# Difference between GAD and DP disorder



## Gypsy85 (Sep 23, 2010)

Hey guys,

so I will see a new psychotherapist on Thursday. I am pretty much sure that my diagnosis will basically be about GAD, DP and depression.

After having read a hell of a lot about anxiety disorders, depression, depersonalisation disorder and the like, I wonder how on earth someone will be able to differentiate between GAD and DP disorder.

Is there any chance to differentiate between the two? Or is it more like: Curing the anxiety and if the DP remains, it is depersonalisation disorder? To me, the symptoms sound so alike that I do not understand how a person could make a proper diagnosis.

Any ideas?

Best wishes,
Steffi


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## Emir (Nov 20, 2010)

I think it's best to lay all your symptoms out on the table (take internet printouts if necessary) and then discuss which ones to work on. As you say, tackling one thing may help another but that would be part of your 'treatment plan' that you set up with your therapist. Here is DP definition acc. to wikipedia:

'Depersonalization (or depersonalisation) is a malfunction or anomaly of the mechanism by which an individual has self-awareness. *It is a feeling of watching oneself act*, while having no control over a situation.[1] It can be considered desirable, such as in the use of recreational drugs, but it usually refers to the severe form found in anxiety and, in the most intense cases, panic attacks. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance. It can be a disturbing experience, since many feel that, indeed, they are living in a "dream".

*Depersonalization is a subjective experience of unreality in one's sense of self, while derealization is unreality of the outside world.* Although most authors currently regard depersonalization (self) and derealization (surroundings) as independent constructs, many do not want to separate derealization from depersonalization.

Chronic depersonalization refers to depersonalization disorder, which is classified by the DSM-IV as a dissociative disorder. Though depersonalization-derealization feelings can happen to anyone subject to temporary severe anxiety/stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including dissociative identity disorder and "dissociative disorder not otherwise specified" (DD-NOS). It is also a prominent symptom in some other non-dissociative disorders, such as anxiety disorders, clinical depression, bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, migraine, sleep deprivation, and some types of epilepsy.[citation needed]'


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## Gypsy85 (Sep 23, 2010)

I am extremely curious what he will say. He is specialised in anxiety, personality and trauma disorders and I have found that DP is categorized under all of these. He also does CBT


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## Emir (Nov 20, 2010)

Sounds like you'll be in good hands!


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## Guest (Feb 6, 2011)

j4mtj said:


> Sounds like you'll be in good hands!


Agreed!


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## Guest (Feb 6, 2011)

From the Merck Manual. The section of Psychiatry is more updated than the DSM-IV

http://www.merckmanuals.com/professional/sec15/ch196/ch196b.html

*Generalized Anxiety Disorder* - it is under the Heading of Anxiety Disorders
Generalized anxiety disorder is characterized by excessive, almost daily anxiety and worry for ≥ 6 mo about many activities or events. The cause is unknown, although it commonly coexists in people who have alcohol abuse, major depression, or panic disorder. Diagnosis is based on history and physical examination. Treatment is psychotherapy, drug therapy, or both.

Generalized anxiety disorder (GAD) is common, affecting about 3% of the population within a 1-yr period. Women are twice as likely to be affected as men. The disorder often begins in childhood or adolescence but may begin at any age.

*Symptoms and Signs*

The focus of the worry is not restricted as it is in other mental disorders (eg, to having a panic attack, being embarrassed in public, or being contaminated); the patient has multiple worries, which often shift over time. Common worries include work and family responsibilities, money, health, safety, car repairs, and chores.

The course is usually fluctuating and chronic, with worsening during stress. Most people with GAD have one or more other comorbid psychiatric disorders, including major depression, specific phobia, social phobia, and panic disorder.

---------------------------
(I fit GAD very well, including the Co-Morbid Disorders, and I have chronic DP/DR regardless of the state of my overall level of anxiety. I try to ignore negative thinking as much as possible. It was very disruptive as a child, teen, college student. Less so as an adult.)
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http://www.merckmanuals.com/professional/sec15/ch197/ch197b.html

*Under the heading of Dissociative Disorders
Depersonalization disorder* consists of persistent or recurrent feelings of being detached from one's body or mental processes, usually with a feeling of being an outside observer of one's life. The disorder is often triggered by severe stress. Diagnosis is based on symptoms after other possible causes are ruled out. Treatment consists of psychotherapy.

About 20 to 40% of the general population have had a transient experience of depersonalization, frequently occurring in connection with life-threatening danger, acute drug intoxication (marijuana, hallucinogens, ketamine Some Trade Names

, Ecstasy), sensory deprivation, or sleep deprivation. Depersonalization can also occur as a symptom in many other mental disorders as well as in physical disorders such as seizure disorders (ictal or postictal). When depersonalization occurs independently of other mental or physical disorders and is persistent or recurrent, depersonalization disorder is present. It is estimated to occur in about 2% of the general population.

