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10 Simple Ways to Relieve Depersonalization

Depersonalization Disorder is a persistent feeling of being disconnected from your body and thoughts. It can feel like you’re living in a dream, or looking at yourself from outside your body. The world may feel like it’s flat and unreal, as if it’s in 2D or behind a pane of glass.

Depersonalization Disorder can be an intensely frightening experience. It’s generally brought on by trauma (from violence, abuse, panic attacks) or, as is becoming more common, a bad drug experience. It’s also a surprisingly common condition: It’s estimated that 50% of all people will experience feelings of depersonalization at some point in their lives, and up to 2% of the population of the US and UK may have it as a chronic condition.

As frightening as the condition and its various symptoms are, it’s still based on anxiety and there are ways to alleviate it. The goal is to refocus your mind away from the intrusive thoughts so the brain can lower your anxiety down to normal levels and stop the feelings of depersonalization.

With that in mind, here’s a few practical tips you can use on a daily basis to relieve depersonalization.

  1. Read Aloud. Depersonalization (or DP) is notorious for the intrusive thoughts it causes. Reading aloud is a great way to focus the mind away from these. As this study shows, “Reading aloud (uses) several cognitive processes such as recognition of visually presented words… analysis of the meaning of words, and control of pronunciation.” Basically this means that it keeps your brain really busy! Your concentration becomes intensely focused, making this an excellent exercise for reducing thoughts of anxiety and depersonalization.
  2. Cut out Caffeine. Coffee and soft drinks contain a lot of caffeine, which can push up your anxiety levels and feelings of DP. And coffee consumed later in the day can take hours to wear off, affecting your sleep patterns. It also increases your blood pressure and heart rate and can leave you feeling fatigued once the caffeine leaves your system. If you’re a coffee lover, don’t worry — you can get back to it once you recover. But for the moment, you want your body and brain to be in as calm a state as possible — so cut caffeine out of your diet completely.
  3. Listen to Podcasts and Music. If you have a smartphone, you have access an infinite selection of podcasts. Pick out a few that interest you and keep them with you at all times. Put them on at any quiet moment. Feelings of anxiety and depersonalization tend to worsen when you’re idle and have time to focus on them. So be prepared for any spare time with your earphones and smartphone — while you’re waiting for the bus, walking the dog, wherever. Keep your mind occupied. The same goes for music, put on your favorite albums and sing along!
  4. Avoid Drugs. As the legalization of marijuana continues, more people are turning to it as a way to relax and unwind. But using it with anxiety disorders is not recommended. A bad drug experience can cause paranoia, increased heart rate, disorientation, frightening hallucinations and can actually worsen your depersonalization symptoms. In fact, weed is one of the most common triggers for depersonalization disorder, so using more to try to alleviate it is very risky.
  5. Get Up Early. One of the most important ways to alleviate depersonalization is to re-establish a healthy sleeping pattern, which is often disrupted by the condition. Sleep loss and bad dreams are commonly reported with DP. One very simple way to deal with this is to get up earlier in the morning. With anxiety and DP it can be difficult to get motivated, especially first thing in the morning. But don’t lie around in bed as that will promote negative thoughts. Get up, shower, exercise!
  6. Go to Bed Early When you rise early, your body will naturally start to get tired and slow down at an appropriate time in the evening. Follow your body’s rhythms and go to bed when you feel tired. Don’t stay up watching TV or looking through social media. This will help to re-establish a healthy sleeping pattern, which is crucial to anxiety reduction and your recovery from depersonalization.
  7. Practice Your Hobbies. With depersonalization, you can spend a lot of time worrying about and researching the condition. This can actually be counterproductive because as with any anxiety spectrum disorder, the more time you spend focusing on the condition, the worse it can get. It’s a lot more beneficial to fill your spare time with positive, constructive activities. Play an instrument, learn a language, go to the gym and exercise. These will all help to refocus your mind away from anxious thoughts and alleviate feelings of depersonalization.
  8. Don’t Overreact. With depersonalization, as with any anxiety condition, you‘ll have good days and bad days. The trick is not to overreact to either. If you’re feeling anxious and depersonalized, don’t be disappointed. And if the feelings are lessened or gone altogether, don’t get too excited. Just go about your day as if it didn’t bother you either way. That tells your brain that the anxious feelings are ultimately not important, which is the most effective way to turn off the feelings of anxiety and DP in the long term.
  9. Don’t Avoid Any Activities. Depersonalization can be very frightening, especially when it comes to getting outside the house, traveling etc. These situations can increase anxiety, which in turns aggravates the feelings of DP. It’s vital to remember though that you’re not in danger, and that it’s just a feeling. What’s more important is not to avoid any activity because you may feel anxiety or depersonalization. When you do the activity anyway, it registers in your brain that you were able to complete the task safely, despite the anxious feelings. This is much the same as Exposure Therapy, and is a vital step towards eliminating unwanted anxiety.
  10. Be Social! With DP, as with any anxiety spectrum condition, it can seem particularly tough to get out in the world and spend time with your friends. Depersonalization sufferers often report feeling particularly anxious when talking to others and may have trouble staying focused on conversations. This can seem scary but it only happens because your concentration is temporarily affected by anxious thoughts. It will pass in time. In the meantime it’s really important not to avoid social situations. Spending time with your friends, family and co-workers will help to keep your mind occupied with positive, constructive thoughts.

