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Depersonalization disorder (DSM-IV Dissociative Disorders 300.6[1]) (DPD) is a dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. The symptoms include a sense of automation, going through the motions of life but not experiencing it, feeling as though one is in a movie, feeling as though one is in a dream, feeling a disconnection from one’s body; out-of-body experience, a detachment from one’s body, environment and difficulty relating oneself to reality.
Occasional moments of depersonalization are normal;[2] persistent or recurrent feelings are not. A diagnosis of a disorder is made when the dissociation is persistent and interferes with the social and occupational functions necessary to everyday living. Most cases of depersonalization disorder are triggered by abuse, trauma, and drug use, although a variety of genetic and environmental factors are implicated. Depersonalization disorder can be conceptualized as a defense mechanism as the core symptoms of the disorder are thought to protect the victim from negative stimuli. Depersonalization disorder is often comorbid with anxiety disorders, panic disorders, clinical depression and/or bipolar disorder.
An individual diagnosed with depersonalization disorder may feel as if he or she is going insane although reality testing remains intact during episodes and continuous depersonalization, such that a person suffering from the disorder will be able to behave and interact normally with his or her environment. This fact can be distressing for those with DPD; the friends and family of the victim do not realize that anything is wrong, because the subjective experience of dissociation is not a visible phenomenon. While a nuisance, and very distressing to the sufferer, people with depersonalization disorder represent no risk to society, since their grasp on reality remains intact.[3]
The core symptom of depersonalization disorder is the subjective experience of unreality. Common descriptions are: watching oneself from a distance; out-of-body experiences; a sense of just going through the motions; feeling as though one is in a dream or movie; not feeling in control of one’s speech or physical movements; and feeling detached from one’s own thoughts or emotions.[4] Individuals with the disorder commonly describe a feeling as though time is ‘passing’ them by and they are not in the notion of the present. These experiences may cause a person to feel uneasy or anxious since they strike at the core of a person’s identity and consciousness.
Sufferers retain the ability to distinguish between their own internal experiences and the objective reality of the outside world. Brief periods of depersonalization are notably caused by severe anxiety, stress, a lack of sleep, or a combination. Environmental factors include fluorescent lighting and high levels of sensory stimuli.[5]
Some of the more common factors that exacerbate dissociative symptoms are negative effects, stress, subjective threatening social interaction, and unfamiliar environments. Factors that tend to diminish symptoms are comforting interpersonal interactions, intense physical or emotional stimulation, and relaxation.[5]
Fears of going crazy, brain damage, and losing control are common complaints. Individuals report occupational impairments as they feel they are working below their ability, and interpersonal troubles since they have an emotional disconnection from those they care about. Neuropsychological testing has shown deficits in attention, short-term memory and spatial-temporal reasoning.[6]
An analogy is comparing real life to a game, a game everyone plays, all the time. Someone suffering from depersonalization disorder constantly feels as if they cannot get into the game; any stimulus feels contrived or artificial to them. The rules of this game seem to have been forcibly applied upon them (anything from movement, to gravity or hunger) instead of being inherently applicable to them. If understanding dawns upon them of what they should be experiencing, it is often through reason and observation, or the feeling of knowing what and why it is happening. This sort of insight seems to rob everything of its spontaneity, its importance already having been diminished because of their sense of detachment. They are perpetual, and almost all the time cynics of our reality, although unconsciously and involuntarily.
Common words to describe the condition are as follows. Feeling as though I am: a shell, dead, unreal, a zombie, a robot, an automaton. Other descriptives are: Inability to recognize oneself in the mirror and a distorted perception of the body. Most of these symptoms can lead on to making the individual feel as though they are ‘invisible’. These symptoms can also be considered derealization and jamais vu. Many people who suffer from depersonalization disorder also describe a sense of being an observer and participant. For instance, while the individual with the disorder undertakes a specific action or task, a part of him/her questions what he/she is doing. This persistent “nagging” a individual endures with the disorder again produces more anxiety and makes the person feel more mentally detached. Of course, these symptoms can vary with intensity and can have different effects on different people.
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