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.  

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!