DPDR and OCD/Hypochondria

In this post I will be talking about an important but often neglected part of chronic DPDR, namely the involvement of obsessive tendencies and/or hypochondria. In literature, not a lot of attention is paid to the connection, but I would like to make some connections. Firstly, a very good read is this post from a neuroscientist where I’ll be taking many concepts from, so please go read her post first.

So, what this post mentions is that obsessive tendencies are often seen in individuals with chronic or long-term DPDR, which seems to be more than a coincidence or a simple predisposition: her idea is that, by some unknown mechanism, obsessive tendencies (seem in both OCD and hypochondria) seem to keep the DPDR disorder going after being triggered by high levels of anxiety. This is interesting since this implies a treatment option: tackle the obsessive thoughts and the DPDR will most likely vanish by itself. This treatment is one often recommended by ex-sufferers (see dpselfhelp.com’s recovery stories) and by therapists with experience treating the condition.

Furthermore, the medication used by the leading research unit in the UK is a combination of Clomipramine and Lamotrigine. Now, Clomipramine is a tricyclic antidepressant (mentioned in my post about antidepressants) that strongly targets OCD and obsessive tendencies and is used often in treatment resistant obsessive thoughts. Recent research has also shown positive results in using Lamotrigine as a supplement to general antidepressants in treating these same obsessive tendencies. This adds to the evidence given in the post I linked earlier, and shows that psychological and medicinal treatment should focus more on the obsessive side of OCD rather than try to suppress its more obvious symptoms. This is a very important result that should be studied in more detail, since in my opinion it’s the key to treating many treatment resistant cases of long term DPDR.

In my case I had, and still have, a bad case of hypochondria. This is why this is an important topic for me to discuss, since I believe it’s my own personal key to recovery. Knowing the key is, unfortunately, only half the battle… However, I’m slowly but surely crawling out of a deep, deep hole, and it’s important for all of us to remember our progress since it’s not something you feel day to day. Wish me luck in my further recovery, and I for sure wish you the same.

See you next post,

Cedric

DPDR and Objective Reality

This post will talk more about the derealization part of DPDR, the side I struggle with the most… I will start by saying that not all of this discussion is what I would call scientifically factual, since it involves many concepts of philosophy which is not quite an exact science.

So, derealization is a vicious disease: it changes how you experience reality itself. One issue that keeps coming up for me that is hard to understand for others is what I will call the ‘Objective Reality’, the true way to experience reality. Now, this is a hard topic and the most important thing I want you to take away from all this is that reality did NOT change because of your derealization nor are you so traumatized you can never see or feel it like you used to. Trust me on this, I have been through the worst possible hell (although you might not believe me if you’re struggling yourself, I remember I was sure nobody else could suffer like me and make it through) and I am now closer to being myself than I ever was in the past two years. It is possible, and you WILL get better.

Ok, now, onto the discussion on ‘Objective Reality’. This has two sides: first there is the ‘meaning of reality’, and once this is established we can talk about the ‘meaning of life’. A clear ‘objective’ view of these two are needed when we are in the midst of a derealization crisis, when reality seems empty and meaningless and we struggle to find a reason to keep going. However, having a grasp on this is also important when (not if) you do get well, as it can give more meaning and purpose to your life.

First I want to talk about the meaning of reality itself, which is the more scientific of the two sides. There are still many ways to interpret it, when we look at it from the point of view of a physicist (especially the more theoretically inclined ones like me) reality can seem a bit empty sometimes. Everything is made up of fundamental particles that just react according to some strange laws of physics that people made up to, well, find a mathematical way of describing the universe. From this point of view, one I never used to find scary before I endured derealization, reality and even life itself is completely pointless and we as humans only follow some (admittedly difficult) physical equations. In physics there is no consciousness, no happiness, no good and bad, no alive or dead… a scary idea for most of you I’m sure. Luckily biology is there to save us since we are not only a group of molecules that somehow stick together, we are also animals that can think and process the signals our sensory inputs give us. All of this does something strange: it gives color and warmth to the raw emptiness of the universe that physics shows us. We have emotions, instincts, wants and needs… we experience reality in a unique human way that, using the biological definition that is, is beautiful and warm, full of color and meaning… It is this way of looking at reality that all of us are born with, and that derealization tries to take away from us. Don’t let it do this, objectively reality has meaning to us all.

