Depersonalization of personality

This phenomenon refers to deviations in the sphere of self-awareness, including both a disorder of self-awareness and its cognitive form. Normally, each person separates his own “I” from the entire surrounding world, somehow evaluating himself, his physical characteristics, level of knowledge and moral values, his place in society. Depersonalization is a special psychopathological state of change in the subjective attitude to his own “I”. The subject loses the feeling of uniqueness, activity and indivisibility of his own personality, the naturalness of his self-expression is lost. He constantly compares his current self with his former self, analyzes his thoughts, actions, behavior. The results of the subject's self-analysis are not comforting - the sharpness and clarity of perception of the surrounding reality have disappeared, it practically no longer interests him, his own actions have lost their naturalness, have become automatic, imagination, flexibility of mind, fantasy have disappeared. Such hypertrophied reflection causes significant psychological discomfort in the subject, he feels isolated, is aware of the changes that have occurred to him and experiences this very painfully.

During depersonalization, there is a rupture of the reflexively conditioned transition of the real world into the subjective one, transformed by the consciousness of a given person, that is, the formation of self-awareness is interrupted. A person observes his own life detachedly, often feeling qualitative changes in his personality, the inability to control his actions, the lack of control over parts of his body. The phenomenon of split personality is characteristic. An accompanying condition is derealization - a complete or partial disruption of sensory perception of the surrounding reality, concerning exclusively qualitative changes.

Detachment from one's own "I" and temporary shutdown of the emotional component of perception for a short time is considered a normal reaction of the human psyche to acute stress, mental anesthesia, allowing one to survive a traumatic event, abstract from emotions, analyze the situation and find a way out of it. However, depersonalization/derealization syndrome can last for a long time - for weeks, months, years, no longer depend on the affective background and exist autonomously. And this is already a pathology. Clinical manifestations of the syndrome are observed in symptom complexes of psychoses, neuroses, progressive mental and general diseases. Impaired self-perception can exist for a long time as a reaction to a psychotraumatic event outside of diseases of the central nervous system and in a completely healthy, but overly impressionable and vulnerable person.

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Epidemiology

To date, there is no single approach and clear interpretation of the phenomenon of depersonalization. Representatives of different psychiatric schools use this term to designate various symptom complexes of mental disorders. Some consider only the alienation of mental processes within the framework of depersonalization, while in other cases the term is used more broadly - it includes disturbances in the idea of the body scheme, mental automatisms, deja vu and jemé vu. Therefore, the comparison of observations of researchers is very relative.

Most psychiatrists agree that it is virtually impossible to diagnose depersonalization in children. The manifestation of most cases of the phenomenon is attributed to the age range from 15 to 30 years.

The formation of self-awareness occurs in adolescence, so the younger generation is at risk. However, depressive episodes in adolescents are almost never accompanied by symptoms of depersonalization. The greatest number of cases of such disorders among the youngest patients are a manifestation of weakly progressive schizophrenia, are observed in epileptics, and adolescents who abuse psychoactive substances are also susceptible to them.

In adults, symptoms of depersonalization are more common in depressive disorders.

The opinions of child psychiatrists differ significantly; some see rudimentary symptoms in children with schizophrenia as early as three years of age, while others can diagnose the pathology closer to ten years of age.

There are also significant differences in the gender component. Some authors did not notice a significant difference between men and women, while others, in particular German psychiatrists, noted a significant predominance of female patients – four women to one man.

The possibility of short-term episodes of depersonalization in the majority of the population is recognized (estimated at approximately 70%), and in this case there is no division by gender. However, the long-term course of the syndrome is twice as common in women.

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Causes depersonalization syndrome

As an independent nosological unit, this syndrome is considered a type of neurasthenia, but in an isolated form it is extremely rare. More often, it is part of a symptom complex of schizophrenia, epilepsy, obsessive-phobic or compulsive disorder, depression, and may have an organic origin. Patients suffering from depersonalization often have a mild organic cerebral deficit. In these cases, the patient is diagnosed with an existing disease.

