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1. Everything is unreal

Q. I do have panic attacks, but before they start I get a feeling that nothing is real, including myself. I sometimes feel as if I am standing behind myself and it is really frightening. I can also feel really dizzy which only makes everything worse. I do panic, but I panic as a result of these feelings. No one seems to understand what I am saying. They think that it is all part of the attack, but it isn't. Stop these unreal feelings and I won't panic.

2. Triggering panic attacks

Q. I am someone who suffers from panic disorder and generalised anxiety. Your theories on dissociation and how these detached/spacey feelings trigger panic attacks really struck a chord with me. Dissociation is one of my biggest symptoms. I am currently taking a drug to control my panic attacks. In general I am more relaxed, however, it does nothing to help the dissociation. In fact, I would say the drug makes me feel more spacey/bewildered and detached. Now that I realize this is a major panic trigger, is there anything I can do or tell myself while in this state to halt my panic attacks?

A. These are the Derealisation and depersonalisation symptoms. Derealisation is the experience of 'that nothing seems real' and depersonalisation is the experience of feeling 'detached from the body'. They are common panic attacks symptoms and are part of the range of sensations relating to the ability to dissociate.

We have found over the years, dissociation is playing a major role in spontaneous panic attacks. Those of us who do dissociate have had this ability since we were children, although many of us have forgotten we did it as children. It seems some of us 'grow' out of it but when as adults we experience major stress and/or are not eating or sleeping properly, this ability is activated once again.


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The research on dissociation is now speculating that some people with panic disorder, dissociate first and then panic or become anxious. A theory we are in complete agreement with.

The ability to dissociate is on a scale 0- 10.

0 = people who have no dissociative experiences to 10 which maybe indicative of Dissociative Identity Disorder. People with Panic Disorder don't have DID and measure about 4 -5 on the scale.

Other words for Dissociation, include depersonalisation, Derealisation, self hypnotic trance, altered states of consciousness. When people dissociate they get a variety of symptoms, including 'feeling detached from the body - out of body' experiences', not feeling real, seeing their environment through a white or a grey mist, stationary objects may appear to move, tunnel vision, sometimes they may feel an electric shock move through the body, or a 'whoosh' of intense burning heat, a burning tingling heat or a feeling of intense energy moving through the body. It is quite easy to induce this state in people who are vulnerable to them.

The major way we do this during the day is by staring. Either out of a window, at the wall, TV, computer, book etc. Staring can induce a trance state and most of the dissociative 'symptoms' show the trance states we can reach are quite deep. Fluorescent lighting also appears to be a cause for the trance states. The research on nocturnal panic attacks shows they happen on the change of consciousness from dreaming sleep to deep sleep or deep sleep back to dreaming. This is similar to the change in consciousness when we induce the trance states during the day.

The essence of all of this is to be (a) aware of how we can induce these states during our normal daily activity and why they happen at night, and (b) lose our fear of them so we don't panic. We teach people why there is nothing to be frightened of by this ability and that they are not going insane. After all, we as individuals are proof we don't go insane. If that was going to happen it would have happened to us a along time ago!

We also teach people to become aware on a moment to moment basis if they need to, of how it happens and how it can happen so easily. When people can see this, we teach them to work with their thinking and not buy into the panic/anxiety thoughts, 'What's happening to me'...'I'm going insane' etc. We all put ourselves under more stress by the way we think about our symptoms. This only makes us more vulnerable to it happening. The harder we resist it, the worse it becomes.

Meditation is also a great way to desensitise ourselves to the various trance states plus a great way to practice non resistance and working with thoughts.
Have you spoken to your doctor about your medication? The increase in symptoms may be a side effect.

Strange sensations

Q. Thank-you for your site! I stumbled across it while totally overwhelmed by symptoms one day at work - no more work was done that day but I felt so comforted! I've had a disorder for almost 5 years now, and I experience dissociation, a "moving brain" feeling that literally never stops and incredibly intense itching sensations beneath the skin that make me want to scream! I can't seem to find any reference to the itching and moving-brain sensations in any literature: is this common?
I have been in therapy for about 2 years and am taking medication and things have improved but I'm still very uncomfortable almost all the time. It sounds ridiculous but only now am I gradually realizing that I'm "causing" these symptoms myself. I would love to feel at peace - I can't remember the last time I could just relax and get some relief from the symptoms. It helps so much to know you're out there!

A. We are glad the site has been of help to you. We know how important it is to be able to identify with other people who have an Anxiety Disorder. Re the itching and the 'moving brain'. Have you checked with your doctor to make sure the symptoms are not an effect of your medication. Or that the itching is not part of an allergy reaction? People with panic disorder usually also develop allergies, food, environmental etc.

We assume from your email your disorder is an anxiety disorder as our reply is based upon the symptoms you mention in an anxiety disorder context. We have found over the years many people with panic disorder do dissociate and the itching underneath the skin can be part of it. Some people comment it can also feel like 'ants' crawling. Re the 'moving brain'. We are not sure what you mean by this. Some people report a tingling or the 'ant' crawling sensations across the scalp. Some people report a vibration sensation, or they feel as if the top of their scalp is being cut off, others report a great pressure from within the head pressing against the scalp. None of these symptoms are in the literature but they not uncommon.There can also be the dissociative sensation of stationary objects moving, buildings swaying, the road undulating etc.

The way we think does create many of our symptoms. We always suggest people contact a Cognitive Behavioural Therapist (CBT). They can assist us to begin to work at changing our negative thinking patterns. And if you are prepared to really work at it, it can change your life.

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