When Thinking, Sensing, and Self-Experience Shift

Valsa Madhava, MD

2 days ago

5 min read

Week 6 of the Symptom Patterns Series

Changes in thinking, the senses, perception, and the sense of self that can appear together in withdrawal — described cautiously.

Recognizing These Changes

Not every withdrawal symptom is as easy to point to as a racing heart or a tremor. Some of the hardest to describe are changes in thinking, the senses, and the sense of self.

In this pattern, prominent features may include changes in thinking and mental clarity, heightened sensitivity to light or sound, altered perception, and a sense of feeling unreal or detached from oneself or one's surroundings. Companion symptoms may include anxiety or arousal and sleep disruption.

These features can appear together, but they do not necessarily rise and fall as one. No single symptom identifies the pattern, and the same symptom may occur in other patterns.

Because these experiences are subjective and hard to put into words, they can feel especially unsettling. Naming them can help — so long as we are careful about what the naming does and does not mean.

A Note on "Brain Fog" and Memory

Some people describe mental fogginess, trouble concentrating, or a sense that memory is not working the way it used to. These are experiences patients may report during withdrawal.

These are self-reported experiences — descriptions of how thinking feels. They are not the same as findings from cognitive testing. This article does not claim that cognitive function has been objectively impaired or establish whether such changes recover over time. Those are separate questions that require different evidence.

Feeling Unreal or Detached

Some people go through periods of feeling unreal or detached from themselves or their surroundings — as if watching life from behind glass, or as if things around them are not quite real. These experiences have names (depersonalization and derealization), and they can be frightening, especially if they are unfamiliar.

These are recognized experiences and do not, by themselves, mean that a person is losing touch with reality. They can also occur outside withdrawal, including with anxiety and panic.

On their own, they do not point to any one cause, and describing them here is not a psychiatric diagnosis.

If these experiences are distressing or persistent, seeking support from a clinician is appropriate. They deserve attention without assuming that something catastrophic is happening.

Why These Experiences Are Hard to Interpret

Like the other patterns in this series, these changes are strongly nonspecific. Difficulty concentrating, sensory sensitivity, and feeling detached can overlap with anxiety, sleep loss, stress, and low mood. Similar experiences can arise in situations that have nothing to do with benzodiazepines.

These experiences, by themselves, cannot identify their own cause. They are recognizable, but they are not specific enough to tell a person what is producing them.

Information That May Add Context, and When to Seek Support

No single piece of information settles what an experience means, but some can add context:

the relationship of the changes to a dose reduction or cessation;
whether appropriate evaluation has considered other causes, including sleep, mood, and stress;
how the present experiences compare with what the person experienced before benzodiazepine use;
how they evolve over time.

None of these features proves the cause on its own, and none replaces individual evaluation.

If any of these experiences are distressing or persistent, seeking support from a clinician is appropriate and worthwhile.

What the Pattern Can — and Cannot — Tell Us

Recognizing this pattern can make a disorienting set of experiences feel more understandable, and it can help a person and their clinician describe and follow what is happening.

This is the broadest and most interpretive grouping in the series. Within the Five-Axis Stress Biology Framework™ educational framework, these changes involve functions described across more than one area, rather than a single one. Unlike the earlier patterns, this article does not point to one dominant axis or one mechanism.

Because benzodiazepines act on widely distributed systems in the nervous system, changes in thinking, sensing, and self-experience are biologically plausible during withdrawal.

However, human benzodiazepine-withdrawal studies have not demonstrated the specific mechanisms responsible for this proposed grouping.

This grouping is a descriptive way of naming experiences that may appear together. It is not a statistically established subtype, a diagnosis, or evidence that these experiences share one underlying mechanism.

Recognition may help organize the experience, but it cannot determine whether the symptoms reflect withdrawal, anxiety, poor sleep, low mood, or a combination. These questions are worth working through with a clinician, and no medication should be changed on the basis of a symptom picture alone.

Transition to Mixed and Overlapping Patterns

In practice, a person's symptom picture may include features of more than one pattern. The boundaries can overlap, and some symptoms may be difficult to place at all.

The next article examines this overlap in Mixed and Overlapping Patterns.

Figure 6. Changes in thinking, sensing, and self-experience

This figure illustrates self-reported changes in thinking, concentration, memory experience, sensory sensitivity, perception, and the sense of self that may appear together. Anxiety or arousal and sleep disruption may also be present. The figure is descriptive: it does not establish impaired cognitive function, a shared mechanism, or a diagnosis. These experiences may have several possible causes, and distressing or persistent symptoms deserve individual medical evaluation.

About the Evidence

These patterns are provisional educational descriptions informed by published withdrawal literature, the author's own exploratory cross-sectional analysis of 39 people (in preparation for publication), the Five-Axis Stress Biology Framework™ educational framework, and clinical observation.

They are not diagnoses or fixed subtypes and do not establish a mechanism. Changes in thinking described here are self-reported; this article makes no claim about measured cognitive function. These experiences can also occur with anxiety, poor sleep, stress, and low mood, and describing them is not a diagnosis.

If they are distressing or persistent, support from a clinician is appropriate. These descriptions do not replace individual medical evaluation, and medication changes should not be made on the basis of them alone.

Selected Scientific References

Ashton, H. (1991). Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment, 8(1–2), 19–28. https://doi.org/10.1016/0740-5472(91)90023-4
Medford, N., Sierra, M., Stringaris, A., Giampietro, V., Brammer, M. J., & David, A. S. (2016). Emotional experience and awareness of self: Functional MRI studies of depersonalization disorder. Frontiers in Psychology, 7, 432. https://doi.org/10.3389/fpsyg.2016.00432
Shade, K. N., et al. (2025). Long-term neurological consequences following benzodiazepine exposure: A scoping review. PLOS ONE, 20(8), e0330277. https://doi.org/10.1371/journal.pone.0330277

Feeling unreal or detached (depersonalization/derealization) is discussed only as a recognized experience. Medford et al. (2016) concerns depersonalization research outside benzodiazepine withdrawal and is cited only for biological plausibility, not as evidence of a mechanism demonstrated in withdrawal. This article makes no claim about measured cognitive function. The Series 4 organizational analysis is the author's own exploratory analysis of the same 39-person symptom matrix, in preparation for publication and not yet posted or externally replicated.

For educational purposes only. Not a substitute for individual medical evaluation.