Depersonalization is a dreamlike feeling of being disengaged from one's surroundings. It leads to a sense that things are "less real" than they should be. People who experience depersonalization tend to feel detached from themselves.
Those who experience severe depersonalization say that it feels as if they are watching themselves act from a distance without having a sense of complete control. The person with this condition will be aware that these are only feelings and not reality.
A 2005 article in Advances in Psychiatric Treatment describes depersonalization as a "disturbing sense of being 'separate from oneself,' observing oneself as if from outside, feeling like a robot or automaton."
There may be "an unpleasant, chronic, and disabling alteration in the experience of self and environment."
Depersonalization is an aspect of dissociation, but while dissociation involves feeling detached from many things, depersonalization specifically refers to a sense of detachment from oneself and one's identity.
The National Alliance for Mental Illness note that almost half of all Americans experience dissociation at some time, but chronic depersonalization, leading to depersonalization disorder, is less common.
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What causes depersonalization and dissociation?
Depersonalization involves a sense of detachment from oneself, possibly in an out-of-body experience.
Experts do not know exactly what causes depersonalization. It is thought to stem from an imbalance in brain chemicals.
As with other dissociative disorders, feelings of depersonalization are usually triggered by life-threatening or traumatic events, such as extreme violence, war, a kidnapping, or childhood abuse.
One suggestion is that if a susceptible person experiences dissociation as a result of trauma, for example, it becomes established and is apt to recur.
Some recreational drugs, such as ketamine, and other substances may also trigger feelings of depersonalization.
- Cannabis use has been linked to epidodes of depersonalization or dissociation, as has withdrawal from cannabis usage.
- Perceptual disturbances such as depersonalization have been reported among people who are withdrawing from benzodiazepines.
- Alcohol may induce depersonalization in some people, according to evidence published in the journal Biological Psychiatry.
- Hallucinogens can lead to depersonalization when ingested.
Most people who experience depersonalization also have another psychiatric or mental disorder. Linked conditions include dissociative disorders, and some non-dissociative disorders.
Dissociative disorders include:
- Dissociative amnesia, in which people may forget information about themselves or things that have happened to them
- Depersonalization-derealization disorder, which can involve out-of-body experiences, a feeling of being unreal, and an inability to recognize one's image in a mirror. There may also be changes to bodily sensation and a reduced ability to act on an emotional level
- Dissociative identity disorder, or "multiple personality disorder," where a person becomes confused about who they are and feel like a stranger to themselves. They may behave differently at different times or they may write in different handwriting.
In some cultures, people seek to attain depersonalization through religious or meditative practices. This is not a disorder.
Risk factors and symptoms
Clinically significant depersonalization is thought to affect between 1 and 2 percent of the general population.
Dissociation and depersonalization are ways of switching off from past trauma.
The average age at which the first experience occurs is 22.8 years, but 1 in 3 people with the condition notice it before the age of 16 years. It is more likely among adolescents or young adults. Those with depression, multiple personality disorder, schizophrenia, and obsessive compulsive disorder are at higher risk.
Abuse of certain drugs may increase the risk, as does withdrawal from benzodiazepines or cannabis. While it is not sure that drugs cause the condition, using cannabis, for example, has been cited as a trigger in people who are susceptible.
It may also be that people with dissociative disorder are more likely to use drugs and alcohol to help them cope.
People who experience dissociation are likely to have memory loss or gaps in memory, especially of specific people, events, or periods in life.
People with dissociative disorders are more likely to display obsessive behavior. This may include self-harming or repeatedly looking in a mirror to check that they are real. The self-harming behavior may be related to the trauma rather than the lack of a sense of reality.
Anxiety is also common, whether as a cause or effect of dissociation.
If dissociation is a result of trauma, a flashback to the unwanted memory may trigger an episode.
During a dissociative episode, some people will have an out-of-body experience, in which they feel as if they are watching themselves as an observer, or watching their own life from a distance.
They may feel disconnected from their own body, and life may feel like a dream, where everyone around seems unreal. They may also feel that they are not in control of their actions.
For some people, an episode can involve physically traveling to a different place and taking on a different identity while there. The individual may not remember their own identity.
Diagnosis and treatment for depersonalization disorder
A doctor may diagnose dissociative disorder by asking a patient about their symptoms and their personal and medical history. Neurological tests may be necessary to rule out conditions such as epilepsy.
Reports suggest that a person with dissociative disorder will commonly use the expression "as if," in sentences like, "I feel as if I am not real," or "as if I am a robot."
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) lists the following as diagnostic criteria for depersonalization disorder:
- Feeling detached from one's mental processes or body
- Intact reality testing
- Clinical significantly distress, functional impairment, or both
- Symptoms do not occur exclusively as a part of another disorder or due to the direct physiological effects of a substance
There is currently no treatment for depersonalization or dissociation, but antidepressants help to relieve symptoms in some people. Experts suggest that a combination of medications, specifically lamotrigine and a selective serotonin reuptake inhibitor (SSRI), may help.
Anecdotal evidence suggests that avoiding bright lights or keeping to a regular, monotonous routine may help some people to cope.
Cognitive behavior therapy (CBT) can help patients to view their symptoms in a nonthreatening way and to reduce the anxiety and obsessive behavior which often accompanies them.