Symptoms of depersonalization disorder

The first signs appear as a feeling of a sharp qualitative change in oneself today in relation to oneself before. The disorder manifests itself acutely immediately after severe stress, sometimes in the premorbid there is an anxiety disorder, gradually developing into depersonalization. In the initial stage, most patients, according to the observations of Yu. V. Nuller, had predominantly somatopsychic symptoms with the addition of mental anesthesia. During this period, along with the symptoms of depersonalization, patients had anxiety, melancholy, sometimes strong fear or obsessive thoughts that contradicted the patient's moral and ethical criteria, frightening him and causing him mental anguish. Often, the symptoms of depersonalization prevailed in the morning hours, and the symptoms of anxiety disorder intensified at night.

Over time, the mental suffering subsided, the course of the disease became more monotonous, and symptoms of derealization were added. Some patients developed overvalued or delusional ideas about the presence of an unrecognized somatic disease, they looked for its manifestations in themselves, mainly, these were complaints about various kinds of discomfort, most often - myalgia. In fact, patients with isolated disorders of perception are very healthy people in somatic terms with good immunity, rarely even suffering from acute respiratory viral infections.

Depersonalization syndrome manifests itself, first of all, by increased self-analysis, heightened and deep "self-digging", comparison with one's previous state and other people. Constant comparison of one's new state with the previous one, as a rule, causes a feeling of loss of personal individuality, naturalness of perception. Patients complain that emotional fullness, naturalness of perception and feelings have left their lives, they have become soulless "living dead", automatons. The perception of reality and oneself in it is also distorted - derealization and depersonalization rarely occur in isolation, much more often they go hand in hand. The same patient experiences symptoms of alienation not only from his "I", but also a disrupted perception of the surrounding world - it loses its colors, becomes flat, alien, faceless and unclear.

Normally, all personal mental manifestations of a person – sensory and physical sensations, mental representations have a subjective coloring of “my personal” sensations and perceptions. With depersonalization, the same mental manifestations are felt as “not mine,” automatic, devoid of personal belonging, the activity of one’s own “I” is lost.

Mild forms manifest themselves in complaints of detachment, a sense of change in oneself, twilight consciousness, blurred perception, lack of emotions - joy, pity, sympathy, anger. In more severe forms of depersonalization, patients complain that they do not feel alive, that they have turned into robots, zombies, their personality has disappeared. Later, a split personality may occur. The subject feels that two people with diametrically opposed personality characteristics live inside him, they exist and act in parallel, autonomously from each other. The owner's "I" knows them both, but does not control their actions.

Total depersonalization occurs when the patient notes the complete loss of his "I", stops opposing himself to the surrounding world, dissolving in it, completely losing self-identification. This, the most severe, stage of the disease is also divided into functional (reversible) and defective (irreversible), occurring as a result of organic damage to the brain or a disease leading to the development of such a defect.

Various attempts have been made to classify depersonalization both by clinical symptoms and by developmental features. Currently, its types are distinguished by the predominant symptoms into autopsychic, allopsychic (derealization) and somatopsychic depersonalization, although they are almost never encountered in their pure form. Their features will be discussed in more detail below.

According to ontogenesis, depersonalization is divided into three types. The first develops at a younger age under the influence of external provoking factors. Its specificity is the feeling of loss of sensory (developing first) forms of self-awareness - self-awareness of one's personality, body and its parts, one's mental and physical activity, the unity of one's own "I". This includes alienation of thoughts and actions, automatisms, split personality. At the peak of depersonalization of the first type, the patient feels the complete disappearance of his "I", turning it into "nothing". Accompanied by derealization, occurs in diseases of the central nervous system, borderline and schizoaffective disorders, in cyclothymics. Supplemented by symptoms of neurasthenia - fears, dizziness, sweating, melancholy and anxiety, obsessive states. Usually occurs in the form of periodic and not very frequent attacks against the background of long, quite stable periods of enlightenment.

