Depersonalization: She does not recognize herself in the mirror. She has been held captive for a long time and she does not know what is real and what is not. Image: Antionette by Ava Randa. License: CC BY-ND 2.0.
Depersonalization/Derealization Disorder is a Dissociative Disorder. People with Depersonalization/Derealization Disorder may describe some of these experiences or feelings:
I am no one, I have no self
My head feels as if it's filled with cotton wool
I feel robotic, like an automaton
I know I have feelings but I don't feel them
My thoughts don't feel like mine
I feel like I'm watching myself from outside myself
Out of body experiences ("split self")
Everything around me seems artificial, lifeless, or dead
It's like there is a glass wall between myself and the world
Things look blurry, like being in a dream or looking through a fog (visual distortion)
things look too large or too small
sounds are muted or too loud [3]:302, [9]:3-5
Many people experience brief episodes of Depersonalization or Derealization in their lives. A diagnosable disorder only exists if symptoms are persistent, not better described by another diagnosis and not only occuring when under the influence of drugs/alcohol. [3]:302, [10]
Causes
Many people with this disorder have a history of childhood trauma; particularly emotional abuse and emotional neglect. Other known factors include witnessing domestic violence, by raised by a parent with serious mental illness or the sudden death or suicide of a relative or close friend. The average age of onset is 16, and 95% of people have symptoms prior to the age of 25.
Another known cause of this disorder is recreational drug use (substance use), especially Marijuana, ecstasy and Ketamine (Special K).[12]:5 Depersonalization/Derealization Disorder caused by drug use cannot be cured by stopping using the drug that caused it, this is because the disorder can only be diagnosed if symptoms continue after stopping using the drug.[3]:305 Marijuana (cannabis) use may occur prior to new panic attacks and depersonalization/derealization symptoms.
Diagnostic Tests
The Steinberg Depersonalization test is a brief self-report questionnaire which can be used alongside an evaluation by a clinician to determine is Depersonalization is present.[4] Depersonalization/Derealization Disorder can also be diagnosed using clinical interviews, including the Structured Clinical Interview for Dissociative Disorders, known as the SCID-D (Revised), which can diagnose all dissociative disorders. The Dissociative Experiences Scale can also aid diagnosis.
The newest guide to diagnosing mental disorders is the DSM-5, released in 2013.[3] Code 300.6
"
A. The presence of persistent or recurrent experiences of depersonalization, derealization or both:
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/or physical numbing).
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 symptoms cause 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 other medical condition (e.g., seizures).
The conditions below may cause a person to describe symptoms similar to Depersonalization/Derealization disorder.
Illness anxiety disorder, for example if there are
vague physical complaints or
fears of permanent brain damage
Major depressive disorder if
only numbness, deadness and apathy occur
Obsessive-compulsive disorder, if there is
obsessive checking of symptoms or rituals
Other dissociative disorders such as Dissociative Identity Disorder, Dissociative Amnesia and Conversion Disorder (Functional Neurological Symptom Disorder). If Dissociative Identity Disorder (DID) is present, Depersonalization/Derealization Disorder should not be diagnosed in addition because these experiences are also known to occur within DID
Anxiety disorders, e.g. panic disorder, social anxiety disorder, or specific phobia may be diagnosed if
symptoms only occur during a panic attack
Psychotic disorders,
delusions or results from reality testing can confirm a psychotic disorder, for example a Delusional Disorder or Schizophrenia, may cause a person to believe they are dead or the world no longer exists.
Substance or medication-induced disorders, Depersonalization/derealization disorder can be caused by acute use of, or withdrawal from, Marijuana (cannabis), hallucinogens(e.g., LSD, magic mushrooms, mescaline), ketamine, MDMA/ecstasy, and salvia but should not be diagnosed unless symptoms continue for some time after the substance use ends.
Mental disorders due to another medical condition, e.g. temporal lope epilepsy, or partial and frontal lobe epilepsy.
Symptoms which begin after age 40 or atypical symptoms may suggest an underlying physical health condition. [3]:304-5
ICD Diagnostic Criteria
The most recent approved version of the International Classification of Diseases, the diagnostic guide published by the World Health Organization is the ICD-10, published in 1992.[2] The draft ICD-11 criteria for Depersonalization/Derealization Disorder gives this description:
"Depersonalization-derealization disorder is characterized by persistent or recurrent experiences of depersonalization, derealization, or both. Depersonalization refers to the experience of feeling detached from, and as if one is an outside observer of, one's mental processes, body, or actions. Derealization refers to the experience of feeling detached from, and as if one is an outside observer of, one's surroundings. Clinical findings are not consistent with a recognized neurological disorder or other health condition, are not better explained by another mental and behavioural disorder, and are not part of an accepted cultural, religious, or spiritual practice. The sensory symptoms are sufficiently severe to cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning." [6]
Last updated July 2015.
ICD 10 Diagnostic Criteria
Code F48.1
Depersonalization-derealization syndrome
A rare disorder in which the patient complains spontaneously that his or her mental activity, body, and surroundings are changed in their quality, so as to be unreal, remote, or automatized. Among the varied phenomena of the syndrome, patients complain most frequently of loss of emotions and feelings of estrangement or detachment from their thinking, their body, or the real world. In spite of the dramatic nature of the experience, the patient is aware of the unreality of the change. The sensorium is normal and the capacity for emotional expression intact. Depersonalization-derealization symptoms may occur as part of a diagnosable schizophrenic, depressive, phobic, or obsessive-compulsive disorder. In such cases the diagnosis should be that of the main disorder."
Treatment
Treatments that have been suggested include psychotherapy, for example cognitive and behavioral therapy, and psychoanalysis, and psychiatric medication. Only limited information is available about the effectiveness of treatments for Depersonalization/Derealization disorder and no clear evidence-based treatment was found in recent research, although this was mostly due to a lack of randomized clinical trials. [1], [8]
Hunter et al. (2005) published a study of 21 patients who received an average of 13 sessions of psychotherapy (Cognitive Behavioral Therapy), finding patients had reductions in their levels of dissociation, depersonalization, anxiety, and depression, with 29% no longer meeting the diagnostic criteria after treatment. Improvements continued during the following 6-months. [7]
Although some drugs, including the recreational/illegal drugs Ketamine and LSD, are known to increase Dissociation, there are no known anti-dissociative drugs.[11]:4, [13]:472 In randomized clinical trials, Lamotrigine was a medication found to be effective in one study (but not in another), outcomes with Fluoxetine and biofeedback were no better than the control groups, although Fluoxetine was found to be helpful for those with an existing Anxiety Disorders in addition to Depersonalization/Derealization.[8] The drugs Naloxone and Naltrexone, which are used to treat alcohol or opioid addiction and opioid overdoes, may proof effective when used in very low doses, but there is not yet much clinical research on their effectiveness at treating depersonalization.[13]
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research. Retrieved November 17, 2014, from http://www.who.int/classifications/icd/en/GRNBOOK.pdf
World Health Organization. (July 7, 2015). ICD-11 Beta Draft (Joint Linearization for Mortality and Morbidity Statistics).
Hunter, E. C., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour research and therapy, 43(9), 1121-1130. doi:10.1016/j.brat.2004.08.003. PMID: 16005701.
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., and Spiegel, D. (2012). doi:10.1002/da.21889 The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications. Depress Anxiety, 29(8) pp.701-708.
