In psychiatry, depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Those affected often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". based on the findings that depersonalization and derealization are prevalent in other dissociative disorders including dissociative identity disorder.
Though degrees of depersonalization can happen to anyone who is subject to temporary anxiety or stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Both depersonalization and derealization are important symptoms in the spectrum of dissociative disorders, including dissociative identity disorder and "dissociative disorder not otherwise specified" (DD-NOS). They are also prominent symptoms in some other non-dissociative disorders, such as anxiety disorders, clinical depression, bipolar disorder, schizophrenia, schizoid personality disorder, hypothyroidism, endocrine disorders, schizotypal personality disorder, borderline personality disorder, obsessive–compulsive disorder, migraines, and sleep deprivation; they can also be symptoms of some types of neurological seizure, and it has been suggested that there could be common aetiology between depersonalization symptoms and panic disorder, on the basis of their high co-occurrence rates.
Description
thumb|An attempt at a visual representation of depersonalization
Individuals who experience depersonalization feel divorced from their own personal self by sensing their body sensations, feelings, emotions, behaviors, etc. as not belonging to the same person or identity. Often a person who has experienced depersonalization claims that things seem unreal or hazy. Also, a recognition of a self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increase these perceptions.
Depersonalization is a subjective experience of unreality in one's self, while derealization is unreality of the outside world. Although most authors currently regard depersonalization (personal/self) and derealization (reality/surroundings) as independent constructs, many do not want to separate derealization from depersonalization.
History
In 1904, Sigmund Freud described his own experience of depersonalization at the Athens' Acropolis. He described the incident 32 years later, in 1936. He interpreted his experience as an unconscious psychological defense, in which he was repressing feelings of guilt for outliving his father, whose cause of death remained unknown.
In his case study of the Wolf Man, Freud emphasized that depersonalization and derealization serve psychologically defensive functions. A young Russian man known as the "Wolf Man" experienced derealization, which is the sensation of being separated from his surroundings by a veil. This description of being separated from one's surroundings by a veil is reminiscent of derealization. This symptom was accompanied by fear of wolves. Freud's case description revolves around the man's dream of white wolves in a tree peering at him through an open window.
Epidemiology
Despite the distressing nature of symptoms, estimating the prevalence rates of depersonalization is challenging due to inconsistent definitions and variable timeframes. It can also accompany sleep deprivation (often occurring when experiencing jet lag), migraine,
epilepsy (especially temporal lobe epilepsy, complex-partial seizure, both as part of the aura and during the seizure), obsessive-compulsive disorder, severe stress or trauma, anxiety, the use of recreational drugsespecially cannabis, hallucinogens, ketamine, and MDMA, certain types of meditation, deep hypnosis, extended mirror or crystal gazing, sensory deprivation, and mild-to-moderate head injury with little or full loss of consciousness (less likely if unconscious for more than 30 minutes). Interoceptive exposure is a non-pharmacological method that can be used to induce depersonalization. but depersonalization/derealization disorder is diagnosed approximately equally across men and women, with symptoms typically emerging in adolescence.
A similar and overlapping concept called ipseity disturbance (ipse is Latin for "self" or "itself") may be part of the core process of schizophrenia spectrum disorders. However, specific to the schizophrenia spectrum seems to be "a dislocation of first-person perspective such that self and other or self and world may seem to be non-distinguishable, or in which the individual self or field of consciousness takes on an inordinate significance in relation to the objective or intersubjective world" (emphasis in original). 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 in stress. 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.
Causes
A case-control study conducted at a specialized depersonalization clinic included 164 individuals with chronic depersonalization symptoms, of which 40 linked their symptoms to illicit drug use. Phenomenological similarity between drug-induced and non-drug groups was observed, and comparison with matched controls further supported the lack of distinction. The severity of clinical depersonalization symptoms remains consistent regardless of whether they are triggered by illicit drugs or psychological factors.
Pharmacological
Depersonalization has been described by some as a desirable state, particularly by those that have experienced it under the influence of mood-altering recreational drugs. It is an effect of dissociatives and psychedelics, as well as a possible side effect of caffeine, alcohol, amphetamine, cannabis, and antidepressants. 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.
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.
Graham Reed (1974) claimed that depersonalization occurs in relation to the experience of falling in love.
Situational
Experiences of depersonalization/derealization occur on a continuum, ranging from momentary episodes in healthy individuals under conditions of stress, fatigue, or drug use, to severe and chronic disorders that can persist for decades. Researchers compared protein expression in serum samples of individuals with depersonalisation-derealization disorder (DPDR) and healthy controls, and found that many key proteins involved in maintaining homeostasis were present at altered levels. Decreased levels of C-reactive protein (CRP), complement C1q subcomponent subunit B, and apolipoprotein A-IV, and increased levels of alpha-1-antichymotrypsin (SERPINA3) were observed in patients with DPDR. Furthermore, expressions of CRP and SERPINA3 were found to be linked with the ability to inhibit cognitive interference of DPDR.
Psychobiological mechanisms
Proximate mechanism
Depersonalization involves disruptions in the integration of interoceptive and exteroceptive signals, particularly in response to acute anxiety or trauma-related events. Studies have highlighted abnormalities in primary somatosensory cortex processing and insula activity as contributing factors to depersonalization experiences. Additionally, abnormal EEG activities, notably in the theta band, suggest potential biomarkers for emotion processing, attention, and working memory.
Chronic symptoms may represent persistence of depersonalization beyond the situations under threat. For those with both depersonalization and migraine, tricyclic antidepressants are often prescribed.
If depersonalization is a symptom of psychological causes such as developmental trauma, treatment depends on the diagnosis. In cases of dissociative identity disorder or other dissociative disorders in which extreme developmental trauma interferes with formation of a single cohesive identity, treatment requires proper psychotherapy. Depersonalization 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 derealization disorder.
A 2001 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." The anticonvulsant drug lamotrigine has shown some success in treating symptoms of depersonalization, often in combination with a selective serotonin reuptake inhibitor and is the first drug of choice at the depersonalisation research unit at King's College London.
Research directions
The Depersonalisation Research Unit at the Institute of Psychiatry in London conducts research into depersonalization disorder. Researchers there use the acronym DPAFU (Depersonalisation and Feelings of Unreality) as a shortened label for the disorder.
In a 2020 article in the Journal Nature, Vesuna, et al. describe experimental findings which show that layer 5 of the retrosplenial cortex is likely responsible for dissociative states of consciousness in mammals.