Depersonalization or Derealization Disorder DSM-5 300.6(F48.1)

Depersonalization or Derealization Disorder DSM-5 300.6(F48.1)

DSM-5 Category: Dissociative Disorders

Depersonalization disorder, also known as depersonalization-derealization syndrome, is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who persistently experience feelings of detachment, either bodily or cognitively, from themselves or from their environment. Depersonalization disorder falls under the dissociative disorders group of conditions, which are characterized by feelings of disconnection from reality.

Introduction

Depersonalization disorder, or depersonalization-derealization syndrome, is an often chronic and distressing condition that causes the sufferer to feel that they are detached from themselves, their feelings or their reality, in an almost robotic sense.

Patients may experience depersonalization in relation to themselves, as if they are viewing their lives from the outside, while others might experience derealization, which relates to feeling detached from one’s surroundings and other people, who may appear as if part of a dream1.

Depersonalization disorder and depersonalization-derealization syndrome are diagnosed in an estimated two per cent of the population and affect women and men equally, although there is growing consensus that the disorder is more common that official figures suggest. Onset of the condition is usually at around 16 years of age2.

Symptoms of depersonalization disorder

An individual suffering from depersonalization may experience:

  • Detachment from emotions
  • Distorted body image
  • Difficulty recognizing their own reflection
  • Loss of sensation in parts of the body
  • Feeling unreal or like a spectator in their own lives

Sufferers of derealization may experience:

  • Feeling detached from their surroundings
  • Feeling that general life events are unreal
  • Perceiving objects as changing in shape, size or color
  • Feeling that people they know are strangers
  • Feeling that environments they know are unfamiliar

Patients may experience symptoms of one or both elements for a diagnosis of depersonalization disorder to be made. Symptoms may be sporadic or chronic1.

Diagnostic criteria for depersonalization disorder

Dissociative disorders can be difficult to diagnose for a number of reasons, namely:

  • Comorbidity with other conditions or differential diagnoses
  • A lack of information about any early childhood trauma that may have occurred
  • Difficulty on the part of the patient in recalling unpleasant historical events

Because depersonalization disorder can be relatively complex to identify, it sometimes takes time for an accurate diagnosis to be made3. The following diagnostic criteria will often be used by medical professionals when assessing a patient:

  • Symptoms of depersonalization and/or derealization
  • Onset of symptoms that cannot be attributed to another disorder or outside agency
  • Sufferers have an intact sense of reality and know their unreal experiences are not real
  • The disorder causes significant distress and/or social or occupational impairment

A range of diagnostic techniques may be employed for greater insight into the patient’s condition, such as structured interviews, questionnaires and other psychological tests.

In sufferers experiencing the onset of depersonalization disorder at the age of 40 or over, MRI and EEG tests may be performed to check for physical causes, and urine toxicology tests may also be advised4.

Causes of depersonalization disorder

There is no single known cause for depersonalization disorder or depersonalization-derealization syndrome but a number of factors have been linked to the onset of the condition, most commonly:

  • Episodes of severe stress, depression and panic
  • Misuse of drugs like marijuana and hallucinogens

Onset of depersonalization disorder is also associated with childhood trauma, in particular emotional abuse or neglect; dissociation is a natural response to traumatic events that are out of the sufferer’s control. Experiencing a severe accident, being subjected to an assault or suffering emotional abuse, for example, can invoke this psyche-protective response.

Links have also been made between depersonalization disorder and physical anomalies in the transmission and functioning of endocrine hormones and brain chemicals, although further research is required to create a stronger case for association2.

Comorbidity

Depersonalization disorder may present alongside other conditions, including:

  • Anxiety
  • Depression
  • Avoidant personality disorder
  • Borderline personality disorder
  • Obsessive compulsive disorder (OCD)5

Sufferers of post traumatic stress disorder (PTSD) and panic disorder may also experience symptoms of dissociation6.

Differential diagnosis

Dissociation is a symptom of various mental health disorders and can also be a side effect of taking drugs or medication. In cases of suspected depersonalization disorder, the following potential causes may need ruling out:

  • Schizophrenia
  • Bipolar disorder
  • PTSD
  • Drug or alcohol misuse
  • Medication
  • Coming off medication3

Living with depersonalization disorder

People living with depersonalization disorder often find the condition causes them distress and negatively impacts on social and occupational areas of life. Feelings of detachment from the self in terms of bodily sensations, emotions and behavior may have adverse effects on an individual’s ability to function normally in everyday tasks and interpersonal exchanges.

