Depersonalization disorder

Depersonalization disorder

DSM-IV-TR characterizes depersonalization disorder as a persistent or recurrent alteration in the perception of the self to the extent that a person’s sense of his or her own reality is temporarily lost. Patients with depersonalization disorder may feel that they are mechanical, in dream, or detached from their bodies. The episodes are egodystonic, and the patients realize the unreality of the symptoms.

Some clinicians distinguish between depersonalization and derealization. Depersonalization is the feeling that the body or the personal self is strange and unreal; derealization is the perception of objects in the external world as strange and unreal.

The distinction provides a more accurate description of each phenomenon than is achieved by grouping them together under the rubric of depersonalization.

1. Epidemiology

Asanoccasional isolated experience in the lives of many persons, depersonalization is a common phenomenon and is not necessarily pathological. Studies indicate hat transient depersonalization may occur in as many as 70 percent of a given population,with no significant difference between men and women. Children frequently experience depersonalization as they develop the capacity for self awareness, and adults often undergo a temporary sense of unreality when they travel to new and strange places.

2. Etiology

Depersonalization may be caused by psychological, neurological, or systemic disease. Systemic cause includes endocrine disorders of the thyroid and the pancreas. Experience of depersonalization have been associated with epilepsy, brain tumors, sensory deprivation and emotional trauma, and depersonalization phenomena have been caused byelectrical stimulation of the cortex of the temporal lobes during neurosurgery.

Depersonalization is associated with an array of substances including alcohol, barbiturates, benzodiazepines, scopolamine-adrenergic receptor antagonist, marijuana and virtually any phencyclidine (pcp)-like or hallucinogenic substance.

3. Diagnosis and clinical Features

The DSM-IV-TR diagnostic criteria for depersonalization disorder require persistent or recurrent episodes of depersonalization that result insignificant distresstopatients or in impairment of their ability to function in social, occupational or interpersonal relationships. The disorder is largely differentiated from psychotic disorders by the diagnostic requirement that reality testing remain intact in depersonalization disorder.The disorder cannot be diagnosed if the symptoms are better accounted for by another mentaldisorder, substance ingestion, or a general medical condition.  The central characteristic of depersonalization is the quality of unreality and estrangement.

4. Differential Diagnosis

Depersonalization may occur as a symptom in numerous other disorders. The common occurrence of depersonalization in patients with depressive disorder and schizophrenia should alert clinicians to the possibility that the patients who initially complain of feeling of unreality and estrangement are suffering from one of the more common disorders.A history and the mental status examination usually should disclose the characteristic features of depressive disorders and schizophrenia.

Because psychometric drugs often induce long lasting changes in the experience of the reality of the self and the environment, clinicians must inquire about the use of such substances. The presence of other clinical phenomena in patients complaining of a sense of unreality should usually take precedence in determining the diagnosis.

5. Course and Prognosis

Inmost patients, the symptoms of depersonalization disorder first appear suddenly; only few patients report a gradual onset. The disorder starts most often between the ages of 15 and 30 years, but it has been seen in patients as young as 10 years Dissociative Disorder
(Conversion Disorders of age; it occurs less frequently after age 30 and almost never in the late decades of life.A few follow-up studies indicate that in more than 50 percent of cases, depersonalization tends to be long lasting condition.

6. Treatments

Little attention has been given to the treatment of patients with depersonalization disorder.At this time, too few data exist on which to base a specific pharmacological  treatment,but the anxiety usually responds to anti-anxiety agents.As with all patients with neurotic symptoms, the decision to use psychoanalysis or insights-oriented psychotherapy is determined not by the presence of the symptom itself but by a variety of positive indications derived from an assessment of the patient’s personality, human relationships,and life situations.