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.  

Why I Love Labels, Part 1

The insert in a sample pack of Zoloft saved my life.

The Zoloft helped, too. So did cognitive-behavioral therapy, my family, and a couple great self-help books. But the first and most dramatic step away from agony and toward relief was taken the moment I read the insert beside a small cardboard blister pack.

The insert described a panic attack.

Nearly six months before I read that insert, I had my first real panic attack. An anxiety attack is different: the horror I felt when separated from my mother was emotional. Panic, alternately, is in the body. You suffocate. You trade hearts with a hummingbird. The beating isn’t heavy like when you run; it’s faster and wilder, and it hurts. It’s a punch from inside your chest, over and over and loud in your ears. Maybe sort of like drowning. And your hands fall asleep or go numb. You sweat, and you feel sick to your stomach, and you notice a million little signs of death, like how your tongue is choking you or the subtle pop of an artery exploding and wasting all your blood. Yes, there’s terror, but it’s bodily, from your core and in your veins. The fear isn’t in your mind, it’s in your brain. And, though sometimes the panic is triggered by a stalled elevator or news from North Korea, a panic attack is a narcissist. It turns you inward, dampens the world. Panic gets caught in its own reflection.

I was young, and it came without warning and then refused to leave, haunting me instead with convincing warnings about aneurysms and punctured lungs. I realized I was dying. Over and over, I realized it. The attacks, which last only a few interminable minutes, became more frequent and then constant. Eventually I was having several complete panic attacks every day, and symptoms of panic between each attack. I went to bed every night with my heart speeding and woke up every morning gasping and shaking. I never had a chance to catch my breath. I literally couldn’t get an hour of relief. It was like that for almost three months. My pediatrician, whom I begged for answers, told me it was anxiety. Ha! I knew anxiety. I’d been diagnosed with separation anxiety at five or six. This wasn’t anxiety, this was me dying! Obviously.

Finally, after a particularly awful night spent struggling to breathe, my mom took me to a psychiatrist. He listened to my symptoms and immediately identified my condition as Panic Disorder, something I’d never heard of. Medicine and therapy, he said, would fix it. I didn’t believe him, though, until he showed me the insert in the sample pack of my new prescription. It listed the symptoms of a panic attack: rapid heartbeat, feeling like you’re being smothered, dizziness, nausea, believing that you’re dying, feeling like you’re going crazy. Tingling extremities. Feeling dreamy and confused and pixilated.

My face basically exploded. “This is exactly what I have!” I said. “Every single thing on this list. All of them! Every day!”

“That’s Panic Disorder,” said the psychiatrist. And, just like that, my life was saved.

Stand Up For Mental Health!

I have Panic Disorder and OCD.

I suffered immensely until I got help. Today, I am stable and panic-free thanks to education, lifestyle changes (no caffeine for me), cognitive-behavioral therapy (CBT), and venlafaxine. Medication certainly isn’t right for everyone, but it’s a crucial part of my anti-anxiety treatment. While I’m obviously very open about my mental illnesses, I’m less willing to discuss my medication use. People have strong opinions about psychiatric medication, and they should. No medication should be taken frivolously. CBT is very effective, and lifestyle changes will, by definition, change your life. And in my experience, nothing is more important than education. Understanding your disorder gives you power over it. Sometimes, however, medication is necessary.

I’ve decided to tell the world about my use of venlafaxine in honor of healthyplace.com’s new campaign, Stand Up for Mental Health. The campaign is “dedicated to eliminating the stigma of mental health,” and I’m proud to be a part of it.

If your child is suffering from mental illness, make sure she knows that there’s no reason to feel ashamed.

Remember, anxiety disorders and most other mental illnesses are treatable. Anxiety disorder treatments are particularly effective. Never be ashamed to ask for help. Your child only gets one childhood, and you’re already dedicated to making it great. Seeking treatment for your child’s anxiety disorder could be the most important decision you make as a parent.

If you’re concerned about the cost of therapy or medication, there are a lot of affordable alternatives. First of all, look for reduced-fee therapy. Find a free support group in your area. Educate yourself and your children about their disease. Knowledge really is power. Finally, search online for tips and information about addressing the needs of anxious children. (For example, are you caught up on this blog?)

You’re not alone.

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Anxiety Disorder Treatments Are Effective

Surprising Anxiety Trigger 5: Medications

A variety of medications can cause anxiety, especially in individuals with anxiety disorders. Before giving your child even over-the-counter medications, consider the risk of increased anxiety. Because the benefits of medication sometimes outweigh the side effects, it may be necessary to coach your child through her anxiety or combat the anxiety with medication prescribed by your pediatrician.

You probably already know that stimulants, like caffeine or amphetamines, can trigger anxiety. Children with ADD/ADHD are often prescribed a stimulant as treatment. Some children with comorbid ADD/ADHD and anxiety can tolerate stimulants. Other children, especially those with Panic Disorder, may experience very rapid heart rate combined with feelings of terror. Talk to your pediatrician or psychiatrist for more information.

Some cough and cold medicines, like the decongestant pseudoephedrine (Sudafed), are also stimulants. These medications can cause increased heart rate, shaking, nervousness, and anxiety. Talk to your pediatrician before giving your anxious child pseudoephedrine or similar medications, and report side effects, especially those that are severe.

Antihistamines like Benadryl (diphenhydramine) typically cause drowsiness, but some children experience a paradoxical effect and become excited or energetic. Anxiety can also occur in this situation.

If your child has asthma, you may already have noticed that his inhaler can cause shaking and increased heart rate. If your child’s asthma medication is causing anxiety, it’s important to ensure that the child is still taking the medication appropriately, in spite of his discomfort. Talk to your pediatrician, and check back for an upcoming post about asthma and anxiety.