These simple tips will help to alleviate the day-to-day symptoms of depersonalization and give you a strong groundwork for complete recovery!

Depersonalization Disorder is a persistent feeling of being disconnected from your body and thoughts. It can feel like you're living in a dream, or looking at

Cannabis-Induced Depersonalization-Derealization Disorder

An association between cannabis use and the emergence of psychotic disorders among susceptible individuals is increasingly being described in the medical literature (1). However, little is known about how cannabis use relates to other psychiatric sequelae (2). Moreover, there is a dearth of literature on the clinical characteristics of and risk factors for depersonalization-derealization disorder as precipitated by cannabis use (3).

The principal clinical features of depersonalization-derealization disorder are persistent or recurrent experiences of depersonalization or derealization (4). Depersonalization is a dissociative symptom in which one feels like an outside observer with respect to one’s thoughts, body, and sensations (3). Derealization is marked by feelings of unreality and detachment from one’s surroundings (4), such that one’s environment is experienced as remote or unfamiliar (5). Both symptoms may be a cause of significant distress and functional impairment (4–6).

Transient episodes of depersonalization or derealization have been known to occur across a broad range of psychiatric disorders, including schizophrenia (7). However, persons with depersonalization-derealization are distinguished from those with psychotic disorders by the presence of intact reality testing regarding the dissociative disturbance (4). Whereas an individual with schizophrenia may believe that he or she is actually outside of his or her body, persons with depersonalization-derealization are aware that the dissociation is merely an uncanny sensation (5). Persons with depersonalization-derealization do not appear to be at risk for developing psychotic disorders (2, 3).

The lifetime prevalence of depersonalization-derealization disorder is approximately 2% both in the United States and worldwide (4). The average age at onset is 16 years (8), and women and men are equally affected (5). Persons with the disorder may present with comorbid psychiatric disorders, including personality disorders (8). However, it is uncommon for an individual with depersonalization-derealization disorder to have schizotypal or schizoid personality disorder (8). Personality disorders do not appear to predict symptom severity (8).

Several precipitants have been implicated in depersonalization-derealization disorder, including panic attacks (3) and recreational drugs (5). The most common psychoactive drug precipitant of the disorder is cannabis (3, 5). Although depersonalization and derealization symptoms may occur as part of a panic attack (5), persons with depersonalization-derealization disorder continue to experience symptoms following resolution of the panic attack (3). A cognitive model suggests that those predisposed to anxiety may develop fears regarding episodes of depersonalization and derealization (e.g., fear of “going mad”), which may contribute to the emergence of the symptoms following panic attacks or substance intoxication (9).

Cannabis-induced depersonalization-derealization disorder has been described in the literature for many years (10, 11). However, this type of dissociative disorder is not typically addressed in contemporary reviews focusing on the implications of cannabis use (2). Here, we examine data on prolonged experiences of depersonalization and derealization following cannabis use to provide insight into the clinical features of and risk factors for cannabis-induced depersonalization-derealization disorder.

