07/28/11

Coping and Questions

Important Preface
Depersonalization can potentially accompany many, if not all, mental illnesses as well as neurological disorders such as migraine, epilepsy, stroke, brain tumor, brain trauma and the like. To put your mind at ease and know what illness(es) you are dealing with, you must get a complete physical and mental work-up and diagnosis of your symptoms by an M.D. psychiatrist. Getting a proper diagnosis means getting the proper treatment plan.

still here
Please remember I am not a doctor and my statements here should never be interpreted as a substitute for professional medical diagnosis and treatment.


Why wasn’t this book around 35 years ago! It very well might have changed my life. A MUST BUY! I do believe CBT would be most effective in individuals who have episodic DP/DR, or DP/DR associated with panic.


Everyone has his/her own way of coping with depersonalization and derealization. Below are coping methods I've found useful over the years. I also address questions that DP sufferers often ask.

Many of these suggestions seem self-evident, simplistic, obvious; but I find I "forget" the positive productive things I can do (no matter how "insignificant" or "meaningless" they seem to me). I forget that fighting DP is often overwhelming. Remember that being productive does not mean you must win the Pulitzer prize -- necessary proof of my worth for many years. Do what you can within your limitations and feel proud of all of your accomplishments. None of them are insignificant.

I know at times literally nothing seems to help and you simply cannot be comforted by anything or anyone. At those times repeating "This is only an illness, this is DP, this is anxiety, it will pass" can be somewhat calming, like a mantra. Going to sleep is always an option, as well as what I call "seeking the familiar."

Even though it seems impossible, try to reach out to another human being. Pick up the phone and try to talk with someone who understands about what is happening or can distract you with some other topic. Of course if you feel unbearably frightened and helpless, or you fear you might harm yourself, immediately contact your psychiatrist, your therapist, your family doctor, a family member, or a suicide hotline. Consider getting yourself to a hospital.

Update:
An encouraging new book has just come out. I thought I’d place this at the top of this section as it is a book by a well-respected professional.

Overcoming Depersonalization and Feelings of Unreality
Anthony S. David, 2007
This book is now available in the US through amazon.com. Anthony David, is a Professor of Psychiatry at the Maudsley Hospital and Institute of Psychiatry, London. He is one of a number of experts in Dissociation and other psychiatric disorders. The fact that there is now a book available specifically for DP/DR sufferers is astonishing to me. Treatment focus is Cognitive Behavioral Therapy. My sense is this approach would be most helpful for individuals who have just been diagnosed and in the earliest stages of an anxiety disorder accompanied by DP/DR.

Index of Coping Skills


You Are Not "Going Crazy"
No, you are not going "crazy" ... this is a fear of many whose primary disabling symptoms are DP and DR. Your DP can get very serious, and some have been temporarily hospitalized for not being able to function with DP, but this doesn't mean you are (of the old definition) "insane" anymore than anyone with "garden variety" OCD, panic, anxiety, or depression is "insane."

I dislike the words "crazy", "insane", or "schizo." They are extremely derogatory and conjure up old stereotypes of screaming, babbling patients in a locked mental facility.

Those who ask this question most likely fear schizophrenia, psychosis, or a total loss of touch with reality. DP, panic, and anxiety alone as your primary concerns are highly unlikely to be signs of impending schizophrenia or psychosis.

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There is indeed a difference between psychosis and neurosis and, in simplest terms, those of us w/DP, anxiety, panic, and depression are "neurotic."
Remember this is a very simplistic explanation; the critical differences between neurosis, (a dated term in my opinion), and psychosis are:

Neurosis:
"A mental and emotional disorder that is less serious than a psychosis. It is not characterized by disturbance of the use of language, thought, or interpersonal interactions. It is accompanied by various bodily and mental disturbances -- "visceral" (instinctual and not intellectual) symptoms such as anxiety and phobias."

Psychosis:
"A serious mental illness such as schizophrenia, marked by a loss of (or greatly lessened ability) to test what one is thinking and feeling about the real world is really true."

