Depersonalization

My interest to investigate this mental disorder spawns from an experience shared with me by a client which were symptoms like those described below. It belongs to the category of dissociative disorders. Butcher, Mineka, & Hooley’s (2013) included in their textbook the Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5) criteria for depersonalization disorder, which is described below:

A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

  1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and physical numbing).
  2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post traumatic stress disorder, or another dissociative disorder.

A quote from a leader in the field included in the textbook I think describes the disorder best: “The feeling puzzles the experiencers: the changed condition is perceived as unreal…The object of the experience…is commonly described as isolated, lifeless, strange, and unfamiliar; oneself and others are perceived as ‘automatons,’ behaving mechanically, without initiative or self-control” (Butcher, Mineka, & Hooley, 2013, p. 282). As Mendoza et al. (2011, p. 413) puts it simply, “patients maintain their judgment that nothing has changed, just their feeling about themselves or about the surroundings.”

In the middle of my client’s senior year in college, she reported sensing this feeling of detachment. She recalled the symptoms being the worst right before finals week in the winter. She would catch herself staring into space, feeling alien to her own mind and body. Often, she would ask herself these questions following a chat with her friends: What did we just talk about? What just happened? What am I doing? What is going on? Looking back, she believes it was a high amount of stress and anxiety that made her feel and think like this.

Luckily, the symptoms my client was experiencing are not completely out of the ordinary. According to Simeon et al. (1997, p. 1107), “depersonalization is a rather common experience that spans from the normal to the pathological and may constitute the third most common psychiatric symptom after anxiety and depression…One study found a 46% 1-year incidence of depersonalization experiences in a sample of college students.” These feelings, which are commonly experienced as brief episodes—such as the feeling of jet lag or being under the influence of substances—are usually brought on by stress or fatigue. It is when these symptoms are persistent, long-lasting, pervasive, and causes significant distress and impairment, without the influence of drugs or another mental disorder. Population and clinic surveys suggest that clinically significant depersonalization affects 1–2% of the population and that it begins most commonly in adolescence or early adulthood (Medford, 2012, p. 139).

Medford (2012, p. 140) lists some common complainants of those afflicted with depersonalization disorder:

  • Numbed emotional experiencing
  • heightened self-observation
  • altered body experience, feelings of not being in control of movement
  • changes in the experiencing of time and space
  • feelings of mind emptiness
  • inability to imagine things,” as well as perceptual anomalies, for example, the external world seeming oddly flat and two-dimensional, or colors seeming less (or, sometimes, more) vivid than previously

When it comes to strategies in treating depersonalization disorder, options to a client may be limited. There is of course psychotherapy which would aim at helping the client5 understand why their symptoms may be occurring, learning techniques to distract themselves from the symptoms, learning techniques to make them feel more connected to their world and feelings, discovering coping skills to address stress and stressful situations, and if appropriate, helping that person to address any depression, anxiety, and/or trauma they may have experienced that influenced this disorder in being expressed. It is important to note that depersonalization disorder often co-occurs with a person experiencing a traumatic event, severe stress, depression, and/or anxiety. Fortunately, medications do exist in that they may be used to treat specific symptoms or to treat depression and anxiety that are often associated with depersonalization disorder (Mayo Clinic).

If you or someone you know needs help please contact the Youth Crisis Center Hopeline at 1-877-720-0007 or the Jacksonville Youth Crisis Center at 904-720-0002.

References

1. Butcher, J.N., Mineka, S., & Hooley, J.M. (2013). Abnormal psychology (15th ed.). Boston: Pearson Education Inc.,

2. Mayo Clinic. (2017, May 16). Depersonalization-derealization disorder. Retrieved from http://www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/diagnosis-treatment/treatment/txc-20318910

3. Medford, N. (2012). Emotion and the unreal self: Depersonalization disorder and de-affectualization. Emotion Review, 4(2), 139-144.

4. Mendoza, L. Navines, R., Crippa, J.A., Fagundo, A.B., Gutierrez, F., Nardi, A.E., Bulbena, A.,

5. Valdes, M., Martin-Santos, R. (2011). Depersonalization and personality in panic disorder. Comprehensive Psychiatry, 52(4), 413-419.

6. Simeon, D., Gross, S., Guralnik, O., Stein, D.J., Schmeidler, J., & Hollander, E. (1997). Feeling unreal: 30 cases of dsm-III-r depersonalization disorder. Am J Psychiatry, 154(8).

 

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