Depersonalization

This article is about the psychological symptom. For the diagnosis, see depersonalization disorder.

Depersonalization (or depersonalisation) is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation.^[1] Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance. It can be a 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. Though degrees of depersonalization and derealization can happen to anyone subject to temporary severe anxiety/stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including dissociative identity disorder and "dissociative disorder not otherwise specified" (DD-NOS). It is also a prominent symptom in some other non-dissociative disorders, such as anxiety disorders, clinical depression, bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, migraine and sleep deprivation. It can be considered desirable, such as in the use of recreational drugs.

In social psychology, and in particular self-categorization theory, the term depersonalization has a different meaning and refers to "the stereotypical perception of the self as an example of some defining social category".^[2]

Description

Individuals who experience depersonalization 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.^[3] Often a person who has experienced depersonalization claims that things seem unreal or hazy. Also, a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increase these perceptions.^[4]

Depersonalization is a subjective experience of unreality in one's sense of self, while derealization is unreality of the outside world. Although most authors currently regard depersonalization (self) and derealization (surroundings) as independent constructs, many do not want to separate derealization from depersonalization.^[5]

Prevalence

Depersonalization is the third most common psychological symptom, after feelings of anxiety and feelings of depression.^[6] Depersonalization is a symptom of anxiety disorders, such as panic disorder.^[7] It can also accompany sleep deprivation (often occurring when suffering from jet lag), migraine, epilepsy (especially temporal lobe epilepsy)^[8], obsessive-compulsive disorder, stress, and anxiety; Interoceptive exposure is a non-pharmacological method that can be used to induce depersonalization.^[9]

A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response. Individuals high on the absorption subscale, which measures a subject's experiences of concentration to the exclusion of awareness of other events, showed weaker cortisol responses.^[10]

Pharmacological And Situational Causes

Depersonalization may also be a desirable effect, such as in the case of recreational drugs. It is an effect of dissociatives and psychedelics, as well as possible side effect of caffeine, alcohol, cannabis, and minocycline.^{[11][12][13][14][15]} It is a classic withdrawal symptom from many drugs.^{[16][17][18][19]}

Benzodiazepine dependence, which can occur with long term use of benzodiazepines, can induce chronic depersonalization symptomatology and perceptual disturbances in some people, even in those who are taking a stable daily dosage, and it can also become a protracted feature of the benzodiazepine withdrawal syndrome.^[20][21]

Lieutenant Colonel 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.^[22]

A hypothesis, posited by writer David Zweig, called Fiction Depersonalization Syndrome, suggests that depersonalization may be triggered by being immersed in a highly mediated environment. ^[23]

Treatment

Treatment is dependent on the underlying cause, whether it is organic or psychological in origin. 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. For those suffering from depersonalization with migraine, tricyclic antidepressants are often prescribed.

If depersonalization is a symptom of psychological causes such as developmental trauma, treatment depends on the diagnosis. In case of dissociative identity disorder or DD-NOS as a developmental disorder, in which extreme developmental trauma interferes with formation of a single cohesive identity, treatment requires proper psychotherapy, and—in the case of additional (co-morbid) disorders such as eating disorders—team of specialists treating such an individual. It can also be a symptom of borderline personality disorder, which can be treated in the long term with proper psychotherapy and psychopharmacology.^[24]

The treatment of chronic depersonalization is considered in depersonalization disorder.

A recently-completed study at Columbia University in New York City has shown positive effects from transcranial magnetic stimulation (TMS) to treat depersonalization disorder. Currently, however, the FDA has not approved TMS to treat DP.^{[citation needed]}

A recent Russian study showed that naloxone, a drug used to reverse the intoxicating effects of opioid drugs, can successfully treat depersonalization disorder. According to the study: "In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization."^[25]

Research

The Depersonalisation Research Unit at the Institute of Psychiatry in London is a world leader in research in depersonalization disorder.^[26] Researchers there use the acronym DPAFU (Depersonalisation and Feelings of Unreality) as a shortened label for the disorder.

See also

• Alienation
• Brain fog
• Catatonic state
• Cognition
• Compassion fatigue
• Derealization
• Dissociation (psychology)
• Ego death
• Hallucinogen persisting perception disorder
• Human spirit
• Out-of-body experience
• Post-traumatic stress disorder
• Psychedelic experience
• Psychological trauma
• Spiritual crisis