The second and more subjective meaning I want to discuss is the ‘meaning of life’. There has been a lot of discussion on this by philosophers from ancient times till the current day, and there have been many conclusions all equally valid in their own ways, but in this post I will look at my own meaning that makes the most sense to ME and that I hope gives you some feeling of purpose as well. Biologically, the meaning of life is clear for all lifeforms: multiply. That’s all, it’s that simple. For birds this means laying eggs and living long enough to teach their children to fly and eat, for trees it means spreading as many seeds as possible in their lifespan, for bacteria it means to divide and spread, and for humans it means to have children and give them as much education as necessary until they can live independently. The difference is, however, that humanity has evolved beyond our simple biological needs. Of course, to ensure humanity’s survival making babies and educating them is still very important, but we as individuals are free to CHOOSE our life’s meaning. Once you realize this you get a feeling of freedom, but it has a more scary side: what do we feel gives us purpose? What if nothing does? This is the most subjective, but also the most important, discussion in this post and one you can only decide within your own mind. For some it’s religion that gives meaning, for others it’s richdom or success (in whatever way they want to define it), for some it’s to have children… For me, personally, I have chosen happiness as my life goal. Not just for myself, but for me and all my loved ones and even random people I will never see again. That is what gives my life meaning and purpose, and this entire discussion is what I try to remember anytime it feels like the derealization is taking over.

I think this is an important post to read, and I’d like you to keep in mind what gives you meaning. It’s alright if you feel like nothing does at the moment, you will find it when you get better, just remember that objectively you experiencing and existing in this reality is important and meaningful.

See you next post,

Cedric

Explaining DPDR to Others

In this post I would like to go more into detail in something we certainly all have trouble with: explaining what DPDR is like to others, and even to ourselves. I’m sure most of the sufferers have spent countless hours thinking of ways to actually put into words what it feels like to actually be in the thick of the disorder and while I’m certain an actual understanding of the severity and intensity is impossible without having been through it themselves, I hope this post gives you some way of putting this horrible disorder into words.

As I mentioned in my earlier blog post on safety, the mental effect DPDR has on you is something very weird and scary indeed. I’ve always thought that the idea of anxiety or depression is relatively easy to explain to others, since we’ve all had to deal with these feelings in a certain amount. For depression it is more linked to our inner sense and our past, while for anxiety the influence comes more from outside and from the imagined future. However, as I mentioned before, normal anxiety feels like an outwards attack into the bubble of safety everyone has, shrinking it and with it your feeling of safety in the world. DPDR, on the other hand, does something way more vicious and cruel: it destroys your safety bubble from within, taking away its very core and the basic building blocks holding it all together. What I mean to say is that it takes away out sense of humanity and our connection to reality, something truly unimaginable to the healthier of mind and in some way even to the lucky ex-sufferers. This implies we have to find another way of explaining these emotions, and the best way is through the use of “as-if’s” and analogies. In this article I will write down some I’ve come across or invented myself over the years, as to hopefully let you more easily express yourself to your doctor, psychiatrist, or loved ones.

The first one I want to talk about is feeling like you’re an alien, freshly arrived in a very depressing and dead new world. To me this one makes a lot of sense, as it’s explained in simple terms and because in my bad moments I have an enormous issue with the feelings of emptiness and depressiveness of reality. On top of this, the feelings of how physics or human and other animals’ anatomy or emotions seem bizarre and scary is something I also find difficult to deal with myself, and is something I heard many people mention as a hard symptom to live with.

Secondly, derealization can be described as waking up from a dream, except in this case the dream was reality itself. This one is a bit harder for others to understand, but it rings so true for me since it conveys well how much the disorder takes over your worldview and how convincing the existential thoughts and feelings can be. An issue I dealt with (and often still do) is the thought or feeling that what we feel and think in the derealized state is the objective reality, which can often be so strong it makes you feel depressed, panicked, and hopeless. I will talk more about the objective reality in another post, since for me this is possibly the hardest symptom to deal with.

A third analogy I found people could somewhat understand, and is somewhat related to the previous one, is that it’s like realizing your life and your reality is just like a theater play, where everyone else is just going through the motions. Everything feels make belief, fake, and meaningless. This again shows the feeling of it being more objectively true since it feels fake to actually even participate in life, and even doing small things start feeling pointless and horrible.