The second type is characterized by changes in cognitive (more ontogenetically late forms of self-awareness). The patient feels profound changes in his personality, stops perceiving people around him, avoids contacts. Patients complain of loss of ideological and moral values, a feeling of complete emptiness, depersonalization. Manifestations of somatopsychic and allopsychic derealization are also more pronounced and painful. This type often develops in people suffering from simple schizophrenia and schizo-like psychopathy. It is accompanied by painful reflection, hypochondriacal delirium, progresses and leads to personality changes.

The third (intermediate in severity between the two types mentioned above) is a feeling of loss of the emotional component. In the initial stages, the patient notices emotional insufficiency, with the development of the condition, emotions are increasingly lost and lead to the absence of mood as such. Autopsychic, first of all, depersonalization (mental anesthesia) can also be accompanied by alienation of one's body, its needs. The surrounding world is also perceived as colorless and alien.

Comorbidity of depersonalization with other disorders has been found, which can occur in isolation without symptoms of personal alienation. For example, depression, anxiety disorder, phobias, obsessive states, panic attacks can be accompanied by the phenomenon of alienation - a protective reaction in the form of depersonalization/derealization syndrome is activated. Although comorbid disorders do not always occur. In some patients, self-awareness disorders deepen gradually, smoothly and without symptoms of other disorders. Such patients talk about the loss of their own "I" quite indifferently, claiming that they act automatically, and nothing is connected with their mental "I" anymore, and it does not concern them at all.

Anxiety and depersonalization

Genetically determined pathological anxiety is one of the main risk factors for the development of depersonalization in practically healthy people. Experts note that the appearance of complaints about the alienation of one's own "I" in any form is preceded by increased anxiety, prolonged worry. People susceptible to this disorder are touchy, vulnerable, impressionable, sensitive not only to their own suffering, but also to the suffering of other people and animals.

At the same time, those around them assessed them (before the symptoms appeared) as energetic people, possessing leadership qualities, able to enjoy themselves, rejoice in the beauty of nature, good books and "infect" others with their good mood. At the same time, their strong anxious reaction to troubles was also noticeable.

Depersonalization in anxiety disorder, that is, constant anxiety for which there are no real reasons, is part of a symptom complex, like panic attacks. Such components can be observed all together, and some components may be absent.

Anxiety disorder is characterized by a constant and unreasonable feeling of uneasiness, when the patient's extremities become cold, the mucous membrane of the oral cavity dries out, the head spins and aches, and the pain is diffuse, covering the head on both sides, there is pressure in the chest, breathing and swallowing are difficult, and symptoms of indigestion may be observed. Anxiety disorder is diagnosed in people who complain that such symptoms do not go away for several weeks.

The phenomenon of depersonalization does not occur in all patients with anxiety disorder, it is more often observed in patients with its panic form. However, against its background, anxiety intensifies. The patient is aware of his condition, it worries him even more, makes him worry about the safety of his sanity. Anxiety disorder is the main one and it must be treated. In such cases, the patient is prescribed drugs with a pronounced anti-anxiety effect - anxiolytics. It is noted that after anxiety is relieved, depersonalization also loses its resistance to drug treatment, and the patient's condition quickly stabilizes.

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Panic attacks and depersonalization

Vegetative-vascular dystonia is a fairly common condition, which is often “written off” for various incomprehensible and not always diagnosable symptoms of nervous system disorders. One of the manifestations of VSD are panic attacks, when, outside of a situation that poses a real danger, a wild, uncontrollable fear spontaneously arises. Panic disorder or cardiac neurosis, as this condition is also called, is accompanied by severe weakness (legs give way), a sharp increase in heart rate, increased blood pressure, shortness of breath, trembling (often very strong - teeth chatter, it is impossible to hold an object) of the limbs and / or the whole body, paresthesia, dizziness resulting from hypoxia (pre-fainting state), increased sweating, nausea or even vomiting. A panic attack is an acute stress for the body, so in some people this condition is accompanied by depersonalization / derealization syndrome. Which, of course, makes the panic attack worse, frightens the patient himself, and causes a new panic attack.