References

1. ^ American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0-89042-024-6.
2. ^ Turner, John; Oakes, Penny (1986). "The significance of the social identity concept for social psychology with reference to individualism, interactionism and social influence". British Journal of Social Psychology 25 (3): 237-252. 
3. ^ Depersonalization Disorder at Merck Manual of Diagnosis and Therapy Home Edition
4. ^ Daniel. "Depersonalization disorder: A feeling of being 'outside' your body". http://www.mayoclinic.com/health/depersonalization/AN00595. Retrieved 2007-09-08. 
5. ^ Radovic F., Radovic S. (2002). "Feelings of Unreality: A Conceptual and Phenomenological Analysis of the Language of Depersonalization". Philosophy, Psychiatry, & Psychology 9: 271–279. doi:10.1353/ppp.2003.0048. 
6. ^ Simeon D (2004). "Depersonalisation Disorder: A Contemporary Overview". CNS Drugs 18 (6): 343–354. PMID 15089102. 
7. ^ Sierra-Siegert M, David AS (December 2007). "Depersonalization and individualism: the effect of culture on symptom profiles in panic disorder". J. Nerv. Ment. Dis. 195 (12): 989–95. doi:10.1097/NMD.0b013e31815c19f7. PMID 18091192. 
8. ^ Michelle V. Lambert, Mauricio Sierra, Mary L. Phillips, and Anthony S. David. The Spectrum of Organic Depersonalization: A Review Plus Four New Cases J Neuropsychiatry Clin Neurosci, May 2002; 14: 141 - 154.
9. ^ Lickel J, Nelson E, Lickel A H, Brett Deacon (2008). "Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study". Journal of Cognitive Psychotherapy: an International Quarterly 22: 4. 
10. ^ Giesbrecht, T.; T. Smeets, H. Merckelbac and M. Jelicic (2007). "Depersonalization experiences in undergraduates are related to heightened stress cortisol responses". J. Nerv. Ment. Dis. 195 (4): 282–87. doi:10.1097/01.nmd.0000253822.60618.60. PMID 17435477. 
11. ^ Stein, M. B.; Uhde, TW (July 1989). "Depersonalization Disorder: Effects of Caffeine and Response to Pharmacotherapy". Biological Psychiatry 26 (3): 315–20. doi:10.1016/0006-3223(89)90044-9. PMID 2742946. 
12. ^ Raimo, E. B.; R. A. Roemer, M. Moster and Y. Shan (June 1999). "Alcohol-Induced Depersonalization". Biological Psychiatry 45 (11): 1523–6. doi:10.1016/S0006-3223(98)00257-1. PMID 10356638. 
13. ^ Cohen, P. R. (2004). "Medication-associated depersonalization symptoms: report of transient depersonalization symptoms induced by minocycline". Southern Medical Journal 97 (1): 70–73. doi:10.1097/01.SMJ.0000083857.98870.98. PMID 14746427. 
14. ^ "Medication-Associated Depersonalization Symptoms". http://www.medscape.com/viewarticle/468728_3. 
15. ^ "Depersonalization Again Finds Psychiatric Spotlight". http://pn.psychiatryonline.org/cgi/content/full/38/16/18. 
16. ^ Marriott, S.; P. Tyrer (1993). "Benzodiazepine dependence: avoidance and withdrawal". Drug Safety 9 (2): 93–103. doi:10.2165/00002018-199309020-00003. PMID 8104417. 
17. ^ Shufman, E.; A. Lerner and E. Witztum (2005). "[Depersonalization after withdrawal from cannabis usage]" (in Hebrew). Harefuah 144 (4): 249–51 and 303. PMID 15889607. 
18. ^ Djenderedjian, A.; R. Tashjian (1982). "Agoraphobia following amphetamine withdrawal". The Journal of Clinical Psychiatry 43 (6): 248–49. PMID 7085580. 
19. ^ Mourad, I.; M. Lejoyeux and J. Adès (1998). "[Prospective evaluation of antidepressant discontinuation]" (in French). L'Encéphale 24 (3): 215–22. PMID 9696914. 
20. ^ Ashton H (1991). "Protracted withdrawal syndromes from benzodiazepines". J Subst Abuse Treat (benzo.org.uk) 8 (1-2): 19–28. doi:10.1016/0740-5472(91)90023-4. PMID 1675688. http://www.benzo.org.uk/ashpws.htm. 
21. ^ Terao T; Yoshimura R, Terao M, Abe K. (January 15, 1992). "Depersonalization following nitrazepam withdrawal". Biol Psychiatry 31 (2): 212–3. doi:10.1016/0006-3223(92)90209-I. PMID 1737083. 
22. ^ Grossman, Dave (1996). On Killing: The Psychological Cost of Learning to Kill in War and Society. Back Bay Books. ISBN 0-316-33000-0. 
23. ^ Fiction Depersonalization Syndrome
24. ^ Sierra M, Baker D, Medford N, et al. (2006). "Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases". Clin Neuropharmacol 29 (5): 253–8. doi:10.1097/01.WNF.0000228368.17970.DA. PMID 16960469. 
25. ^ Nuller, Yuri L.; Morozova, Marina G.; Kushnir, Olga N.; Hamper, Nikita (2001). "Effect of naloxone therapy on depersonalization: a pilot study". Journal of Psychopharmacology (Bekhterev Psychoneurological Research Institute. St-Petersburg, Russia: Journal of Psychopharmacology) 15 (2): 93–95. doi:10.1177/026988110101500205. PMID 11448093. http://jop.sagepub.com/cgi/content/abstract/15/2/93. Retrieved 9 August 2009 
26. ^ Depersonalisation Research Unit - Institute of Psychiatry, London