# I am better and I want to help.



## pax (Feb 19, 2009)

My DP/DR started roughly 2 and half years ago. It was not drug induced, but rather came from persistent anxiety arising from a personal situation. The depression came later and eventually became inseparable. I believe I reached some of the lowest depths possible. Over the past year I have managed to get progressively better. It isn't completely gone, but I feel I am at least 90 percent normal. I made a promise to myself that if I got better, I would come back to give my input. I have been pondering about exactly what I should focus on regarding my experience and I have ideas of some of the things I want to emphasize. In addition I also want to field any questions you have. There is an important exam coming up, so I won't be able to post my thoughts for at least 4-5 days, but in the mean time post any questions you want me to address, and I will try to incorporate them into my next post. Getting better is possible.


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## Matt210 (Aug 15, 2004)

Hey,

Glad to hear you are doing better. The board needs more people like this. I don't blame people for running off back to their lives when they get better (I did it myself), but it means there are very few positive and inspiring posts on here.

Don't know if I have any specific questions for you that you won't cover in your story. Mostly wondering what your treatment plan was, whether you used meds, etc.

Looking forward to hearing from you.


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## bums (Dec 22, 2008)

Whats the remaining 10%?


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## pax (Feb 19, 2009)

It was just another morning after waking up, but it wasn?t quite the same kind of morning, and it wasn?t quite the same kind of waking up. Because as oppose to waking from a dream, I woke up instead into a nightmare that would consume every aspect of my life for many many months to come. Prior to the depersonalization/derealization I prided myself on my intelligence, which of course was wrecked by the dp/dr. I could spend an hour trying really hard to stay focus enough to read one paragraph, then not remember anything I just read, because the brain fog was so pervasive. This was personally devastating, considering the fact I did 99+ percentile on all of my standardized exams before dp/dr. I am not an emotional guy to begin with, and never really appreciated it, but when the dp numbed out any semblance of emotion that I had, I missed it dearly. I was so numb that I could not even feel sadness. There was such a great sense of disconnect that at one point I zoned in and out of awareness, as if every few seconds I would suffer a black out. 
With all that said, let?s get to how I managed to slowly get out it. One week post dp/dr I started feeling better. I would say I functioned around 70 percent normal and it lasted 4-5 days. Then I slipped completely back into the oblivion for 1 year +. Those few days of recovery were very crucial later on, because those days reaffirmed to me that the effects of DP/DR were NOT PERMANENT. I was given a work up to rule out other problems and then started counseling. There was the question of whether or not I should be put on drugs. It was around this time that I stumbled on this forum and started reading the posts. What I seem to observe, correctly or incorrectly, was that drugs would not completely cure me. I did not want to be dependent on drugs just so I could suppress some of the symptoms of dp/dr, so instead I decided that I was going to beat it on my own terms. I am lucky in that my family is supportive both financially and emotionally, though my parents at that point like to imagine I had no problems. They believe that if you just ignore it, it will go away. This is also an advice that is tossed around this forum. Something I don?t completely agree with. All that is background, I am going to now list the points I found relevant and helpful.
Important note: I came to the conclusion that my DP/DR is due to anxiety/stress, and was not drug induced, so I am not sure how relevant my ideas will be for those who had drug induced DP/DR.
DP/DR:
1.	It is a problem and if you are reading this now, you or someone you know also has this problem. Don?t actively try to deny this, because the effort you expend doing so will only feed it.
2.	Notice how you spend every day looping the same thoughts. Thoughts tied somehow to DP/DR. I can no longer feel emotions, I am not as intelligent, I am not as productive because I have DP/DR, DP/DR is keeping me from doing so many things I want to do, I think the DP/DR has been getting better, I think the DP/DR has been getting worse, I heard there are a, b, c, d, e ways to improve it, I need to do a, b, c, d, e ways, I heard there is a miracle pill, there must be something out there for me to directly treat this DP/DR, if I think about it long enough I will figure a way out of this, and so on. 
3.	These thought patterns are very bad, and I believe one of the underlying causes why people who actively struggle against DP/DR do not get better.
4.	Now identify the things in life besides DP/DR that causes you stress. Pick one that you believe you can change, so it no longer causes you stress, and works toward nullifying this stress factor. 
5.	As you are trying to nullify one stressful factor, you should also try to be doing something else. Something hopefully productive. Maybe a job or volunteer work that you know you would find meaningful if you were not so numb. Try to choose something low stress.
6.	Also find something to do that you find is relaxing. Is it cooking? Is it meditation? Is it sports? Do it.
7.	Stop thinking about things, just do them.
8.	While you are doing all of these things, don?t ask yourself if you are improving or not. Acknowledge that you have DP/DR, but keep your thoughts from thinking about it too often. This is tough, but that is why you need to be doing things in order to keep your mind from obsessing about DP/DR. 
9.	Truly understand that getting better can be a very, very slow process. Accept this fact.
10.	Once you have removed that stressful factor, pinpoint another stressful factor in your life and start to remove that one also.
11.	Love yourself. Not because you are good looking, or rich, or smart, or athletic, but because you need no reason to love yourself. Please understand that you do not need a reason to love yourself.
With that said I am in medical school right now, so I am pretty busy with a bunch of commitments. But I feel that I have enough time to correspond with two other people with DP/DR. I think one of the problems with DP/DR is that there is a tunnel vision, and it limits one?s abilities to realize which course of actions will be productive and beneficial. So through emails or maybe instant messengers we can correspond, and I will listen to your stories and offer suggestions as to what you can do. I can also be someone you can talk to who really understands what it feels to be stuck in the fog. Because my experience was obviously due to and hence only pertains to stress/anxiety, I feel that I can only try to help people who have anxiety induced dp/dr. So whoever wants to take part in this, post below. This offer is especially pertinent to those who feel they have no one they can really talk to.

