What are the signs of losing touch with reality. How can early intervention help in psychotic episodes. What are the benefits of timely treatment for mental health disorders. How do hallucinations and delusions manifest in acute psychotic episodes. Why is it crucial to recognize prodromal symptoms in adolescents.

Recognizing the Signs: When Reality Slips Away

Losing touch with reality, often referred to as a psychotic episode, can be a distressing experience for both the individual and their loved ones. But what exactly does it mean to lose touch with reality? Let’s explore the key symptoms and manifestations of this complex mental health issue.

Hallucinations: When Senses Deceive

Hallucinations are false sensory perceptions that occur in the absence of external stimuli. They can affect any of the five senses, but auditory hallucinations are particularly common in psychotic episodes. For instance, Shraddha, the 20-year-old student mentioned in the case study, experienced auditory hallucinations where she heard a voice speaking to her through her computer.

• Auditory hallucinations: Hearing voices or sounds that aren’t there
• Visual hallucinations: Seeing objects, people, or phenomena that don’t exist
• Tactile hallucinations: Feeling sensations on the skin without any physical cause
• Olfactory hallucinations: Smelling odors that aren’t present
• Gustatory hallucinations: Tasting flavors without any source

Delusions: Unshakeable False Beliefs

Delusions are fixed, false beliefs that persist despite evidence to the contrary. In Shraddha’s case, she firmly believed that her computer had been hacked and that her friends were spying on her. These beliefs led to significant changes in her behavior and daily life.

Common types of delusions include:

• Persecutory delusions: Believing others are out to harm or conspire against you
• Grandiose delusions: Believing you have special powers or importance
• Referential delusions: Thinking that neutral events or coincidences have personal significance
• Somatic delusions: False beliefs about your body or health

The Prodromal Phase: Early Warning Signs

Before a full-blown psychotic episode occurs, individuals may experience a prodromal phase. This period can last for months and is characterized by subtle changes in thoughts, feelings, and behaviors. Recognizing these early warning signs is crucial for timely intervention.

Identifying Prodromal Symptoms

How can you recognize the prodromal phase? Here are some key indicators:

• Mild psychotic symptoms that the person recognizes as irrational
• Vague suspicions about others’ intentions
• Sleeplessness or changes in sleep patterns
• Social withdrawal and isolation
• Decline in personal hygiene and self-care
• Difficulty concentrating or making decisions
• Unusual or magical thinking

Regular mental health check-ups during this phase can help healthcare professionals identify and address emerging issues before they escalate into a full psychotic episode.

The Impact of Psychosis on Daily Life

When an individual experiences a loss of touch with reality, the effects can be far-reaching and disruptive to their daily life. Understanding these impacts is essential for both patients and their support systems.

Academic and Professional Consequences

One of the most immediate and noticeable effects of psychosis is often a decline in academic or professional performance. In Shraddha’s case, we see how her psychotic symptoms led to:

• Missed classes and exams
• Declining grades
• Inability to maintain normal daily routines

This disruption can have long-term consequences on an individual’s educational or career trajectory if not addressed promptly.

Social Withdrawal and Isolation

Psychotic symptoms often lead to social withdrawal, as seen in Shraddha’s case where she isolated herself from her flatmates. This isolation can further exacerbate symptoms and make it more difficult for the individual to seek help or maintain supportive relationships.

Neglect of Personal Care

Another common consequence of psychosis is the neglect of personal hygiene and self-care. This neglect can lead to physical health issues and further social isolation, creating a cycle that’s difficult to break without intervention.

The Importance of Early Intervention in Psychosis

Early intervention in cases of psychosis is not just beneficial—it’s crucial for improving outcomes and preventing long-term complications. But why exactly is early intervention so important?

Benefits of Timely Treatment

Early intervention in psychosis offers numerous advantages:

1. Improved chances of complete recovery
2. Better response to medication
3. Lower risk of relapse
4. Quicker return to normal life activities
5. Preservation of social skills and relationships
6. Reduced need for hospitalization
7. Lower risk of suicide
8. Less stress on family members

These benefits underscore the importance of recognizing and addressing psychotic symptoms as early as possible.