Number four is one I thought of to show the horribleness of the disorder, and one that is meant to explain the worst days, or weeks, or months, where you’re so stuck you don’t even see the point anymore to getting better. In this analogy it feels like suddenly realizing you’re in a dark and very scary room, and that what you thought was your life and reality is actually just a tv-show you’ve been watching on a small screen in the room. This is horrible because you get convinced this ugly, dark, scary room is real and that your life and existence are fake and meaningless. It convinces you it’s impossible to get better and that, objectively, the depersonalized derealized state is the real truth.

There are many more analogies I can relate to, but they’re all somewhat similar for me and everyone experiences DPDR differently. I would love to hear some more ways to express it to others from all of you, since getting support and understanding from your loved ones and having them realize the seriousness of the disorder really helps you improve, even (especially) when everything seems dark and hopeless.

See you next post,

Cedric

DPDR and Antidepressants

Today I wanted to talk a bit about antidepressants, namely the SSRIs and Tricyclics. Why these? Well, for one they are the most prescribed antidepressants worldwide, and they are also the ones I have some personal experience with. It’s important to understand their role in stabilizing your mood, anxiety, depression, and how they help your recovery.

Now, there is a lot of literature on the working of antidepressants for both depression (obviously) and anxiety. For a general review I will simply point to their respective Wikipedia articles, but most of the details are not useful for us to discuss in detail. Important to note is that the SSRIs (Selective Serotonin Reuptake Inhibitors) block the reuptake of serotonin in the brain, causing an increase in the level of serotonin. This is important because, to put it simply, serotonin is a chemical that makes us feel good: it lowers feelings of depression, and it regulates anxiety. Worldwide, SSRIs are the most widely prescribed antidepressants for both anxiety and depression disorders. The reason for this is simple, they are generally effective (although how effective is still unclear and the cause of much discussion) and have (comparably) little side effects. Tricyclics, on the other hand, enhance the neurotransmission of both serotonin and norepinephrine, making them more effective. It is an older type of antidepressant, and for general use they have mostly been replaced by the newer SSRIs. While their efficacy is mostly regarded to be similar or better than the SSRIs for some types of depression and anxiety, they also carry with them a higher risk of both minor and serious side effects.

Now, I have had long term personal experience with only two antidepressants: Escitalopram (Lexapro), an SSRI, and Anafranil (Clomipramine), a tricyclic. Escitalopram I took for several months, and while I didn’t have many serious side effects (except the first few weeks, which are generally the hardest for any antidepressant) I also didn’t see much improvement in both my obsessive anxiety spirals or the feeling of DPDR. Next I tried Anafranil and while the side effects are a lot more noticable (fatigue, weight gain, sweating…), it has a much stronger effect on the obsessive side of anxiety. In most literature I could find Anafranil is sort of a last resort drug for treatment resistant OCD, with a surprisingly high success rate. Since I believe that most long term DPDR is kept going by a tendency to obsessively worry and ponder over the disorder and its effects, this makes Anafranil a good fit for DPDR and I have had very good effects in lowering my anxiety levels and it has (mostly) kept me out of the awful anxiety spirals that used to drag me into the deepest hell that is strong DPDR.

From the literature and the feedback of users I can see that this is a general trend, with Anafranil strongly affecting the obsessive tendencies of the user, and thus being a promising drug to help those with obsessive DPDR. It is also important to note that one must have patience, since the full effect of Anafranil on obsessive thinking can take six to twelve weeks to really kick in.

So, if you are strongly suffering from the effects of DPDR and are unhappy with the medicine you are currently taking, I would advise you to talk to your doctor or psychiatrist about trying Anafranil. Of course I am not a doctor so take everything I say with a grain of salt, and listen to the opinion of the professionals over mine, but I hope this post might help point someone in the right direction as far as medication goes.

Now, there are other types of medication I want to talk about including antipsychotics and the infamous Lamictal (Lamotrigine), but that will have to wait for another post.

Kind regards, and see you next post,

Cedric

DPDR and Safety

Feeling safe and secure is something all of us strive for. For most of us, this safety is found in being at home, in a place you know and love, or having loved ones around. For people with anxiety this ‘safety area’ shrinks somewhat, making it for example more difficult to socialize with others or even leave the house depending on the severity of the disorder. Yet we, as all of you can hopefully still remember, have always had a feeling of familiarity and safety in some of the few things we as humans all have in common: our humanity, and our place in reality itself.