Answer to the question about being ?90%? better and what about the remaining ?10%? percent:
Before the DP, when I am faced with an interesting intellectual problem or a challenge, my mind can go into overdrive and I feel like I gain a higher level of consciousness. This has rarely happened post DP and not to the same level of intensity. In addition, I feel I am not as insightful, quick, or has a memory as good as pre DP ? though the differences are not big.


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## obiwan (Feb 23, 2009)

Dear Pax,

It is wonderful to hear you're in medical school. Congratulations! And I am thrilled to hear that you are on the road to recovery. I'm currently dealing with dp and am in medical school as well. I wish it would just go away. Did yours ever come in swings? Did you continually feel like you would say things and then wonder where the words were coming from? Or why you were saying them? Or look at your hands and wonder who's they were? All are terrifying...and I hope someone else out there has felt these too (though I really don't wish them on anyone, at any point in time) but it would be so good to communicate with someone who has felt this way and to know that I am not alone. If you have any suggestions to getting through dp, I would greatly greatly appreciate them. I've tried everything. Not eating sweets, exercising, swimming, meditation, calming music, being alone, protein diet. As soon as I come close to how I remember feeling nearly normal, something sends me over the edge, I have a panic attack, and I regress right back to where I was before.

Thank you for your original post. It was so good to read that there are success stories. I hope medical school is going well for you!
Obiwan


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## pax (Feb 19, 2009)

All those things you mentioned obiwan, I felt too. The DP/DR was cyclic in nature, but over time the cycles progressively got better. During medical school the major triggers of my DP/DR were approaching exams, but there was something really interesting about these experiences. Even though the stress of the exams initially made the symptoms worse, but as I focus more and more on the exams the dp/dr symptoms receded, and the days surrounding the exam (pre, during, and post) they are nearly completely gone. I believe the symptoms receded, because as many posters have also attested, my focus on something else took away the obsessive thoughts that were feeding the DP/DR. This is why I truly believe DP/DR comes from recursive loops of the same obsessive, anxiety provoking thoughts (both conscious and subconscious). The very fact you think about your DP/DR symptoms or ways to treat them are actually feeding it. I am NOT advocating denial. The steps/points I outlined are meant for you to first redirect your actions toward something else other than DP/DR, so maybe in turn your focus will eventually shift too, and in the end hopefully your thought patterns (both consciously, and unconsciously) will shift. Are you part of the US system and what year in med. school are you?


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## obiwan (Feb 23, 2009)

Pax...I agree about thinking too much about dp. The more you think about it the more you are aware of it. Today, however, I tried not to think about but sometimes it just consumes your thoughts so much that however much you push the thought away, it completely envelopes you. Its when such thoughts soak through me that I feel like I am even more detached from myself and my surroundings. Do you have any tricks to wiping threatening thoughts away? I'm trying to study now...yes, I'm in the US med system...as a first-year...and find writing here much more interesting. Are you also in the US med world?