Challenges in Early Detection

Despite the clear advantages of early intervention, detecting psychosis in its early stages can be challenging. Why is this the case?

• Symptoms may be subtle or easily dismissed
• Individuals may be reluctant to seek help due to stigma
• Some symptoms might be mistaken for typical adolescent behavior
• The prodromal phase can be difficult to distinguish from other mental health issues

Overcoming these challenges requires increased awareness and education about early signs of psychosis, both among the general public and healthcare professionals.

Differential Diagnosis: Unraveling the Complexity

When an individual presents with psychotic symptoms, especially in adolescence, it’s crucial to consider a range of potential causes before arriving at a definitive diagnosis. Why is this differential diagnosis process so important?

Beyond Primary Psychotic Disorders

While conditions like schizophrenia are often associated with psychotic symptoms, several other disorders can present similarly, particularly in young people:

• Temporal lobe tumors
• Metabolic diseases (e.g., disorders of copper metabolism)
• Certain types of epilepsy
• Delayed effects of head injuries
• Substance-induced psychosis
• Mood disorders with psychotic features

These diverse possibilities highlight the need for a comprehensive evaluation and potentially multiple follow-up appointments to ensure an accurate diagnosis.

The Role of Medical Investigations

How do healthcare professionals differentiate between these potential causes? A combination of approaches is typically used:

1. Detailed medical history
2. Physical examination
3. Neurological assessment
4. Blood tests to rule out metabolic disorders
5. Brain imaging studies (e.g., MRI or CT scans)
6. Electroencephalogram (EEG) to detect seizure activity
7. Psychological evaluations

This thorough approach helps ensure that underlying medical conditions are not overlooked and that treatment is tailored to the specific cause of the psychotic symptoms.

Treatment Approaches for Psychotic Episodes

Once a psychotic episode has been identified, what are the primary treatment approaches? The management of psychosis typically involves a multi-faceted approach, combining medication with psychosocial interventions.

Pharmacological Interventions

Antipsychotic medications are often the first line of treatment for acute psychotic episodes. These medications work by altering the brain’s neurotransmitter systems, particularly dopamine, to reduce psychotic symptoms.

Key points about antipsychotic treatment include:

• Different types of antipsychotics are available, with varying side effect profiles
• Dosage and medication choice are tailored to the individual
• Regular monitoring is essential to assess effectiveness and manage side effects
• Treatment may need to be continued even after symptoms improve to prevent relapse

Psychosocial Interventions

While medication is crucial, psychosocial interventions play a vital role in comprehensive treatment. These may include:

1. Cognitive Behavioral Therapy (CBT) for psychosis
2. Family therapy to improve support and understanding
3. Social skills training
4. Occupational therapy to assist with daily living skills
5. Supported employment or education programs

These interventions aim to help individuals manage their symptoms, improve their quality of life, and reintegrate into their communities.

The Role of Family and Support Systems

The importance of a strong support system in managing psychotic disorders cannot be overstated. How can family and friends contribute to the recovery process?

Education and Understanding

One of the first steps for families is to educate themselves about psychosis. This includes:

• Understanding the nature of psychotic disorders
• Learning to recognize early warning signs of relapse
• Being aware of treatment options and their potential side effects
• Understanding the importance of medication adherence

This knowledge empowers families to provide informed support and advocate effectively for their loved ones.

Practical Support

Families can offer practical assistance in various ways:

1. Helping to maintain a stable, low-stress environment
2. Assisting with medication management
3. Encouraging adherence to treatment plans
4. Supporting healthy lifestyle choices (e.g., diet, exercise, sleep hygiene)
5. Helping to navigate healthcare and social service systems

This practical support can significantly improve treatment outcomes and quality of life for individuals with psychotic disorders.

