Depersonalization disorder: symptoms, causes and treatment

A mental alteration that makes us feel strangeness about our own body, as if it were unreal.

Let us imagine that we had never seen ourselves in a mirror and one day by chance we saw our image reflected: it is likely that at first we would feel some surprise and even wonder if that person is us. Let us also imagine that we had a camera behind us and we were watching the image as if it were a movie: probably our actions reflected on a screen would be somewhat strange to us, as if more than actors we were spectators of them.

Now let us imagine that these feelings of strangeness could not be explained by novelty or context: this is what happens to people suffering from a particular type of disorder, depersonalization disorder.

Depersonalization disorder

The name depersonalization disorder is given to a type of dissociative disorder, which is characterized by the following characteristics a certain rupture between mental faculties or a discontinuity or disconnection between them. In the case of depersonalization disorder, it is the very recognition or familiarity with oneself that has been disconnected.

Depersonalization disorder is characterized by an experience of great strangeness. an experience of great strangeness towards oneself.. There is a feeling of being unreal, of not being an actor but an observer of one's own actions, absence of a self and/or a feeling of mental and physical numbness. Although a sensation of this type may not be symptomatological sporadically, the existence of this disorder will be considered when such sensations occur habitually and/or persistently.

It is common the presence of a feeling of disembodiment or of not being in one's own body, experience of lack of belonging to one's own body. All this generates clinically significant discomfort and suffering and/or a limitation in the person's daily life.

The experience of this disorder can be really distressing, given the sensation of not being real even though the subject knows consciously that it is real.. It is not uncommon for a great fear of losing one's sanity, or even identifying oneself as the living dead, to appear. Problems of concentration and performance in multiple tasks, including work, usually appear. Depression and anxiety are frequent if the problem is not solved, and in some cases suicidal thoughts may appear.

It is important to bear in mind that this is not a case of delirium or psychotic disorder, and that the judgment of reality is preserved (although there may also be strangeness towards the environment, it is still known to be real) and it is not caused by other mental disorders, medical illnesses or substance use. However, it should be noted that depersonalization can appear as a symptom in these contexts, although in this case we would be talking about depersonalization as a symptom and not as a disorder per se.

Another related disorder: derealization

Depersonalization disorder can occur solely as a strangeness towards oneself, but it is relatively common that the sensations of strangeness towards oneself also occur towards the perception of reality..

We are talking about derealization, in which there are difficulties in the perception of the reality of things, often identifying the feeling of being dreaming and perceiving the world as something unreal and false. The time and the space are perceived like altered and the world happens to give sensation of artificiality and distortion.

Causes

The possible causes of appearance of the disorder of depersonalization can be multiple, not existing a unique possible cause for it and being the concrete causes of its appearance unknown in most of the cases.

However, as a dissociative disorder it is usually associated with the experience of highly stressful situations. Continuous psychosocial stress, the presence of sexual abuse in childhood or at present, the presence of high levels of panic, bereavement situations after the death of loved ones or other traumatic events may be probable causes or relatively frequent triggers.

At the biological level, it has been observed in some experiments that patients with this disorder have a lower activation of the sympathetic autonomic system and reduced electrodynamic activity and a reduction of electrodermal activity. A lower activation of the insula and an activation of the ventrolateral prefrontal cortex in response to unpleasant stimuli have also been observed. This pattern seems to reflect a defensive behavior before the presentation of aversive stimuli, reducing the emotional response to them and producing part of the symptomatology.

Likewise, although we would no longer be talking about the disorder itself but about depersonalization as a symptom, these episodes can also appear in cases of intoxication due to substance use by substance abuse, poisoning, head injuries or confusional states.

Treatment of depersonalization

Depersonalization can be treated through psychotherapy, although in many cases it is a chronic disorder, or it may disappear and then return in the face of situations of stress. may disappear only to return in situations of stress and anxiety..

In general, the treatment will depend on the situations that triggered the disorder, being necessary to work with the subject on the moment of appearance of the disorder, the sensations that it generates and what it is associated with. It will also be necessary to carry out psychoeducation and work on possible complications, such as the appearance of depression. Training in problem solving and stress management can be useful, as well as trying to strengthen the connection with oneself (e.g. through grounding techniques). It is possible to work from multiple perspectives, such as cognitive restructuring from the cognitive-behavioral or psychodynamic current.

Sometimes the application of different psychotropic drugs can also be useful, although there is little evidence in this regard. However, some studies seem to indicate that some substances have some efficacy, for example the Anticonvulsant known as lamotrigine or opioid antagonists such as naltrexone.

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
• Burón, E.; Jódar, I. and Corominas, A. (2004). Depersonalization: from disorder to symptom. Actas Españolas de Psiquiatría, 32 (2): 107-117.
• Sierra-Siegert, M. (2018). Depersonalization: clinical and neurobiological aspects. Colombian Journal of Psychiatry, 37 (1).