Depersonalization Disorder

Depersonalization Disorder

This dissociative disorder involves lack of integration of one or more components of perception. The essential feature of deper-sonalization disorder is the occurrence of persistent feelings of unreality, detachment, or estrangement from oneself or one’s body, usually with the feeling that one is an outside observer of one’s own mental processes (American Psychiatric Association, 2000). Individuals suffering depersonalization are distressed by it. They are aware of some distortion in their perceptual experi-ence and therefore are not hallucinating or delusional. Affected individuals often fear that they are “going crazy”. The symptom is not infrequently transient.

Derealization, in which affected individuals notice an altered perception of their surroundings, resulting in the world seeming unreal or dream-like, frequently occurs as well. Such individuals often ruminate anxiously about this symptom and are preoccupied with their own somatic and mental functioning.

Depersonalization frequently cooccurs with a variety of other symptoms, especially anxiety, panic, or phobic symptoms. It is often a symptom of PTSD and also occurs as a symptom of alcohol and drug abuse, as a side effect of the use of prescription medication, and during stress and sensory deprivation. The symp-tom of depersonalization is also commonly seen in the course of a number of other neurological and psychiatric disorders. It is considered a disorder when it is a persistent and predominant symptom. The phenomenology of the disorder involves both the initial symptoms themselves and the reactive anxiety caused by them.

Treatment

Depersonalization is most often transient and may remit with-out formal treatment. Recurrent or persistent depersonalization should be thought of both as a symptom in itself and as a com-ponent of other syndromes requiring treatment, such as anxiety disorders and schizophrenia.

The symptom itself may respond to training in self-hypnosis. Paradoxically, induction or deliberate worsening of symptoms may provide relief by teaching a method of controlling them. For example, a hypnotic induction may induce transient depersonalization symptoms, such as a sense of detachment from part of the body, in such individuals. This is a useful exercise, in that by having a structure for inducing the symptoms, one pro-vides the patient with a context for understanding and control-ling them. They are presented as a spontaneous form of hypnotic dissociation that can be modified. Such individuals can be taught to induce a pleasant sense of floating lightness or heaviness in place of the anxiety-related somatic detachment. The use of an imaginary screen to picture problems in a way that detaches them from the typical somatic response is also helpful. Other relaxa-tion techniques such as systematic desensitization, progressive muscle relaxation and biofeedback may also be of help. Psycho-therapy aimed at working through emotional responses to any traumatic or other stressors that tend to elicit the depersonaliza-tion is also helpful.

Pharmacological approaches involve balancing therapeu-tic benefit and risk. Antianxiety medications are most commonly used and may be helpful in reducing the amplification of deper-sonalization caused by anxiety. However, depersonalization and derealization are also side effects of antianxiety drugs, so their use should be carefully monitored. Increasing dosage, a standard technique when there is lack of therapeutic response, may also increase symptoms, leading to a spiral of increasing symptoms and drug dosage but without therapeutic benefit.

However, appropriate pharmacological treatment for comorbid disorders is an important part of treatment. Use of antianxiety medications for generalized anxiety or phobic dis-orders or of antipsychotic medications for psychotic disorders is often beneficial in conditions in which there is contributory comorbidity.