Emotional Support and Communication

Emotional support is crucial for individuals recovering from psychotic episodes. Effective strategies include:

• Maintaining open, non-judgmental communication
• Expressing empathy and understanding
• Avoiding criticism or blame
• Encouraging social connections while respecting boundaries
• Participating in family therapy or support groups

By providing emotional support, families can help reduce stress and improve overall well-being for their loved ones.

Long-term Outlook and Recovery

What does the future hold for individuals who have experienced a psychotic episode? The long-term outlook can vary significantly depending on various factors, including the underlying cause, the duration of untreated psychosis, and the effectiveness of interventions.

Factors Influencing Prognosis

Several factors can impact the long-term outcomes for individuals with psychotic disorders:

• Early intervention and treatment
• Adherence to treatment plans
• Strength of support systems
• Presence of co-occurring mental health or substance use disorders
• Individual resilience and coping skills
• Access to comprehensive, ongoing care

Understanding these factors can help in developing personalized treatment plans and setting realistic expectations for recovery.

The Recovery Journey

Recovery from psychosis is often described as a journey rather than a destination. This process may involve:

1. Symptom management and reduction
2. Developing insight into the condition
3. Rebuilding social relationships
4. Returning to work or education
5. Regaining independence in daily activities
6. Finding meaning and purpose in life despite challenges

It’s important to note that recovery doesn’t necessarily mean a complete absence of symptoms, but rather the ability to lead a fulfilling life despite occasional challenges.

Ongoing Support and Monitoring

Long-term management of psychotic disorders often requires ongoing support and monitoring. This may include:

• Regular check-ups with mental health professionals
• Medication management and adjustment as needed
• Participation in support groups or peer support programs
• Continued psychosocial interventions as appropriate
• Lifestyle modifications to support overall mental health

This ongoing care helps maintain stability and prevent relapses, supporting individuals in their long-term recovery journey.

Breaking the Stigma: Mental Health Awareness

One of the significant challenges in addressing psychotic disorders is the persistent stigma surrounding mental health issues. How can we work to break down these barriers and promote better understanding and support for individuals experiencing psychosis?

Education and Awareness

Increasing public knowledge about psychotic disorders is crucial in combating stigma. This can be achieved through:

• Public education campaigns
• Integration of mental health education in school curricula
• Media portrayals that accurately represent mental health issues
• Open discussions about mental health in communities

By fostering understanding, we can help create a more supportive environment for those experiencing mental health challenges.

Challenging Misconceptions

Many misconceptions about psychosis persist in society. Addressing these directly can help reduce stigma:

1. Psychosis is not a result of personal weakness or character flaw
2. People with psychotic disorders are not inherently violent or dangerous
3. Recovery from psychosis is possible with proper treatment and support
4. Psychotic symptoms are not the same as “split personalities” or multiple personality disorder
5. Psychosis is a medical condition, not a choice or a punishment

By challenging these misconceptions, we can promote a more accurate and compassionate understanding of psychotic disorders.

Promoting Help-Seeking Behavior

Stigma often prevents individuals from seeking help for mental health issues. To encourage help-seeking behavior, we can:

• Normalize discussions about mental health
• Highlight success stories of individuals who have sought help
• Improve access to mental health services
• Encourage supportive workplace and educational policies
• Promote the idea that seeking help is a sign of strength, not weakness

By creating an environment where seeking help for mental health issues is accepted and encouraged, we can improve outcomes for individuals experiencing psychosis and other mental health challenges.

Loss of touch with reality

Adolescence

Sometimes people present with sleeplessness, along with mild psychotic symptoms such as odd thoughts or behavior that they recognise as irrational, or vague doubts about the intentions of neighbours or co-workers.

Shraddha, a 20-year-old Indian girl studying in the UK, called her mother late one night screaming that somebody was trying to kill her. She said her computer had been hacked into, and the hacker spoke to her through the computer. He kept telling her to run out into the traffic as she didn’t deserve to live. Sometimes he called her vulgar names and mocked her.