Symptoms and Signs

Patients feel detached from their body, mind, feelings, or sensations. Most patients also say they feel unreal (derealization), like an automaton, or as if they were in a dream or in some other way detached from the world. Some patients cannot recognize or describe their emotions (alexithymia). Patients may describe themselves as the "walking dead." Symptoms are almost always distressing and, when severe, profoundly intolerable. Anxiety and depression are common.

Symptoms are often chronic; about 1/3 of patients have recurrent episodes, and 2/3 have continuous symptoms. Episodic symptoms sometimes become continuous.

Patients often have great difficulty describing their symptoms and may fear or believe they are going crazy. They always retain the knowledge that their unreal experiences are not real but rather are just the way that they feel. This awareness differentiates depersonalization disorder from a psychotic disorder, in which such insight is always lacking.

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DP and GAD are pretty specific and separate disorders.

I have chronic Social Anxiety, GAD, Panic (much less as an adult), Clinical Depression, Chronic DP/DR
These problems are CO-MORBID
*Most psychiatric problems don't exist alone or in a vacuum. They are frequently co-morbid with other disorders. It's very rare for just "one thing" to go wrong in the brain.*


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## Gypsy85 (Sep 23, 2010)

Thank you for your report, Dreamer! I definitely fit GAD, but I also have DP/DR chronic for almost 8months now.

Yeah, I am rather negative at the moment and always expect the worst to happen: What struck me most in your post was the constant repitition of the word CHRONIC. I mean... Am I really the "lucky" one to choose all disorders that are CHRONIC and FOREVER???

I have read about many people, who have recovered from GAD and even from primary depersonalisation disorder. How come? If these disorders are always chronic? Or do they just become chronic after years?


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## Guest (Feb 7, 2011)

Gypsy85 said:


> Thank you for your report, Dreamer! I definitely fit GAD, but I also have DP/DR chronic for almost 8months now.
> 
> Yeah, I am rather negative at the moment and always expect the worst to happen: What struck me most in your post was the constant repitition of the word CHRONIC. I mean... Am I really the "lucky" one to choose all disorders that are CHRONIC and FOREVER???
> 
> I have read about many people, who have recovered from GAD and even from primary depersonalisation disorder. How come? If these disorders are always chronic? Or do they just become chronic after years?


My pleasure, I like to research or report what I find.

Yeah, we're both "lucky" LOL.

I think what people have to remember is, if you have a psychiatric illness, it is something you are predisposed to and that you have a greater risk of getting. In terms of whether it remains chronic or not has to do with so many factors. In one sense, I CAN'T recall not having all of these qualities/symptoms. I felt "non scary" DP/DR at age 4 or 5. I recall "moments of clarity" or "clear spaces" in childhood. Some longer lasting than others.

I think for me, if I'd had early intervention, and no abuse, my situation wouldn't be as bad.

Thing is, mental illnesses, and the disability they cause, vary on a spectrum, and my other favorite motto "EACH CASE IS UNIQUE" -- every single one. And this is true of all illnesses. Someone can have cancer, and never have a recurrence. Someone with juvenile onset diabetes can never get "well" but can control the illness over time. Some do very poorly with diabetes, others have long full lives.

I think it is simply statistically important to show that longitudinal studies prove that some people suffer from these illnesses their entire lives with better times and worse times. Others get better, go into remission. I do know people my age and older (I'm 52) who have been anxious/depressed their entire lives. And the problem with chronicity and no relief adds to depression.

We get dealt a hand of cards ... all of us. And do the best we can.

Take Care,
D


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## Gypsy85 (Sep 23, 2010)

This does not sound that good









It is hard for me to accept that, because for 20 years, I have been COMPLETELY normal and have never been abused. I cannot believe that this should change within a minute forever.

But as you said: We all have our cards and do the best we can!


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## Guest (Feb 7, 2011)

Gypsy85 said:


> This does not sound that good
> 
> 
> 
> ...


Dear Gypsy,

If you are 20 years old, you fall into an age group where many mental illnesses appear, as if they'd been "dormant" in childhood. My worst DP/DR began around adolescence. My high school years were Hell with anxiety and DP.

Not everyone here has been abused either. Why you have DP -- can't answer that. You have to examine all possible precipitating factors, even family history. This indeed can be trauma induced, but is not the only way you can have DP/DR and that is what stumps the experts. But you say you are being diagnosed with an ANXIETY DISORDER as well as DP/DR. DP/DR seems to love the company of anxiety, and so do a lot of other disorders.

If you are anxious, there is a precipitating factor. Are you saying the anxiety came out of the blue? Is it related to ANYTHING -- hormones, a brief stressful event that you don't think of as "traumatic", lack of sleep ... so many factors.

If you sought help, you were feeling bad. Can you pinpoint why/when you started feeling "not right."?


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## Gypsy85 (Sep 23, 2010)

Thank you for going so deep in my question, Dreamer









I have always been a bit anxious, but not in a pathological sense. I worried a lot in the past as well and got stressed out because of important events but -as mentioned- this was by no means pathological! The whole family from my mother's side is fairly anxious as well, but also not in a pathological sense.

