Depersonalization, Derealization, and Panic Disorder

These Frightening Thoughts Are Common For Those with Panic Disorder

stressed woman with hands on head
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Panic disorder is a psychiatric condition that causes recurring panic attacks—episodes characterized by a cluster of disturbing physical and psychological symptoms. Typical symptoms during a panic attack a person include shortness of breath, shaking, and chest pain that can cause someone to fear they're having a heart attack.

The mental and emotional symptoms that accompany these bodily sensations can be equally frightening. Many people who have panic attacks describe feeling as if they're going insane, losing control, even dying.

Two very specific psychiatric symptoms that often occur during panic attacks are depersonalization and derealization. Although they're somewhat similar and may occur together, they are separate and distinct symptoms. Here's a look at each.

Depersonalization

The hallmark of depersonalization is the sensation of being detached from your body—as if you're no longer inhabiting your physical self but rather observing it from a distance. You may feel as if you have no control over your actions. This terrifying feeling often is accompanied by thoughts and fears of losing touch with reality or losing control over yourself.

Depersonalization can cause frightening physical sensations such as numbness or tingling. It also can be a symptom of another mental illness, such as depression; a result of drug abuse; and a side effect of anti-anxiety medications.

Derealization

Derealization involves feeling detached from your surroundings. You may feel disconnected from external objects in your immediate environment, including other people. Even your closest family members or friends may seem like strangers.

Often people describe derealization as feeling spaced out or foggy. People and objects in the environment may begin to seem unreal, distorted, or cartoon-like. Others report feeling trapped by their environment or viewing their surroundings as surreal and unfamiliar. It could feel as if you're in a strange country or on another planet.

What You Can Do

It's not totally understood what causes depersonalization or derealization to occur during a panic attack. One theory is that these symptoms, alone or together, may serve as built-in mechanisms for coping with extreme stress and anxiety. During a panic attack, they may allow you to put some distance between yourself and the unpleasant feelings you're having.

There's no treatment for either depersonalization or derealization alone, but it's good to note that once a panic attack begins to subside, these symptoms also will fade away and there are things you can learn to do to help speed up this process.

If you're experiencing derealization, try using your senses in any way you can to bring yourself back to reality. Pinch the skin on the back of your hand. Hold something that's cold or really warm (but not hot enough to burn you) and focus on the sensation of temperature. Count or name items in the room. Try to keep your eyes moving so that you don't zone out or start to lose touch again.

If you're experiencing depersonalization, slow your breathing. Often during an anxiety attack, breathing becomes rapid and shallow, and that interferes with blood flow to the brain. Take very long, slow, deep breaths, focusing on sustaining the exhale as well as the inhale. And since depersonalization causes feelings of detachment from others, reach out to a friend or loved one to talk to. Let them know what you're feeling and ask them to keep talking to you: It doesn't matter what you talk about as long as it keeps you grounded in the reality of the moment.

Professional Help

As symptoms of a panic disorder, depersonalization and derealization may feel very scary and disturbing, but they aren't considered either dangerous or life-threatening. Once the panic disorder is being treated, panic attacks and the symptoms they bring on should no longer arise.

A qualified mental health professional who you feel comfortable with (and who accepts your insurance or has fees that are in your budget) can help you deal with panic disorder. Your general practitioner or a local mental health referral service are good places to start to look for a therapist or psychiatrist.

Treatment for panic disorder typically involves medications for panic disorder, psychotherapy, or both. Sometimes it takes a bit of trial-and-error to get craft an effective treatment plan for a mental health problem such as panic disorder, so be patient. Simply seeking help will likely have you feeling better.

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Article Sources
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Illnesses, 5th edition, 2013.