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Depersonalization disorder

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Depersonalization disorder (DPD) is a mental disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. In the DSM-IV-TR this disorder is classified as a dissociative disorder; in the ICD-10 it is called depersonalization-derealization syndrome and classified as an independent neurotic disorder.[1] Common descriptions of symptoms are: feeling disconnected from one's physicality; feeling as though one is not completely occupying the body; not feeling in control of one's speech or physical movements; feeling detached from one's own thoughts or emotions; a sense of automation, going through the motions of life but not experiencing it or participating in it; loss of conviction with one's identity; feeling a disconnection from one's body; inability to accept one's reflection as one's own; difficulty relating oneself to reality and the environment; feeling as though one is in a dream; and out-of-body experiences.[2] Depersonalization is described as suffering from episodes of surreal experiences. Some of these experiences have been also reminiscent of panic attacks and paroxysmal anxiety. While many people experience brief moments of depersonalization, in others it may last much longer and can become a persistent problem.[3] Diagnostic criteria for Depersonalization disorder include, among others, persistent or recurrent experiences of feeling detached from one's mental processes or body.[4] A diagnosis is made when the dissociation is persistent and interferes with the social and occupational functions necessary for everyday living. Providing an accurate description through investigation has proved challenging due to the subjective nature of depersonalization, the ambiguity of the language used to describe episodes of depersonalization and because the experiences of depersonalization overlap with those of derealization, which are two separate disorders.[5]

Depersonalization disorder is thought to be largely caused by severe traumatic lifetime events including childhood abuse, accidents, war, torture, panic attacks and bad drug experiences. It is unclear whether genetics play a role; however, there are many neurochemical and hormonal changes in individuals suffering with depersonalization disorder.[6]

Although the disorder is an alteration in the subjective experience of reality, it is not related to psychosis, as sufferers maintain the ability to distinguish between their own internal experiences and the objective reality of the outside world. During episodic and continuous depersonalization, sufferers are able to distinguish between reality and fantasy, and their grasp on reality remains stable at all times.[7]

While depersonalization disorder was once considered rare among the general population, lifetime experiences with the disorder are common in about 1%-2% of the general populace. While these numbers may seem small, depersonalization experiences were frequently described by a majority of the population but in varying intensities.[5]

Depersonalization disorder is associated with cognitive disruptions in early perceptual and attentional processes.[8]

SymptomsEdit

The core symptom of depersonalization disorder is the subjective experience of "unreality in one's sense of self",[9] and as such there are no clinical signs. Patients who suffer from depersonalization also experience an almost uncontrollable urge to question and think about the nature of reality and existence as well as other deep philosophical questions.[3]

Individuals who experience depersonalization can feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to the same person or identity. Also, a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which can intensify these perceptions even further.

Common descriptions: Feeling disconnected from one's physicality; feeling like one is not completely occupying the body; not feeling in control of one's speech or physical movements; and feeling detached from one's own thoughts or emotions; experiencing one's self and life from a distance; a sense of just going through the motions; feeling as though one is in a dream or movie; and even out-of-body experiences.[2] Patients suffering from depersonalization disorder have also certain visual stimulations such as hallucinations and rapid fluctuations in lighting. While the exact cause of these hallucinations has not yet been determined, it is generally accepted that patients suffering from them is caused by previous drug usage. These hallucinations differ from true hallucinatory phenomena as they are closer to being optical distortions or illusions rather than psychotic breaks.[3] Individuals with the disorder commonly describe a feeling as though time is 'passing' them by and they are not in the notion of the present. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious.

Factors that tend to diminish symptoms are comforting interpersonal interactions, intense physical or emotional stimulation, and relaxation.[10] Some factors are identified as relieving symptom severity such as diet or exercise; alcohol and fatigue are listed by others as worsening symptoms.[11]

First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment.[5] The majority of patients suffering from depersonalization disorder misinterpret the symptoms, thinking that they are signs of serious mental illness or brain dysfunction. This commonly leads to an increase of anxiety experienced by the patient which contributes to the worsening of symptoms.[12]

Occasional moments of mild depersonalization are normal;[13] strong, severe, persistent, or recurrent feelings are not.

Diagnostic criteria (DSM-IV-TR)Edit

The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:

  1. Persistent, recurring feeling of being detached from one’s mental processes or body; as if an observer
  2. During depersonalization, reality testing is intact
  3. Depersonalization causes significant distress, and impairment in social, occupational, or other functioning
  4. Depersonalization is not related to another disorder, substance use, or general medical condition
Main article: Schizophrenia: History of the disorder.
Main article: DD:Theoretical approaches.
Main article: DD:Epidemiology.
Main article: DD:Risk factors.
Main article: DD:Etiology.
Main article: DD:Diagnosis & evaluation.
Main article: DD:Comorbidity.
Main article: DD:Treatment.
Main article: DD:Prognosis.
Main article: DD:Service user page.
Main article: DD:Carer page.

BibliographyEdit

Key Texts – BooksEdit

Simeon D. & Abugel J. (2006)Feeling Unreal : Depersonalization Disorder and the Loss of the Self.Oxford University Press, USA ISBN 0195170229

Additional material – BooksEdit

Key Texts – PapersEdit

Additional material - PapersEdit

External linksEdit

  • Depersonalization Community – Support site for those suffering from depersonalization and derealization.
  • DreamChild – Personal page of experiences and advice by one sufferer of chronic depersonalization disorder.
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