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The key difference between the two (in very simple terms) is "loss of insight," or loss of the ability to know one is mentally ill. In a psychotic episode an individual loses touch with reality in a very literal sense -- not simply feeling a loss of connectedness, but actually losing both the connectedness and awareness of this loss.
If you have insight you are very aware that what you are experiencing is "not right" and you make conscious efforts to feel normal again. The psychotic individual is often incapable of actually knowing he or she is ill. If you are asking yourself, "Am I crazy, am I becoming psychotic?" more than likely you are not. The symptoms of psychosis are also very different from the perceptual distortion of DP or DR in and of themselves.

Also an individual does not necessarily have psychotic episodes all of the time. Each individual is unique. Such episodes can be episodic or periodic depending on the illness and the severity of the illness.

There are instances when an individual with depression may experience a depressive psychosis and may hear voices telling him to harm himself. Such individuals can be aware that these voices are "not right,", they shouldn't be hearing them. So even someone who is actually hallucinating can have insight. They know what is happening to them is not right, not supposed to be happening. Insight is mainly the key as well as the overall constellation of symptoms.

I firmly believe that all of us who feel these distortions in thinking and feeling, neurotic or psychotic, have neurological disorders. We with depersonalization are not psychotic, but psychotic individuals are struggling as well; they shouldn't be considered "lesser" human beings and can benefit from psychiatric treatment. This isn't "us" vs. "them" -- both the psychotic and neurotic are battling medical disorders. These disorders are on a spectrum, a matter of degree, and unique to each individual.

You are not going "crazy," though DP can be as disabling as any serious mental illness.

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Structure, Routine, and Distraction
My personal equation is: CHANGE=STRESS=ANXIETY=DP=MORE ANXIETY (and the cycle begins).

Change can take many forms. Stress can take many forms. Stress can be external or internal; some of it you can control some you can't. This makes a daily routine imperative -- one tailored to your ability to function, your needs, goals, and limitations.

Know what is in your power to control and you will be able to work around it. Know what exacerbates your DP and either face it head on or eliminate it from your life.

Try to keep a very regular, predictable daily routine, one that is not beyond your tolerance level, but one that challenges you a bit, gives you contact with others, a sense of purpose, and plenty of distraction. Try to keep regular hours -- get up at the same time each day, go to bed at the same time each night. And have something to look forward to each day.

I have had to accept I have limitations because of my DP. I no longer engage in many activities I love. I have no children because of this illness. My career has been compromised, many life goals have passed me by. But in the process of getting better, even at 48, I have found new outlets for my talents. Have faith that what you cannot do may be replaced with something just as meaningful.

Sometimes I think I have finished mourning the past, but dreams die hard. I am not saying this is an easy task. But life is worth living. Take it day by day and take control of what makes each day more productive, more positive.

Make peace with what you can't handle, and cultivate those talents, that strength you have to continue with other pursuits. Set goals, a daily routine that produces less stress. Try to believe we all hold an important place in this world regardless of our limitations.

And remember, never lose hope that we can get better. That many have conquered DP, depression and anxiety. We live in a time where advances in neuropsychiatry and alternative treatments are moving at an incredible pace.

And one final note. For some of us with any kind of mental illness, just getting up in the morning can be torture. I have been there. I highly encourage you, no matter how awful you feel to get up at a reasonable hour in the morning, take a shower, and dress for the day. If this is all you can do, you will still feel better, and this can help lead to a next step, be it cleaning your home, taking a walk, etc. No accomplishment is too small. Attempt to make your life as normal as possible, though I know this is so difficult.

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Stay Physically Healthy
Vigorous exercise significantly increases my DP and outdoor activities exacerbate my DR. Regardless, many DP sufferers engage in all forms of exercise as a means of decreasing anxiety and releasing some "feel good" endorphins.

Yoga is a popular exercise which is more aerobic than it appears. Exercise classes or gyms get you out of the house. Exercise videotapes are great to use at home.

For overall health and peace of mind, engage in some form of exercise -- something you really enjoy or simply have to get done anyway. Garden, weed, walk, run, hike, vacuum, clean the house, clean the refrigerator, roller blade, wash your car, walk through a large museum or botanical garden, organize a closet...