Pathogenesis

Some individuals who use cannabis will never experience depersonalization or derealization during or after cannabis use (5). However, depersonalization and derealization remain potential side effects of cannabis (12), of which many clinicians are unaware (5). In general, cannabis-induced symptoms of depersonalization and derealization are time-locked to the period of intoxication, peaking approximately 30 minutes after ingestion and subsiding within 120 minutes of exposure to the drug (12, 13). However, among a subgroup of persons who use cannabis, symptoms of depersonalization or derealization persist for weeks, months, or years (3, 5), even after discontinuation of the substance (2, 11). Those who experience prolonged symptoms may have cannabis-induced depersonalization-derealization disorder (2, 10).

The pathogenesis of cannabis-induced depersonalization-derealization disorder can be marked by an initial dissociative disturbance with a severity that subsides but later returns in episodes that eventually become chronic (3). In other cases, onset can be more abrupt, with symptoms emerging during intoxication and persisting unremittingly for months or years (5). For other individuals, symptoms do not occur until hours or days following an episode of cannabis use (3).

Risk Factors

Several factors appear to be associated with risk for cannabis-induced depersonalization-derealization disorder (see box). Most affected individuals have a prior history of an anxiety disorder (6), such as panic disorder (11) or social phobia (2). Additionally, males (6) and adolescents (2) may be disproportionately affected by cannabis-induced symptoms, perhaps due to the higher rates of cannabis use among these groups (14) or to biological predisposing factors (6). Use of cannabis during periods of marked distress (11) or after exposure to trauma (10) may increase risk for cannabis-induced symptoms. Other risk factors may include sudden withdrawal from regular cannabis use (15), severe intoxication (10), and history of prior cannabis-induced symptoms (3) or prior transient substance-induced symptoms (11).

Risk Factors for Cannabis-Induced Depersonalization-Derealization Disorder a

High-potency cannabis use

Frequent cannabis use

Cannabis use after trauma exposure

Cannabis use under acute distress

Sudden withdrawal from regular cannabis use

Experiences of panic attacks or depersonalization or derealization during intoxication

History of depersonalization or derealization symptoms

History of transient cannabis-induced depersonalization or derealization disorder

History of cannabis-induced depersonalization-derealization disorder

History of acute anxiety or panic attacks

History of obsessive thinking

History of sociophobic or avoidant behavior

Family history of depersonalization-derealization disorder

Family history of anxiety disorders or panic attacks

a For further details regarding factors that may be associated with risk for cannabis-induced depersonalization-derealization disorder among individuals who received a definitive diagnosis, see Hürlimann et al. (2), Szymanski (10), and Moran (11).

Individuals naive to cannabis or those with little previous exposure to the substance do not appear to be less prone to onset of cannabis-induced depersonalization-derealization disorder. Simeon et al. (16) examined 89 individuals who developed prolonged experiences of depersonalization and derealization following cannabis use, 28% of whom disclosed using cannabis between 100 and 500 times prior to symptom onset. Sudden emergence of the disorder among persons who use cannabis regularly may be due to life stressors that increase sensitivity to cannabis and risk for mental disorders. Moran (11) examined individuals who used cannabis regularly while experiencing periods of marked distress, such as divorce. Cannabis use during such periods of distress appears to contribute to symptom onset among individuals with little or no prior exposure (10).

Association With Acute Anxiety

There appears to be a strong relationship between acute anxiety and symptom onset in both cases of cannabis-induced depersonalization-derealization disorder (3) and depersonalization-derealization disorder unrelated to drug use (8). Persons who experience prolonged depersonalization-derealization symptoms following cannabis use often report experiencing a panic attack during intoxication (16), which may be due to altered hypothalamic-pituitary-adrenal axis functioning (17). However, the emergence of cannabis-induced depersonalization-derealization disorder is not always associated with panic (5), which suggests that cannabis may be a direct cause of symptom onset without mediation of anxiety symptoms (6).

Sierra and Berrios (18) proposed that beyond a specific threshold of anxiety, a “left-sided prefrontal mechanism” inhibits the amygdala and, in turn, the anterior cingulate, leading to blunted autonomic arousal and feelings of detachment from the self. Concurrently, disinhibited amygdala arousal systems may activate the dorsolateral prefrontal cortex, thereby inhibiting the anterior cingulate, giving rise to other experiential features of depersonalization-derealization disorder, including mind emptiness and indifference to pain (18). Although patients with depersonalization-derealization disorder often show attenuated autonomic arousal (3), PET imaging data on transient cannabis-induced symptoms do not support this model (13). Elucidating how cannabis may be associated with symptom onset is challenging, given the varying strains of cannabis and chemical compounds that are currently available (19).

