Depersonalization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Depersonalization (or depersonalisation) is an 'alteration' in the perception or experience of the self so that one feels 'detached' from, and as if one is an 'outside' observer of, one's mental processes or body. It can be considered desirable, such as in the use of recreational drugs, but it usually refers to the severe form found in anxiety and, in the most intense case, panic attacks. A sufferer feels that he or she has changed and the world has become less real, vague, dreamlike, or lacking in significance. It can sometimes be a rather disturbing experience, since many feel that indeed, they are living in a "dream."

Chronic depersonalization refers to depersonalization disorder, which is classified by the DSM-IV as a dissociative disorder. Derealization is a similar term to depersonalization, and the two are often used interchangeably. However, more specifically, derealization is the feeling that "nothing is real," while depersonalization is the feeling that one is "detached" from one's body or world. Though these feelings can happen to anyone, they are most prominent in anxiety disorders, clinical depression, bipolar disorder, sleep deprivation, and some types of epilepsy.

Description

Individuals who experience depersonalization feel divorced from both the world and from their own identity and physicality. Often a person who has experienced depersonalization claims that life "feels like a movie" or things seem unreal or hazy. Also a recognition of self breaks down (hence the name). DP can result in very high anxiety levels, which further increase these perceptions.

One way to describe the physical manifestation of the feeling is to compare it to a film technique called the vertigo shot or dolly zoom. In this technique, the subject of the picture stays fixed on the shot while all the surrounding background is pulled away - providing a sense of vertigo or detachment. People may perceive this feeling in a cyclical manner, where the feeling is experienced back-to-back in succession.

Sometimes the physical manifestation is more like a strobe light of the senses. Information is processed at a much more staggered rate and therefore the subject feels as though his or her senses are being distorted and fragmented.

Causes

Depersonalization is a side effect of dissociatives and hallucinogens, as well as common drugs such as marijuana, caffeine, alcohol, and minocycline. It is a classic withdrawal symptom from many drugs.

Depersonalization can also accompany sleep deprivation, stress and anxiety as well as being a symptom of anxiety disorders such as panic disorder.

A study of undergraduate students found individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited more pronounced cortisol response. Individuals high on the absorption subscale, which measures experiences of concentration to the exclusion of awareness of other events going on around them, showed weaker cortisol responses.

Differential Diagnosis

• Anxiety disorders

• Illness anxiety disorder
• Major depressive disorder
• Mental disorders due to another medical condition

• Obsessive-compulsive disorder
• Other dissociative disorders
• Psychotic disorders
• Substance/medication-induced disorders

• Ecstasy

• Hallucinogens
• Ketamine

• Marijuana
• Salvia

Epidemiology and Demographics

Prevalence

The prevalence of depersonalization/derealization is 2,000 per 100,000 (2%) of the overall population.

Risk Factors

• Anxiety

• Childhood interpersonal traumas
• Depression

• Emotional abuse

• Emotional neglect
• Growing up with a seriously impaired,mentally ill parent
• Illicit drug use

• Hallucinogens
• Ketamine
• MDMA
• Salvia

• Tetrahydrocannabinol

• Physical abuse
• Severe stress

• Sexual abuse
• Unexpected death or suicide of a family member or close friend

• Witnessing domestic violence

Treatment

Treatment is dependent on the underlying cause.

If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as amyotrophic lateral sclerosis, Alzheimer's, Multiple Sclerosis (MS), neuroborreliosis (Lyme Disease) or any other neurological disease affecting the brain.

If depersonalization is a psychological symptom then treatment may be dependent on the diagnosis. Depersonalization is often a symptom of borderline personality disorder, which can be treated in the long term with proper psychotherapy and psychopharmacology.[3]

Treatment of chronic depersonalization is considered in depersonalization disorder.

See also

• Depersonalization disorder
• Dissociation (psychology)
• Dissociative Disorders (DSM-IV Dissociative Disorders)
• Alienation
• Post-traumatic stress disorder
• Cognition
• Brain fog
• Hallucinogen persisting perception disorder
• Derealization
• Out-of-body experience

References

• Lt. Col. Dave Grossman, in his book On Killing, suggests that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill other human beings.
• Existentialists use the term in a different context. The treatment of individuals by other people as if they were objects, or without regard to their feelings, has been termed depersonalization. Determinism has been accused of this. See also objectification.
• R. D. Laing used depersonalization to mean a fear of the loss of autonomy in interpersonal relationships by the ontologically insecure.