Depersonalization in VSD is not, in principle, a life-threatening symptom and occurs as a defensive reaction, however, it greatly reduces a person’s quality of life. If at the initial stage alienation does not last long, a few minutes – until the attack passes, then in advanced cases the attacks become more frequent, and depersonalization leaves practically no room for normal perception of the world.

Depersonalization during panic attacks is resistant to treatment. First of all, it is necessary to eliminate panic attacks and the reasons causing them. In this case, sessions with a psychotherapist are indispensable. After eliminating panic attacks, depersonalization goes away on its own.

As a consolation for those prone to panic attacks and anxiety disorder, which also often occurs in patients with vegetative-vascular dystonia, they do not have schizophrenia, they do not have psychosis, they are not going crazy and will not go crazy.

Depersonalization and obsessive thoughts

The syndrome itself essentially exists not in objective reality, but in the subject's consciousness and, therefore, is an obsessive thought. Of course, the condition is unpleasant and frightening, causing obsessive thoughts about impending madness. A person who has once experienced depersonalization begins to think about it, and the next episode is not long in coming.

Some representatives of the human race have a predisposition to such neurotic disorders. They are usually prone to unmotivated anxiety and panic attacks. Such subjects only need the slightest psychological trauma, which others would simply not notice, to feel themselves outside their personality. The unstable consciousness flies away from danger so as not to completely collapse.

But since a person in a state of depersonalization understands that his feelings are deceiving him, he begins to have obsessive thoughts about losing his mind, fear of a repeat of the episode, a huge desire to get rid of the disorder and panic that it is forever.

Doctors and people who have overcome depersonalization advise changing your habitual thinking, and perhaps your lifestyle, gradually getting rid of obsessive thoughts and not dwelling on the problem. There are many psychotherapeutic methods and medications for this, and you should not neglect the advice of people who have overcome the problem.

Symptoms such as obsessive thoughts and depersonalization can also be observed in mental illnesses, injuries, tumors, and other brain damage. People suffering from obsessive-compulsive disorder are prone to depersonalization. To exclude such pathologies, it is necessary to undergo a comprehensive examination.

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Nagualism and Depersonalization

In a historical sense, the origin of Nah-Wa'hl Ism (from the word Nagual - the second "I", the guardian spirit, hidden from the eyes of strangers) goes back to the ancient Indian religious teachings, shamanism, however, at present, as its preachers claim, it has nothing in common with religion.

For Castaneda, thanks to whom the term “nagualism” became widely known, it denotes a hidden side of human consciousness, invisible to the outside eye and difficult to define in words.

Modern nagualism represents a certain direction of self-knowledge, declaring the primacy of self-education in oneself of the ability to rely on one's own strengths and the basis of one's "I" - will. In the practices of nagualism, special meaning is given to the formation of one's own volitional intention of the individual, since it is believed that all other active principles of consciousness are determined by external conditions - ontogenesis, phylogenesis, cultural environment and collective psyche.

The philosophy of nagualism is very liberal and recognizes the right to the existence of different points of view on the world, even the most senseless and pathological. There are many truths, each person has his own, so he has the right to build his life, obeying his own views. Each person lives in his own subjective reality. Philosophy is quite complex, and each guru presents it with his own cuts.

Nagualism practices, such as stopping the internal dialogue, include achieving states reminiscent of depersonalization/derealization syndrome. The attacks of opponents of this trend and accusations of them in developing the said mental disorder are probably greatly exaggerated and groundless, since achieving a state of detachment from emotions occurs at the will of the practitioner. It is doubtful that the achieved result, which he was striving for, can frighten him.

Self-improvement practices include self-observation, isolating one's own automatisms and the reasons that led to behavioral patterns. It is assumed that the results of self-analysis are sincerely accepted, regardless of their correspondence to one's ideas about oneself. Ultimately, this should lead to the creation by the will of the practitioner of one's own consciousness independent of external influence.