While acute anxiety is known to be involved in the emergence of depersonalization-derealization disorder symptoms, less is known about why such symptoms may persist following cannabis use. Rather than a direct pharmacologic effect, persistent symptoms have been thought to be associated with causal attributions and fears regarding an episode of dissociation (20). Some patients have attributed their symptoms to brain damage (11), while others have refused pharmacological intervention due to the fear of such intervention worsening their symptoms (11). In light of the consistent relationship between anxiety and symptoms of depersonalization-derealization disorder (3, 5), it is possible that such beliefs or fears about symptom episodes may perpetuate otherwise transient substance-induced symptoms (20). It would be less likely that prolonged symptoms are due to residual drug effects, given that tetrahydrocannabinol is typically eliminated from the body within a few weeks (2).

Conclusions

We reviewed data on prolonged experiences of depersonalization or derealization following cannabis use to provide insight into the clinical features of and risk factors for cannabis-induced depersonalization-derealization disorder. Most risk factors were derived from cases of individuals who received a definitive diagnosis of depersonalization-derealization disorder after using cannabis (2, 10, 11). The most significant risk factor appears to be a history of pathological anxiety (3, 5), which may be contributory to both symptom onset (14) and the persistent nature of the syndrome (20). Anxiety-prone young males who use cannabis may be at ultra-high risk for cannabis-induced depersonalization-derealization disorder, particularly when cannabis is used under marked distress.

Depersonalization-derealization disorder has been considered a hardwired coping mechanism through which feelings of unreality and detachment from one’s self and one’s surroundings help one to cope with acute distress (3). Episodes of depersonalization or derealization associated with cannabis use are typically time-locked to the period of intoxication (12). However, in susceptible individuals who use cannabis, “external stressors and intrapsychic factors may contribute to its continued use as a defense mechanism,” as described by Syzmanski (10). Interventions aimed at mitigating anxiety and targeting intrapsychic factors may prove to be useful in treating cannabis-induced depersonalization-derealization disorder (20).

Prolonged symptoms following cannabis use have been associated with psychotic syndromes in some case reports (10, 11). However, persons who meet diagnostic criteria for depersonalization-derealization disorder present with intact reality testing and do not have a psychotic disorder (2, 4). Although symptoms of depersonalization-derealization disorder may occur in the prodrome of schizophrenia (3), validated instruments used in the assessment of early- and late-prodromal schizophrenia have not revealed any evidence of risk for psychosis among patients with cannabis-induced depersonalization-derealization disorder (2). It is noteworthy that in our review, individuals who did not show signs of prodromal schizophrenia reported experiencing some of the more severe clinical features of depersonalization and derealization, including sensations of physical separation from their bodies and agency (2). Prolonged and severe dissociation following cannabis use may, therefore, not always be an indication of evolving psychosis.

Distinguishing cases of cannabis-induced psychosis from cases of cannabis-induced depersonalization-derealization disorder may be critical in guiding appropriate diagnosis and treatment of this distressing dissociative disorder.

Key Points/Clinical Pearls

Cannabis-induced depersonalization-derealization disorder is characterized by persistent or recurring episodes of depersonalization or derealization.

Cannabis-induced depersonalization-derealization disorder is distinguished from psychotic disorders by the presence of intact reality testing; patients with cannabis-induced depersonalization-derealization disorder do not appear to be at risk for developing psychotic disorders.

Symptoms of cannabis-induced depersonalization-derealization disorder are typically time-locked to the period of intoxication, although marked anxiety regarding dissociation may contribute to the symptomatic presentation of the disorder.

Active treatment of cannabis-induced depersonalization-derealization disorder should incorporate treatment of patients’ anxiety regarding dissociation symptoms.

The authors thank John G. Keilp, Associate Professor of Clinical Psychology in Psychiatry at Columbia University and Research Scientist at New York State Psychiatric Institute. The authors also thank Peter Gordon, Associate Professor of Neuroscience and Education at Teachers College, Columbia University.

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