I had 4 months of immense stress, continuous worry and overwork. In the end I lost something that was of extreme importance through my entire life and it just made BHAM and I got DP. I remember that moment EXACTLY. From that moment on, my worries increased until I reached the point where I was worrying the whole day.

I am woken up by a racing heart and I go to sleep with a racing heart.


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## Gypsy85 (Sep 23, 2010)

Sorry, I have forgotten something:

I can DEFINITELY say that I did not have DP in my childhood. That is something I am completely sure of. I am 25. I said the first 20 years were completely normal, because I had flashes of DR/DR in the past 5 years (juyt for 2seconds, not disturbing at all). I have realised as well, that in the past 5 years, I have become more of a deep thinker. I have become more self-reflected too. Yeah, and the worries increased as well


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## Guest (Feb 8, 2011)

Gypsy85 said:


> Thank you for going so deep in my question, Dreamer
> 
> 
> 
> ...


- OK, you have a someone anxious personality to begin with and agreed "not pathological" -- it hasn't interfered with your life. 
- Family history of being anxious -- but again not pathological.
- 4 months of intense stress
- DP that came on suddenly soon thereafter

For some individuals this makes perfect sense. MANY people in this worldl don't have much anxiety. I know such people and I am endlessly stunned, and don't understand why they DON'T have it. Anxiety is NECESSARY to our survival ... if we didn't run from a lion in days of old we'd get our arm bitten off. In modern times we are anxious about completing some projects at work or school -- it is something of a motivator.

You certainly have the background. Which means this really "didn't come out of the blue."

And four months of unremitting stress ... could be a precipitating factor for DP/DR IN SOME PEOPLE.

It sounds you have caught this early enough in your life. I hope you work in CBT with a therapist to control the anxiety, to work on lessening worries. Change diet, exercise, social activities (more pleasant for you), distract yourself with projects and praise yourself for work well done. And you may want to confide in some family members. It is possible that other relatives with anxiety have/had DP/DR in the past, or maybe now, and wouldn't talk about it.

There is also Dialectical Behavioral Therapy which you can do in a group session -- I had four months (covered by insurance as it is a recognized treatment). It is based on Zen Buddhism and CBT, but it is NOT "voodoo" .. it is clinically tested and proven (see Marsha Linehan, University of Washington, who developed this in the 1980s/1990s.)

It helps you see things in a more positive light. Let go of worry. Not look at things in "black and white" but find a more logical middle ground approach to stressors.

Not saying this is easy. And if anything it takes work. The effectiveness of CBT and DBT is not as simple with CHRONIC DP. It is easier to treat panic attacks that LEAD to episodes of DP/DR. If you control panic, you control the DP/DR. I have a number of friends who had success with that. And if you need to, take medication. I have had luck with several. But it is up to your doctor to choose what is right for you. I will say, that Klonopin (clonazapam) -- yes though a benzo -- saved my life. Other benzos have a very short half-life and can be abused. (Valium/Ativan/Xanax, etc.) A medication can be a temporary bridge to getting your boundaries.

Also, I don't believe much in repressed memories. I had abuse and I remember it very clearly. Some who have abuse DON'T WANT TO TALK ABOUT IT, they haven't FORGOTTEN.

Also, consider PTSD in the military. You don't have PTSD! But SOME personnel obviously respond very poorly to life threatening situations. Others, for some reason are less affected. We all are unique.

Cheers,
D


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## Gypsy85 (Sep 23, 2010)

Thank you Dreamer









I will start CBT on Thursday.

Today I realised how important it is for me to reduce the fear. For about a months, I had completely forgotten what normal feels like. I even started to wonder whether this is my new self already. Today I managed to not worry for just...let's say...30s? And afterwards I had short flashes of what it feels like to be normal.

Even if CBT does not eliminate the DP (completely), I think lesson the fear will help me enjoy my life a bit more.


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## Guest (May 3, 2011)

Gypsy85 said:


> Hey guys,
> 
> so I will see a new psychotherapist on Thursday. I am pretty much sure that my diagnosis will basically be about GAD, DP and depression.
> 
> ...


from my case, I know for sure that DP/DR/GAD/PANIC are the same thing. the reasons why they call it different way are :

1. different people will experience the symptoms differently, some will feel more of the derealization, other will feel more of the head pressure, etc.
2. there are simply "worrier" people who believes they have a "disorder", but the only thing they should do is just calm down. there is a huge difference between ACUTE
anxiety, and attention-whores

I was never a worrying person, I was never a hypochondriac, I was never (and still isn't) someone who fears or panics constantly. But after my panic attack, I got DP/DR, anxiety, constant panic attacks, muscle tremors, thinking about death constantly, intrusive thoughts, total loss of confidence or at least a feeling of total loss of confidence.

this is ONE thing, in different forms.


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