Depersonalization Disorder (including Derealization)

DepersonalizationA sense of detachment from the self. Depersonalization disorder includes derealization, since the two often co-occur. {{See also| Depersonalization disorder}} Disorder is categorized in the DSM-5 as a Dissociative Disorder and has been combined with derealizationDepersonalization disorder includes derealization, since the two often co-occur. . Depersonalization disorder involved an individual feeling detached from their environment, in particular emotionally detached.

Depersonalization is a symptom found in many psychiatric disorders, but in Depersonalization Disorder it is the primary disorder. ^[1] It's origin seems to be in that brainThe brain is a approximately a 1300-gram organ containing 100-billion neurons. It is the control center of the central nervous system. The mind and brain are not the same thing. (see mind) The mind emerges out of interactions between the brain and relationships during the earliest years of childhood. Different child-parent attachment relationships form differing physiological responses, patterns for interpersonal relationship and how an individual views the world. {{Rp|9}} (see attachment) regions involved with these emotions are less activated. ^[1]

DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. {{Rp|384}}-5 Diagnostic criteria

The DSM-5 includes the following criteria for the combined disorder Depersonalization/Derealization Disorder:

A. An individual consistently has a feeling of both or either depersonalization or derealization.

1. Depersonalization: Experiences of unreality, detachmentCharacterized by distant interpersonal relationships and lack of emotional involvement {{Rp|24}}, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g.,perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing.)" ^[2]
2. DerealizationDepersonalization disorder includes derealization, since the two often co-occur. : "Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted."

B. "During the depersonalization or derealization experiences, reality testing remains intact."

C. "The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" , medication or other medical condition (e.g., seizures)." ^[2]:157
D. "The disturbance is not better explained by another mental disorderThe DSM-5 psychiatric manual defines this as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."{{Rp|20}}." ^[2]:156-1577

As with any dissociative disorder, the symptoms must be severe enough to cause clinically significant distress or significantly impair the individual's functioning in at least one major area of life (eg, work or social life).^[2]

ICD-10 Diagnostic Criteria

F48.1 Depersonalization-derealization syndrome

"A rare disorder in which the patient complains spontaneously that his or her mental activity, body, and surroundings are changed in their quality, so as to be unreal, remote, or automatized. Among the varied phenomena of the syndrome, patients complain most frequently of loss of emotions and feelings of estrangement or detachment from their thinking, their body, or the real world. In spite of the dramatic nature of the experience, the patient is aware of the unreality of the change. The sensorium is normal and the capacity for emotional expression intact. Depersonalization-derealization symptoms may occur as part of a diagnosable schizophrenic, depressive, phobic, or obsessive-compulsive disorder. In such cases the diagnosis should be that of the main disorder."^[3]

Depersonalization

Depersonalization sometimes referred to as DPD (depersonalization disorder) is frequently described as is feeling as if one is outside of their own body or that their own body is unreal, but is a complex disorder with a consistent set of symptoms being reported for over a hundred years.^[4]:69 Psychiatrists Sierra and Berrios analyzed historic reports of depersonalization and determined the following two clusters of symptoms, with the coreThe terms "core" and "original" were used back in history to mean the part that body was born with, but today we know there is no such part. Many also incorrectly assume the host or ANP is what they call the core. {{Rp|59}} {{Rp|80, 87-88}} (see personality and alters) (see personality)Note: Outside of the dissociative disorders the term core is used by some to mean an individuals "suchness;" a part that is "beneath narrative and memory, emotional reactivity and habit." {{Rp|208-209}} symptoms are the most frequently reported and the most distressing.^[4]:70

Nonchanging core symptoms

• visual derealization
• altered body experience (for example vision, hearing, smell, taste, touch or pain)^[4]:74
• emotional numbing
• loss of agency feelings
• changes in the subjective experiencing of memory^[4]:70

  Other symptoms

• unreality experiences not related to vision
• mind-emptiness (subjective inability to entertain thoughts or evoke images)
• heightened self-observation
• altered time experiences

Derealization

This is frequently described as feeling detached from one's environment.

Diagnosis

SCI-DER, Cambridge Depersonalization Scale and Steinberg Depersonalization Test

The SCI-DER, CDS and Steinberg Depersonalization Test are all questionnaires designed to assess depersonalization and derealization in order to assess symptoms, although these should not be used for a definitive diagnosis.

SCID-D

This is a structured clinical interview, which is the diagnostic tool for depersonalization/derealizationA sense of detachment from the self. Depersonalization disorder includes derealization, since the two often co-occur. {{See also| Depersonalization disorder}} disorder and all dissociative disorders. It was developed by Dr Marlene Steinberg to assess all dissociative disorders.^[5] Dr Steinberg is co-author of the well known book THE STRANGER IN THE MIRROR: Dissociation The Hidden Epidemic.^[6]

Causes

Depersonalization is believed to be "a response that is intended to distance the self from overwhelmingly painful or conflictual impulses or feelings", and makes sense as a "defense"specific, unconscious, intra-psychic adjustment that occurs in order to resole emotional conflict and to reduce an individual's anxiety. A mental mechanism, an ego defense mechanisms, or an adjustive technique."{{Rp|97}} mechanism against over-whelming traumatic stress".^[4]:74

Links to other disorders

Depersonalization and derealization disorder cannot be diagnosed if the symptoms are transient rather than persistent and reoccuring, or if they only occur within another mental health or physical health disorder. Experiences of depersonalisation and derealization may occur during acute stress disorder, posttraumatic stress disorder, other specified dissociative disorder, dissociative identity disorder, Schizophrenia, Obsessive-Compulsive Disorder and others.

See also SCI-DER and CDS including the Steinberg Depersonalization Test

References

1. ^ a b Phillips, Mary L; Medford, Nicholas; Senior, Carl; Bullmore, Edward T; Suckling, John; Brammer, Michael J; Andrew, Chris; Sierra, Mauricio; Williams, Stephen C.R; David, Anthony S. Depersonalization disorder: thinking without feeling. Psychiatry Research: Neuroimaging, volume 108, issue 3, 1 December 2001, page 145–160. (doi:10.1016/S0925-4927(01)00119-6)
2. ^ a b c d APA, (2013). Diagnostic and Statistical Manual of Mental Disorders-5.
3. ^ World Health Organisation, (2010). ICD-10 Classification of Mental and Behavioural Reaction to severe stress, and adjustment disorders.
4. ^ a b c d e Simeon, Daphne (2006) (coauthors: Abugel, Jeffrey). Feeling Unreal: Depersonalization Disorder and the Loss of the Self. Oxford University Press..
5. ^ Steinberg, M. (1993). Structured clinical interview for DSM-IV dissociative disorders (SCID-D). Washington, DC:American Psychiatric Press..
6. ^ Steinberg, Marlene (2000) (coauthors: Schnall, Maxine). . Harper. 0060195649.