Most specialists are inclined to believe that depersonalization/derealization syndrome develops under the influence of a stress factor in interaction with the features of the individual model of the subject's response to a psychotraumatic situation. In almost all known cases, the appearance of symptoms of this disorder of self-awareness was preceded by the presence of severe anxiety, fear, and worry in the patient. Moreover, in women, stress was most often associated with situations threatening the life of their child, and in men - their own. Although often the cause of the disorder were also less significant events.

The causes of the syndrome, as well as many other mental illnesses and deviations, have not been precisely established. It is believed that the mildest form of depersonalization, which is referred to as the first type, is caused mainly by external causes - stressful situations and related nervous strain in subjects in borderline mental states, intoxication with psychoactive substances, cerebral insufficiency of organic origin of a mild degree. Infantile personalities prone to hysteria and phobias, children and adolescents are susceptible to the development of the first type of syndrome. In this case, earlier forms of self-awareness associated with the well-being of the individual are lost. The disorder occurs in the form of paroxysms, periodically arising against the background of a completely favorable mental state.

Depersonalization of the second type has a more severe course and is caused by internal reasons. It is often observed in sluggish schizophrenia, in mentally excitable individuals prone to hypertrophied reflection and getting stuck. This type is more common in males during the period of personality formation - late puberty and adolescence. A certain maturity of self-awareness is necessary for the development of this type of syndrome, often the first type smoothly flows into the second as they grow older. Patients subjectively feel the loss of personal specificity, with a pronounced picture, the patient develops a feeling of complete loss of his "I", social communications are lost.

The third type (psychic anesthesia) is also of endogenous origin and occupies an intermediate position in severity between the two already described. It occurs in mature people, mainly women, with a diagnosis of endogenous depression, less often in psychopaths and people with cerebral deficiency of organic genesis. It is manifested by the loss of the emotional component and is accompanied by symptoms of depersonalization.

A significant risk factor for the development of the syndrome are certain personality traits of the individual. People susceptible to this syndrome often have inflated claims, overestimate their capabilities, do not take into account any objective circumstances, and, having not received what they want and not feeling the strength to continue the fight, they fence themselves off from their own "I", feel that they have lost their previous personal qualities. A tendency to long-term fixation on negative events and self-analysis, suspiciousness increases the likelihood of developing the syndrome. It is believed that the exhausted psyche of such a subject creates a protective barrier to prevent more serious mental health disorders or the development of vascular crises. A protracted protective process, when the situation is not resolved on its own, turns into a pathology requiring medical intervention.

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Risk factors

Taking into account all of the above, the most likely risk factors for the development of depersonalization symptoms are:

• hereditary predisposition to pathological anxiety, constitutionally determined low stress resistance;
• acute or chronic overstrain of the body;
• lack of sleep, chronic fatigue and inability to regain strength;
• forced or conscious loneliness, rejection in the family, among peers;
• vegetative-vascular dystonia;
• cervical osteochondrosis;
• alcoholism, drug addiction (including addiction to caffeinated drinks and drugs that cause drug dependence), gambling addiction;
• diseases of the central nervous system;
• mental disorders;
• somatic diseases affecting hormonal balance and metabolism;
• hormonal and psychological nuances associated with age-related crises, pregnancy;
• physical or psycho-emotional abuse in childhood;
• witnessing scenes of violence.

Patients with depersonalization have many common histories of illnesses since childhood: frequent acute tonsillitis in childhood, which resulted in its chronic form; inflammation of the gallbladder, frequent complaints of intestinal spasms, later - lumbago and myositis, especially in the cervical region, myalgia; discomfort in the spine and epigastrium, behind the sternum in the heart area; thyroid hyperplasia was often observed, etc. Even minor exciting events caused them to have jumps in blood pressure, sleep disorders and other vegetative symptoms. They were often visited by obsessive scary thoughts that eventually turned into phobias.

