Depersonalization disorder

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Definition

Depersonalization is a state in which the individual ceases to perceive the reality of the self or the environment. The patient feels that his or her body is unreal, is changing, or is dissolving; or that he or she is outside of the body.

Depersonalization disorder is classified by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, text Revision, also known as the DSM-IV-TR as one of the dissociative disorders. These are mental disorders in which the normally well-integrated functions of memory, identity, perception, and consciousness are separated (dissociated). The dissociative disorders are usually associated with trauma in the recent or distant past, or with an intense internal conflict that forces the mind to separate incompatible or unacceptable knowledge, information, or feelings. In depersonalization disorder, the patient's self-perception is disrupted. Patients feel as if they are external observers of their own lives, or that they are detached from their own bodies.

Depersonalization disorder is sometimes called "deper- e sonalization neurosis." p cD

Depersonalization as a symptom may occur in panic o disorder, borderline personality disorder, post-trau- i matic stress disorder (PTSD), acute stress disorder, or another dissociative disorder. The patient is not given io the diagnosis of depersonalization disorder if the d episodes of depersonalization occur only during panic so attacks or following a traumatic stressor. d r

The symptom of depersonalization can also occur in normal individuals under such circumstances as sleep deprivation, the use of certain anesthetics, experimental conditions in a laboratory (experiments involving weightlessness, for example), and emotionally stressful situations (such as taking an important academic examination or being in a traffic accident). One such example involves some of the rescue personnel from the September 11, 2001 terrorist attacks on the World Trade Center and the Pentagon. These individuals experienced episodes of depersonalization after a day and a half without sleep. A more commonplace example is the use of nitrous oxide, or "laughing gas" as an anesthetic during oral surgery. Many dental patients report a sense of unreality or feeling of being outside their bodies during nitrous oxide administration.

To further complicate the matter, depersonalization may be experienced in different ways by different individuals. Common descriptions include a feeling of being outside one's body; "floating on the ceiling looking down at myself' feeling as if one's body is dissolving or changing; feeling as if one is a machine or robot; "unreal" feeling that one is in a dream or that one"is on automatic pilot." Most patients report a sense of emotional detachment or uninvolvement, or a sense of emotional numbing. Depersonalization differs from "derealiza-tion," which is a dissociative symptom in which people perceive the external world as unreal, dreamlike, or changing. The various ways that people experience depersonalization are related to their bodies or their sense of self.

Depersonalization is a common experience in the general adult population. However, when a patient's symptoms of depersonalization are severe enough to cause significant emotional distress, or interfere with normal functioning, the criteria of the DSM-IV-TR for "depersonalization disorder" are met.

Description

A person suffering from depersonalization disorder experiences subjective symptoms of unreality that make him or her uneasy and anxious. "Subjective" is a word e d d n io at iz al n o e p e D

Abuse—Physical, emotional, or sexual harm.

Depersonalization—A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving; or that he or she is outside the body.

Depersonalization neurosis—Another name for depersonalization disorder.

Derealization—A dissociative symptom in which the external environment is perceived as unreal or dreamlike.

Dissociation—A reaction to trauma in which the mind splits off certain aspects of the traumatic event from conscious awareness. Dissociation can affect the patient's memory, sense of reality, and sense of identity.

Dissociative disorders—A group of disorders marked by the separation (dissociation) of perception, memory, personal identity, and consciousness. Depersonalization disorder is one of five dissociative disorders defined by DSM-IV-TR.

Hypothalamic-pituitary-adrenal (HPA) system—A

part of the brain involved in the human stress response. The HPA system releases cortisol, the primary human stress hormone, and neurotransmitters that activate other brain structures associated with the "fight-or-flight" reaction. The HPA system appears to function in abnormal ways in patients diagnosed with depersonalization disorder. It is sometimes called the HPA axis.

Reality testing—A phrase that refers to a person's ability to distinguish between subjective feelings and objective reality. A person who knows that their body is real even though they may be experiencing it as unreal, for example, is said to have intact reality testing. Intact reality testing is a Diagnostic and

Statistical Manual of Mental Disorders, 4th Edition, Text Revision (also known as the DSM-IV-TR) criterion for depersonalization disorder.

Selective serotonin reuptake inhibitor—Commonly prescribed drugs for treating depression. SSRIs affect the chemicals that nerves in the brain use to send messages to one another. These chemical messengers (neurotransmitters) are released by one nerve cell and taken up by others. Neurotransmitters not taken up by other nerve cells are taken up by the same cells that released them. This process is termed "reuptake." SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be taken up by other nerve cells.

Serotonin—A widely distributed neurotransmitter that is found in blood platelets, the lining of the digestive tract, and the brain, and that works in combination with norepinephrine. It causes very powerful contractions of smooth muscle, and is associated with mood, attention, emotions, and sleep. Low levels of serotonin are associated with depression.

Stress—A physical and psychological response that results from being exposed to a demand or pressure.

Stressor—A stimulus or event that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism.

Subjective—Referring to a person's unique internal thoughts and feelings, as distinct from the objects of those thoughts and feelings in the eternal world.

Tricyclic antidepressants (TCAs)—Antidepressant medications that have the common characteristic of a three-ring nucleus in their chemical structure. Imipramine and amitriptyline are examples of tricyclic antidepressants.

that refers to the thoughts and perceptions inside an individual's mind, as distinct from the objects of those thoughts and perceptions outside the mind. Because depersonalization is a subjective experience, many people who have chronic or recurrent episodes of depersonalization are afraid others will not understand if they try to describe what they are feeling, or will think they are "crazy." As a result, depersonalization disorder may be underdiagnosed because the symptom of depersonaliza-tion is underreported.

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