She had shared a flat with two other girls for a couple of years when she started her undergraduate course in the UK. Everything had been fine and the girls had become good friends. Six months ago she had begun suspecting that her flatmates were  spying on her. So she had taken to staying holed up in her room, door locked and curtains drawn. As she avoided going to the kitchen to cook, and the bathroom to bathe, her health and hygiene were neglected. She stopped attending classes and exams as well, and her grades suffered.  Finally, she moved out into a small flat to live alone. As she had informed her parents about the move and given a credible reason for it, they did not suspect anything to be amiss.

Following that phone call, her panic-stricken mother caught the first flight out and brought her home.

She came in for a consultation a day or two later accompanied by her mother. As her mother laid out the facts, Shraddha sat quietly in her chair looking utterly exhausted and blank. She did not add anything, nor did she contradict her mother. She did not even seem to register where she was, or with whom. When I asked her a simple question – was she sleeping well? – she merely directed a perplexed gaze at me but did not reply. She seemed to be somewhere else altogether.

This is not an uncommon presentation in psychiatric clinics. All the symptoms Shraddha experienced were typical:

• Hallucinations – she heard a voice saying things to her

• Delusions – she completely believed that her computer was hacked, also that her friends were spying on her

• Disorganisation – the way she had started to live, neglecting herself, lacking motivation to do things

• Social withdrawal, lack of normal feelings, poverty of speech

When people bring in a family member or a friend who has been through this harrowing experience they usually refer to it as a nervous breakdown.   In psychiatric parlance it is simply called an acute psychotic episode, meaning it is something that has suddenly happened (acute), there are symptoms like hallucinations and delusions that show a lack of touch with reality (psychotic) and it may be temporary (episode).

Sometimes people present with sleeplessness, along with mild psychotic symptoms such as odd thoughts or behavior that they recognise as irrational, or vague doubts about the intentions of neighbours or co-workers. There is an awareness of this change at a subliminal level, a feeling that something is not quite right. This is called the prodromal phase. A prodromal phase lasting a few months before the full syndrome develops is common. This might have been the clinical picture if Shraddha had presented four or five  months before. Had her mental state been examined once a week or so by a psychiatrist, treatment could have been started earlier, and the breakdown averted.

When such a person is first seen in the hospital the focus is on controlling psychotic symptoms with antipsychotic medications. However, as there are other disorders that present with psychotic symptoms in adolescence, it is necessary to wait for a few months and watch what happens. These disorders are relatively rare, e.g. tumours of the temporal lobe, metabolic diseases like disorders of copper metabolism, certain types of epilepsy, etc. Even a head injury that was not considered serious when it happened may cause similar symptoms days or months later. These can be diagnosed only by regular reviews and appropriate  investigations. It is  important to comply with the prescribed treatment, because the doctor’s next step depends on the patient’s response to medication and other parameters used to assess progress.

Early intervention is imperative. For one thing, it improves the chances of complete recovery. Secondly, there are these benefits:

• Good response to medication and lower risk of relapse

• Quicker return to school/work and normal life

• No loss of social skills, intact interpersonal relationships

• No need for hospitalization

• Reduced risk of suicide (that can happen in response to hallucinations, as it could have in the case above)

• Less stress on family members

In this series Dr Shyamala Vatsa highlights the fact that teenage changes can mask incipient mental health problems. These articles show how early symptoms of mental disorder can be taken for ordinary teenage behavior. As illustrated by the stories of young people who have suffered unnecessarily, it is important for friends and family to recognize when a behavior is outside normal limits, and seek help before things spin out of control.

Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years. If you have any comments or queries you would like to share, please write to her at [email protected]

We are a not-for-profit organization that relies on donations to deliver knowledge solutions in mental health. We urge you to donate to White Swan Foundation. Your donation, however small, will enable us to further enhance the richness of our portal and serve many more people. Please click here to support us.

psychosis

adolescence

Wonder Years

column

Shyamala Vatsa

Symptoms, Causes, Diagnosis, and Treatment

Written by Natalie Slivinski

• Symptoms
• Causes
• Diagnosis
• Treatment

Derealization is a mental state where you feel detached from your surroundings. People and objects around you may seem unreal. Even so, you’re aware that this altered state isn’t normal.

