Depersonalization disorder: symptoms, causes, and treatment
Imagine that we had never seen ourselves in a mirror and one day we happened to see our image reflected: it is likely that at first we felt some surprise and even wondered if that person was us. Let’s also imagine that we had a camera behind us and we were watching the image as if it were a film: probably our acts reflected on a screen would be a little strange to us, as if we were more than actors, we were spectators of them.
Now imagine that these feelings of strangeness could not be explained by novelty or context: this is what happens to people who suffer from a particular type of disorder, depersonalization disorder .
It is called depersonalization disorder to a type of dissociative disorder, which are characterized by assuming a certain break between mental faculties or a discontinuation or disconnection between them. In the case of depersonalization disorder, it is the very recognition or familiarity with oneself that has been disconnected.
Depersonalization disorder is characterized by the existence of an experience of great strangeness towards oneself . There appears the sensation of being unreal, of not being an actor but an observer of our own actions, absence of a self and/or a sensation of mental and physical numbness. Although a sensation of this type may not be symptomatic in a sporadic way, the existence of this disorder will be considered when these sensations occur in a habitual and/or persistent way.
The presence of a feeling of disembodiment or of not being in one’s own body is common, an experience of not belonging to one’s own body. All this generates a clinically significant discomfort and suffering and/or a limitation in the person’s day-to-day life.
The experience of this disorder can be really distressing, given the sensation of not being real despite the subject knowing at a conscious level that he is . It is not strange that a great fear may appear at the idea of losing one’s sanity, or even identifying oneself as the living dead. Problems of concentration and performance in multiple tasks, including work, often appear. Depression and anxiety are frequent if the problem is not solved, and in some cases suicidal thoughts may appear.
It is important to keep in mind that this is not a case of delirium or psychotic disorder, and that the judgment of reality is preserved (although there may also be strangeness towards the environment, which is still known to be real) and is not caused by other mental disorders, medical illnesses or substance abuse. 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: unrealization
Depersonalization disorder can occur only as an estrangement from oneself, but it is relatively common for feelings of estrangement from one’s own person to also occur in the perception of reality .
We are talking about unrealization, in which there are difficulties in the perception of the reality of things, often identifying the sensation as that of dreaming and perceiving the world as something unreal and false. Time and space are perceived as altered and the world becomes artificial and distorted.
The possible causes of the appearance of depersonalization disorder may be multiple, there being no single possible cause for it and the specific causes of its appearance being unknown in most cases.
However, as a dissociative disorder it is usually associated with the experience of highly stressful situations. Continued psychosocial stress, the presence of childhood or current sexual abuse, high levels of panic, grief over the death of loved ones, or other traumatic events may be relatively frequent probable causes or triggers.
At a biological level, it has been observed in some experiments that patients with this disorder have a lower activation of the autonomic sympathetic system and a reduction of the electrodermal activity. Less activation of the insula and activation in the ventrolateral prefrontal cortex in response to unpleasant stimuli has also been observed. This pattern seems to reflect a defensive behavior in the face of aversive stimuli, reducing the emotional response to them and producing part of the symptoms.
Likewise, although we would no longer be talking about the disorder itself but about depersonalization as a symptom, these episodes can also appear in cases of intoxication due to substance use, poisoning, head trauma or confusional states.
Depersonalization can be treated through psychotherapy, although in many cases we are facing a chronic disorder or may disappear to return to situations of stress and anxiety .
In general, the treatment will depend on the situations that triggered the disorder, and it will be necessary to work with the subject on the moment of appearance of the disorder, the sensations that generate it and what it is associated with. 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). One can work from multiple perspectives, such as cognitive restructuring proper to the cognitive-behavioral stream or psychodynamics.
Sometimes the application of different psychotropic drugs can also be helpful, although there is little evidence of this. 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.
- 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). Despersonalization: from the disorder to the symptom. Actas Españolas de Psiquiatría, 32 (2): 107-117.
- Sierra-Siegert, M. (2018). Depersonalization: clinical and neurobiological aspects. Revista Colombiana de Psiquiatría, 37 (1).