Depersonalization disorder: symptoms, causes and treatment

Imagine that we have never seen ourselves in a mirror and that one day, by chance, we saw our reflected image: it is likely that at the beginning we felt surprised and we even wondered if this person was us. . Also imagine that we have a camera behind us and we are looking at the image as if it were a movie – our actions reflected on a screen would probably be a little strange to us, as if we were spectators rather than actors.

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

    Depersonalization disorder

    It is called depersonalization disorder to a type of dissociative disorder, which is characterized by the hypothesis a certain break between mental faculties or an interruption or disconnection between them. In the case of depersonalization disorder, it is one’s own 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 arises, if you are not an actor but an observer of our own actions, the absence of self and / or a feeling of mental and physical numbness. Although such a sensation may not be sporadically symptomatic, the existence of this disorder is taken into account when these sensations occur habitually and / or persistently.

    The presence of sensation of descorporización or of not being in the own body is habitual, experience of lack of property of the own body. All of this generates clinically significant discomfort and suffering and / or limitation in the person’s daily life.

    The experience of this disorder can be really painful, given the feeling of not being real despite knowing the subject at a conscious level that he is. It is not uncommon for great fear to arise at the thought of losing your sanity, or even identifying yourself as an undead. Concentration and performance problems often arise in multiple tasks, including work. Depression and anxiety are often common if the problem is not resolved, and in some cases, thoughts of suicide may appear.

    It is important to keep in mind that we are not dealing with a case of delirium or psychotic disorder, and that the judgment of reality is preserved (although there may be a weirdness of the environment is always known to be real) and that the feeling is not caused by other mental disorders, medical illnesses, or drug addiction. Despite this, it should be noted that depersonalization can appear as a symptom in these contexts, even if in this case we would speak of depersonalization as a symptom and not as a disorder in itself.

    Another related alteration: non-realization

    Depersonalization disorder may only arise as a strangeness to itself, but it is relatively common for feelings of strangeness towards the person himself are also given towards the perception of reality.

    We are talking about unrealization, in which there are difficulties in perceiving the reality of things, often identifying the feeling as that of dreaming and perceiving the world as something unreal and false. Time and space are seen to be altered and the world begins to give a sense of artificiality and distortion.

      the causes

      The possible causes of depersonalization disorder can be many, there is no single possible cause for this and the exact causes of its occurrence being unknown in most cases.

      However, as a dissociative disorder, it is usually associated with very stressful situations. Ongoing psychosocial stress, the presence of sexual abuse in childhood or today, the presence of high levels of panic, grieving situations following the death of loved ones or other traumatic events may be probable causes. or relatively frequent triggers.

      Biologically, it has been observed in some experiments that patients with this disorder they have less activation in the sympathetic autonomic system and a reduction in electrodermal activity. Lower activation of the insula and activation in the ventrolateral prefrontal cortex have also been observed in the face of unpleasant stimuli. This pattern appears to reflect defensive behavior in the face of the presentation of aversive stimuli, reducing the emotional response to them and producing some of the symptoms.

      Also, even if we would no longer speak of the disorder itself but of depersonalization as a symptom, these episodes can also appear in case of intoxication for substance use, intoxication, traumatic brain injury or confusional states.

        Treatment of depersonalization

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

        In general, the treatment will depend on the situations that triggered the disorder, and it is necessary to work with the subject when the disorder appears, the sensations that generate it as they associate it. It will also be necessary to conduct psychoeducation and work on possible complications, such as the onset of depression. Training in problem solving and stress management can be helpful, as well as trying to strengthen the bond with oneself (For example using rooting techniques). It is possible to work from multiple perspectives, such as the cognitive restructuring of the cognitive-behavioral stream or psychodynamics.

        Sometimes the application of different psychotropic drugs can also help, although there is little evidence in this regard. However, some studies seem to indicate that certain substances have some effectiveness, 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. Spanish Acts of Psychiatry, 32 (2): 107-117.
        • Serra-Siegert, M. (2018). Depersonalization: clinical and neurobiological aspects. Catalan Society of Psychiatry, 37 (1).

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