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## pax (Feb 19, 2009)

I feel you must *stop actively* pushing the thoughts away. Any thoughts or actions done *explicitly/forcefully* to decrease DP/DR symptoms will make them worse. You can still engage in relaxing techniques like meditation, yoga, etc., but it means you should not do them with reducing DP/DR as an overt goal. That is why you must take an indirect approach. Fill your days with activities, so you gradually change your focus, and then subsequently change your thought patterns. Getting better is possible, but it is a very gradual process. When you next feel the DP/DR symptoms or the anxiety that provokes it, *just accept them*. Don't wonder when it will get better, or how it can get better. Accept them and move on with the activities you have planned. Since you are in medical school there is so much stuff you need to do. I really think medical school played a big part in me getting better, because I was forced to be so busy. As I get more and more consumed by the work I had to do, I focused less and less on the DP/DR symptoms, and as I focused less on them, they gradually went away. 
1. *Accept the symptoms*
2. Do some relaxing things *without any goals of reducing DP/DR*
3. Stay busy with schoolwork/life
4. Gradually your focus will shift
5. Thoughts will shift
6. DP/DR will subside


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## pax (Feb 19, 2009)

I don't know if you have gotten to this part yet at your school, but my personal perception of DP/DR is that it is very similar to Obsessive Compulsive Disorder. We spent only a little time on DP/DR at our school, but quite a lot of time on OCD.
The premise of OCD is this:
1. Obsessive (repetitive, persistent) thoughts that provoke anxiety.
2. Compulsive (repetitive, persistent) physical action or *mental* action that is routine and done in order to lessen the anxiety. These physical/mental actions are considered to be compulsive *avoidance behavior*
So: anxious thoughts ----> nonsensical, repetitive actions (like washing hands 10 times) to decrease anxiety
If you know behavioral psychology, this basically means that the nonsensical, repetitive actions are negatively reinforced via operant conditioning. The anxious thoughts, similar to the perpetuation of phobias, are perpetuated via compulsive *avoidance behavior*.
What I suspect non-drug induced DP/DR to be like:
1. Initial stressful event that causes anxiety. 
2. Compulsive mental action of DP/DR to lessen/avoid anxiety.
but this is where DP/DR diverges from OCD
3. The compulsive mental action of DP/DR, as oppose to lessen/avoid anxiety, actually produces more anxiety, via anxious thoughts regarding DP/DR symptoms.
4. So your mind responds by being *even more DP/DR!*
5. More DP/DR produce more anxious thoughts about DP/DR
So it becomes the following loop: initial stressful event/anxiety --->compulsive DP/DR ---> anxious thoughts about DP/DR--->compulsive DP/DR ---> anxious thoughts about DP/DR--->compulsive DP/DR ---> anxious thoughts about DP/DR--->compulsive DP/DR ---> anxious thoughts about DP/DR.
To treat OCD, you allow for the obsessive anxious thoughts, but block the ritualistic compulsive avoidance behavior. The obsessive anxious thoughts will lessen via the behavioral psychology principles of exposure/extinction. As the anxious thoughts lessen, so will the urge to commit the ritualistic compulsive avoidance behavior. The problem with DP/DR is that any means taken to directly stop/prevent the compulsive DP/DR mental action, will contain anxious thoughts associated with whether or not it will be effective - basically anxious thoughts associated with DP/DR. Since the anxious thoughts are perpetuated, the compulsive DP/DR action will be perpetuated, and the loop will be maintained. In order to break this loop, you need to somehow decrease the anxious thoughts, *without directly targeting the compulsive DP/DR*. As I have stated before, I feel you can decrease these anxious thoughts by:
1. Reduce stress/anxiety causing factors in your life
2. Get involved with something
3. By being involved you change your focus
4. By changing your focus, you change what you are thinking about
5. So you shift some of your thoughts away from DP/DR and consequently the anxiety it provokes.
6. As you decrease your anxious thoughts about DP/DR, there will be less anxiety to provoke the compulsive mental action of DP/DR.
7. Follow this loop to decrease both the obsessive anxious thoughts, and DP/DR.


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## pax (Feb 19, 2009)

Also understand that getting better, at least without drugs, is a gradual process. The more you consciously want the recovery to speed up, the more persistent it will be in remaining. As always, *any *thoughts directed at DP/DR will just increase it. So don't even deny its existence. _*First you must accept!!*_


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## Matt210 (Aug 15, 2004)

I have to disagree with part of what you are saying - mostly what you are exploring in your later posts as I thought your initial post touched upon some EXCELLENT points.

As someone who suffers from OCD and has entirely obsessive thoughts that lead to DP/DR, etc. both my personal experience and research I have done suggest the exact opposite. I have heard the theory before that we need to allow the thoughts and to challenge them. But for me, and I think for many people with DP/DR this is a dangerous road. There is no way to think yourself out of unreality. There is no cognitive behavioral technique regarding reality that won't keep the cycle going. Accepting and exploring the thought of "Is this real? Is this a dream" can lead nowhere good because there is no way to prove that this is not a dream, etc.

For me, it is most important to stop obsessive thoughts at the point they begin. Push them from my mind, and focus away. Do not explore them. By exploring them you add fuel to the fire.


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## Matt210 (Aug 15, 2004)

> feel you can decrease these anxious thoughts by:
> 1. Reduce stress/anxiety causing factors in your life
> 2. Get involved with something
> 3. By being involved you change your focus
> ...


