Article: Depersonalization disorder

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Depersonalization Disorder (DD) is a dissociative disorder in which sufferers are affected by persistent feelings of depersonalization. The symptoms include a sense of automation, feeling a disconnection from one's body, and difficulty relating oneself to reality.

Occasional moment of depersonalization are normal, but a persistent feeling is not. Brief periods of depersonalization are notably engendered by stress, a lack of sleep, or a combination. It becomes a disorder when the dissociation interferes with the social and occupational functions necessary to everyday living. Often a victim of DD feels as if he or she is going insane, though this is almost never the case. Anxiety disorders are often linked to depersonalization, because anxiety can sometimes lead to DD. In addition, DD can cause anxiety since the person feels abnormal and uneasy at the loss of their sense of self.

Reality testing will remain intact during an episode of depersonalization, meaning that a person suffering from the disorder will be able to respond to questions and interact with his or her environment. This fact can be distressing for those with DD; the friends and family of the victim do not realise that the dream-like state is not intentional. In fact, others may not even notice that a person has DD, since the person's behaviour is usually completely normal.

Depersonalization disorder often begins in the late teens or early twenties and usually resolves itself by age 30. While a nuisance, and very distressing to the patient, people with depersonalization disorder represent no risk to society, since their grasp on reality remains intact.

Psychodynamic psychotherapy and behavioral therapy have been used to treat Depersonalization Disorder, but in most cases the disorder will dissipate on its own. While DD is not a psychotic disorder by any means, antipsychotic drugs can often improve or completely alleviate symptoms from severe depersonalization disorder. Combinations of antidepressants and mood stabilizers are also tried. However, not all patients are willing to tolerate the side effects of these drugs. Alprazolam or other potent benzodiazepine derivatives are also used in the treatment.

Diagnostic criteria (DSM-IV-TR)

The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:

1. Persistent, recurring feeling of being detached from one’s mental processes or body; as if an observer
2. During depersonalization, reality testing is intact
3. Depersonalization causes significant distress, and impairment in social, occupational, or other functioning
4. Depersonalization is not related to another disorder, substance use, or general medical condition

Differential diagnosis

Some disorders have similar symptoms. The clinicians, must differentiate between and rule out the following disorders to establish a precise diagnosis.

Causes

Depersonalization is the third most common psychological experience, after feelings of anxiety and feelings of depression, and often occurs after life threatening experiences, such as accidents, assault, or serious illness or injury. Depersonalization disorder is little studied, and little is known about its causes and epidemiology.

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Bibliography

Key Texts – Books

Simeon D. & Abugel J. (2006) Feeling Unreal : Depersonalization Disorder and the Loss of the Self. Oxford University Press, USA ISBN 0195170229.

Additional material – Books

Key Texts – Papers

Additional material - Papers