Depersonalization



Depersonalization (or depersonalisation) is a malfunction or anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. It can be considered desirable, such as in the use of recreational drugs, but it usually refers to the severe form found in anxiety and, in the most intense cases, panic attacks. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance. It can be a disturbing experience, since many feel that, indeed, they are living in a "dream".

Depersonalization is a subjective experience of unreality in one's sense of self, while derealization is unreality of the outside world. Although most authors currently regard depersonalization (self) and derealization (surroundings) as independent constructs, many do not want to separate derealization from depersonalization.

Chronic depersonalization refers to depersonalization disorder, which is classified by the DSM-IV as a dissociative disorder. Though depersonalization-derealization feelings can happen to anyone subject to temporary severe anxiety/stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified (DD-NOS). It is also a prominent symptom in some other non-dissociative disorders, such as anxiety disorders, clinical depression, bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, migraine, sleep deprivation, and some types of epilepsy.

In social psychology (including social identity theory and self-categorization theory), the term depersonalization has a different meaning. In this area of research, depersonalization refers to a switch to a group level of self-categorization in which self and others are seen in terms of their group identities.

Description
Individuals who experience depersonalization feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to the same person or identity. Often a person who has experienced depersonalization claims that life "feels like a movie" or things seem unreal or hazy. Also, a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increase these perceptions.

One way to describe the physical manifestation of the feeling is to compare it to a film technique called the vertigo shot or a dolly zoom. In this technique, the subject of the picture stays fixed within the shot while the surrounding background is pulled away, providing a sense of vertigo or detachment. People may perceive this feeling in a cyclical manner, where the feeling is experienced back-to-back in succession.

Prevalence
The symptom of depersonalization is the third most common psychological symptom, after feelings of anxiety and feelings of depression. Depersonalization can also accompany sleep deprivation (often occurring when suffering from jet lag), migraine, obsessive-compulsive disorder, stress, and anxiety; it is a symptom of anxiety disorders, such as panic disorder. Interoceptive exposure is a non-pharmacological method that can be used to induce depersonalization.

A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response. Individuals high on the absorption subscale, which measures a subject's experiences of concentration to the exclusion of awareness of other events, showed weaker cortisol responses.

Non-psychological causes
Depersonalization may also be a desirable effect, such as in the case of recreational drugs. It is an effect of dissociatives and psychedelics, as well as possible side effect of caffeine, alcohol, cannabis, and minocycline. It is a classic withdrawal symptom from many drugs.

Benzodiazepine dependence, which can occur with long term use of benzodiazepines, can induce chronic depersonalization symptomatology and perceptual disturbances in some people, even in those who are taking a stable daily dosage, and it can also become a protracted feature of the benzodiazepine withdrawal syndrome.

Treatment
Treatment is dependent on the underlying cause, whether it is organic or psychological in origin. If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), neuroborreliosis (Lyme disease), or any other neurological disease affecting the brain. For those suffering from depersonalization with migraine, tricyclic antidepressants are often prescribed.

If depersonalization is a symptom of psychological causes such as developmental trauma, treatment depends on the diagnosis. In case of dissociative identity disorder or DD-NOS as a developmental disorder, in which extreme developmental trauma interferes with formation of a single cohesive identity, treatment requires proper psychotherapy, and&mdash;in the case of additional (co-morbid) disorders such as eating disorders&mdash;team of specialists treating such an individual. It can also be a symptom of borderline personality disorder, which can be treated in the long term with proper psychotherapy and psychopharmacology.

The treatment of chronic depersonalization is considered in depersonalization disorder.

A recently-completed study at Columbia University in New York City has shown positive effects from transcranial magnetic stimulation (TMS) to treat depersonalization disorder. Currently, however, the FDA has not approved TMS to treat DP.

A recent Russian study showed that naloxone, a drug used to reverse the intoxicating effects of opioid drugs, can successfully treat depersonalization disorder. According to the study: "In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization."

Research
The Depersonalisation Research Unit at the Institute of Psychiatry in London is a world leader in research in depersonalization disorder. Researchers there use the acronym DPAFU (Depersonalisation and Feelings of Unreality) as a shortened label for the disorder.

Popular culture

 * Matthew Perry's character, Hudson Milbank, suffers from depersonalization disorder in the movie Numb.
 * Lieutenant Colonel Dave Grossman, in his book On Killing, suggests that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill other human beings.
 * Existentialists use the term differently, to mean treatment of individuals by other people as if they were objects, or without regard to their feelings. Determinism has been accused of this. See also objectification.
 * R. D. Laing used depersonalization to mean a fear of the loss of autonomy in interpersonal relationships by the ontologically insecure.
 * In the memoir Girl, Interrupted, Susanna Kaysen describes her experience in a mental institution, where she later bit into her hand because she had "to see if she had bones"; she was later diagnosed with a depersonalization attack.
 * In the Bret Easton Ellis novel American Psycho and the 2000 film adaptation of the same name, the protagonist, serial killer Patrick Bateman, remarks repeatedly through first-person narration his feelings of depersonalization. Throughout the story, Bateman experiences at some point or another most, if not all, the symptoms of DPD: he frequently experiences panic attacks, hallucinations, random fits of crying, and confusion over his personality (or lack thereof), the latter exacerbated by his compulsion to "fit in" and the inability of his acquaintances to tell him and others apart. Bateman occasionally addresses his ailment directly, including a monologue where he laments, "There wasn't a clear, identifiable emotion within me, except for greed and, possibly, total disgust. I had all the characteristics of a human being—flesh, blood, skin, hair—but my depersonalization was so intense, had gone so deep, that the normal ability to feel compassion had been eradicated, the victim of a slow, purposeful erasure. I was simply imitating reality, a rough resemblance of a human being, with only a dim corner of my mind functioning."
 * The feeling of depersonalization was the inspiration for Suzanne Vega's song "Tom's Diner"
 * The Norwegian painter Edvard Munch's famous masterpiece The Scream is thought to have been inspired by Depersonalization disorder.