Although now that I am going back and reading this more carefully - this isn't far off. It is important to get involved in life, and shift thoughts away from DP/DR, etc. But this seems to contradict your previous point about not pushing DP/DR thoughts aside.

Perhaps I am misunderstanding. Are you simply stating we should not engage in a battle with our DP/DR thoughts? Because this is more in line with what I think as well. Acceptance is fine - accepting that they are there and that we have them is essential. But to not give them the time of day through exploration is what is most important.


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## pax (Feb 19, 2009)

Matt210 said:


> > feel you can decrease these anxious thoughts by:
> > 1. Reduce stress/anxiety causing factors in your life
> > 2. Get involved with something
> > 3. By being involved you change your focus
> ...


I have read your posts and your thoughts and mine are very similar. As I have said, you *should not actively engage DP/DR *directly, and you *should not actively push DP/DR aside*. It is like telling someone that they should not think about cake. They cannot actively not think about cake, because they must think about not thinking about it. By acceptance, I am advocating *against denial*, which I believe will not work. You should not deny that you have dp/dr. Acceptance *does not mean *to actively think about dp/dr. I am emphasizing the modification and commitment to actions first - like your work. Which I believe will change your focus, and eventually your thoughts away from DP/DR. I do not believe there are any contradictions in what I say. Focusing on your life so that your *thoughts naturally shift away from DP/DR*, is the not the same as *actively pushing DP/DR aside*.


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## Matt210 (Aug 15, 2004)

pax said:


> Matt210 said:
> 
> 
> > > feel you can decrease these anxious thoughts by:
> ...


Yep, it seems we are more on the same page than I thought. Should have read your post more carefully.

I get what you mean now, I was just confused - but your cake analogy actually makes a lot of sense. And of course I agree with you about denial - I swept my DP/DR under the carpet for a while. Not that I didn't believe i had it, but that I hadn't fully accepted it as a part of me. It was like a flu that I just wanted to get better. It came back with a vengeance. Acceptance is of course an important step.


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## pax (Feb 19, 2009)

Matt, your posts make me realize that there are parts in mine that may need clarification. My discussion of OCD and its treatment was meant to illustrate how similar it is to DP/DR. I believe they stem from the same kind of loop obsessive anxiety - compulsive action loop.* I do not suggest* using the treatment regime for OCD on DP/DR. This is because in OCD there is a clear way to prevent the ritualistic compulsive action, but with DP/DR there is no clear way to prevent the compulsive DP/DR action. I believe that DP/DR is a subconscious mental action in response to obsessive anxious thoughts. Since you can't prevent the DP/DR, you should instead shift away from the obsessive anxious thoughts by engaging yourself in something else, like your life.


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## Matt210 (Aug 15, 2004)

pax said:


> Matt, your posts make me realize that there are parts in mine that may need clarification. My discussion of OCD and its treatment was meant to illustrate how similar it is to DP/DR. I believe they stem from the same kind of loop obsessive anxiety - compulsive action loop.* I do not suggest* using the treatment regime for OCD on DP/DR. This is because in OCD there is a clear way to prevent the ritualistic compulsive action, but with DP/DR there is no clear way to prevent the compulsive DP/DR action. I believe that DP/DR is a subconscious mental action in response to obsessive anxious thoughts. Since you can't prevent the DP/DR, you should instead shift away from the obsessive anxious thoughts by engaging yourself in something else, like your life.


I am 'Pure O' in my OCD diagnosis - so I don't have rituals or compulsions that make me feel better. So for me the path to getting better is one and the same with DP/DR. But you are completely right - and I can see why you got better. You are doing all the right things and thinking all the right things. Many of the same thought patterns led to my recovery. Unfortunately I relapsed for a number of reasons, which is why it is important to keep reinforcing what we have learned even when we are better.

When I said goodbye to DP/DR and these forums back in 2006 I really thought I would never be back. But I very gradually let myself slip back into old habits and sunk lower than I ever have before. In addition to doing all the things you say, we need to continue to accept and deal with our anxieties in life before they become too much to handle. Stop bad thought patterns as soon as they start happening, while we are still strong.


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## jay2008 (Nov 6, 2007)

Hello,

First off....excellent post! Your story sounds exactly like mine and I know mine was not drug-induced but brought on by a series of intense panic attacks. I have gradually gotten better myself and have very little repetitive thoughts regarding DP/DR.

My one issue is still huge though...the visual disturbances, as I call them. I still see things very "flat" and fluorescent lights hurt my eyes as they appear too intense. Everything looks odd and distant under these lights.

Did you or do you still have this experience? If so, do you have any suggestions on how to make it better?

Thanks! - James


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