Psychosis, derealization, depersonalization, and dissociation with depression and anxiety

Symptoms like depersonalization, derealization, dissociation, delusions, and hallucinations can be incredibly disturbing. They are often thought of as being signs of a psychotic disorder or severe trauma, but if these symptoms only occur during depressive episodes, they may actually be part of a mood disorder. We can also experience disconnections from reality because of intense psychological distress, including periods of prolonged or significantly heightened anxiety. Dissociation is somewhat like the mind’s version of going into shock. It’s a temporary anesthetic to protect us from the immense emotional pain that we’re experiencing. The prefrontal cortex, the very front most region of the brain, is responsible for our orientation to person, place, and time. When activity in the frontal lobe decreases, we lose some (or all) of this ability to orient to these anchors. This can be terrifying or disturbing if you don’t know what it is or don’t realize that it’s temporary and something that is, to some degree, supposed to happen. Understanding what all of these processes are and the neurological reasons for them makes them a lot less scary. Hopefully that’s what you get from this episode.