Sleep can help or exacerbate DP. Many with DP, anxiety, and depression feel constantly tired. I often feel this way. First check with your doctor to see if your medications may be causing this. Not sleeping enough or sleeping too much can make DP worse. Try to keep a regular sleep pattern. If you aren't working or getting out of the house, occupy yourself to avoid sleep. There is always something to do around the house.

Eat nutritious meals, take in plenty of water and eliminate caffeine and artificial sweeteners; the latter is especially important if you suffer from IBS, (Irritable Bowel Syndrome, which is an unfortunate companion of anxiety.) Caffeine can exacerbate anxiety and DP and is found in coffee, tea and many popular soft-drinks. Limit or cease alcohol intake and eliminate all recreational drugs. Many have had DP onset with the use of cannabis or other recreational drugs; why tempt Fate with "just an occasional toke?" don't make things harder on yourself by not taking care of your general health.

Getting physically ill (such as with the flu) can exacerbate DP. You can feel worse with a cold, flu or more serious physical condition. Seek medical help as necessary and know this will pass when you are feeling better.

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DP and Somatic Symptoms vs. Other Medical Illnesses
DP and anxiety sufferers experience numerous strange symptoms that are very real, but are generated by the brain. For example visual disturbances can occur with DP precipitated by recreational drugs. One may see trails of light, "shimmering walls," sparkles, "halos" around lights, and the like. Others feel dizzy, faint, have vertigo, or experience strange electrical "shocks" going through one's head (often a side-effect of medication withdrawal).

Sometimes such symptoms are medical symptoms that need to be treated like any other physical illness.

I experienced swirling pinwheels and "sparkles" in my peripheral vision for about 3 years when I was at university. My psychiatrist at the time kept telling me these were "somatic psychiatric symptoms of stress." This was not the case. I actually had the warning signs of retinal detachment which necessitated emergency surgery at the age of 24. Fortunately my retinas are in good shape now.

Case in point: If you are experiencing any unusual symptom it may just be part and parcel of the DP or anxiety/panic. On the other hand it could very well be an actual medical problem. Don't become alarmed. Even if only to ease your mind, seek medical help. You don't need any more medical problems -- the DP is enough!

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How Do I Explain This To Family And Friends?
If depersonalization and derealization are difficult for medical professionals to fully understand, you know how difficult it is for mentally healthy individuals to comprehend. DP and DR are invisible to others. -- "You "look so normal, why can't you just pull yourself together? I can't see anything wrong with you at all." Explaining what you're feeling is extremely difficult and it is especially difficult to explain how your symptoms impact your daily functioning and your ability to enjoy life.

I have never discussed my illness with employers and I admit I have given up on trying to explain my DP/DR symptoms to most people altogether. I often simply say I have severe depression. Unfortunately there is still stigma attached to being mentally ill and most people who have not been touched by mental illness do not understand that the brain can get sick.

In communicating with close friends or family it is helpful to present case histories, personal stories, or simple medical descriptions. Give them time to read some short articles and suggest they ask you questions. The key is to present someone with clear, simple information, and not overload them with details. Bottom line, don't expect an understanding of your illness, but more an understanding that you are limited by these symptoms and they are of a medical, neurological origin -- not that "you aren't trying hard enough." You might mention your need to take medications. For some this makes DP/DR "sound more like a real illness."

Fortunately (or unfortunately) a very effective explanation can be, "This is like a bad trip that never goes away." Many friends (some of whom you'd never think may have tried LSD, or any recreational drug for that matter) will seem to understand immediately. I hear stories however of friends then expressing, "Wow, how great to feel like you're tripping all of the time!" Discouraging to say the least.

Bottom line is most people will have an extremely difficult time understanding any mental illness. However, I have found that certain friends and family who love you will accept your limitations, respect them and remain supportive as best they can. This is not easy for them either -- those who don't want you to be ill, who want you to be "your old self" again.

I have found dear friends who accept me as I am, and those who have dropped out of my life since I have "come out of the closet." This is the risk you take in trying to explain your situation. But you will be pleasantly surprised at who will stand by you, regardless. It is a test of love and strength for both you and your loved ones. You will also find that some of your friends and family have their own "secret burdens" and will find relief in sharing their problems with you. There is some advantage to be open about our human frailties, there should be no shame in sharing them. But understand that some people will never understand, and may walk away -- often out of fear or confusion. This is beyond your control, and not your fault, it is just a fact of life.