More than half of all people may have this disconnection from reality once in their lifetime. But about 2% of people experience it often enough for it to become a type of dissociative disorder.

Derealization is similar but distinct from depersonalization. The latter involves a feeling of detachment not from your environment, but from your own body, thoughts, or feelings. It’s as if you’re watching what’s happening to yourself as an outsider.

Derealization usually happens in episodes, which means symptoms come and go. During an episode, you might feel as if:

• You are in a dream or “fog.”
• A see-through wall or veil is separating you from your surroundings.
• The world appears lifeless, muted, or fake.
• Objects or people look “wrong” — blurry, unnaturally sharp, too big, or too small.
• Sounds are distorted, too loud, or too soft.
• Time seems to speed up, slow down, or stand still.

Episodes can end in a few minutes or stretch for months at a time. But even as you feel like you’re going “crazy,” you always recognize that something is off. This is a key difference from psychotic disorders, where you can’t distinguish what’s real and what’s imaginary.

Derealization sometimes can be a symptom of a medical condition. Other times, it can happen on its own, often in reaction to severe trauma or stress.

Health conditions linked to derealization include:

• Seizures
• Dementia
• Drug abuse
• Schizophrenia
• Panic attacks
• Depression
• Others dissociative disorders, like amnesia

The most common event that can trigger derealization is emotional abuse or neglect at a young age. The experience prompts the child to detach from their surroundings as a way to manage the trauma. Other causes of stress might include:

• Physical or sexual abuse
• Witnessing domestic violence
• Parents or guardians with a severe mental disorder
• Unexpected death of a loved one
• PTSD from war or conflict
• Trauma from an accident or a natural disaster

Future episodes of derealization can be brought on by everyday stressors, including problems at work or in your relationships.

Derealization almost always starts in late childhood or early adulthood. The average age it starts is around 16, and 95% of cases are diagnosed before age 25.

No lab test can diagnose derealization. Your doctor may first try to rule out physical causes. They may use imaging tests such as an MRI, EEG, or an X-ray, or a urine screen to check for toxic chemicals.

If those tests don’t show anything, your doctor will refer you to a mental health expert. They will diagnose you with derealization disorder if you:

• Have constant or repeated bouts of symptoms
• Know that what you’re seeing or experiencing is not real
• Are deeply distressed or your symptoms severely interfere with your life

Many people who have derealization recover fully, sometimes on their own. Others are able learn how to get through episodes calmly.

But if you’ve been enduring it for a long time or if your root cause was very traumatic, you may need professional help. That’s especially true if you also have depression or anxiety that often comes with derealization.

The No. 1 treatment for derealization is psychotherapy. This form of talk therapy teaches you ways to share your experience and strategies to handle your episodes. Your doctor also may prescribe medication, mainly to ease any symptoms of depression or anxiety that come with the disorder.

Through psychotherapy, you may learn how to:

• Keep yourself from obsessing about unreal experiences.
• Distract yourself with activities.
• Ground yourself in reality using your five senses (for example, by playing loud music or holding something very cold).
• Address negative feelings and figure out the causes of your symptoms.
• Talk about your feelings using specific words.

Top Picks

Depersonalization: a syndrome that interferes with feeling – BBC News Ukraine

• Adam Iley
• because of her illness, familiar places seem like decorations

  People with depersonalization syndrome, the world seems unreal, two-dimensional, as if in a fog. Every hundredth suffers from this disorder, but despite this, British doctors are not taught to work with such patients, experts say.

  “The connections you think are valuable lose their original meaning. You know you love your family. But the thing is, you’re more aware of it than you feel it,” says Sarah on the BBC’s Victoria Derbyshire program .

  Sarah is an actress, she constantly tries on different images and reproduces other people’s emotions. But in reality, for most of her conscious life, she is emotionally paralyzed and unable to experience any feelings.

