Depersonalization: Description
Depersonalization describes an alienation from one’s own person. Those affected have a disturbed self-perception and feel detached from themselves. In the case of derealization, on the other hand, those affected are plagued by the impression that their environment is not real. Depersonalization and derealization often occur together and are therefore referred to as depersonalization and derealization syndrome or combined under the term depersonalization.
Almost everyone experiences such symptoms in life in a mild form and for a limited time. However, depersonalization disorder means that those affected suffer from it over a long period of time or in recurring episodes.
Depersonalization is a disorder that has been little researched to date. In many cases, it is overlooked. Sometimes it hides behind another mental disorder, sometimes those affected do not dare to go to the doctor with these symptoms because they are afraid that the doctor will not take them seriously or will think they are crazy.
Depersonalization: Who is affected?
Depersonalization: Symptoms
Depersonalization and derealization can occur in various degrees of severity. A mild form of depersonalization can also be observed in everyday life when people are under extreme stress or after alcohol abuse. However, this altered perception due to exhaustion is only short-lived and does not need to be treated.
Reduced perception of pain
Life-threatening situations that put the body under severe stress can trigger longer-lasting depersonalization symptoms. In psychologically stressful or painful situations, depersonalization reduces the perception of pain. It is therefore a protective mechanism of the psyche against strongly unpleasant sensations.
Alienation and unreal reality
Those affected often not only perceive themselves differently, but also their environment. This perception is so unreal that people find it difficult to put it into words. They often describe their vision as blurred or as if in a dream. People can appear lifeless, objects can be perceived as larger or smaller and sounds can be heard distorted.
Automated actions
They do not perceive themselves as the person carrying out activities. Although they are aware of their actions, it is as if they are standing next to themselves and observing themselves. As those affected have no inner connection to their actions, they perceive them as alien and automated.
Emotional emptiness
Depersonalization is often accompanied by a feeling of inner emptiness. Those affected do not react to emotional events. They show neither joy, sadness nor anger. They therefore often appear cool and absent. These symptoms are very similar to those of a depressive mood and are not easy to distinguish from one another. Depersonalization can also occur as a symptom of depression. Conversely, depression can also occur as a result of depersonalization symptoms.
Memory problems
Relation to reality
In contrast to people with psychosis, people with depersonalization syndrome know that the altered perception occurs because of their illness. People with psychotic states, on the other hand, are convinced that their view of the world is real. For example, they believe that other people can manipulate their thoughts and feelings. People with depersonalization symptoms recognize that it is not the world that has changed, but that something is wrong with their perception. This knowledge increases the level of suffering and causes anxiety for those affected.
Brooding and anxiety
The fear of going crazy is a common consequence of depersonalization and derealization. Symptoms of detachment from themselves and their environment make people feel deeply insecure. Anxiety, compulsions and depression also often go hand in hand with depersonalization. Many people do not talk about their problems for fear of not being taken seriously.
Depersonalization: causes and risk factors
Experts attribute the development of depersonalization and derealization to the interaction of various factors. It is assumed that predisposition influences whether the mental disorder occurs or not. So far, there is no evidence of a hereditary component.
Direct triggers of depersonalization
Stress plays a central role as a concrete trigger of depersonalization. Traumatic experiences in particular can trigger depersonalization. Serious illnesses, accidents or even professional and severe interpersonal crises can be the beginning of depersonalization. In unbearable situations, people may distance themselves inwardly from themselves and the event. Experts assume that this reaction is a protective mechanism when other coping strategies are not sufficient. Those affected are then only physically present, but they are not present in their thoughts. Depersonalization is often described as the calm after the storm. Only when the stress subsides do the symptoms of depersonalization appear.
Early neglect
Researchers have found that emotional neglect in childhood in particular promotes depersonalization. Those affected received too little attention from their parents, were humiliated or not noticed. The lack of support from the social environment can lead to unfavorable coping strategies. The first symptoms of alienation from oneself and one’s environment can appear as early as childhood. The severity of depersonalization depends on the intensity and duration of the negative experiences.
People who neglect their physical and mental health may experience depersonalization symptoms. Depersonalization can also be the result of illicit drug use or alcohol intoxication. Insufficient sleep and inadequate hydration can also cause symptoms of depersonalization or exacerbate existing symptoms.
Depersonalization: examinations and diagnosis
The first point of contact is your family doctor. He or she will carry out a physical examination if depersonalization syndrome is suspected. This is because depersonalization can also occur as a result of physical illnesses, such as epilepsy or migraines. The doctor must also rule out the possibility that the symptoms occur as a side effect of medication or as a result of withdrawal. Drugs can also cause feelings of alienation. The GP will refer the patient to a specialist for a precise diagnosis and treatment.
To diagnose depersonalization, a psychiatrist or psychotherapist will conduct a detailed interview with the patient. With the help of clinical questionnaires, the doctor or therapist can determine whether depersonalization is actually the case or whether other mental disorders are present.
The doctor or therapist may ask the following questions to diagnose depersonalization disorder:
- Do you sometimes have the impression that you are looking at yourself from the outside?
- Do your surroundings sometimes seem unreal to you?
- Do you sometimes have the feeling that other people or objects are not real?
According to the International Classification of Mental Disorders (ICD-10), the diagnosis of depersonalization and derealization syndrome requires at least either depersonalization or derealization:
- Depersonalization syndrome: Those affected perceive their feelings and experiences as alien, detached from themselves, distant, lost or as belonging to someone else. They also complain about the feeling of “not really being here”
- Derealization syndrome: Those affected perceive their surroundings, objects or other people as unreal, distant, artificial, colourless or lifeless.
In addition, those affected must be aware that the altered perception is not generated externally, but arises from their own thoughts.
Depersonalization: Treatment
Reducing anxiety
At the beginning of therapy, the therapist explains the mental disorder to the patient in detail (psychoeducation). The patient experiences that their suffering is taken seriously and that their distorted perception is not a sign of “madness” but part of an illness. The patient learns to question negative and catastrophizing thoughts and to replace them with realistic assessments. An important aim of the therapy is to reduce anxiety and thus relieve the person psychologically.
Stress management and coping strategies
Another component of therapy is dealing with stress. For many patients, stress leads to depersonalization symptoms. They leave their body and thus distance themselves from their environment and the problems. This process becomes automatic after a while. With the help of a diary, the patient should note down which situations trigger the symptoms of depersonalization. This overview helps the person affected to better recognize patterns and processes of the disorder.
If symptoms of alienation occur, biting into a chili pepper or clapping loudly can help to bring you back to reality. Distraction can also be a helpful method. Conversations or sporting activities should direct thoughts back to reality. Distraction also prevents anxiety from building up. Through these and other strategies, patients learn to control depersonalization symptoms.
Relaxation exercises are not recommended for depersonalization, as too much rest can trigger the symptoms. Calming activities, such as walks, are therefore more suitable for recovery.
Dealing with the causes
In many cases, traumatic experiences are the cause of depersonalization. In order to deal with trauma, the patient should first have learned how to deal with the symptoms. It is also important that the affected person is able to perceive, express and control their emotions to some extent. Only after the stabilization phase can the traumatic causes be addressed.
Depersonalization: course of the illness and prognosis
If the symptoms are severe, those affected usually suffer from symptoms of depersonalization and derealization for a long time. With the help of psychotherapy, however, they can learn to control the symptoms better. Those affected can also have a positive influence on the course of the disease by reducing stress. However, the symptoms of depersonalization worsen under psychological stress.