Now, depersonalization and derealization disorder is also strongly connected to anxiety, yet it works in a different and much more vicious way. Instead of taking our safety area and slowly shrinking it, it takes away what we as humans take for granted the most: our feeling of our humanity and objective reality itself. In a sense, it tears a large hole in our safety area, in the one place that keeps the rest of the fabric whole. This is one of the reasons it’s so hard to convey to others who have had the luck to never be affected by it the huge impact DPDR has on our lives, since these sensations are pretty much impossible to imagine for the normal mind. At the same time this is also why the disorder is so scary and disturbing, and why it leaves such a large impression on its sufferers.

This lack of the most basic feelings of safety we as humans possess is what I also believe to be our greatest obstacle in overcoming the DPDR disorder. In order to beat it we are required to stop fighting and fully accept this feeling (and that’s what it is: just a feeling) of being in danger, and realize we’re actually completely safe and able to get well again, no matter how much our instincts tell us otherwise. I will post more on the way to recovery in other blog posts.

This is a shorter post for the new year, but I hope it sheds some light on the disorder for both sufferers and the casual reader.

See you next post,

Cedric

DPDR and Depression

Again not the promised general review of DPDR, but it’s a long and difficult subject that I’m currently working on. Coming soon, I promise.

The feelings of depression that accompany DPDR is a subject that I’ve not found much information about, be it in research and online, yet it is an important aspect to understand since it influences both your emotions and thoughts greatly. In this post I will write about the similarities and differences between DPDR and depression, and how DPDR can and eventually likely will bring out some symptoms of depression. It is important to note that, even now, the exact causes of both depression and DPDR are unfortunately not fully understood.

It is said that the core symptom of depression is anhedonia, meaning a loss of interest and pleasure in activities that normally would bring joy and happiness with them. To some of us with DPDR-symptoms this can sound familiar, since seeing reality as alien, empty, and lifeless, is a symptom common to the disorder. I sometimes still struggle to see the difference in myself, since it’s such a subtle difference.

Depression, however, also has many symptoms not inherently linked to DPDR. This includes low self-esteem, pain, low energy, feeling suicidal… all of which is not a (direct) result of DPDR, signaling a different underlying cause.

On the other hand, some more similarities appear when we look a little deeper. Hopelessness and high levels of anxiety are seen in both depression and DPDR, though both of these seem a logical result from their underlying syndromes.

Finally, I have very often seen that a high comorbidity is seen between the two diseases. For the evolution of depression into DPDR, I found very little actual information. One possible cause could be the increased anxiety levels, since anxiety is inherently linked to DPDR. Secondly, and this is just my thinking, is that when one transitions from a normal state into a state of deep depression the changed perception of reality causes everything to feel dreamlike, unreal, unrecognizable… all symptoms of DPDR. The causal link from DPDR to depression, on the other hand, is something in which a lot of us have some degree of understanding. Firstly there are already the similar symptoms as described above, and some others like low energy and a suicidal feeling are simply logical consequences of spending a long time in a dissociated state where one is actively unhappy and has a mind full of torturous thoughts and feelings. Admittedly, there is still a lot of discussion (although more is always welcome) and I certainly don’t have all the answers, but I have seen this dangerous transition in myself, giving rise to two hospitalizations due to suicidal OCD (more on this in another post) and a general growing feeling of hopelessness and despair.

This post is a work in progress, and I will add more information as I discover it.

See you next post,

Cedric

My Journey So Far Part I

This is going to be a long post, and if you’re only interested in treatment you can safely skip this one. I said I would post a general outline of DPDR first, but it seems my inspiration brought me elsewhere…

So, without further ado, here is my journey with anxiety, panic disorder, OCD-like thought patterns, and eventually DPDR. In this first post I will talk about everything pre-DPDR, in the hope of having some of the readers finally find out what is wrong with them, and that what they are going through is perfectly normal.

Up until starting university at the age of 18 I was a perfectly normal child (as far as children can be called normal) and teenager. Other than some social anxiety, which is a big part of most teenagers life, I was leading a perfectly happy and fulfilling life. In the first year of my higher studies, however, I started encountering some (at least looking back, that is) strange obsessive tendencies. During my first stressful exam period around December 2010 I noticed I got obsessed with the idea that I was losing my hair. Despite no real evidence that my hairline was, in fact, receding, I had a strange conviction I was balding. At the time this all seemed normal, even recording the length from my eyebrows to my hairline and checking the mirror hourly to check if I was really really sure I was not rapidly going bald somehow.

