(Note: the following is a guest post by Justin Matheson, a fellow anxiety sufferer and blogger over at Anxiety Really Sucks!.)
I had my first panic attack about a year and a half ago, and it was the scariest moment of my life. Knowledge from undergraduate courses in abnormal psychology helped me to recognize what was going on fairly quickly. However, that recognition afforded me little comfort. I’d heard all about the most common symptoms of panic attacks: accelerated heart rate, sweating, trembling, hyperventilation. I had all of these – but that wasn’t what was troubling me most. It was the feeling of detachment, the feeling of pulling away from the world around me, that really frightened me.
As I stood in the Walmart parking lot, a smothering feeling of unreality clouded my mind. Thoughts raced through my head: what is going on? Am I going crazy? Am I dying? Is this a nightmare? That was my first experience with dissociation.
If you’re not familiar with the term, dissociation describes a state of detachment from reality that is fairly common in both panic disorder and PTSD. Dissociation can occur normally: you’ve probably experienced it during states of boredom when you “zone out”. At the pathological level, dissociative symptoms come in two main flavors — derealization and depersonalization.
Derealization is the feeling that your surroundings are “off”. You may feel like the environment is lacking emotional depth or that it’s covered in a veil (like someone put plastic wrap over your eyes). From my experience, it feels like I’m stuck in a virtual reality simulator – I know I’m me, I know my thoughts and actions are my own, but my surroundings don’t seem to be real. (I imagine it’s a bit like what Neo feels when he goes back into the Matrix after being freed.)
Depersonalization, in contrast, is sort of the opposite feeling. You may feel like you’re in a dream or like you’re watching yourself from outside your body. I would say it feels more like being a video game character – I’m conscious of what’s happening around me, I have my own thoughts, but it seems like someone else is controlling what I’m doing. Everything seems automated or predetermined.
For several months, a feeling of detachment was one of my main triggers – so every time I woke up feeling groggy or had a beer, I would worry about panicking. (Quick note – alcohol can induce an acute state of dissociation.)
Recently, I’ve started to dissociate without the accompanying panic. The good news: I can have a beer without having a panic attack. The bad news: I have days on end of feeling like I’m not fully present. Since I’m constantly feeling a bit detached, I have memory disturbances from time to time; I can’t remember how I got somewhere or whether I washed my hands before eating.
I also have trouble concentrating on what other people are saying. The longer someone talks without letting me interject, the harder it becomes to stay in the present and focus. There have been weeks where I couldn’t let anyone talk to me for more than a minute or two because it exacerbated the derealization – I felt like I was just watching a movie of someone talking.
How can you deal with dissociative symptoms? It can be very difficult to live with depersonalization and derealization when they become chronic. The first few months I felt these symptoms, I was terrified there was something really wrong with me. When your perception of the outside world is compromised, you feel like you’re going crazy or you’re losing your grip on reality. Fortunately, these symptoms are not life threatening and will eventually go away.
In order to get relief from these troubling symptoms, you may want to try grounding techniques. Grounding is a common technique that is used in anxiety disorders, and is all about staying in the present and accepting reality. Here are some easy exercises that you can try:
- Appeal to your senses. Take a moment and list out two things that you can see, hear, taste, smell, and feel.
- Appeal to your rationality. Re-orient yourself in the present by asking yourself some basic questions like “Where am I?”, “What is the date today?”, “What season is it?”.
- Tense your muscles. If you’ve ever done a progressive muscle relaxation, then you’ll be familiar with this concept. Start with flexing your toes, think about how that feels, and then relax them. Try this with different muscle groups.
- Take a warm shower. For some reason, I’ve found that the best way to overcome my derealization is having a long, hot shower. The feeling of the hot water on your skin kind of forces you to stay in the present and accept that your surroundings are real.
I’ve found grounding techniques to be quite helpful for quick relief from depersonalization and derealization. It’s not rocket science — it’s just about reminding your brain that you do exist and the world around you is real (assuming we’re not actually in the Matrix).
- “Self-help strategies for PTSD” from Anxiety BC. [Warning: PDF]
Justin spends most of his time in Montreal studying psychology and biotechnology. When he has a break from school, he likes cooking, pretending to go to the gym, writing horror stories, and watching a lot of supernatural dramas. He hopes one day to become a professor and expert on anxiety disorders. He writes a blog called Anxiety Really Sucks! and can be followed on Twitter @justinrmatheson.