You are not Alone: Understanding the Depths of Depersonalization Disorder

Depersonalization is a severe psychological condition, which is characterized by persistent or recurrent feelings of detachment from one’s own body. Depersonalization and Derealization are two common types of Dissociative disorders that can severely impede one’s daily functioning. Dissociation can be defined as a discontinuity or disruption in one or more aspects of psychological functioning; such as memory, identity, and perception of reality.

In Derealization, the external world may seem indifferent or dream-like or even distorted to an individual, and in Depersonalization, the perception of the individual alters leading them to temporarily lose their sense of own identity. In DSM-IV, Depersonalization and Derealization were presented as two separate conditions, whereas in DSM-5, it has been treated as the same category.

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Exploring Depersonalization Disorder and Its Causes

We generally possess a coherent sense of ourselves and are conscious of our surroundings. However, people going through severe stress or any traumatic events can experience disintegration from reality. They might not remember why they are at a specific place or even who they are. Often they start to incorporate themselves into believing that they have a different personality, different memories that they never had. The prevalence of this disorder is estimated as 1-2% of the general population involving both male and female gender ratios.

Causal Factor Behind Depersonalization Disorder

Although the cause of Depersonalization Disorder is not entirely certain, however, researchers have suggested extreme trauma and abuse, sudden death of loved ones, history of substance abuse or other mental conditions may be responsible for developing this disorder.

Acute Stress and Post Traumatic Theory:

Acute stress such as excessively stressful work situations or day-to-day life situations may cause a way of escape through a feeling of loss of identity. According to posttraumatic theory, an individual who experiences a severely abusive childhood often strives to cope with the dreadful experience of abuse by detaching themselves from their own identity, leading to Depersonalization and Dissociative Identity Disorder. It helps them to ease some of the painful memories and keep reinforcing to occur again and again.

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Physical abuse or domestic violence:

It is evident that children who experience harsh torment in their early lives have adverse consequences on the development, which sparks the progress of this disorder. As a coping mechanism, they start to feel disconnected from their thoughts, memories, and identity to feel safe from the unpleasant memories of sexual or physical abuse.

Sudden death of loved one:

Another causal factor for Depersonalization disorder sprouts from the sudden or accidental demise of a loved one. Such events may lead to emotional numbness within the affected individual, enabling them to create an estranged feeling of reality to escape the overwhelming emotional turmoil.

History of other mental illnesses:

Though under the periods of depersonalization, reality testing remains sound, unlike psychotic episodes. However, Depersonalization can be an early sign of the development of psychotic states in later life. In people with depersonalization, comorbid conditions, including anxiety disorder, or mood disorder can enhance the symptoms of dissociation.

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Diagnosis of the disorder

To verify the presence of depersonalization disorder, clinicians must evaluate whether there is any history of drug abuse or any other mental health conditions such as; seizures, PTSD, or borderline disorder. A clinician may diagnose depersonalization/derealization disorder in a person when they exhibit the following criteria:

1. Persistent or recurrent experience of Depersonalization, Derealization, or both Symptoms of depersonalization include feelings of being unreal or being distanced or even being an intruder observing one’s thoughts and sensations. A distorted sense of time, unreal or no sense of self-identity is another set of feelings experienced in Depersonalization. Symptoms of Derealization involve the experience of delicacy or detachment from one’s surroundings; for instance, the person may feel objects around them are not real or dreamlike, lifeless.
2. Unlike psychotic disorders, throughout the episode of depersonalization, reality testing remains intact.
3. Clinically significant distress in every aspect of daily functioning.

Intervention for Depersonalization disorder

Although the number of systematic research on the treatment of depersonalization/derealization disorder is significantly less. Through various case histories, it has been presented that treatment may help mitigate the associated problems of anxiety and depressive episodes. Psychotherapy and medical treatment can alleviate the distress experienced by the individual.

Medication and biological treatment:

Different types of antidepressants, and anti-anxiety medications have indicated modest effects on depersonalization disorder. These medications should not be consumed without consulting a professional psychiatrist. A recent biological treatment, involves rTMS (Repetitive Transcranial Magnetic Stimulation) administrating on the temporoparietal part of the brain, an area that is highly responsible for the sense of unified self and body.

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Cognitive Behavioural Therapy:

The most effective treatment of Depersonalization disorder is CBT. In general, CBT helps to recognize distorted thought patterns and restructure them. CBT helps to address challenging cognitive biases experienced in depersonalization. It helps people to estimate the accuracy of their thoughts and differentiate between unrealistic views and objective reality. Some Grounding Techniques such as listening to live music, or holding something to sense its texture, help the person to connect with the real surroundings and make them feel connected with themself.

Psychodynamic Techniques:

Psychodynamic therapy is another one of the most efficient treatments for Depersonalization. This therapeutic technique delves into the experience of the individual and releases the conflicts and traumatic memories through catharsis. It helps the person be more insightful by actively addressing the unconscious mind.

EMDR:

Eye movement Desensitization Reprocessing is especially used for the treatment of PTSD. As traumatic experience is one of the causes of depersonalization, EMDR can be used to ease the emotional pain behind the sense of dissociation. Therapists incorporate bilateral stimulation generally through guided eye movement. This helps the person to associate with the present moment and relieve the psychological tension.

Living with depersonalization/derealization disorder can pose a challenge as individuals predominantly perceive a disconnected or unfamiliar sense of self or the outside world. However, psychoeducation and realization of the treatment of this disorder are crucial for both the affected person and his caregiver.