  The reason for this is a little-studied mental disorder called depersonalization.

  Sarah had the syndrome three times. The first time it happened was when she was preparing for her final exams.

  The main sign of depersonalization is the feeling that a person loses physical connection with the world around him and his own body.

  It is believed that this is how a defense mechanism manifests itself when, during stress or a serious shock, consciousness is disconnected from reality. Some drugs, such as marijuana, can cause the same effect.

  • Researchers: Instagram is the worst social network for the psyche of young people
  • Psychologist’s blog: where to get motivation?
  • Does sport help with depression?

  For people with depersonalization syndrome, the world can change in a second.

  “It was an unexpected switch. Everything around seemed alien and even intimidating. Suddenly, the apartment and other places where you used to be become a film set for you, and all your things become scenery,” says Sarah.

  Other patients report feeling that they are outside their body, that it does not belong to them, and that the world around them seems two-dimensional and flat.

  This happened to Sarah during the second episode.

  “I was reading, I had a book in my hands. And suddenly my hands began to look like a picture on which two hands were drawn. There was a feeling that the real world and my perception of it did not coincide.”

  Sarah’s disorder is not uncommon. Three independent studies have proven that it occurs in one person out of a hundred.

  Experts argue that the disorder has long been recognized as a medical disease. It is as common as obsessive-compulsive disorder or schizophrenia.

  Some untreated patients may suffer lifelong symptoms of depersonalization. And yet, not all doctors know what it is.

  A doctor who recently graduated and suffers from this disorder himself stated that depersonalization was not taught in medical school or in continuing education courses for therapists.

  He admitted that he had misdiagnosed his patients at least twice. According to him, he will be very surprised if it turns out that at least one of his colleagues has heard about this syndrome.

  Sarah says that she has encountered at least 20 professionals in her life who had no idea what she was talking about. Among them are consultants, therapists, district psychiatrists and doctors.

  The Royal College of General Practitioners (RCGP) in London said that mental health was a key element of an expanded curriculum for physicians.

  The institute added that the study of more complex psychological problems is still in development.

  The Royal College of Psychiatry stressed the need to ensure that these disorders are properly understood.

  Photo caption,

  Dr. Elaine Hunter runs the only referral center in the UK that treats patients with depersonalization

  Poor diagnosis is only part of the problem, access to treatment is another complication.

  There is only one specialized clinic in the UK. Its resources are limited, it can only accept 80 patients a year. Despite the fact that 650 thousand people can potentially suffer from this disease.

  A referral from a local doctor is required to access this health center free of charge. And even if the patient is diagnosed with depersonalization, treatment will have to wait several months or longer.

  After a year of waiting in line, Sarah decided that the only way out was to pay for the treatment herself.

  “I used to have panic attacks all the time. It’s really scary. I knew it was a crisis,” she says.

  A specialist center for patients with depersonalization syndrome operates at the Maudsley Hospital in south London. However, there are restrictions for patients under 18 years of age; the center only treats adults.

  Often the disease occurs in adolescence. Dr. Elaine Hunter, who heads the center, is concerned that she has to withhold care for children and adolescents.

  “Sometimes fifteen-year-olds who are deeply depressed and frightened come to us, but we have nothing to offer them,” she says.

  One of the adult patients of the center developed the syndrome at the age of 13. For two years she could not leave the house, she experienced ten panic attacks a day caused by the disorder.

  At the beginning of the treatment, she did not even recognize her own parents.

  Dr. Hunter hopes that over time, the right treatment will be available to underage patients.

  She believes that treatment should be organized in every district. Physicians in local centers for psychological assistance should undergo special training, then disseminate information among other specialists.

  Photo caption,

  Sarah Ashley couldn’t eat or sleep until after her therapy with Dr. Hunter

  Hunter developed Cognitive Behavioral Therapy (CBT) specifically for patients with depersonalization. She believes that she will be easily mastered by doctors who already have experience in talking therapy.

  Sarah Ashley, a patient of Dr. Hunter, says she was initially skeptical about the technique, but after a while she felt a huge difference.