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Relationships, Intimacy, and DP
Mental and physical illnesses often interfere with having a healthy loving relationship. In every case the problems are unique and vary in severity. Some individuals are able to have fulfilling relationships, while others choose solitude. Chronic mental illness can place tremendous stress on both partners in a relationship, or on an entire family.

DP is extremely difficult for healthy people to understand, even the most empathetic people. A partner or lover who doesn't understand DP or mental illness can feel frustrated trying to "help" or "make you feel better." Some partners may begin to believe "you aren't trying hard enough to get better," that "you seem perfectly fine." Even those who love you unconditionally can become worn down trying to understand and accommodate your symptoms and feelings.

Sadly, DP sufferers often have difficulty truly enjoying an intimate relationship. The sense of distance and disconnectedness makes love a painful experience. Many go through the motions to please a partner. Others are unable to do so.

Side effects from medications can also affect the libido in both men and women. This is obviously especially difficult for men. I have heard from some men, however, that intimacy actually helps them escape the DP for a time. As a woman I have never felt this way, though I'm sure this is true as well for some women. Genuine, loving intimacy can be a powerful distraction if one is not seriously depersonalized.

I wish I had an easy answer for how to handle this problem. Mental illness affects all areas of life, occupational and social. I can only state the following for myself:

The most successful relationships in my life have been with men who have some emotional problems themselves. I don't seek out such relationships; I have always unconsciously gravitated to such men and vice versa. But in many successful relationships this need not be the case. Over the years, I have become more open about my emotional problems (with well-chosen people in my life). It just seems more constructive to get things out in the open from the start.

And on a more encouraging note, medications, time and therapy have lessened the debilitating power of my DP, and have given me the ability to enjoy intimacy far more than in the past.

Healthy people need loving and unconditionally accepting partners. Those of us with mental illness are no exception. There are many caring partners for all of us out there. Give them a chance. Give yourself a chance. There is nothing more important in life than a strong, loving relationship. The loving support of a partner is critical in maintaining one's emotional health.

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Advice For Women
Hormones: PMS, Menstruation, Pregnancy, Post-Partum, Menopause, Birth Control.

It is a medical fact that changing hormones can have a significant impact on all women and those with emotional disorders are no exception. Women in particular, have a roller-coaster of hormonal changes throughout their lives. There is also a growing awareness that hormones affect men as well.

PMS and a monthly menstrual cycle can exacerbate symptoms of DP/DR, anxiety and depression. Try keeping a journal. I plotted a chart for several months simply to track my symptoms; I wanted to see when the DP/DR got worse. Without fail in the week before my period I experienced a significant worsening of all of my symptoms and I realized that had been happening for most of my life.

It is also interesting that the beginning of my chronic DP came at around the time I first started menstruating. I'm not saying this was the only trigger, but it may contribute to exacerbation of emotional disorders in all young people at that age. Mental illness often appears in both sexes as children "come of age." The teenager brain is not fully developed. This is certainly not the only reason, but it is clearly a contributing factor.

Don't hesitate to discuss this with your psychiatrist and OB/GYN. Going on a hormonal birth control regimen can give you a completely accurate time frame which can assist in preparing for/avoiding bad days, and sometimes making them much less difficult.

An important note re: hormonal contraception. I was informed some years ago that anticonvulsants (such as Klonopin, Neurontin, or Lamictal) can reduce the efficacy of some birth control pills and the chances of pregnancy can increase. Your OB/GYN may suggest a change in the type or strength of birth control pill you are taking.

It is also obvious that pregnancy, the postpartum months, and menopause can also cause problems, sometimes very serious (such as post-partum depression). Do not hesitate to consult with both your psychiatrist and your OB/GYN at these extremely stressful times particularly when planning a pregnancy or as soon as you know you are pregnant. There is help available. Do not hesitate to ask your health care providers.

