In depersonalization, the patient experiences his or her own person or parts of the self as alien. The cause has been controversial to date.
What is depersonalization?
The term depersonalization originates from psychology and was coined by Krishaber and Dugas in the 19th century. Patients of this perceptual disorder suffer from alienated self-perception. Often depersonalization overlaps with derealization, in which the patient perceives his environment as alienated and unreal. Both body and one’s personality, perceptions, memories, or own thought processes and emotions may feel alien or not belonging in the context of depersonalization. The same can be true for one’s own expressions or actions. If such an alienated perception of one’s own person and environment is permanently present, then we are talking about a mental disorder. According to ICD-10, depersonalization belongs to the neurotic form. The DSM speaks of a dissociative disorder. The prevalence for depersonalization experiences is officially stated to be about 1:200,000, making the disorder a rare phenomenon. Studies suggest a considerably higher prevalence. The considerable number of unreported cases is probably due to misdiagnoses such as temporal lobe epilepsy. The scientific background of depersonalization is controversial so far. In the secondary form, the disorder may accompany physiological and psychological illnesses such as post-traumatic stress disorder. In the primary form, it occurs in stress-inducing or life-threatening situations and, in this case, need not be pathological depending on the duration of the condition. The same is true for momentary depersonalization during spiritual experiences or under the influence of medications and drugs.
Causes
The exact cause of depersonalization is explained by different models. Neurophysiological theories rely on patterns of neural representation and mirror neurons, which respond the same way when observing actions of the environment as when performing them. One’s own behavior is also presented neuronally. Depersonalization and derealization may consequently be due to abnormalities in the mirror neuron systems. Neurochemical theories assume an involvement of the neurotransmitter systems, which unbalance neuronal information flows and are involved in stress reactions anyway. Other theories see the cause in the serotonergic system and thus in an excessive serotonin level or agonist level of the central nervous messenger substances. The glutamatergic system has also been suggested as a cause because glutamatergic substances act as NMDA antagonists and can cause reduced activity in the limbic system. There are also causative theories regarding dysregulation of the opioid system. Psychotraumatology sees depersonalization as a reaction to traumatic experiences. By restricting certain brain activities, the body is better able to respond to dangerous situations. Depth psychology sees depersonalization as a protective defensive reaction to unbearable feelings, thoughts, and states by leaving one’s own person. Cognitive psychology approaches see mental information processing as the cause.
Symptoms, complaints, and signs
Depersonalization manifests itself in an enormously diverse range of symptoms. Emotional numbness is among the leading symptoms. Patients experience an inability to feel or an unreality of their own emotions. People and objects no longer touch them. Often the body experience is affected by altered perceptions, for example as lifeless or alien. Just as often, the voice or one’s own reflection seem alien. Many patients tell of perceiving themselves and their environment from a different perspective, for example, from the ceiling of the room. Some also see themselves as if on a screen or simply stand next to their own person. Own movements and mental processes feel robotic. A volitional decision does not precede them, but they feel as if remotely controlled. Memories seem distant, although they are only hours away. Thus, the sense of time changes. In addition to these leading symptoms, auditory and tactile perceptions may seem alien. Emptiness of thought, an increase in pain threshold, or derealization may also occur.In derealization, things in the environment appear altered and often as if in a dream or distorting mirror. Patients find the alienation experiences disturbing and are often afraid of losing their mind or actually being in a dream or coma. Despite the altered perception, delusions are not present. Thus, the reality check remains intact. The same applies to the assessment of tasks, the own person or the environment. Only the subjective view of the persons on themselves and the environment changes in perception, but the perception of the object character remains intact. For example, although affected persons experience other persons as if they were hallucinating, they still know that they are actual persons.
Diagnosis
The diagnosis of depersonalization is made according to ICD-10. Only prolonged depersonalization has disease value. Differentially, the phenomenon should be evaluated as a purely psychological or neuropsychiatric phenomenon and should also be distinguished from other mental disorders.
Complications
Usually, depersonalization results in severe psychological disturbances that must be treated by a psychologist in any case. Without treatment, suicidal thoughts and eventually suicide may occur. Those affected can no longer perceive or associate certain people or objects from their environment correctly. This leads to upsets, anxiety and panic. Most patients experience emotional numbness. Feelings can no longer be perceived. This has a negative effect on other people and can lead to the termination of friendships or to social conflicts. Similarly, physical pain also triggers few emotions. The patient’s visual perception is also disturbed and severely limited. The patient feels listless and weak. Often the affected person withdraws strongly. Even movements are only possible with difficulty, it is no longer possible to feel fun and joy. Treatment usually takes place through discussions with a psychologist. These can be supported by medication, although it cannot be predicted whether the treatment can really combat depersonalization. It often takes several months before the psychologist finds the cause of depersonalization and can treat it specifically.
When should you see a doctor?
