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Depersonalization Disorder

by Daphne Simeon, MD

Depersonalization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes (depersonalization) and a feeling of being an outside observer of one’s life.

  • The disorder is usually triggered by life-threatening danger or other severe stress.

  • Feelings of detachment from self may occur periodically or continuously.

  • After tests are done to rule out other possible causes, psychologic testing helps to diagnose the disorder.

  • Psychotherapy and cognitive-behavioral therapy help some people.

Feeling temporarily detached (depersonalized) is the third most common psychologic symptom (after anxiety and depression). This feeling often occurs after people experience life-threatening danger, take certain drugs (for example, marijuana, hallucinogens, ketamine, Ecstasy), become very tired, or are deprived of sleep or sensory stimulation (as may occur when they are in an intensive care unit). Depersonalization disorder occurs in about 2% of the population.

Symptoms

People feel detached from their body, mind, feelings, or sensations. People may say they feel unreal, like an automaton, or as if they were in a dream or in some other way detached from the world. People may describe themselves as the “walking dead.” The symptoms almost always cause great discomfort. Some people find them intolerable.

Symptoms are often persistent. Symptoms recur in episodes in about one third of people and occur continuously in about two thirds. Episodic symptoms sometimes become continuous.

People often have great difficulty describing their symptoms and may fear or believe that they are going crazy. However, people always remain aware that their unreal experiences are not real but rather are just the way that they feel. This awareness is what separates depersonalization disorder from a psychotic disorder. People with a psychotic disorder always lack such insight.

Diagnosis

Doctors suspect the disorder based on symptoms. A physical examination and sometimes other tests are done to rule out other disorders that could cause the symptoms, including other mental health disorders and substance abuse. Tests may include magnetic resonance imaging (MRI), electroencephalography (EEG), and urine tests to check for drugs. Psychologic tests and special structured interviews and questionnaires can also help doctors with the diagnosis.

Treatment and Prognosis

Depersonalization disorder often disappears without treatment. People are treated only if the disorder persists, recurs, or causes distress. Psychodynamic psychotherapy and cognitive-behavioral therapy have been effective for some people. Depersonalization disorder is often associated with or triggered by other mental health disorders, which require treatment. Any stresses associated with the beginning of the depersonalization disorder must also be addressed.

Techniques that can help include the following:

  • Cognitive techniques can help block obsessive thinking about the unreal state of being.

  • Behavioral techniques can help people become absorbed in tasks that distract them from the depersonalization.

  • Grounding techniques use the five senses (hearing, touch, smell, taste, and sight) to help people feel more connected to themselves and the world. For example, loud music is played or a piece of ice is put in the hand. These sensations are difficult to ignore, making people aware of themselves in the present moment.

  • Psychodynamic techniques focus on helping people to work through intolerable conflicts and their associated feelings, which are dissociated from consciousness.

Some degree of relief is usually achieved with treatment. Complete recovery is possible for many people, especially those whose symptoms occur in connection with stresses that can be dealt with during treatment. Other people do not respond well to treatment, although they may gradually improve on their own. A few remain unresponsive to all treatments. Antianxiety drugs and antidepressants sometimes help, particularly if people also have anxiety or depression.

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  • KETALAR