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Depersonalization
disorder consists of persistent or recurrent feelings of being detached from
one's body or mental processes, usually with
a feeling of being an outside observer of one's life. It is often
triggered by severe stress. Diagnosis is by history. Treatment consists
of psychotherapy.
The experience of depersonalization is common, frequently occurring in connection with life-threatening danger, such as accidents, assaults, and serious illnesses and injuries; it can occur as a symptom in many mental disorders and seizure disorders. When depersonalization occurs independently of any other mental or physical disorder and is persistent or recurrent, depersonalization disorder is present. It is estimated to occur in about 2% of the general population.
Symptoms,
Signs, and Diagnosis
Patients have a distorted perception of themselves, their bodies, and their lives, which can make them profoundly uncomfortable. A person may feel unreal, as if he is an automaton or is dreaming. Often the symptoms are transient and accompanied by anxiety, panic, or phobic symptoms. However, symptoms can be chronic.
Patients often have great difficulty describing their symptoms and may fear or believe they are going crazy. They always retain the knowledge that their “unreal” experiences are not real but, rather, are just the way that they feel.
Diagnosis is based on the symptoms, after ruling out physical disorders, substance abuse, and other general mental disorders (especially anxiety and depression) and other dissociative disorders. Psychologic tests and special interviews are helpful.
Prognosis
and Treatment
The feeling of depersonalization is often transient and resolves spontaneously. Even when it persists or is recurrent, some patients are minimally impaired if they can suppress the feeling of depersonalization by keeping their mind busy and focusing on other thoughts. Other patients become disabled by the chronic sense of estrangement or by the accompanying anxiety or depression.
Complete recovery is possible for many patients, especially those whose symptoms occur in connection with stresses that can be dealt with in treatment and those whose symptoms have not been protracted. Some patients gradually improve without intervention. Some may progress to more chronic and refractory depersonalization.
Treatment must address all stresses associated with the onset of the disorder as well as earlier stresses, such as childhood emotional abuse or neglect, which may have predisposed patients to later mental insults that trigger the onset of depersonalization. Various psychotherapies (eg, psychodynamic psychotherapy, cognitive behavior therapy, hypnosis) are successful for some patients. Cognitive techniques can help block obsessive thinking about the unreal state of being. Behavioral techniques can help patients engage in tasks that distract them from the depersonalization. Grounding techniques may help patients feel more well-grounded and real in the moment.
Other mental disorders, which are often associated with or precipitated by depersonalization, must be treated. Anxiolytics and antidepressants help some patients, mainly those in whom coexisting anxiety or depression accentuates the depersonalization.
Last full review/revision November 2005
Content last modified November 2005
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