Oral steroids, which are sometimes used to treat persistent allergic reactions* can cause anxiety and other changes in mood. A doctor should monitor your child while she is taking oral steroids.

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*like if your mosquito bites somehow lose their minds and turn your usually beautiful leg into this monstrosity…

The above medications are some of the most likely to cause anxiety, but any drug that makes a child feel “weird,” sick, “antsy,” groggy, or dizzy can inspire panic. Warn your child about possible side effects before they start, but skip mentioning any real dangers associated with the medication. Utilize relaxation techniques and distraction while your child acclimates to new medication, and, most importantly, always discuss medication changes and effects with your doctor.

When a Cold is a Catastrophe

I’m sick.

Over the weekend, I got a fairly nasty cold, and I’m still recovering. To an adult who has control of her anxiety, a cold is an annoyance. For anxious children, however, even minor illnesses can be terrifying.

Children prone to catastrophic thinking are often extremely creative in their fears, especially if they don’t have a good understanding of relevant anatomy.  Sinus pressure is likely to make an anxious young child worry that his head is going to explode, but it may also make him worry that worms have crawled into his nose in the night.  As long as you’re respectful and compassionate, I think it’s okay to sometimes poke gentle fun at your child’s most adorable fears.

To keep things playful instead of traumatizing, acknowledge the child’s fear, explain that the fear itself is a symptom (of anxiety or an anxiety disorder), and make sure the child knows you are on her side and will protect her.  Most importantly, keep even gentle teasing one-on-one; a beloved teacher or parent joking about nose-worms could be comforting and sweet, but additional participants may intentionally or unintentionally humiliate or bully the child.  Also, be careful about joking about plausible consequences of symptoms, such as an ear infection leading to a ruptured eardrum.  Most anxious kids won’t find that sort of “joke” funny.

Below is a list of common cold symptoms and the fears they may inspire in anxious children and adolescents.  Some of the fears are silly, but it’s important to realize that intelligence does not necessarily protect children from anxiety.  A child or teen who knows her fears are unfounded may still be plagued by them.  If your child or student complains of one of the following fears, explicitly disprove his unfounded fears (“sinus pressure will NEVER make your head explode, no matter what) and deemphasize any real risks that don’t require action.

Being able to predict some of your child or student’s fears may help you to better remove those fears.  Just make sure you never inadvertently suggest a new fear: “Ooooh, ear pressure? Don’t worry, I’m sure your eardrums won’t explode!”

Symptom Possible Fears
Cough Suffocation, lung cancer, internal bleeding due to violent cough
Headache Tumor, concussion, meningitis
Pressure, ears Eardrum rupturing, deafness
Pressure, eyes Eyes “popping out”/exploding, blindness
Pressure, sinuses Head exploding, tumors, burst blood vessels
Sore throat Losing the ability to speak
“Stuffy nose” Suffocation, anosmia
Swollen glands Hodgkin’s lymphoma

Parents, note that many over the counter and prescription cold medicines can cause anxiety or panic in individuals with anxiety disorders.  Talk to your pediatrician for more information.  Curious about alternative cold remedies? Read this informative article from Mayo Clinic.

Antibiotic Safety Information
Colds are caused by viruses, NOT bacteria.  Therefore, antibiotics will NOT help prevent, mitigate, or cure a cold.  The misuse of antibiotics helps create resistance strains of bacteria (such as MRSA), and taking antibiotics when you don’t need them can sometimes hurt you. Your body is full of “good” bacteria that helps you digest foods and fight off infection. Children and adults should only take antibiotics when they are prescribed by a real medical doctor.  Always take antibiotics exactly as prescribed.

Magical Thinking in a Hurricane

When I was thirteen, I was struggling with severe Generalized Anxiety Disorder and Obsessive-Compulsive Disorder, neither of which had yet been diagnosed. (I was diagnosed with Separation Anxiety Disorder in first grade, and at thirteen, I still worried excessively about my mom.) I hated school and already felt burned out by the second Tuesday of the year so, as I stepped out of my dad’s car in the morning, I wished that school would be cancelled for the day.

Wishing, even in my own head, was strictly prohibited by the torturous rules enforced by my OCD. But I was exhausted by months of acute anxiety—summer had always been difficult for me and puberty seemed to be exacerbating all my emotional struggles—and the thought slipped through. I did my simplest undoing ritual, which involved whispering “shut up shut up shut up,” and then I dragged myself to class…where a punky girl in an army surplus jacket informed me that the Pentagon had been attacked and New York City was, she thought, being bombed.

I knew I didn’t cause 9/11. I knew the attacks had to have happened hours before I even made that awful wish. I knew that it was disrespectful and narcissistic and absurd to feel responsible for something so horrific. But, in the panic of that day and the consistent anxiety of the following year, I returned again and again to that stupid careless wish.

Magical thinking, the fallacious association between unrelated events, is a significant cognitive symptom of OCD. Humans have evolved to seek out patterns: people who eat this red berry become very ill. Unfortunately, the patterns imaged by sufferers of OCD are typically very frightening. And, although magical thinking is a fallacy, intelligence doesn’t seem to offer much protection. (Imagine any of the many smart people who indulge a few superstitions.)

For healthy adults, a bit of magical thinking can be harmless or even fun. Magical thinking is ubiquitous in young children and rarely causes significant distress. However, anxious children and mentally ill individuals of all ages should avoid magical thinking. If you have an anxious child, be careful when encouraging even benign superstitions. (The weighted risks and benefits of teaching superstition is something that requires its own post.)

Crises like this hurricane can be scary for kids. If your children or students are prone to anxiety, reassure them regularly, shield them from sensationalist news, and show them that your family or school is prepared. Model calmness and optimism. And, if they recently wished for a few days off from school, make sure they know that this hurricane isn’t their fault.