  “[Before CBT] I looked at my own hands or other body parts and felt like they weren’t mine. I looked at myself in the mirror and didn’t realize it was me,” explains Sarah.

  “I couldn’t eat or sleep, and due to stress I lost 42 kg. Now I still have some symptoms, but I can get over them quickly,” she continues.

  Treatment is available but difficult to obtain.

  As Dr. Hunter says, we need to correct the situation in which patients are forced to look up information about their disorder on the Internet, and then explain to the doctor what it is about. Instead of, on the contrary, the doctor told the patient about his illness.

  Depersonalization: what it is and how to bring yourself back to reality

  28 561

  Man among people Know yourselfAntistress

  Photo

  Getty Images

  legs, and it is not possible to put in the head what is happening around. On days like these, advice to quit caffeine and get grounded feels like psyllium. Useful in the moment, they can seem empty under prolonged stress.

  When circumstances are intense, large-scale and impossible to control, we all find ourselves in a borderline situation for a while. At such moments, it becomes easier to understand people with anxiety disorder, depression, borderline personality disorder (BPD), and bipolar affective disorder (BAD).

  From extreme to extreme: do you find it difficult to inhale or exhale?

  “I was whole and I was broken, I was alive and I was killed,” the words from the song of the group “Spleen” are, perhaps, one of the most accurate descriptions of a person living in a difficult, borderline situation. It is normal to be inconsistent, unstable and confused.

  Breathing can become an indicator of the intensity of the anxiety experienced by a person. Psychologist Anastasia Dolganova offers pay attention to what is more difficult to do in a situation of extreme excitement: inhalation or exhalation.

  If you catch air but cannot let it out slowly, we are talking about neurotic anxiety

  A person can feel it at the moments when he is face to face with repressed, forbidden feelings: aggression, greed, lust, jealousy.

  It is in this case that breathing techniques and mobile meditation apps, as well as self-soothing and returning to reality techniques, are effective for relieving symptoms. In the long run, this can be work on accepting the shadow sides, recognizing ambiguous emotions, and forming a more realistic self-image.

  It is more difficult if a person cannot breathe: such a reaction may indicate intense psychotic anxiety

  And the techniques for overcoming it will be different. Such anxiety arises against the background of fear of death, meaninglessness, despair and isolation.

  In Existential Psychotherapy, Irvin Yalom gives a personal example of dealing with the fear of death after a car accident. The psychologist speaks of a background experience that he experiences for several months after: “the world began to seem unreliable.” He becomes sinister, loses his comfort. The internal boundaries of a person in such a situation are blurred, the usual supports are crumbling.

  “We can respond to a crisis of meaning by repressing the theme defensively, by splitting off the consciousness of the suffering part of the personality… We can succumb to despair and become cynical,” write Ursula Wirtz and Jörg Zobeli in The Thirst for Meaning. Man in extreme situations. The limits of psychotherapy.

  Another option is to look for meaning in “dialogue filled with love.” If there is a topic for discussion and space for disclosure, there is a real meeting with another person. Thus, according to Wirtz and Zobeli, intimacy is formed, as a deep interaction of people.

  In a situation of existential “rolling” there is no more effective way to relieve anxiety than to share it with the Other

  Those who are here and now able to hear, understand and accept. Then inexpressible despair and fear begin to take on boundaries, impotence does not go away, but becomes bearable.

  If the dialogue becomes more and more like a game of ping-pong, the interlocutors cannot hear each other and the conversation resembles two alternating monologues, stepping back and increasing the distance is a saving tactic.

  Absurdity, Surprise, and Alienation: How to Survive Derealization

  When circumstances overwhelm you, it can be difficult to cope with it, and sometimes unbearable. In such situations, the human psyche resorts to the most powerful defenses. One of these is depersonalization of . It can act as an independent symptom, be one of the manifestations of bipolar affective disorder, schizophrenia or depression, as well as a mechanism for protecting a healthy psyche in extreme situations.

