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Depersonalization Derealization Disorder

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Depersonalization derealization disorder also known as DPD is a type of dissociative disorder or an anxiety disorder. It is characterized by the presence of recurrent and persistent feelings of derealization or depersonalization experienced by the patient.

Mild depersonalization that is experienced occasionally is considered to be normal. On the other hand, the persistent, strong, recurrent and severe feelings of depersonalization are not normal. The definitive diagnosis of the disorder is made on the presence of these repeated episodes of experiencing a feeling of being detached or separated from one’s body, or mental presence.

Symptoms:                                                                          

The main symptom of the disorder is experiencing unreality and therefore there are no clinical signs that manifest in the patient. Some of the most common features include:

  • Not experiencing motions of life.
  • Sense of automation.
  • The feeling of being part of a movie.
  • Feeling of living a in dream.
  • Loss of personal identity.
  • Feeling disconnected from one’s mental processes or body.
  • Having recurrent out of body experiences (these are associated with feeling a sense of detachment from the body).
  • Finding it hard to relate to reality and the surroundings .
  • Not being able to accept one’s own reflection.
  •  Watching oneself from far away.
  • Experiencing  a feeling of “drifting through the motions”.
  • Not being in complete control of one’s thought and speech.
  • Not being able to control one’s physical movements.
  • Experiencing episodes of being detached from one’s body and emotions.

People who suffer from the depersonalization disorder state that they do not have any notion of the present, and feel as though time is simply passing by them without them realizing it. All these symptoms can cause the patient to become nervous, anxious and uneasy.

Some of the most common complaints of patients suffering from depersonalization disorders include the fear of going crazy, sustaining damage to the brain and not being in control of oneself. Other common complaints include impairments experienced in the occupational field as the patients feel that they are not being able to perform to their complete capacity and ability. They also experience problems in interpersonal matters when they start having emotional disconnections associated with loved ones. Some neuropsychological investigations have proved that there may be defects of the short term memory, attention span as well as the spatial temporal reasoning. The disorder is also related to various disruptions of the cognitive functioning of the brain.

Diagnostic Criteria:

The DSM-IV specifically recognizes 3 possible additional symptoms or features that help in diagnosing Depersonalization Derealization Disorder. These are:

  • A patient feels derealization, which means experiencing the outside or external world as unreal or strange
  • Micropsia or macropsia which is an alternation in the perception of the size and shape of objects
  • A feeling or a sense that other people seem mechanical or unfamiliar.

Diagnosis:

  • The definitive diagnosis of the disorder can only be made if a patient is experiencing the feeling persistently and it tends to interfere with, or affect occupational and social functions which are important in everyday life. The cause of the development of the depersonalization disorder is considered to be some form of traumatic experiences or events during one’s lifetime, which may include accidents, panic attacks, abuse during childhood, witnessing war, unpleasant drug experiences and torture. It is not clear whether or not genetic deformities have any role to play in the development of the disorder, but it has been established that some hormonal changes and neuro-chemical imbalances do occur in patients who suffer from depersonalization disorder.It is thought that some of the most important symptoms of this disorder can protect the patient from various negative stimuli, therefore it can be concluded that the depersonalization disorder is actually a type of a defense mechanism. This disorder can often be found in a patient in combination with clinical depression, anxiety disorders, bipolar disorder, and other panic disorders.

Treatments:

The treatment of the disorder depends upon the cause of the symptoms of the disorder whether the cause is organic or purely psychological. Depersonalization can also be a symptom of other disorders such as Alzheimer’s, Lyme’s disease or multiple sclerosis and these conditions need to be ruled out before definitive treatment is begun.

Depersonalization Derealization Disorder can be treated with a variety of psychotherapeutic techniques. A combination of psychotherapy and medication often helps with the condition3. Cognitive Behavior Therapy along with pharmacotherapy has been successful in treating the condition. Selective serotonin reuptake inhibitors, opoids antagonists and anticonvulsants have all been explored as possible treatment options for the condition.

Patients are taught in Cognitive Behavioral Therapy to interpret their symptoms in a non-threatening way and not to feel as if they are losing their minds. This helps patients improve greatly on many levels and leads towards an overall improvement in their lives.

References:

http://www.mayoclinic.com/health/depersonalization/DS01149

American Psychiatric Association – Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision)

Feeling Unreal: Depersonalization Disorder and the Loss of the Self: Daphne Simeon M.D