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Seek The Familiar
When seriously DPd, there seems nothing that can help. However, simply sitting in a familiar room, or holding a familiar object can be comforting. I often close my eyes and sometimes put my arms around myself, something I did as a child. Sometimes I run my hands over the fabric of the sofa or chair I'm sitting in.

Because my eyesight is so bad and I wear glasses all the time, removing my glasses can be comforting. The myopic blur softens the 2-dimensional appearance of things and the sudden "change" can sometimes give me a minor perceptual "kick" back into reality.

Listen to familiar music. A familiar TV program, especially if it's a rerun, or a favorite video you've seen ten times. Touching, watching, or hearing anything familiar can be grounding for me.

Excessive TV watching can become hypnotizing however and can make you feel more isolated. When I'm very depressed and DPd I've found I feel even worse if I plant myself in front of the TV for too long. So read something "mindless" like "The National Enquirer". Go for pulp fiction. You don't have to go for anything cerebral, just something somewhat engrossing and distracting. Flipping through any magazine, looking at the pictures, reading the article titles, not even reading it, can sometimes help you focus and take your mind off of the DP.

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Keep A Journal
This is an excellent way to keep track of good and bad days. A journal can reveal a pattern of hidden stressors that exacerbate your DP which you can then deal with accordingly.

Monitor caffeine intake, sleep patterns, situations that increase DP. A journal is also an excellent way to chart the efficacy of medications, note side effects or subtle positive effects. You may be surprised to see changes for the better in a journal; this can reinforce feelings of hope and strength.

A journal can be cathartic. Instead of overloading a friend or relative with fears and concerns, writing them out is a constructive release.

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If You're Working Now
I don't feel fully qualified to fill in this section, though I know there are so many of you out there coping with depersonalization on the job. I salute you and I would appreciate input from those of you who are in the workforce now.

I am not gainfully employed at this time, I simply cannot tolerate it, and though I have never been fired from a job in my life, I am terrified at the prospect; that fear causes severe anticipatory anxiety which then gives me severe DP. My "work" now is my writing, Mental Health Advocacy, and I am a student of website design. At this time I know for certain I need to be in a "solo" occupation, though this may change with time. I honestly don't know.

I would also like to point out the importance of being a parent. I consider being a mother or a father a full-time job, even if you have a "real" full-time job as well. There is nothing more important than helping a child achieve his or her full potential -- whatever that is.

I find it terribly painful I have no children. Again, so many of you with DP do. If you are loving those children unconditionally you are doing your job (and more). Kudos to all of you parents out there as well.

Obviously those with work and family have routine and stability and have worked very hard to achieve those gifts. I admit I am both envious and thrilled by those who have overcome DP and severe anxiety or have been able to have full lives. You are an example to everyone that DP/DR, depression, anxiety can be overcome and that life can be lived to its fullest. You are testimony that there is hope for all of us.

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If You Are In School Or University Now
It may not seem like it, but you're in a great situation -- as long as you take advantage of the wonderful supportive community a school or university can be. You may be struggling, but you don't have to isolate yourself or fight this alone. There is no shame in asking for the help and support available. I made the mistake of continuing to keep my illness a secret in school, and it only made things more difficult.

You already have the benefit of routine. You have a regular schedule and some immediate goals -- don't worry about the future either, one day at a time.

You have a tremendous support system. Your school environment has provided fellow struggling students, dorm-mates, roommates, at no extra cost and not much effort. If you aren't living in an apartment, you've got three square meals a day without having to think about it; eat!

You have access to Student Health and Disability Services. Most schools and colleges have these at your disposal, either free or low-cost. Do not feel it is a "cop-out" to take advantage of these services. There should be some form of psychological counseling service and an academic counseling office no matter where you are. If you are having trouble with classes, homework, coping, these are the places to go.

Know your limitations. Don't take a full course load if you feel you can't handle it. There's no need to "keep up" with everyone else. Find an academic counselor find a good one and stick with him or her to get personal attention.

You are eligible to receive special services for all disabilities including mental illness -- you should not be discriminated against, this should not hurt your academic record in any way. You may be able to work out a program of taking courses at your own speed, taking independent study, or working with a tutor.