Perhaps, for people inclined to reflection and subject to depersonalization syndrome, mastering these practices will also allow them to get rid of the fear of madness, of obsessive thoughts about repeated attacks, which is the main danger of depersonalization, to accept their condition and change their habitual thinking. Of course, the creation of an independent consciousness should be carried out only by an effort of will without the involvement of narcotic substances, which were used by ancient Indian shamans.

Emotional depersonalization

Depersonalization distortions of sensory perceptions are accompanied by a partial or complete loss of the emotional component of the mental process (mental anesthesia). Moreover, both the ability to experience pleasant and joyful feelings, which is typical for depressive disorder, and negative emotions - anger, melancholy, hostility - are lost. The phenomenon of mental anesthesia is most clearly represented in depersonalization of the third type, but its components can also be present in other types of disorders. Moreover, the division is very conditional.

Depersonalization most often occurs in overly emotional subjects. They remember that they loved their loved ones and friends, were happy and worried about them, and now they treat them almost indifferently. Music, pictures, nature no longer evoke the same admiration, feelings are dulled, however, the ability to express emotions is preserved. Although there is nothing to express. The mood itself becomes nothing - neither bad nor good. The external world of such patients is also not full of colors and expressiveness.

With somatopsychic depersonalization, pain, tactile, and taste sensations are dulled - tasty food, gentle touches, and pain do not evoke any emotions.

Emotional dullness also affects thinking, memories, past experiences. They become faceless, their emotional content disappears. The patient's memory is preserved, but past events, images, thoughts remain without an emotional component, so it seems to the patient that he does not remember anything.

Psychic anesthesia mainly occurs in adults (more often females) against the background of depressions of endogenous origin (obsessive-compulsive disorder, neuroses and paroxysmal schizoaffective disorder), and also as a side effect of depressions caused by taking antipsychotics. Cases of emotional derealization in psychopaths and in patients with organic lesions of the central nervous system are almost never encountered. Emotional depersonalization develops, as a rule, against the background of prolonged and sufficiently deep discrete anesthetic depressions (occurring in the form of attacks and rarely taking a continuous course). It does not lead to noticeable personality changes.

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Autopsychic depersonalization

With this type of disorder, patients lose the sense of their mental "I", its emotional component disappears. They complain that they do not feel their thoughts, cannot adequately, as before, react to the people and events around them. Because of this, patients experience a lack of mental comfort, however, they know who they are, but do not recognize themselves. In most cases, patients with this disorder even manage to adapt to their condition to a certain extent.

Autopsychic depersonalization is characterized by the loss of naturalness of personal manifestations of patients, who feel their thoughts and actions at the level of automatism. However, patients do not have the feeling that they are controlled by any external force. They consider their actions mechanical and formal, but still their own.

This type of disorder is characterized by pathological mental anesthesia - loss of emotions, the ability to empathize, sympathize, love, rejoice and grieve. In most cases, it is the callousness that causes subjective experiences about the loss of feelings as part of their personality.

The events he is a participant in feel as if they were happening to someone else. The person becomes an outside observer of his own life. In severe cases, a split personality may appear, the patient complains that two people live inside him, thinking and acting differently, and not subject to him. The unreality of such sensations is realized and usually greatly frightens the patient.

Anxiety and panic disorders may arise about what is happening, caused by the assumption of the development of mental illness, brain pathologies. Some, on the contrary, do not want to admit even to themselves that something is wrong with them, apparently panicking to learn about the supposed loss of reason.

In other patients, everything goes more smoothly, without catastrophic reactions. The condition deepens smoothly without sharp exacerbations. Patients complain that their personal qualities have been lost, only a copy of their mental "I" remains, and the "I" itself has disappeared and therefore nothing touches or concerns them anymore.

