132 Depersonalization Disorder (300.6)

This is a video of a woman who was diagnosed with depersonalization disorder. In the video she gives a good description of what it feels like when a person is experiencing an episode caused by depersonalization disorder.

DSM-IV-TR criteria

A. 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).

B. During the depersonalization experience, reality testing remains intact.

C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy)

Associated features

• Associated features may include anxiety or depression. Sometimes, individuals have a hard time with sense of time and may have somatic manifestations. Comorbidity can include Panic Disorder, Borderline Personality Disorder, Post-Traumatic Stress Disorder, Obsessive-compulsive Disorder, Dysthymic Disorder, Acute Disorder, or Major Depressive disorders. Individuals with Depersonalization disorder may have personality disorders as well.
• Individuals with Depersonalization have difficulty describing their symptoms and may fear that these experiences signify that they are “crazy.” Derealization may also be present and is experienced as the sense that the external world is strange or unreal. The individual may perceive an uncanny alteration in the size or shape of objects, and people may seem unfamiliar or mechanical.

Child vs. adult presentation

The disorder is more likely to occur in late adolescence to adulthood.

Gender and cultural differences in presentation

• From various studies, equal numbers of men and women are diagnosed. Individuals from individualistic societies are more likely to suffer from the disorder (see Etiology).
• In clinical samples, this disorder is diagnosed at least twice as often in women than in men.

Epidemiology

• Although much of the general population experiences a depersonalization experience (whether caused by a traumatic experience or danger, or a drug induced experience), only about 2.4% of the population has been diagnosed with depersonalization disorder.
• A transient experience of depersonalization develops in nearly one-third of individuals exposed to life-threatening danger and in close to 40% of patients hospitalized for mental disorders.

Etiology

Similar to the other dissociative disorders, scientists link severe childhood abuse to depersonalization disorders. Brain imaging including pet scans show sensory cortex abnormalities. Positron emission tomography scans used to assess brain glucose metabolism show abnormalities in the sensory cortex including the temporal, occipital, and parietal lobes. The sensory cortex controls the senses and perception of an individual’s body in space. Lower levels of nerve cell responses in the area of the brain that controls emotion may correlate to the emotional detachment that individual’s feel during an episode of depersonalization. Western cultures where individuals live in a more individualistic society may be more likely to suffer from a depersonalization disorder. Individualism is stressed in most Western cultures and may have an effect on an individual’s sense of self. Also, it is thought that trauma and childhood abuse (physical, emotional, and/or sexual) could be a factor to depersonalization disorder.

Empirically supported treatments

• There are currently no empirically supported treatments for this condition. For the most part, DPD remains resistant to traditional treatment measures. Psychotherapeutic techniques like cognitive behavioral therapy have been used to treat this disorder, but none of them have an established effectiveness. Pharmacological options continue to be researched. Some possible options that could be used to treat this condition include selective serotonin reuptake inhibitors, anticonvulsants, and opioid antagonists.
• Also some medications like benzodiazepine tranquilizers (lorazepam and clorazepate) and tricyclic antidepressants (amitriptyline and doxepin) can be helpful in treatment for Desensitization Disorder.
• Despite anecdotal reports that serotonin reuptake inhibitors may improve depersonalisation, there is no proven efficacious treatment for depersonalisation disorder (Simeon, Guralnik, Schmeidler, & Knutelska, 2004).

Proposed Changes in DSM-5 (dsm5.org)

Either (1), (2), or both:

A1. Depersonalization: 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 as though one is in a dream; sense of unreality of self or body; or time moving slowly)

A2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)

B. During the depersonalization or derealization experience, reality testing remains intact
C. The depersonalization or derealization symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The depersonalization or derealization symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., complex partial seizures).
E. The depersonalization or derealization symptoms are not restricted to the symptoms of another mental disorder (e.g.,schizophrenia, panic disorder, acute stress disorder, posttraumatic stress disorder, major depressive disorder, or another dissociative disorder).

Specify if:

a) Depersonalization only

b) Derealization only

Rationale for Change

D and E: Changes allow comorbid diagnoses to be made when warranted.

Severity

Brief Dissociation Scale (Carlson E & Dahlenberg C, 2009)