buyingDepersonalization Disorder
In modern times, mental disorders are of major concern for both scholars and practicing specialists, who are constantly working on their description, classification, detection and treatment. There are numerous disputes and controversies in these studies. The well-known condition of self-alienation was considered to be a mere secondary symptom of other complex diseases until recently. Only after a series of profound researches, it obtained the official recognition as a separate psychological disturbance – Depersonalization Disorder. It actually influences many people and can lead to negative consequences, so it requires proper and thorough treatment.
The basic idea of depersonalization disorder (DPD) is losing the cohesion with one’s own body and feeling detached from it. But that can be observed in different cases of mental distresses. Many physicians still regard depersonalization as a secondary symptom, not a specific illness, what causes frequent misdiagnoses (Sierra, 2009, p. 3). The difficulty in its differentiation can be explained by its tight overlapping with other disorders. To illustrate that, Neziroglu and Donnelly (2010) compare close conditions of daydreaming, depersonalization and dissociative identity disorder, placing them on the scale from mild to severe, correspondingly; and single out chronic depersonalization, naming it a “very destructive and distressing” syndrome (p. 18).
Furthermore, researchers insist that it is necessary to distinguish depersonalization disorder from simple depersonalization. Neziroglu and Donnelly argue that the majority of people have fleeting depersonalization experiences, although they may not comprehend the nature of their state (2010, p.7). Depersonalization often occurs because of alcohol or drug abuse, as a side effect of medications etc. It can last for hours, days or months and even years in severe cases. Neziroglu and Donnelly refer to the observation of Mauricio Sierra, according to which, approximately 2 percent of the American population suffer from DPD (2010, p. 8). Sierra mentions that depersonalization experience is peculiar to teenagers, being short-term at that period (2009, p. 4). However, it might be the onset of chronic disease development in later years.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) of the American Psychiatric Association (2010), there are four essential criteria for detection of depersonalization disorder (p. 532). The first one is incessant or recurrent feeling of self-estrangement, a sense of being an external observer of one’s own mind and body. At the same time, one may perceive one’s movements as mechanical or uncontrolled. Neziroglu and Donnelly provide a vivid comparison of those sensations: “You may feel like you’re in autopilot, or as if some unknown force has taken control of your body and now it acts independently of you” (2010, p. 9).
Further, it is important that the person clearly apprehend the reality without any delusions. DPD only generates a detached view of the reality: “Depersonalization may feel like being encapsulated in a bubble, as if you can’t experience what’s around you” (Neziroglu & Donnelly, 2010, p. 9). The third criterion requires that depersonalization shall be a predominant syndrome, affecting normal life activity. Finally, there must be the absence of immediate effects owing to physical substances or other illnesses, including psychological disorders.
Among the features associated with DPD, the most significant one appears to be derealization, which is an alteration of perceiving the surrounding world, with a sense of unreality. It may also manifest itself in macropsia or micropsia – incorrect estimations of the sizes of material objects. DSM-IV-TR additionally indicates that DPD can be accompanied by anxiety, depression, sensory deprivations and irregularities in time perception (2010, p. 530).
Many factors can trigger symptoms of depersonalization. Some believe it to be a defense mechanism of the human ego in response to traumatic experiences or conflict situations, according to B. Sadock and V. Sadock (2007, p. 669). To support that argument they show that in certain studies, about 60% of patients who had been in dangerous circumstances felt depersonalization.
In the meanwhile, Sierra argues that the latest investigations have proved the existence of neurobiological mechanisms of DPD (2009, p. 4). Specific features that characterize depersonalization are similar for different people from different epochs, notwithstanding transformations of the society, culture and living conditions. Neziroglu and Donnelly agree that DPD symptoms are of a permanent nature, scarcely changing in the course of time (2010, p. 40). Concerning the nature of dissociation process, they suppose that it is “an inhibitory mechanism for autonomic emotional responses” (p. 43). That is, DPD might function as a suppressor of negative states. Sierra holds the same opinion. In case of anxiety, he suggests that in order to balance its “excitatory tendency”, brain replies autonomously in the form of depersonalization condition that has a relevant “inhibitory tendency” (Sierra, 2009, p. 135).
Naturally, it is hard to determine DRD precisely due to its pure subjectivity and absence of manifestations in objective reality, as well as entangled connections with other psychological disturbances. Diagnosing DPD usually is based on the self-reported experiences of individuals with the obligatory subsequent clinical assessment, including mental status examination and relevant drug screens (Sadock B., & Sadock V., 2007, p. 669). Clinicians apply a range of interviews and scales, e.g. the Cambridge Depersonalization Scale, effective in diagnosing DPD in the clinical setting, or the Structured Clinical Interview for Dissociative Disorders, mainly applied for research purposes.
As for treating DPD, there are no fixed procedures at present. Depersonalization caused by traumatic experiences or intoxications is usually transient and may remit without any formal treatment, while depersonalization accompanying a mental distress eventually disappears along with it. According to the examples of B. Sadock and V. Sadock, psychotropic medications generally achieve modest success in treating DPD (2007, p. 669). Concerning psychotherapy, for one group of patients it would be effective to apply distraction and relaxation techniques, which teach the body to cope with an intense anxiety (Sadock B., & Sadock V., 2007, p. 670). Some may find self-hypnosis training useful: hypnosis, on the one hand, induces depersonalization symptoms, and simultaneously allows the person to learn how to identify and control them on the other hand.
As Neziroglu and Donnelly assert in their practical-oriented guide, the most widely used methods of treating depersonalization disorders are Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) (2010, p. 142). The first strategy grounds on the assumption that thinking patterns control human behavior and the correct way of thinking can help overcome mental distresses (Neziroglu & Donnelly, 2010, p. 158). CBT depends on the patients’ understanding the nature of their condition, therefore, it involves a preliminary psycho-educational phase. CBT employs such techniques as reducing avoidance of facing the situation directly, transferring attention from oneself to various internal and external stimuli, as well as keeping diaries to identify adverse factors. CBT may also include physiological interventions, like relaxation trainings. In general, cognitive therapies may not seem to be too sophisticated, however, they proved their efficiency in combatting depersonalization and anxiety disorders.
Acceptance and Commitment Therapy assumes that DPD is caused by the individual’s attempts to escape from unpleasant circumstances, states, thoughts and feelings. Consequently, it relies on the strategies of accepting the reality and maintaining positive presence of the individual in it (Neziroglu & Donnelly, 2010, p. 156). ACT encourages one to stop struggling with unfavorable personal experiences and actively engage oneself in the surrounding world, retaining constant realization of the ‘observer’ role in the process.
To sum up, depersonalization disorder is a rather harmful syndrome, despite its frequently transient nature. Owing to its close relations to other mental distresses, it is still subject to intense discussion and on-going researches. Nevertheless, there are strict criteria for diagnosing DPD and practically tested diagnostic techniques. While the operating methods of DPD treatment have not been fully established yet, the Cognitive-Behavioral Therapy and the Acceptance and Commitment Therapy have been successfully applied for different groups of patients. Nowadays, consulting psychologists should realize the independent status of depersonalization disorder and render appropriate medical assistance to the persons complaining thereof.