If striking changes in personality occur slowly or suddenly, a doctor must be consulted. In many cases, the mental disorder makes it impossible for the person affected to adequately notice the changes and seek help. In these situations, the support of people from the close environment is of immense importance. As soon as the affected person experiences his own life as in a movie, he needs medical care. Lack of feeling about events in his own life, are considered worrisome. If sensations and inner perceptions can no longer be described or experienced, a doctor must be consulted. The change in one’s personality should be well observed and discussed with a medical professional. As soon as the consciousness of the affected person changes, a listlessness is noticeable or feelings can no longer be shown, a physician must be consulted. A visit to the doctor is also necessary if the memory or thinking changes in an unusual way. To be distinguished from this are changes of opinion or further development processes in the course of one’s own life. As soon as the affected person begins to suffer from the changes taking place, he needs a doctor. If he experiences himself as strange or as not belonging to his body and his own thoughts, there is cause for concern.
Treatment and therapy
In secondary depersonalization, the underlying condition is treated. Primary depersonalization can be addressed in several ways. There is no generally applicable or established therapy. Pharmacotherapies that can be considered for treatment are glutamate modulators such as lamotrigine. The same is true for opioid antagonists such as naloxone or selective serotonin reuptake inhibitors such as fluoxetine. The administration of selective serotonin–norepinephrine reuptake inhibitors such as venlafaxine also brought improvement in individual cases. The administration of tricyclic antidepressants clomipramine is also a possibility. Neuroleptics such as aripiprazole and stimulants such as Ritalin have proven equally promising in individual cases.There are also various options for the psychotherapeutic therapy of depersonalization. Depth psychology pursues a psychoanalytic approach to the resolution of the actual conflict from which the patient wants to escape through depersonalization. Cognitive behavioral therapies focus on anxiety. They have patients reevaluate the depersonalization experience, ideally without anxiety. Another treatment option is neuromodulation via electroconvulsive therapy or transcranial magnetic stimulation. Electroconvulsive therapy has been shown to exacerbate depersonalization as often as it has eliminated it, according to studies. Transcranial magnetic stimulation to the right prefrontal cortex has shown positive effects, according to studies. Stimulation to the temporoparietal junction cortex on the right side also resulted in relief.
Outlook and prognosis
The prognosis of depersonalization depends on the intensity of the disorder as well as the age of the patient at initial manifestation. The younger the affected person is at diagnosis, the less favorable the prognosis. Patients often suffer from the disease for many years or decades. The prospect of a rapid recovery is given in the case of a mild manifestation of depersonalization. In this case, there is usually a spontaneous healing within a few days and a permanent freedom from symptoms. Medical treatment is not necessary for these patients, as the symptoms naturally remission. A severe manifestation of the symptoms of the disease is difficult to treat. A prospect of cure is possible in principle, but it involves a long period of regular medical care. In most cases, several years of therapy are required to achieve an improvement in the symptoms. In psychotherapy, patients gradually learn how to cope with the disease in everyday life and can thus achieve a strengthening of their well-being. Conditions of psychological stress intensify the existing symptoms and have an immense influence on the healing process. The prognosis worsens in the case of stress as well as persistent emotional tension. Once the psyche is stabilized, the signs of depersonalization decrease.
Prevention
Because the causes of depersonalization are controversial, there are no recognized preventive measures to date.
Aftercare
Direct aftercare for depersonalization is very difficult in most cases and cannot be performed according to a clear scheme. Affected individuals need regular follow-up even after the condition is cured and should continue to see a psychologist after treatment to prevent the depersonalization from recurring. In some cases, it is also advisable to continue taking medication in order to contain the causes of depersonalization and to treat the illness permanently. Whether a complete cure is possible at all cannot generally be predicted. As a rule, contact with people has a very positive effect on depersonalization and can prevent it. Therefore, those affected should maintain a lot of contact with friends and family. In difficult life situations, these people can offer help to the affected person. Likewise, contact with other sufferers of depersonalization can also have a positive effect on the course of the disease and possibly also draw out approaches to solutions. Stress and permanent physical tension should be avoided, as these factors promote depersonalization. Similarly, adequate fluid intake and a healthy diet can alleviate depersonalization and improve the patient’s quality of life.
Here’s what you can do yourself
Those who perceive themselves and their bodies as unreal and more often feel they are beside themselves should follow some tips in their daily lives. In addition to treatment by a psychologist or psychiatrist, the self-help tips can provide an improvement in the quality of life in everyday life and significantly facilitate the lives of those affected. Since sufferers of depersonalization disorder often have a distorted perception of their own body, physical activity usually has a positive effect on the patient’s body and mind. With endurance sports, such as jogging, cycling or swimming, those affected can feel themselves better again and feel more alive. Yoga also helps sufferers to ground themselves again amidst all the excitement and to remain in mental balance.A balanced diet is extremely important in depersonalization disorder and can have a positive effect on the clinical picture. A healthy diet provides the body with all the nutrients it needs to function properly. Consuming enough water or other beverages is also important to recharge your batteries and stay centered. Through a constant supply of fluids, the organism gains energy and increases its vitality. If you start your day with a rich breakfast, you can fill up enough energy to successfully cope with everyday life with a good body feeling.
