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Depersonalization and Derealization
Depersonalization and DerealizationDepersonalization is a change of self-awareness such that the person feels unreal, detached from his own experience and unable to feel emotion. Derealization is a similar change in relation to the environment, such that objects appear unreal and people appear as lifeless, two-dimensional 'cardboard' figures. Despite the complaint of inability to feel emotion, both depersonalization and derealization are described as highly unpleasant experiences. These central features are often accompanied by other morbid experiences. There is some disagreement as to whether these other experiences are part of depersonalization and derealization or separate symptoms since they do not occur in every case. These accompanying features include changes in the experience of time, changes in the body image such as a feeling that a limb has altered in size or shape, and occasionally a feeling of being outside one's own body and observing one's own actions, often from above. Because patients find it difficult to describe the feelings of depersonalization and derealization, they often resort to metaphor and this can lead to confusion between depersonalization and delusional ideas. For example, a patient may say that he feels 'as if part of my brain had stopped working', or 'as if the people I meet are lifeless creatures'. Such statements should be explored carefully to distinguish depersonalization and derealization from delusional beliefs that the brain is no longer working or that people have really changed. Sometimes it is difficult to make the distinction. Depersonalization and derealization are experienced quite commonly as transient phenomena by healthy adults and children, especially when tired. The experience usually begins abruptly and in normal people seldom lasts more than a few minutes (Sedman 1970). The symptoms have been reported after sleep deprivation and sensory deprivation, and as an effect of hallucinogenic drugs. The symptoms occur in generalized and phobic anxiety disorders, depressive disorders, schizophrenia, and temporal lobe epilepsy, as well as in the rare depersonalization disorder. Because depersonalization and derealization occur in so many disorders, they do not help in diagnosis.
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