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Depersonalization

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Depersonalization (or depersonalisation) is an alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one's mental processes or body. It is a feeling of watching oneself act, while having no control over a situation.[1] It can be considered desirable, such as in the use of recreational drugs, but it usually refers to the severe form found in anxiety and, in the most intense cases, panic attacks. A sufferer feels that he or she has changed and the world has become less real, vague, dreamlike, or lacking in significance. It can sometimes be a rather disturbing experience, since many feel that, indeed, they are living in a "dream".

Chronic depersonalization refers to depersonalization disorder, which is classified by the DSM-IV as a dissociative disorder. Derealization is a similar term to depersonalization, and the two are often used interchangeably. However, more specifically, derealization is the feeling that "nothing is real", while depersonalization is the feeling that one is "detached" from one's body or world. (Though these feelings can happen to anyone who is under temporary severe anxiety/stress, for chronic depersonalization, which individuals experience after suffering severe trauma, see depersonalization disorder.) Derealization and depersonalization disorder are most prominent in anxiety disorders, clinical depression, bipolar disorder, sleep deprivation, and some types of epilepsy.

Description

Individuals who experience depersonalisation feel divorced from both the world and from their own physicality by acting as a completely different identity.[2] Often a person who has experienced depersonalization claims that life "feels like a movie" or things seem unreal or hazy. Also a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increases these perceptions.[3]

One way to describe the physical manifestation of the feeling is to compare it to a film technique called the vertigo shot or dolly zoom. In this technique, the subject of the picture stays fixed on the shot while all the surrounding background is pulled away, providing a sense of vertigo or detachment. People may perceive this feeling in a cyclical manner, where the feeling is experienced back-to-back in succession.[citation needed]

Causes

Depersonalization is a side effect of dissociatives and hallucinogens, as well as common drugs such as caffeine, alcohol, and minocycline.[4][5][6] It is a classic withdrawal symptom from many drugs.[7][8][9][10]

The symptom of depersonalization is the third most common psychological experience, after feelings of anxiety and feelings of depression.[11] Depersonalization can also accompany sleep deprivation(often ocurring when suffering from jet lag), stress, and anxiety; it is a symptom of anxiety disorders, such as panic disorder.[12] Interoceptive exposure is a non-pharmacological method that can be used to induce depersonalization.[13]

A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response. Individuals high on the absorption subscale, which measures experiences of concentration to the exclusion of awareness of other events going on around them, showed weaker cortisol responses.[14]

Treatment

Treatment is dependent on the underlying cause, whether it is organic or psychological in origin. If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), neuroborreliosis (Lyme disease), or any other neurological disease affecting the brain. If depersonalization is a psychological symptom, then treatment may be dependent on the diagnosis. Depersonalization is often a symptom of borderline personality disorder, which can be treated in the long term with proper psychotherapy and psychopharmacology.[15]

The treatment of chronic depersonalization is considered in depersonalization disorder.

  • Matthew Perry's character, Hudson Milbank, suffers from depersonalization disorder in the movie Numb.
  • The alternative rock/metal band Linkin Park sing about depersonalization in a number of their songs, including "Numb" and "Crawling".
  • Lieutenant Colonel Dave Grossman, in his book On Killing, suggests that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill other human beings.[citation needed]
  • Existentialists use the term in a different context. The treatment of individuals by other people as if they were objects, or without regard to their feelings, has been termed depersonalization. Determinism has been accused of this. See also objectification.
  • R. D. Laing used depersonalization to mean a fear of the loss of autonomy in interpersonal relationships by the ontologically insecure.
  • In the memoir Girl, Interrupted, Susanna Kayson describes her experience in a mental institution, where she later bit into her hand because she had "to see if she had bones"; she was later diagnosed with a depersonalization attack.
  • In the Bret Easton Ellis novel American Psycho and the 2000 film adaptation of the same name, the protagonist, serial killer Patrick Bateman, remarks repeatedly through first-person narration his feelings of depersonalization. Throughout the story, Bateman experiences at some point or another most, if not all, the symptoms of DPD: he frequently experiences panic attacks, hallucinations, random fits of crying, and confusion over his personality (or lack thereof), the latter exacerbated by his compulsion to "fit in" and the inability of his acquaintances to tell him and others apart. Bateman occasionally addresses his ailment directly, including a monologue where he laments, "There wasn't a clear, identifiable emotion within me, except for greed and, possibly, total disgust. I had all the characteristics of a human being—flesh, blood, skin, hair—but my depersonalization was so intense, had gone so deep, that the normal ability to feel compassion had been eradicated, the victim of a slow, purposeful erasure. I was simply imitating reality, a rough resemblance of a human being, with only a dim corner of my mind functioning."

See also

References

  1. ^ American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0890420246.
  2. ^ Depersonalization Disorder at Merck Manual of Diagnosis and Therapy Home Edition
  3. ^ Daniel. "Depersonalization disorder: A feeling of being 'outside' your body" (html). Retrieved 2007-09-08.
  4. ^ Stein, M. B. (1989). "Depersonalization Disorder: Effects of Caffeine and Response to Pharmacotherapy". Biological Psychiatry. 26 (3): 315–20. doi:10.1016/0006-3223(89)90044-9. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Raimo, E. B. (1999). "Alcohol-Induced Depersonalization". Biological Psychiatry. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  6. ^ Cohen, P. R. (2004). "Medication-associated depersonalization symptoms: report of transient depersonalization symptoms induced by minocycline". Southern Medical Journal. 97 (1): 70–73. PMID 14746427.
  7. ^ Marriott, S. (1993). "Benzodiazepine dependence: avoidance and withdrawal". Drug Safety. 9 (2): 93–103. doi:10.2165/00002018-199309020-00003. PMID 8104417. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ Shufman, E. (2005). "[Depersonalization after withdrawal from cannabis usage]". Harefuah (in Hebrew). 144 (4): 249–51 and 303. PMID 15889607. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ Djenderedjian, A. (1982). "Agoraphobia following amphetamine withdrawal". The Journal of Clinical Psychiatry. 43 (6): 248–49. PMID 7085580. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  10. ^ Mourad, I. (1998). "[Prospective evaluation of antidepressant discontinuation]". L'Encéphale (in French). 24 (3): 215–22. PMID 9696914. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  11. ^ Simeon D, (2004) Depersonalisation Disorder: A Contemporary Overview. CNS Drugs 18(6): 343-354. PMID 15089102
  12. ^ Sierra-Siegert M, David AS (2007). "Depersonalization and individualism: the effect of culture on symptom profiles in panic disorder". J. Nerv. Ment. Dis. 195 (12): 989–95. doi:10.1097/NMD.0b013e31815c19f7. PMID 18091192. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ Lickel J, Nelson E, Lickel A H, Deacon Brett (2008). "Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study". Journal of Cognitive Psychotherapy: An International Quarterly 22: 4.
  14. ^ Giesbrecht, T. (2007). "Depersonalization experiences in undergraduates are related to heightened stress cortisol responses". J. Nerv. Ment. Dis. 195 (4): 282–87. doi:10.1097/01.nmd.0000253822.60618.60. PMID 17435477. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. ^ Sierra M, Baker D, Medford N; et al. (2006). "Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases". Clin Neuropharmacol. 29 (5): 253–8. doi:10.1097/01.WNF.0000228368.17970.DA. PMID 16960469. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
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