Depersonalization Secondary to Anxiety

[AureusFO18]

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Has anyone had experience in dealing with dissociative patients with depersonalization related to an anxiety disorder? Can anyone explain the connection between the two phenomena to me? From what I've read, it seems as though depersonalization functions as a defense mechanism when stress becomes overwhelming, possibly due to overload of the limbic system. Is this explanation generally on the mark? If you've had experience, what interventions did/didn't work?

I'm both personally interested and intellectually curious (this is not for an assignment, although I may be doing some research with a doc in this area over the summer). I've done some reading on the subject, but there don't seem to be a whole lot of really good resources out there. I'm also a still a premed (at least for the next few months) so forgive me if this post doesn't make sense from a medical perspective.

 

[Regnvejr]

Without the energy right now for more detail, certainly depersonalization is a significant part of PTST, one of the more serious anxiety disorders.

 

[AureusFO18]

Without the energy right now for more detail, certainly depersonalization is a significant part of PTST, one of the more serious anxiety disorders.

Thanks. that's a start

 

[kugel]

A lot of people who have anxiety attacks (whether or not they meet criteria for "panic attack") experience a sense of "things didn't seem real" or "I felt like I was somehow outside looking in" or "like I was stuck in water while the world went on around me." In old movies, this was sometimes portrayed by showing us the room from the anxious person's point of view, and quickly panning the camera around, sometimes with a fisheye lens to exaggerate faces. Sometimes they would speed up the panning until the images were no longer recognizable. All of these things seem to be approximations of how some people with terrible anxiety experience a sense of depersonalization and or derealization.

If this experience is constant and the patient begins to believe that the world/people around them are not real, or that they themselves are not real, this becomes a delusion. If the person senses people and places as real but feels sure that family/friends are "imitators" or "imposters" of the real family/friends, then it is "capgras syndrome" (did I spell that correctly?) Sometimes this is a result of a stroke, sometimes psychosis, and sometimes it is a remake of the classic film Invasion of the Body Snatchers.

 

[whopper]

This might help.

http://arts.monash.edu.au/behaviour/dissociation/whatisdiss.pdf

 

[AureusFO18]

A lot of people who have anxiety attacks (whether or not they meet criteria for "panic attack") experience a sense of "things didn't seem real" or "I felt like I was somehow outside looking in" or "like I was stuck in water while the world went on around me." In old movies, this was sometimes portrayed by showing us the room from the anxious person's point of view, and quickly panning the camera around, sometimes with a fisheye lens to exaggerate faces. Sometimes they would speed up the panning until the images were no longer recognizable. All of these things seem to be approximations of how some people with terrible anxiety experience a sense of depersonalization and or derealization.

If this experience is constant and the patient begins to believe that the world/people around them are not real, or that they themselves are not real, this becomes a delusion. If the person senses people and places as real but feels sure that family/friends are "imitators" or "imposters" of the real family/friends, then it is "capgras syndrome" (did I spell that correctly?) Sometimes this is a result of a stroke, sometimes psychosis, and sometimes it is a remake of the classic film Invasion of the Body Snatchers.

Thanks. This is a great description. I had the impression that depersonalization was more like a sense of detatchment from your personal values than a sense of physical unreality. I was thinking more along the lines of the type of zoning out that goes on when one gets engrossed in a book/TV Show/Movie to escape from anxiety. Your comments make it seem like its a much more physical, viceral feeling. From what I've read, the symptoms of depersonalization generally dissipate with treatment of the underlying anxiety. Do you have any experience or frame of refence on the issue of treatment?

 

[kugel]

Thanks. This is a great description. I had the impression that depersonalization was more like a sense of detatchment from your personal values than a sense of physical unreality. I was thinking more along the lines of the type of zoning out that goes on when one gets engrossed in a book/TV Show/Movie to escape from anxiety. Your comments make it seem like its a much more physical, viceral feeling. From what I've read, the symptoms of depersonalization generally dissipate with treatment of the underlying anxiety. Do you have any experience or frame of refence on the issue of treatment?

Treat the anxiety. Any of the standard anxiety treatment algorithms should be fine, including meds, therapy, workbooks or all of the above. Incidentally, such a situation might be a great place for a focused breathing technique to use at the time of the attack. Many on this board have more experience than I do in this arena, but keep it simple.

You might try having the pt practice getting anxious (imagining an anxiety-provoking recent incident) right in the office, then breathe in on a 2 count ("one-mississippi, two-mississippi") and then breathe out on a 5 count. Something as simple as this accomplishes several goals:
a) concentrating on something other than the stimulus that provoked anxiety
b) providing a sense of control, and not appearing "panicked" (which generally serves to get others involved - increasing the panic)
c) Not Talking
d) preventing hyperventilation and the dizziness that can ensue
e) focusing the Chi and establishing a connection with the lifeforce that is the ether binding all living things in the universe through the creative energy that envelops us all.
http://www.youtube.com/watch?v=Bp3iHjGBfT4


[okay, I made up that last part]😀