  If you look at the reflection in the mirror for a long time, for a few seconds your own face may seem unfamiliar, strange and alien. This is one of the simple and short options for depersonalization. At such moments, a person ceases to feel himself and feel at all. And reality begins to seem like the frames of a surreal film.

  Photo

  Getty Images

  There is another similar condition. Do you know that strange feeling when a familiar simple word suddenly turned into a meaningless, empty sound? You repeat it, but you don’t seem to recognize it. When something like this happens to the outside world, it’s called derealization . The familiar space of a room can become a completely unfamiliar place in a second. This feeling of alienation and unrecognition can be unpleasant, intense, and difficult to bear. For example, Jean-Paul Sartre called this condition nausea.

  “Any human activity – the work that we go to every day, the conduct of religious ceremonies, the daily natural functions – seems strange, if not absurd, if you look at it without emotions and full involvement” – this is how the state of depersonalization is described by Daphne Simeon and Jeffrey Abugel in “I’m not Me. What is depersonalization and how to live with it.”

  Such detachment can be depressing, frightening and hard to bear. Or, on the contrary, when experiencing the death of a loved one, loss and in a difficult life situation, give the person some relief.

  Not living one’s own life, apathy and feeling absurd can last several minutes, days or months

  The duration depends on whether the person has a tendency to depersonalize or is it a single reaction to an excessive stimulus. Short-term depersonalization or derealization is quite normal.

  Simeon and Abugel say that the ideal way to break the vicious cycle of fear and anxiety is to remove the stressful situations that started it. However, this is not always possible. The authors also talk about the healing power of a psychotherapeutic (and not only) conversation, an attempt to gain control over circumstances (through any creative action).

  Checklist: how to recognize depersonalization

  1. You don’t feel anything. Linkin Park’s biggest hit “Numb” describes a state of numbness, a weak sense of self (“I’m so numb that I don’t feel you’re here anymore. / I’m so tired, I understand much more” ^* ). This may be a fairly accurate description of depersonalization.

  2. You are living yourself in a third person. Thoughts, feelings, memories and body – all this is not yours.

  3. You don’t recognize yourself. Your perception distorts the way you see yourself, body parts seem alien and/or altered, your head is foggy and thoughts come with effort. You look at your own hand and seem to take a moment to recognize it as part of you.

  4. You do not feel in control of your body. It seems to move not by your will, but by itself. Speech sounds like from the outside and you do not control it.

  Checklist: how to recognize derealization

  1. You are dreaming. It is difficult to recognize in the state in which you are, reality. Everything is experienced as unreal.

  2. You don’t feel attached. Close people are perceived as strangers.

  3. You distort time and forms. The intervals between the past and the future are inadequately expanded: recent events are subjectively perceived as long past. The shapes of objects and their appearance look strange, distorted, unrecognizable – for example, the room seems to be compressed or stretched.

  What can be done to overcome alienation from reality?

  Establish sleep patterns

  Circadian rhythm disorder can be a trigger for depersonalization/derealization, as well as affect the degree of its manifestation

  Give up alcohol and other substances that cause an altered state of consciousness

  Researchers have not yet found a direct causal relationship, but often these factors stimulate and prolong the feeling of detachment, insensibility.

  Check the list of side effects of the medications you take regularly

  If you endure depersonalization/derealization painfully and you associate its intensity with a specific drug, this is a reason to consult a specialist, change the pills.

  Remember that the experienced state has a beginning and an end

  It will not last forever.

  Repeating to yourself that depersonalization/derealization is a defensive reaction of the psyche

  This is an attempt to separate from the world and avoid a potential threat. Try not to focus on anxiety from the occurrence of such a condition, concentrate on simple routine activities.

  Seek contact with another person

  With a friend, relative or person with a similar experience. Discuss, share and express feelings.

  Talk to a psychologist or psychiatrist

  Request feedback and support from a specialist.

  ^{* I’ve become so numb I can’t feel you there
  I’ve become so tired so much more aware}

  Text: Ekaterina Lakizo

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