Depersonalization disorder Health Article

Definition

Depersonalization is a state in which the individual ceases to perceive the reality of the self or the environment. The patient feels that his or her body is unreal, is changing, or is dissolving; or that he or she is outside of the body.

Depersonalization disorder is classified by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, text Revision, also known as the DSM-IV-TR as one of the dissociative disorders. These are mental disorders in which the normally well-integrated functions of memory, identity, perception, and consciousness are separated (dissociated). The dissociative disorders are usually associated with trauma in the recent or distant past, or with an intense internal conflict that forces the mind to separate incompatible or unacceptable knowledge, information, or feelings. In depersonalization disorder, the patient's self-perception is disrupted. Patients feel as if they are external observers of their own lives, or that they are detached from their own bodies. Depersonalization disorder is sometimes called "depersonalization neurosis."

Depersonalization as a symptom may occur in panic disorder, borderline personality disorder, post-traumatic stress disorder (PTSD), acute stress disorder, or another dissociative disorder. The patient is not given the diagnosis of depersonalization disorder if the episodes of depersonalization occur only during panic attacks or following a traumatic stressor.

The symptom of depersonalization can also occur in normal individuals under such circumstances as sleep deprivation, the use of certain anesthetics, experimental conditions in a laboratory (experiments involving weightlessness, for example), and emotionally stressful situations (such as taking an important academic examination or being in a traffic accident). One such example involves some of the rescue personnel from the September 11, 2001 terrorist attacks on the World Trade Center and the Pentagon. These individuals experienced episodes of depersonalization after a day and a half without sleep. A more commonplace example is the use of nitrous oxide, or "laughing gas" as an anesthetic during oral surgery. Many dental patients report a sense of unreality or feeling of being outside their bodies during nitrous oxide administration.

To further complicate the matter, depersonalization may be experienced in different ways by different individuals. Common descriptions include a feeling of being outside one's body; "floating on the ceiling looking down at myself" feeling as if one's body is dissolving or changing; feeling as if one is a machine or robot; "unreal" feeling that one is in a dream or that one"is on automatic pilot." Most patients report a sense of emotional detachment or uninvolvement, or a sense of emotional numbing. Depersonalization differs from "derealization," which is a dissociative symptom in which people perceive the external world as unreal, dreamlike, or changing. The various ways that people experience depersonalization are related to their bodies or their sense of self.

Depersonalization is a common experience in the general adult population. However, when a patient's symptoms of depersonalization are severe enough to cause significant emotional distress, or interfere with normal functioning, the criteria of the DSM-IV-TR for "depersonalization disorder" are met.