This is my first real run-in with my obsessive tendencies, and despite this being a rather innocent example, it reveals something more deep and ultimately more vicious.

The second example I can think of was the certainty I felt of having bowel cancer (or something equally terrifying), spanning from 2011 up until around 2014. This was not a constant fear, but in that period cancer was a big part of my worries and eating up a significant portion of my thinking. Somewhat simultaneously, I started developing a fear of heart issues triggered by what I think was some heart fluttering or beat skipping, completely harmless occurrences. This was my first obsession that led to a constant checking behavior, where I spent my days obsessively checking my heart rate, the occurrence of any skipping, etc. At some point I was so sure my heart was going to fail on me that every skipped beat, and I was at that time so trained to feel them this occurred frequently, I was preparing myself on the likelihood of certain death via heart failure.

There are many more examples, but what is very interesting is that actually up until around 2017 I never really noticed these obsessions and compulsions to dispel any possible doubt were abnormal and non-issues for most other people. Since most of us grow up with these tendencies they don’t feel out of the ordinary, and actually not having these controlling behaviors looking for certainty seem alien and dangerous. The one thing all those with obsessive hypochondria-like tendencies, something I don’t directly want to define as actual Obsessive-Compulsive Disorder (OCD) but is quite similar, have alike is that they make an overestimation of the risk of certain dangers and want to find certainty that what they fear most is not, in fact, occurring, using certain compulsions. These obsessions and compulsions vary widely, but I would like to talk more on this in another post.

Despite all the previously mentioned hypochondric thoughts and the evasive and checking behaviors I was leading a healthy, happy, meaningful life, with the one downside being a certainty of death in the coming few years through whatever was my leading obsession at the time. It was in the first months of starting my PhD at the end of 2015 I started having panic attacks: unpleasant feelings of impending doom, a hyperfocus on certain bodily sensations, very high heart rate, sweating, and a strange often baseless fear of whatever the current situation was. The inclusion of this change in heart rate and a feeling of impending doom then would strongly trigger the hypochondriac in me, causing me to feel sure I was having a heart attack and was dying. Worrying about this then caused more panic attacks, causing me to eventually have a sort of mental breakdown where I went to the doctors office, crying, sure there was something big wrong with me. Luckily my doctor told me there was nothing wrong with me, informed me about panic attacks, and prescribed me some light dose of Escitalopram to hopefully stop the panic attacks from happening. Relieved by both knowing what’s wrong with me and the existence of some type of medicine to help me, I soon continued my life as before: still certain I would soon be dead because of some horrible disease but, despite this, still happy. At least, that is, until the autumn of 2017…

In part II I will write about the start and progress of DPDR and include a general timeline.

See you next post,

Cedric

First Post

Here it is, my first blog post. Ever.

In this blog I will talk about my ongoing two year journey through the horrible weirdness that is Depersonalization and Derealization Disorder (DPDR). I suffer mostly from the derealization aspect, but I think DP and DR are so intertwined that it’s hard to make a real distinction, hence the name of the disorder.

I have about ten years of experience with generalized anxiety (GAD), four years of experience with panic attacks, and unfortunately over two years of experience with currently only mostly chronic DPDR.

In my first real post I will give an overview on DPDR and its links to anxiety and OCD, for beginners.

Note that, as a scientist (although not in the field of psychology), I will only use what I think are scientifically verified results. This is difficult since there is so so much misinformation about both anxiety and DPDR and their connection, as well as a general lack of high quality research literature to learn from. Additionally, I will use my own experiences with different forms of therapy and medication to show you what I think is the best way of dealing with this terrible, horrible, unbelievably torturous disease…

The most important thing to note in my first blog is that you should not worry, since you can get through this, and because worrying is what keeps DPDR going. It changes many things, both thoughts and emotions, but your actual sense of reality will never ‘fall apart’ or ‘dissolve’ like you fear. The second most important thing is that I know what you are going through, and how it very likely is the most difficult, scary, painful thing that you will EVER face in life. But, believe me, it can and will get better, no matter how deep you think you are.

See you next post,

Cedric

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