The unease caused by feelings of dissociation can, in turn, lead to increased levels of anxiety, exacerbating the condition and producing a growing need to determine what is real and establish the tangibility of the self.

Some sufferers may experience depersonalization disorder as infrequent episodes; others deal with the condition on a daily basis. There are various forms of treatment that can make living with depersonalization disorder more bearable.

Treatment of depersonalization disorder

There is no single cure for depersonalization disorder; rather, there are various approaches to treating the disorder and managing symptoms. Psychotherapy and medication are the most common treatment options for depersonalization disorder, either in isolation or combined.

Psychotherapy

Different methods of psychotherapy employed to treat depersonalization disorder include:

Counselling - a talk therapy enabling individuals to discuss their problems and seek out solutions in a safe environment with a qualified practitioner

Cognitive behavioral therapy - a talking therapy designed to help individuals manage problems by changing their thought processes and subsequent behavior

Grounding techniques - sensory techniques using tactile, audio, visual and other cues to help individuals feel more connected to themselves and their surroundings

Psychodynamic therapy - designed to access the unconscious elements of an individual’s mind to help with problem processing and understanding

Medication

A range of drugs may be used to treat depersonalization disorder but success to date is mixed. In many cases, medications will target other disorders like anxiety and depression, which are sometimes associated with depersonalization disorder or precipitants of the condition4.

Clomipramine - a tricyclic antidepressant commonly used to treat psychological conditions like OCD, panic disorder and major depressive disorder, as well as chronic pain

Fluoxetine - known by the trade name Prozac, an antidepressant of the selective serotonin reuptake inhibitor class, used to treat major depressive disorder, OCD, bulimia nervosa and other psychological conditions

Lamotrigine - an anticonvulsant medication commonly used to treat epilepsy, bipolar disorder and clinical depression

Opioid antagonists - drugs commonly used to treat substance addiction by blocking or reducing the body’s responses to opioids and endorphins, thus limiting euphoria

Prognosis

Although there is no known cure for depersonalization disorder, the prognosis for many sufferers is positive. With the correct diagnosis and effective treatment, many patients can expect to regain control and re-establish a sense of self and connection to their surroundings.

The treatment suggested will depend on various factors, such as the severity of the patient’s condition, any co-existing disorders and the individual’s exact symptoms. It may be the case that therapy is the sole treatment, or a combination of medication and therapy may be alternatively advised.

With treatment, often over the long term, many patients find that their symptoms improve, and episodes of dissociation may become less frequent or disappear altogether7.


Dr. Kevin Fleming obtained his PhD from Notre Dame and is the Founder of Grey Matters International (www.greymattersintl.com) a neuroscience-based behavior change consulting firm.

References:

1. NHS (2014) Dissociative Disorders http://www.nhs.uk/Conditions/dissociative-disorders/Pages/Introduction.aspx#depersonalisation Date Accessed: 04/01/2017

2. Simeon, D. Depersonalisation disorder: a contemporary overview. CNS Drugs. 2004;18(6):343-54. Cited at: https://www.ncbi.nlm.nih.gov/pubmed?term=15089102 Date Accessed: 04/01/2017

3. Mind (2016) Dissociative disorders: What is dissociation?
http://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/#.WGwgf_mLTIU Date Accessed: 04/01/2017

4. Spiegel, D., Willson, J., L. and S. (2015) Depersonalization/Derealization Disorder http://www.msdmanuals.com/professional/psychiatric-disorders/dissociative-disorders/depersonalization-derealization-disorder Date Accessed: 04/01/2017

5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

6. Weiner and McKay, 2013 Weiner, E. & McKay, D. (2013) A preliminary evaluation of repeated exposure for depersonalization and derealization. Behavior Modification. 37(2): 226-42

7. Mind (2013) Dissociative disorders: What treatments can help?
http://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/treatment-and-recovery/#.WGzmuPmLTIU Date Accessed: 04/01/2017

 

 


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