Depersonalization disorder Health Article

Symptoms

The symptoms of depersonalization disorder have been described earlier. Although DSM-IV-TR does not specify a list of primary symptoms of depersonalization, British clinicians generally consider the triad of emotional numbing, changes in visual perception, and altered experience of one's body to be important core symptoms of depersonalization disorder.

DSM-IV-TR notes that patients with depersonalization disorder frequently score high on measurements of hypnotizability.

Demographics

The lifetime prevalence of depersonalization disorder in the general population is unknown, possibly because many people are made anxious by episodes of depersonalization and afraid to discuss them with a primary care physician. One survey done by the National Institutes of Mental Health (NIMH) indicates that about half of the adults in the U.S. have had one or two brief episodes of depersonalization in their lifetimes, usually resulting from severe stress. About a third of people exposed to life-threatening dangers develop brief periods of depersonalization, as do 40% of psychiatric inpatients.

Depersonalization disorder is diagnosed about twice as often in women as in men. It is not known, however, whether this sex ratio indicates that women are at greater risk for the disorder or if they are more likely to seek help for its symptoms, or both. Little information is available about the incidence of the disorder in different racial or ethnic groups.

Diagnosis

The diagnosis of depersonalization disorder is usually a diagnosis of exclusion. The doctor will take a detailed medical history, give the patient a physical examination, and order blood and urine tests in order to rule out depersonalization resulting from epilepsy, substance abuse, medication side effects, or recent periods of sleep deprivation.

There are several standard diagnostic questionnaires that may be given to evaluate the presence of a dissociative disorder. The Dissociative Experiences Scale, or DES, is a frequently administered self-report screener for dissociation. The Structured Clinical Interview for DSM-IV Dissociative Disorders, or SCID-D, can be used to make the diagnosis of depersonalization disorder distinct from the other dissociative disorders defined by DSM-IV. The SCID-D is a semi-structured interview, which means that the examiner's questions are open-ended and allow the patient to describe experiences of depersonalization in some detail—distinct from simple "yes" or "no" answers.

In addition to these instruments, a six-item Depersonalization Severity Scale, or DSS, has been developed to discriminate between depersonalization disorder and other dissociative or post-traumatic disorders, and to measure the effects of treatment in patients.

Treatments

Depersonalization disorder sometimes resolves on its own without treatment. Specialized treatment is recommended only if the symptoms are persistent, recurrent, or upsetting to the patient. Insight-oriented psychodynamic psychotherapy, cognitive-behavioral therapy, and hypnosis have been demonstrated to be effective with some patients. There is, however, no single form of psychotherapy that is effective in treating all patients diagnosed with depersonalization disorder.

Medications that have been helpful to patients with depersonalization disorder include the benzodiazepine tranquilizers, such as lorazepam (Ativan), clorazepate (Tranxene), and alprazolam (Xanax), and the tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and desipramine (Norpramin). As of 1999, newer, promising medications called selective serotonin reuptake inhibitors (SSRIs) became available. Some SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). SSRIs act on brain chemicals that nerve cells use to send messages to each another. These chemical messengers (neurotransmitters) are released by one nerve cell and taken up by others. Those that are not taken up by other cells are taken up by the ones that released them. This is called "reuptake." SSRIs work by preventing the reuptake of serotonin—an action which allows more serotonin to be taken up by nerve cells.

Unfortunately, there have been very few well-designed studies comparing different medications for depersonalization disorder. Because depersonalization disorder is frequently associated with trauma, effective treatment must include other stress-related symptoms, as well.

Relaxation techniques have been reported to be a beneficial adjunctive treatment for persons diagnosed with depersonalization disorder, particularly for those who are worried about their sanity.

Prognosis

The prognosis for recovery from depersonalization disorder is good. Most patients recover completely, particularly those who developed the disorder in connection with traumas that can be explored and resolved in treatment. A few patients develop a chronic form of the disorder; this is characterized by periodic episodes of depersonalization in connection with stressful events in their lives.