The fear of going mad is extremely widespread in depersonalization disorder – so much that it can be described as a fundamental symptom. Also, fears of hearing voices or doing bad things (abusing children, for example) are closely related to this fear.
Fears experienced by those affected can be directly linked to depersonalization disorder. An example is the fear of falling apart internally or to dissolve into “nothingness” and never being able to come back from it. Also, the fear of suffering from a severe neurological disease, for example Alzheimer’s, is directly related to depersonalization symptoms, as is the fear of waking up from depersonalization.
Other fears are related to being together with other people, for example to the fear of losing control in public or flipping out, or to fears of stumbling in front of others or of failing. Also, the fear of not being able to act adequately plays a role.
There is also the fear of not being real and of merely living in an imaginary world. This makes those affected experience severe anxiety; these fears are likely to be among the worst experiences a person can have, believing that neither they themselves nor the world around them is real.
Fears can lead to compulsive thoughts or compulsive actions, for example about hurting themselves or others, being forced to keep themselves in check constantly, counting on the inside or having to perform other rituals, and many other things. Such fears can turn into panic attacks.
Some of those affected experience fears that are so overwhelming and unbearable that they have the need to bash their head against the wall, to cramp, or to shake.
Overcoming fear in psychotherapy can roughly go one of two directions. If the fear is very concrete and realistic, for example the fear of failing in front of others, then confrontation is a useful means to overcome fear. Confrontation means actively seeking out situations that are usually avoided due to fear and to live through the arising fear. After time, a gradual habituation takes place so that the situations are less linked to fear. The best course of action is to establish a hierarchy of fears beforehand in which one’s own fears are ordered based on severity. Then, one starts with those situations that lead to a little fear, for example asking a question during a lecture, until one finally reaches the situations that lead to the most fear, for example giving a presentation in front of others.
Not all fears experienced by people with depersonalization disorder are concrete or realistic. Many experience irrational fears that are not connected to particular situations and that, in addition, emerge suddenly out of nowhere. Intentional confrontation in such cases does not lead to getting used to it, as those affected usually have no other choice than living through it in the first place. For many of those affected it is more helpful to face the emerging fears with relaxation techniques or distractions.
For example, someone who cannot sleep at night in the dark without light because he or she believes they hear voices then will only rarely experience an alleviation of the fear when forcing themselves to live through the darkness. In such a case, it is better to turn on the light and to lessen the fear by using autogenic training or progressive muscle relaxation, or by simply reading or listening to music.