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Pathogenesis

The mechanism of development of depersonalization/derealization syndrome is triggered in a predisposed (hypersensitive to emotional situations, anxious, suspicious) individual by a whole complex of reasons acting against the background of mental exhaustion, threatening disorganization of the mental process or vascular catastrophes. Short-term depersonalization is of a protective nature, which is recognized by all specialists in the field of psychiatry. The protective role is replaced by a pathological one when the defense takes a protracted course and becomes the basis of a painful condition that can last for months and even years.

The presumed pathogenesis of depersonalization is currently considered at the neurophysiological level as an increase in the synthesis of β-endorphins (endogenous opiates) in the neurons of the pituitary gland in response to stress or an increase in the activation of opioid receptors, which disrupts the neurochemical balance and triggers a cascade of changes in other receptor systems. The synthesis of γ-aminobutyric acid is disrupted, which leads to a change in the activity of neurotransmitters that regulate positive emotions and mood - an increase in the level of dopamine in the striatum, serotonin, which inhibits neurons of the hippocampus. Histaminergic structures are affected.

It is assumed that there may be a shutdown of the pleasure center (anhedonia) and the limbic system, which is responsible for organizing emotional and motivational behavior.

The therapeutic effect of naloxone, a drug that blocks opioid receptors, confirms the involvement of the endogenous opiate structure in the pathogenesis of depersonalization.

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Symptoms depersonalization syndrome

The French psychiatrist L. Dugas (one of the authors of the term "depersonalization") interpreted this condition as a feeling of loss of one's own existence, and not its loss, noting that the feeling of "I" is lost only in a fainting and comatose state, at the moment of an epileptic seizure, the phase of deep sleep, and also at the moment of severe clouding of consciousness (amenia).

The main symptom of depersonalization is the patient's subjective feeling that his "I" is acquiring an alien, detached character. A person observes his thoughts, actions, body parts detachedly, the connection of the personality with the outside world is disrupted. The environment, which was previously perceived (which the patient remembers very well) as natural and friendly, becomes decorative, flat, sometimes hostile.

How long does depersonalization last?

The answer to this question depends entirely on the nature of the phenomenon's origin. Personal detachment as a natural protective reaction is short-term - from several hours to several days, depending on the strength of the stress factor and the depth of the mental trauma.

The syndrome can develop against the background of mental or nervous system diseases, acquire a painful permanent or recurrent form and continue for years. Naturally, you should not wait long for depersonalization to pass on its own. If the condition bothers you for more than a week and there is no improvement, you need to be examined and, possibly, undergo treatment. Even a single, but protracted episode requires attention. A series of short-term episodes should also not be ignored.

The manifestation of psychosis has in most cases a sudden acute onset immediately after a psychotraumatic event, sometimes preceded by melancholy and anxiety. After several months, the severity of the disease dulls, and it becomes more monotonous.

In the initial stage, treatment can be most effective. If the patient does not seek medical attention or treatment does not help, the disease becomes chronic. Yu. L. Nuller noted that many of his patients suffered from depersonalization-derealization disorder for a very long time - ten to fifteen years or more.

Many patients got used to their condition, developed a certain way of life and strictly followed it, involving and subordinating members of their family to their illness. The patients occupied all their time with the performance of scrupulously planned activities, to which, as they themselves said, they did not feel the slightest interest, for example, visiting excursions, plays, long walks and other activities positioned by the patients as formal, however, necessary, since everyone does this. Periodically, they visited the doctor, complained that they could no longer live like this, however, when they were offered to try a new method of treatment or to go to the hospital, they refused under any pretext or simply disappeared for a while. The doctors got the impression that they did not really want to get rid of their usual pathology and change their lives.

Complications and consequences

The protective role of the short-term phenomenon of alienation, the emergence of mental anesthesia as a reaction to deep stress is undeniable. This state allows one to survive mental trauma with the least losses for the central nervous system. However, in this case, the depersonalization/derealization syndrome does not last long and ceases on its own with the elimination of the stress effect.

