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Depersonalization disorder is characterized by an unpleasant state of disturbed perception in which external objects or parts of the body are experienced as changed in their quality, unreal, remote, or automatized. The patient is aware of the subjective nature of this experience. The symptom of depersonalization is quite common as a minor feature of other syndromes, but depersonalization disorder is quite rare.
There is insufficient evidence about the etiology of depersonalization disorder to be certain whether it is related to the dissociative disorders. Depersonalization disorder is classified as a dissociative disorder in DSM-IV (though has a separate place in ICD-10). For this reason and even though depersonalization is associated also with anxiety and obsessional disorders, we have chosen to describe the disorder here.
Depersonalization Disorder is where a person "looks at themselves from the outside", and observes their own physical actions or mental processes as if they were an observer instead of themselves. This often brings a sense of unreality, and an alteration in the perception of the environment around them, as well as the person fearing they are not in full control of themselves.
They feel separated from themselves or outside their own bodies. People with this disorder feel like they are "going crazy" and they frequently become anxious and depressed.
An episode of depersonalization disorder can be as brief as a few seconds or continue for several years.
Depersonalization is the third most common psychiatric symptom and frequently occurs in life-threatening danger, such as accidents, assaults, and serious illnesses and injuries; it can occur as a symptom in many other psychiatric disorders and in seizure disorders.
Clinical picture of Depersonalization disorder
Patients describe feelings of being unreal and experiencing an unreal quality to perceptipns They say that their emotions are dulled and that their actions feel mechanical. Paradoxically, they complain that this lack of feeling is extremely unpleasant. Insight is retained into the subjective . nature of their experiences. These symptoms may be intense, and accompanied by deja vu and by changes in the experience of passage of time. Some patients complain of sensory distortions affecting a single part of the body (usually the head, the nose, or a limb), which may be described as feeling as if made of cotton wool.
Two-thirds of the patients are women. The onset is often in adolescence or early adult life, with the condition starting before the age of 30 in about half the cases (Shorvon et at. 1946). The symptoms usually begin suddenly, sometimes when the person feels aroused but sometimes in the course of relaxation after intense physical exercise (Shorvon et at. 1946). Once established, the disorder often persists for years, though with periods of partial or complete remission.
Symptoms of Depersonalization Disorder
Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).
During the depersonalization experience, reality testing remains intact.
The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Treatment of Depersonalization Disorder
Since dissociative disorders seem to be triggered as a response to trauma or abuse, treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used. Many of the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, and can be controlled by the same drugs used to treat those disorders. A person in treatment for a dissociative disorder might benefit from antidepressants or antianxiety medication.
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