 21st birthday!20130204-134428.jpg