If attacks of depersonalization are repeated after the elimination of the psychotraumatic situation and already exist independently of stress, the process should not be left to its own devices. There are cases when depersonalization goes away on its own, like any other disease. But you should not count on this. After all, any problem is easier to solve at the initial stage.

Often, people suffering from attacks of depersonalization develop excessive perfectionism, they acquire unshakable habits, rituals, and it is increasingly difficult for them to return to their previous life. Family members, friends, and relatives are involved in the process, which can lead to a breakdown in family ties and the isolation of the patient.

Even a condition not associated with progressive mental illness does not always resolve itself. Constant reflection leads to the development of obsessions, which over time acquire the character of impulsive actions.

Patients may become amorphous, indifferent to themselves, their appearance, work. Social connections and independence are lost, there is a high probability of committing criminal acts, suicide. The patient initially treats the situation that has arisen critically, realizes its unnaturalness, this causes him a lot of suffering and can lead to depression or aggression towards others or himself.

Therefore, if attacks are repeated or stable depersonalization is formed, it is better to seek help from competent specialists. Full recovery is possible if the syndrome was a consequence of stress, arose against the background of neurosis, and treatment was started in a timely manner.

Depersonalization, which manifests itself as a symptom of a serious progressive mental illness, has consequences and complications of this disease, and in most cases it is attributed to negative symptoms and manifestations of the disease's resistance to treatment. However, even in this case, timely treatment can improve the situation

Diagnostics depersonalization syndrome

Patients usually come to the doctor complaining of a sudden change in the perception of their personality, their moral character, their desires, aspirations, attachments or their body, loss of feelings and loss of trust in their sensations. Moreover, they emphasize that they understand that it seems to them. The descriptions include expressions: “as if”, “it seems”, “I see one thing, but it is perceived as something completely different”. They usually find it difficult to describe the symptoms, since the sensations are often vague and fantastic, while the patient is aware of the bias of his own sensations.

The patient may be prescribed clinical laboratory tests to determine the general level of his health, urine analysis to detect traces of toxic substances.

Ultrasound examination, electroencephalography, magnetic resonance imaging are done to identify organic disorders, especially if some complaints do not fit into the clinical picture of the syndrome, it is impossible to associate the onset of depersonalization with any provoking factor, or the manifestation of the disease occurred late, for example, after the patient's fortieth birthday.

The main diagnostic tool is the depersonalization test, which is a list of the main symptoms of the syndrome. The patient is asked to answer questions about what symptoms he is experiencing. The most famous questionnaire (Nuller scale), which includes various symptoms of derealization and depersonalization, was compiled by famous psychiatrists Yu. L. Nuller and E. L. Genkina. The test is conducted by a specialist, evaluating the patient's answers in points. When the patient scores more than 32 points, the doctor may suspect that he has a disorder.

The diazepam test allows for a more precise diagnosis. This method is considered reliable for distinguishing depersonalization/derealization syndrome from anxiety disorder and depression. Developed by Professor Nuller, it involves the patient's reaction to a jet injection of diazepam into a vein. The dose of the drug varies from 20 to 40 mg and depends on the patient's age and the severity of the disorder.

In patients with depression, the clinical picture remains virtually unchanged with diazepam; the drug causes drowsiness and lethargy.

In case of anxiety disorder, the symptoms of the disorder disappear almost immediately, even during the administration, and sometimes even mild euphoria appears.

In depersonalization/derealization syndrome, the reaction occurs 20 minutes or half an hour later after the drug is administered. Symptoms are completely or partially eliminated: patients experience the emergence of feelings and perception of a colorful real world.

The patient is examined for depression, the preservation of intelligence and ability to think, character accentuations. Using psychodiagnostic methods, family history, relationships with relatives, psychotraumatic situations in the patient's life, resistance to stress and anxiety level are studied.

