Depersonalization Disorder: Symptoms, Causes, and Treatment

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

Now let's imagine that these feelings of strangeness could not be explained by novelty or by context: this is what happens to people who suffer from a specific type of disorder, depersonalization disorder.

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depersonalization disorder

It receives the name of depersonalization disorder to a type of dissociative disorder, which are characterized by assuming a certain rupture between mental faculties or a discontinuation or disconnection between them. In the case of depersonalization disorder, it is self-recognition or familiarity with oneself that has been disconnected.

Depersonalization disorder is characterized by the existence of an experience of great strangeness towards oneself. The feeling of being unreal appears, of not being an actor but an observer of our own actions, the absence of a self and/or a feeling of mental and physical numbness. Although a sensation of this type may not be symptomatological sporadically, if it is will consider the existence of this disorder when these sensations occur habitually and/or persistent.

The presence of a sensation of disembodiment or of not being in one's own body, an experience of lack of belonging to one's own body, is common. All of 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 feeling of not being real despite knowing the subject at a conscious level that it is. It is not uncommon that a great fear of losing one's sanity, or even identifying oneself as undead, can arise. Concentration and performance problems often appear in multiple tasks, including work. Depression and anxiety are often common if the problem is not resolved, and in some cases suicidal thoughts may appear.

It is important to bear in mind that we are not dealing with a case of delusion or psychotic disorder, and the judgment of reality is also preserved (although there may be strangeness also towards the environment is still knowing that it is real) and not being caused by other mental disorders, medical illnesses or consumption of substances. Despite this, 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.

Other related alteration: derealization

Depersonalization disorder can only occur as a strangeness towards oneself, but it is relatively common that the sensations of strangeness towards one's own person are also given towards the perception of reality.

We are talking about derealization, in which there are difficulties in perceiving the reality of the things, often identifying the sensation as dreaming and perceiving the world as something unreal and fake. Time and space are perceived as altered and the world begins to give a sensation of artificiality and distortion.

• Related article: "Depersonalization and derealization: when everything seems like a dream"

Causes

The possible causes of the appearance of depersonalization disorder can be multiple, There is no single possible cause for it. and being the specific causes of its appearance unknown in most cases.

However, as a dissociative disorder that is, as a general rule, it is usually associated with experiencing highly stressful situations. Ongoing psychosocial stress, the presence of childhood or current sexual abuse, the presence of high levels of panic, bereavement situations in the face of the death of loved ones or other traumatic events can be relatively probable causes or triggers frequent.

At a biological level, it has been observed in some experiments that patients with this disorder have less activation in the sympathetic autonomic system and a reduction in electrodermal activity. Less activation of the insula and activation of the ventrolateral prefrontal cortex have also been observed in the face of unpleasant stimuli. This pattern seems to reflect defensive behavior when presented with aversive stimuli, reducing the emotional response to them and producing part of the symptoms.

Also, although we would no longer be talking about the disorder itself but rather depersonalization as a symptom, These episodes can also appear in cases of intoxication due to substance use, poisoning, head trauma or confusional states.

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Treatment of depersonalization

Depersonalization can be treated through psychotherapy, although in many cases we are dealing with a chronic disorder or They can disappear to return in situations of stress and anxiety.

In general, the treatment will depend on the situations that triggered the disorder, being necessary work together with the subject the moment of appearance of the disorder, the sensations that they generate and to what associates. 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 (for example through rooting techniques). You can work from multiple perspectives, such as cognitive restructuring typical of the cognitive-behavioral current or psychodynamics.

Sometimes the application of different psychoactive 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.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Massón, Barcelona.
• Buron, E.; Jódar, I. and Corominas, A. (2004). Depersonalization: from disorder to symptom. Spanish Acts of Psychiatry, 32 (2): 107-117.
• Sierra-Siegert, M. (2018). Depersonalization: clinical and neurobiological aspects. Colombian Journal of Psychiatry, 37 (1).