Description, Causes and Risk Factors:
A disorder characterized by persistent or recurrent experiences of detachment from one's mental processes or body, as if one is an automaton, an outside observer, or in a dream; reality testing remains intact and there is clinically significant distress impairment.
Depersonalization disorder involves an unpleasant, chronic and disabling alteration in the experience of self and environment. In addition to these classic features of depersonalization and derealization, symptoms may also encompass alterations in bodily sensation and a loss of emotional reactivity.
Little is known about the causes of depersonalization disorder, but biological and environmental factors might play a role. Like other dissociative disorders, depersonalization disorder often is triggered by intense stress or a traumatic event -- such as family chaos, abuse, accidents, disasters, or extreme violence -- that the person has experienced or witnessed.
Depersonalization may occur as a transient phenomenon in healthy individuals, particularly in the context of fatigue, during or after intoxication with alcohol and/or drugs, or in situations involving serious danger. It may also occur as a chronic, disabling and clinically significant phenomenon, either as a primary disorder or secondarily in a range of Neuropsychiatry settings (e.g. major depressive disorder, schizophrenia, temporal lobe epilepsy, etc). Until recently, there was a prevailing consensus that the number of individuals who experience this disorder in a pure or isolated form is small. More commonly, depersonalization-derealization phenomena occur in the context of depressive illnesses, phobic disorder, and obsessive-compulsive disorder.
The disease is very common and almost every one has some sort of depersonalization disorder.
The primary symptom of depersonalization disorder is a distorted perception of the body. The person might feel like he/she is a robot or in a dream. Some people might fear they are going crazy and might become depressed, anxious, or panicky. For some people, the symptoms are mild and last for just a short time. For others, however, symptoms can be chronic (ongoing) and last or recur for many years, leading to problems with daily functioning or even to disability.
If symptoms of depersonalization disorder are present, the PCP will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests, such as imaging studies and blood tests, to rule out physical illness or medication side effects as the cause of the symptoms.
If no physical illness is found, the person might be referred to a Psychologist, who are specially trained to diagnose and treat mental illnesses. Psychologists use specially designed interview and assessment tools to evaluate a person for a dissociative disorder.
Pharmacological approaches: There is no recognized drug treatment for depersonalization. However, there is some evidence to support the use of selective serotonin reuptake inhibitor (SSRI) antidepressants, and more recently the combination of lamotrigine and an SSRI has shown promise. The evidence is reviewed briefly here, but it should be stressed that it is composed entirely of small studies and isolated case reports, and that large randomized controlled trials have not been performed.
Psychological approaches: As with Pharmacotherapy, there is no recognized psychological treatment for depersonalization. There are isolated case reports describing successful treatment using psychoanalytical therapy, behavioral therapy, and directive therapy, although in the latter two reports the patients described have high levels of comorbid psychopathology and may not be cases of primary depersonalization.
More recently, a cognitive-behavioral model of depersonalization has been proposed. It is based on the idea, touched on earlier in this article, that anxiety and depersonalization are intimately related, and that depersonalization is best conceptualized as related to anxiety disorders rather than to dissociative conditions.
The model suggests that there are various ways in which depersonalization may initially arise, related to some external psychological stressor and/or as a consequence of a change in mental state (e.g. low mood, anxiety, drug use). Crucially, in those in whom depersonalization becomes chronic and pathological, the appearance of depersonalization features is interpreted as highly threatening (`catastrophic attribution'), leading to a range of cognitions and behaviors that can serve to perpetuate and intensify the symptoms. This leads to a number of practical suggestions for treatment, aimed at Psychoeducation, the reduction of avoidant 'safety behaviors' (such as avoiding social situations) and excessive self-observation (e.g. looking in the mirror to see if one has changed), and challenging the 'catastrophic' attributional style (e.g. ideas such as 'My brain is not working'). This model forms the basis for the cognitive-behavioral therapy (CBT), which is undertaken by a Clinical psychologist trained in CBT, usually in combination with pharmacotherapy initiated and monitored by a psychiatrist.
Relaxation techniques such as progressive muscular relaxation do not appear to be of benefit in depersonalization. Indeed, it has been noted that patients with depersonalization may actually experience an increase in symptoms after using progressive muscular relaxation. However, techniques aimed at refocusing attention away from introspection and self-observation may yet prove to be of benefit, and to this end the use of biofeedback methods may be a worthwhile avenue for future study.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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