"I remember I was having a particularly bad day, and I felt like I could barely process my surroundings," Preston, who has been diagnosed with depersonalization-derealization disorder (DPDR), explains.
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Depersonalization-derealization disorder is classified as such by both DSM5 and ICD11.
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If this response occurs in real-life, non-threatening situations, the result can be shocking to the individual. Depersonalization-derealization disorder may be prevented by connecting children who have been abused with professional mental health help.
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Occasional, brief moments of mild depersonalization can be experienced by many members of the general population; however, depersonalization-derealization disorder occurs when these feelings are strong, severe, persistent, or recurrent and when these feelings interfere with daily functioning.
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During episodic and continuous depersonalization, the person can distinguish between reality and fantasy and the grasp on reality remains stable at all times.Simeon and Abugel p. 32 & 133 While depersonalization- derealization disorder was once considered rare, lifetime experiences with it occur in about 1–2% of the general population. The chronic form of the disorder has a reported prevalence of 0.8 to 1.9%.
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Depersonalization-derealization disorder is thought to be caused largely by interpersonal trauma such as childhood abuse. Triggers may include significant stress, panic attacks, and drug use. Studies suggest a uniform syndrome for chronic depersonalization/derealization regardless of whether drugs or an anxiety disorder is the precipitant. It is unclear whether genetics plays a role; however, there are many neurochemical and hormonal changes in individuals with depersonalization disorder.
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The core symptoms of depersonalization-derealization disorder is the subjective experience of "unreality in one's self", or detachment from one's surroundings. People who are diagnosed with depersonalization also often experience an urge to question and think critically about the nature of reality and existence. It results in significant distress. Individuals who experience depersonalization can feel divorced from their own personal physicality by sensing their bodily sensations, feelings, emotions and behaviors as not belonging to themselves.
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Diagnosis is based on the self-reported experiences of the person followed by a clinical assessment. Psychiatric assessment includes a psychiatric history and some form of mental status examination. Since some medical and psychiatric conditions mimic the symptoms of DPD, clinicians must differentiate between and rule out the following to establish a precise diagnosis: temporal lobe epilepsy, panic disorder, acute stress disorder, schizophrenia, migraine, drug use, brain tumor or lesion. No laboratory test for depersonalization- derealization disorder currently exists.
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Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike/surreal, or visually distorted. In addition to these depersonalization-derealization disorder symptoms, the inner turmoil created by the disorder can result in depression, self-harm, low self-esteem, phobias, panic attacks, and suicide. It can also cause a variety of physical symptoms, including chest pain, blurry vision, visual snow, nausea, and the sensation of pins and needles in one's arms or legs.
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In psychology, emotional detachment, also known as emotional blunting, has two meanings: one is the inability to connect to others on an emotional level; the other is as a positive means of coping with anxiety. This coping strategy, also known as emotion focused-coping, is used by avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder.
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Depersonalization-derealization disorder (DPDR), is a mental disorder in which the person has persistent or recurrent feelings of depersonalization or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals experiencing depersonalization may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. In some cases, individuals may be unable to accept their reflection as their own, or they may have out-of-body experiences.
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The disorder is typically associated with cognitive disruptions in early perceptual and attentional processes. Diagnostic criteria for depersonalization-derealization disorder include persistent or recurrent feelings of detachment from one's mental or bodily processes or from one's surroundings. A diagnosis is made when the dissociation is persistent and interferes with the social or occupational functions of daily life. However, accurate descriptions of the symptoms are hard to provide due to the subjective nature of depersonalization and derealization and persons' ambiguous use of language when describing these episodes.
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Some other factors that are identified as relieving symptom severity are diet or exercise, while alcohol and fatigue are listed by some as worsening their symptoms. First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment. The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety and obsession, which contributes to the worsening of symptoms.
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Cause: Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one. Treatment: Same treatment as dissociative amnesia. An episode of depersonalization-derealization disorder can be as brief as a few seconds or continue for several years.
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In the DSM-5, it was combined with derealization disorder and renamed "depersonalization/derealization disorder" ("DDPD"). In the DSM-5, it remains classified as a dissociative disorder. The ICD-11 has relisted it as a disorder rather than a syndrome as previously, and has also reclassed it as a dissociative disorder from its previous listing as a neurotic disorder. Although the disorder is an alteration in the subjective experience of reality, it is not a form of psychosis, as the person is able to distinguish between their own internal experiences and the objective reality of the outside world.
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Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in. Chronic depersonalization refers to depersonalization/derealization disorder, which is classified by the DSM-5 as a dissociative disorder, based on the findings that depersonalization and derealization are prevalent in other dissociative disorders including dissociative identity disorder. Though degrees of depersonalization and derealization can happen to anyone who is subject to temporary anxiety or stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety.
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Dissociative disorder not otherwise specified (DDNOS) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder, and the reasons why the previous diagnoses weren't met are specified. "Unspecified dissociative disorder" is given when the clinician doesn't give a reason. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". F44.89. Examples of DDNOS include chronic and recurrent syndromes of mixed dissociative symptoms, identity disturbance due to prolonged and intense coercive persuasion, disorders similar to dissociative identity disorder, acute dissociative reactions to stressful events, and dissociative trance.
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