Derealization & Depersonalization: Peculiar Bits of Business
Derealization & Depersonalization: Peculiar Bits of Business
The most troubling phenomena my panic and anxiety readers and clients report are the dissociative states, derealization and depersonalization (DD). I’ve written two Internet articles on DD; however, I wanted to share some fresh thoughts. Please understand my deep frustration in not being able to offer the solutions for which you may be looking. Unlike so many “authorities” that offer “miracle cures,” I simply won’t lie to you. But ongoing study and discussion of DD serves to increase awareness, which will ultimately lead to concrete relief alternatives.
DD are peculiar bits of business. I mean, they’re the source of terror and desperation for those who didn’t invite them to the dance, yet to a recreational drug user or one who enjoys altered perceptual states they’re honored guests. Let me share a funny story. It was 1972 and I was a freshman at Michigan State. Well, one night the floating party rolled around to our dorm room and the joints began to circulate. I was a marijuana-virgin, but against my better judgment I gave it a go. In very short order I found myself in a dissociative state, running up to my older brother’s fifth floor room to tell him what happened, hoping to find a measure of relief for my horror. He offered absolutely no comfort, as he tore out of the room in a mad dash for what he was sure would be some killer weed. By the way, what I had experienced wasn’t foreign, as I began having bouts of derealization at age nine.
Possible Causes
Given that DD are the third most common psychiatric presentation, trumped only by anxiety and depression, a look-see into its generation is always worthwhile and interesting. Now, before we get started I want to point out that DD can present whenever there’s a blockage of the pathway connecting perception and emotion. And the most common road blocks are a manifestation of a genetic predisposition, brain injury caused be internal or external factors, and emotional trauma and disorders. I’m going to list some common triggers of DD, but before I do you have to promise you won’t obsess over the possibility of being a sufferer of anything on my list (unless, of course, you are). Okay, let’s start with childhood emotional trauma, acute and chronic stress, Alzheimer’s, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), stroke, brain tumors, and traumatic brain injury (TBI). And then there’s the legal and illegal substances merry-go-round, most commonly the use and abuse of marijuana, alcohol, caffeine, as well as recreational and prescription drugs. I’ll also add to the list the prolonged use of benzodiazepines (Xanax, Ativan, Valium, Klonopin, etc.). Heck, even the use of minocycline, a tetracycline antibiotic often used for the treatment of acne and lyme disease, can lead to DD. And go figure, in an almost cruel bit of turnabout, DD are classic withdrawal symptoms. Seems they present in the midst of a substance issue and on the way out the door.
Recent research has brought to light the potential involvement of cortisol in the generation of DD. Cortisol, the “stress hormone,” is produced in the adrenal glands. It’s best known for ramping-up our physical response to phenomena such as life stressors, trauma, excessive exercise, anxiety, and depression by passing word to the neurotransmitter and hormone norepinephrine (noradrenaline) to flip the switch on our sympathetic nervous system, our fight/flight headquarters. And, boom, off to the races we go. Obviously, situational secretion of cortisol is natural and necessary; however, when it’s secreted in the presence of chronic stress all sorts of icky physical consequences may occur, as well as generalized anxiety and panic. And DD. The bottom-line is the researchers used a measurement instrument known as the “Dissociative Experiences Scale.” And the subjects that tested high on the DD subscale had a much higher cortisol response to stimuli. So if the connection between stress, anxiety, and DD weren’t already obvious to you, the research bangs the point home.
Anyone who’s suffered from DD knows they can present in so many ways. Well, research is discovering that these variations can be traced to alterations in brain functioning. For example, the sensation of emotional detachment has been linked to lower levels of neural (having to do with neurons) response in the areas of the brain responsible for emotional feeling. And an increase in neural response was noted in the areas of the brain responsible for emotional regulation. For your reference and research purposes, key brain anatomy involved in emotion include the amygdala, anterior cingulate cortex, orbital prefrontal cortex, and the orbitofrontal cortex. What’s interesting here is the connection between emotion (amygdala) and thought (anterior cingulate, orbital prefrontal, and orbitofrontal cortices), this having much to do with the pathway between perception and emotion I mentioned earlier. As long as
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