Depersonalization Disorder - Who Are You Really?

Depersonalization disorder is common but also among the least recognized psychiatric conditions in the world.

Depersonalization disorder leads to the following thoughts: “I don’t seem like me.” “Who am I?” “I don’t recognize myself in the mirror.” It’s also quite recurrent among those who’re going through a period of high anxiety and stress.

The search for identity and purpose is constant. Everyone wonders who they are, where they came from, and where they’re going at one point or another. This is normal. However, it’s much more common and intense in depersonalization disorder.

Firstly, you must understand you’re dealing with what’s clinically known as a dissociative disorder. It’s a mental condition where the person experiences failures in memory, consciousness, identity, and perception.

What’s depersonalization?

The main characteristic of this disorder is persistent or recurrent episodes of depersonalization, derealization, or both. This condition was first described at the end of the 19th century. Furthermore, it often occurred alongside other conditions such as panic disorder and depression.

• Studies such as the one conducted at the Institute of Psychiatry, Psychology, and Neuroscience in London reveal that what people actually experience is an intense emotional reaction. In fact, MRI scans show a high level of activity in the insular cortex.
• Also, there’s a feeling of unreality, strangeness, and a sort of distancing from oneself in general.
• A person with depersonalization may feel detached from themselves and even feel worthless.
• In fact, it may even lead to them not accepting their own emotions, thoughts, and sensations.

People with this condition often describe feeling like a robot and lacking control over their own speech and movements.

Perceptual glitches are a characteristic of derealization

The environment may be seen as artificial, colorless, and lifeless. Derealization usually manifests with subjective visual distortions. These range from blurred vision, increased visual acuity, enlarged or reduced field of vision, two-dimensionality, etc.

• There may also be alterations in the distance or size of objects.
  • Macropsia is one of these effects and consists of seeing objects larger than they really are.
  • Micropsia is the opposite.
• Auditory distortions, muting, or accentuating voices or sounds appear.

Exclusionary criteria

It should be clear that the aforementioned alterations can’t be the result of the ingestion of drugs or disease (such as epilepsy) in any diagnosis of this disorder.

Nor must these disturbances be a criterion for schizophrenia, panic disorder, major depression, acute stress disorder, or post-traumatic stress disorder.

Subjective characteristics of depersonalization disorder

People with depersonalization disorder may have difficulty describing their symptoms. In addition, they feel like they’re going crazy. Another frequent experience is fear of irreversible brain damage.

• Another common symptom is a subjective altered sense of time (e.g., too fast, too slow).
  There’s also a subjective difficulty in vividly recalling memories of the past (and feeling part of them).
• Also, they often experience a sensation of fullness in their head as well as tingling and fainting sensations.
• In addition, it isn’t uncommon to find different degrees of anxiety or depression in those who experience episodes of depersonalization. A curious observation is these people tend to react physiologically intensely to emotional stimuli.

These physiological changes are due to the activation of the hypothalamic-pituitary-adrenal axis. This is the inferior parietal lobe and the limbic prefrontal cortex circuits.

Diagnosis of depersonalization disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a person diagnosed with depersonalization/derealization disorder has to meet the following diagnostic criteria:

1. There are persistent or recurrent experiences of depersonalization, derealization.
   • Depersonalization is experiences of unreality, distancing, of being an external observer with respect to one’s thoughts, feelings, sensations, body, or actions.
   • Derealization is experiences of unreality or detachment from the environment. For example, people or objects seem unreal, dreamlike, hazy, lifeless, and even visually distorted).
2. Reality testing remains intact during depersonalization or derealization experiences.
3. Symptoms involve clinically significant distress or impairment in social, occupational, and other important areas of functioning.
4. The disturbance can’t be attributed to the physiological effects of a substance. Drugs/medications, or a medical condition like epilepsy, for example.
5. The disturbance isn’t best explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or any other dissociative disorder.

Development and course of depersonalization disorder

On average, depersonalization/derealization disorder manifests at the age of 16, although the disorder could begin in early to mid-childhood. In fact, most people with this condition recall having symptoms this early.

• More than 20 percent of cases appear after the age of 20 and only 5 percent after the age of 25.
• Onset in the fourth decade of life or later is unusual.
• The onset may be extremely sudden or gradual. In fact, the span of depersonalization/derealization episodes can vary widely, from brief (hours or days) to continued (weeks, months, or years).

A chronic clinical condition

Given the rarity of the onset of the disorder after the age of 40, there may be some underlying medical conditions in these cases. These conditions may be lesions in the brain, seizure disorders, and sleep apnea.

• The course of the disease is often chronic. While the intensity of symptoms in some people may wax and wane considerably, others report a constant level of intensity which, in extreme cases, may recur for several years and even decades.
• Similarly, increased intensity of symptomatology could be due to stress, worsening mood or anxiety symptoms, new stimulating circumstances, and physical factors such as lighting or lack of sleep. It’s also important to note that not everyone with some of these symptoms will develop the disorder.

You may need to see a specialist who can evaluate your problem if these symptoms are chronic and seriously interfere with your daily life.

Treatment

The therapeutic strategy for depersonalization disorder usually involves two basic strategies:

• Pharmacological (with psychotropic drugs such as naloxone).
• Psychotherapeutic.

Finally, cognitive-behavioral therapies have a good success rate in these cases. The goal is to strengthen the patient’s connection with themselves.