With psychological counseling you have someone to talk to. Don't isolate yourself. Health services can refer you to therapists of all kinds to get you on the proper medications, or to find someone to help you cope.

Lean on people -- real friends (chosen wisely) and confide in them. Life at university for me was a godsend. The routine, friends, food, entertainment, they're all provided for you. You aren't out in "the real world" yet. I didn't realize this until I graduated. Try to participate in things you enjoy. Realize that everyone has struggles and you will be surprised at how many friends may not understand all that you're going through, but who are willing to listen. I wish I had known how many friends I could have turned to as a young adult, but I was ashamed.

Please do not feel ashamed. You have a medical illness. You are a human being. There are compassionate people out there -- lean on them.

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Continuing Education
Take courses at a local university or community college in anything you'd really enjoy learning more about.

I have studied everything from computer programming to figure drawing, music, anthropology, mythology, and more. Enroll for "no credit" or "audit" so you feel no pressure about a grade. There are courses offered online as well.

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Volunteer
When I work in a non-paying position, I feel less pressure that I "must" show up with a "professional façade" and suffer from a constant/chronic fear of getting fired. I have never been fired from a job, yet the very thought of it increases my stress level and hence my DP.

I have volunteered as a literacy tutor, in a community garden project, in a mental health day-care center and a mental health legal office. I'm now actively involved in mental health advocacy with N.A.M.I. and with simply getting the word out about dissociative disorders.

Don't let anyone tell you that you that volunteer work can't be used as a reference when seeking a paid position. If you treat your volunteer work as if it were a regular job, show up on time, and do good work, there is no reason you can't use your volunteer employer as a reference.

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Get A Pet
Especially a low maintenance pet such as a cat. The key is distraction and routine. You will be forced to care for your critter which gives you purpose. A dog is obviously more work, but any pet can be an unconditionally loving companion. A dog can get you out of the house for some exercise as well.

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Slow Down
My DP is guaranteed to worsen if I don't leave plenty of time to accomplish something or to make a class or appointment. The more rushing around, the more things seem to blur together. I don't need to explain that for me Rushing=Stress=DP.

I tend to be rather "hyper" to begin with. I feel I need to "entertain" others. I find myself wearing myself in this manner. Go about your daily activities at your own pace. And just be yourself. I have to make a conscious effort to do this on a regular basis.

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Human Contact
Sometimes I am astounded at how much better I feel once I have forced myself to go to a social occasion or merely meet a friend for lunch. I may be initially overwhelmed with anticipatory anxiety and DP, but often, after having spent time in a social situation I begin to relax and again become distracted. I'm not saying this is easy. Over the years I have become increasingly isolated and I know this only reinforces itself and the fear of social interaction. At least give it a try. It may be far easier for different individuals. We are all so unique.

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If You Have Suicidal Thoughts, Get Help Now
Many times I've felt I could not continue feeling seriously DPd/DRd and depressed. Yet, I am here to tell you I have found the right medications, therapy, and new goals -- things that make me far more enthusiastic about living a productive life. I know I am far better than I was 20 years ago. I am not cured, but had I not waited for current advances in medicine, neuropsychiatry and psychopharmacology, I would be missing out on a lot of wonderful things life has to offer.

Please know I have been through this myself many times ... you may want to give up, but literally give yourself time to feel less hopeless. Time can give you a new perspective. Sometimes after a good night's sleep you can see the world anew. I beg of you to hold on, get help, and give yourself time.

Remember your resources and lean on them. Do not keep your feelings secret from family, a close friend, your doctor, your therapist. They are all there to help.

Also every phonebook in the United States (to the best of my knowledge) has a local Suicide Hotline. There are Mental Health Crisis Intervention numbers in many communities. There are Local Hospitals you can call. And barring all else, you can call 9-1-1.

It might be a good idea to keep such numbers by the phone as well as the names of friends -- just to remind yourself they are out there. Just knowing your options is sometimes enough to keep you going. I still encourage you to reach out. You will always be surprised by the compassion of others.

Suicide is never your first option. Please remember that. Reach out before you do anything rash, no matter how frightened or miserable you feel. I can say this as I have been on the edge, many times. To this day, I am glad that each time I chose to stay around.

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