Depersonalization and OCD
Depersonalization occurs when an individual has an experience of unreality; feels detached from their mind, self, or body; or feels like they are observing themselves or life from outside of their body. They feel disconnected from their own body. People with OCD may fear that a wide range of unusual or uncomfortable sensations are a sign of depersonalization, or experience persistent fear about what could happen to them if they were to experience depersonalization.
Some people with obsessive-compulsive disorder (OCD) may experience strong, persistent fears about the experience of depersonalization and being disconnected from their own body. OCD focused on fears of depersonalization often falls under the OCD subtype called Existential OCD, encompassing fears and obsessions about one’s existence and identity.
People experiencing fears of depersonalization may feel as though they are outside of their bodies and watching themselves. They may feel like they are in a dream-like state and disconnected from reality. It can be very frightening and confusing, as depersonalization may sometimes become a symptom of severe OCD and related disorders. Depersonalization may also be an involuntary mechanism to cope with the intense anxiety of OCD, as depersonalization can cause people to feel numb or disconnected from their emotions.
Common obsessions experienced by people with OCD involving fears about depersonalization may include:
- What if I lose identity?
- What if I am not really me?
- What if my perception of my reality is wrong?
- How can I be sure that I am actually who I am?
- Am I really in control of my behavior?
- What if I am actually in a computer simulation?
- How can I know what is “true” reality?
- What if I never feel anything again?
- What if I become so emotionally numb that I lose myself?
People with Existential OCD centered around fears of depersonalization may be triggered by situations involving high anxiety, lack of control, unfamiliar sensations, or similar sensations like derealization or dissociation. Derealization is an experience of unreality or a feeling of detachment from one’s surroundings. An individual experiencing derealization may feel disconnected from the world, feeling like the world is distorted or like they are in a dream-like state.
Common triggers for people with fears about depersonalization may include:
- Hearing about/learning about psychosis
- Death and funerals
- Feeling emotionless or numb
- Feeling like you are not yourself
- Severe stress
- Prolonged anxiety
- Prolonged intrusive thoughts
- Lack of sleep
How can I tell if I’m experiencing depersonalization fears involved in OCD and not something else?
This is an excellent question. To know if you may be suffering from OCD, you need to learn to recognize the OCD cycle.
The OCD cycle is composed of: 1) intrusive thoughts, feelings, images, or urges; 2) anxiety or distress that comes as a result; 3) compulsions performed to relieve the distress and anxiety caused by obsessions or to prevent a feared outcome. Understanding this cycle can help you distinguish OCD from other conditions. Something to keep in mind is that if you are feeling an intense urgency to know something or feel better immediately and with certainty, that is a red flag that OCD may be at work.
Uncomfortable sensations and intrusive fears can and do happen to everyone. Most people who do not have OCD are able to brush these thoughts or concerns off rather easily, but people with OCD struggle to do this. People who suffer from these intrusive thoughts and fears are plagued by intense doubt and uncertainty surrounding their own reality, purpose, the universe, the meaning of life, and death. They feel the need to know exactly whether or not they are experiencing true reality. They may fear losing themselves or the idea of being controlled by an outside source. These persistent fears, when accompanied by a strong urge to get rid of anxiety through mental or physical actions, are a strong sign of OCD.
When people with COd centered on a fear of depersonalization experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions. Compulsions are behaviors or mental acts that one does to alleviate the distress and discomfort caused by intrusive thoughts, and they can look different in every person. Compulsions may provide temporary relief, but do nothing to keep obsessions from returning again and again; in fact, performing compulsions often inadvertently strengthens obsessions and fears, reinforcing the idea that obsessions and anxiety pose an actual threat or danger.
Compulsions performed mentally or physically by people with OCD involving fears surrounding depersonalization may include:
- Repeated checking of any unusual sensations or emotions
- Seeking reassurance from others that they are acting like themselves
- Self-reassurance that one is in their usual state of mind
- Rumination about unanswerable questions
- “Checking” emotions and emotional responses
- Distraction or substance use
- Avoidance of stress or triggers
How to overcome fear of depersonalization
Existential OCD involving fears about depersonalization can become debilitating, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can find freedom from the OCD cycle and live without being ruled by fear.
ERP is the gold standard treatment for OCD and many other anxiety disorders. It is backed by decades of clinical research proving its effectiveness and shows promising results within 12-25 sessions on average. In ERP, you’re gradually and safely exposed to the thoughts and situations that are likely to trigger intrusive thoughts and anxiety. With your therapist’s guidance and support, you will learn how to resist the urge to respond to feelings of discomfort and anxiety with compulsions. By doing this over time, you will learn that you are able to tolerate anxiety, experience decreased anxiety and distress in response to OCD triggers, and feel more confident in your ability to sit with uncertainty and discomfort.
Examples of possible exposures done to treat depersonalization fears in Existential OCD may include:
- Creating and listening to a loop tape about the worst-case scenario involving an extended period of depersonalization
- Reading stories about depersonalization or psychosis
- Purposeful daydreaming
If you’re struggling with OCD, As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.