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Differential diagnosis

Based on the examination data, a final diagnosis is made. The predominant symptoms of the syndrome are determined: depersonalization or derealization, its type. Organic and somatic pathologies, alcohol and drug use, and the consequences of drug therapy are excluded. The main diagnostic criterion for the disorder is that patients do not lose the ability to realize that their sensations are subjective, that objective reality does not correspond to their perception, and are fully conscious.

Oneiroid, amentia, derealization-depressive syndrome require precise differentiation, since the prescription of medications and the success of treatment depend on the correct diagnosis.

Cotard's delusion (the central place in it is occupied by nihilism in relation to both one's own life and to everything around) is characterized by symptoms that are more similar to the delirious state of depersonalization, which in severe cases reaches this height. However, in periods of clarity, individuals with depersonalization make contact and realize that they exist.

Delirious delirium and hallucinations of any etiology resemble severe depersonalization disorder in their symptoms, however, episodes of delirium are characterized by such vivid symptoms of agitation and confusion that in most cases their differentiation is not difficult. The greatest difficulty is presented by cases of hypokinetic delirium, when the patient is relatively calm.

The most difficult thing is to differentiate depersonalization/derealization syndrome from schizophrenia or schizoid personality disorder. This is facilitated by the emotional coldness of patients, the loss of warm feelings even towards close people, the difficulty in putting their feelings and experiences into words, which can be taken for fruitless, complex, ornate speech constructions.

A diagnostic marker may be information about events preceding the onset of the syndrome: in the case of neurotic origin, there is always a connection with a stress factor, but in the case of schizophrenia, as a rule, there is none.

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Treatment depersonalization syndrome

In cases where mental or somatic pathology has become the cause of the symptoms of depersonalization/derealization, the only way out is to treat the underlying disease. When it is cured or stable remission is achieved, the symptoms of depersonalization disappear, and, as a rule, it is they who are the first to appear.

Read more about how to treat depersonalization here.

A condition that develops as an independent neurotic syndrome against the background of acute or prolonged stress, occurs suddenly and plunges a person, at a minimum, into confusion. Naturally, we are not talking about a condition that lasts for several minutes or hours, but about regular attacks or a persistent disorder, that is, about pathology.

Much depends on the severity of the disorder and the state of the psyche. There are cases when depersonalization syndrome successfully passed on its own, however, you should not delude yourself with hope for this. It is necessary to act, and to achieve success, use the recommendations of psychologists, as well as people who have experienced a similar condition and know from their own experience what line of behavior to choose in order to say goodbye to the disorder and perhaps even avoid the use of psychotropic drugs.

Prevention

To prevent the occurrence of the syndrome and its relapses, those who have already encountered a similar condition are usually recommended to lead a healthy and open lifestyle; in some cases, it would be good to change their place of residence and circle of friends.

However, the main thing is to change yourself, make your view of the world more positive, soberly assess your capabilities and set realistic goals. If you can’t do this on your own, it is recommended to undergo a course of rational psychotherapy.

It's good to do something for the soul - preferably sports, dancing is possible, preferably in a group. Physical activity that is feasible helps to produce internal substances with an antidepressant effect.

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Forecast

Depersonalization that is not associated with progressive mental illnesses – epilepsy, schizophrenia and organic pathologies of the central nervous system – in most cases resolves successfully.

Of course, people who seek help in the first days of a pathological condition have a better chance of getting out of the situation without consequences. Sometimes a few conversations with a psychotherapist are enough to fully recover.

In some cases, usually advanced ones, the syndrome becomes chronic and resistant to treatment. Much depends on the patient himself, if he wants to get rid of psychological discomfort, tries to distract himself, focusing his attention on rational thoughts and actions, then his prognosis is much more favorable. In some, the syndrome becomes a permanent recurrent character. However, with isolated depersonalization of neurotic genesis, significant personality changes are not observed.

If the patient experiences pronounced personality changes and develops pronounced productive psychotic symptoms, then the prognosis is less favorable and depersonalization can lead to social maladjustment, partial or complete loss of ability to work and independence.

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