People with autopsychic depersonalization often stop communicating with friends and relatives; cannot remember what they love; often freeze in one place and in one position, as if they do not know what to do next; complain of partial amnesia; do not show emotions.

A pronounced predominance of autopsychic depersonalization or its isolated variant is most often found in schizophrenics with various forms of the disease, however, it can also be observed in organic cerebral pathologies.

Allopsychic depersonalization

This type is also called derealization or a disturbance in the perception of the surrounding reality. The condition occurs suddenly and is manifested by the perception of the surrounding world in one plane, seeing it as in a picture or photograph, often black and white or cloudy. The acuity of color and sound sensations is lost. The surrounding environment seems “flat”, “dead”, or is perceived dull, as if through glass, in the head - an absence of thoughts, in the soul - emotions. In general, it is difficult for the patient to grasp what mood he is in, because there is none - neither bad nor good.

Memory problems may arise, the patient often does not remember recent events - where he went, who he met, what he ate, and whether he ate at all. Paroxysms occur when the patient feels that he has already seen or experienced everything that is happening (déjà vu), or has never seen (jemez vu).

The present time for such patients usually flows slowly, some complain of the feeling that it has stopped altogether. But the past is perceived as one short moment, since the emotional coloring of past events is erased from memory.

Difficulties may arise when it is necessary to think abstractly, associative connections are disrupted. Disturbances in the perception of external reality are often accompanied by sensations of changes in the qualitative characteristics of one's own personality and/or one's own body. The experience of detachment of the patient's "I" from the surrounding reality comes to the foreground, the real world seems to be covered with a translucent film, covered with haze, separated or decorative. Patients complain that the surrounding reality "does not reach" them.

Such patients often turn to ophthalmologists with complaints of visual disorders; usually, no specific disease of the visual organs is diagnosed in them.

During a more in-depth and thorough interview, the doctor may establish that the patient is not complaining of a deterioration in vision. He is concerned about the blurriness of the surrounding environment, its unrecognizability, and lifelessness. Patients complain of unusual and unpleasant sensations in the eyes, head, and bridge of the nose.

In allopsychic depersonalization, patients often have poor orientation in the area, sometimes even in familiar and habitual surroundings, do not recognize good acquaintances on the street when meeting, and have poor ability to determine distance, time, color, and shape of objects. Moreover, they can often reason something like this: I know that an object is blue (red, yellow), but I see it as gray.

Attacks of deja vu or jamais vu are characteristic of organic cerebral pathology, and such paroxysms also occur periodically in epileptics. The same applies to "never heard" and "already heard.

Full-blown disorders with predominant symptoms of derealization develop mainly in young people or middle-aged patients. In elderly patients, allopsychic depersonalization is practically not observed.

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Somatopsychic depersonalization

Yu. L. Nuller noted that this type of disorder is usually observed in the initial acute period of the disease. The characteristic complaints of patients diagnosed with somatic depersonalization are that they do not feel their body or individual parts of it. Sometimes it seems to them that some part of the body has changed size, shape, or has disappeared altogether.

Often patients feel as if their clothes have disappeared, they do not feel them on themselves, while patients do not suffer from objective disturbances of sensitivity - they feel touches, pain from injections, burns, but somehow detachedly. All parts of their body are also in order, their proportions have not changed, and patients are aware of this, but they feel something completely different.

The manifestations of somatopsychic depersonalization include the absence of a feeling of hunger, the taste of food and pleasure from the process, as well as the feeling of satiety. Even the most favorite dish does not bring pleasure, its taste is not felt, so they often forget to eat, eating for such patients becomes a painful process, which they try to avoid. The same applies to the performance of natural needs. Patients do not feel relief and satisfaction from these processes.

They complain that they do not feel the temperature of water, that it is wet, the air - dry, wet, warm, cold. The patient sometimes cannot say whether he slept, because he does not feel rested. Sometimes they claim that they have not slept for six months or two or three months.

This type of disorder is accompanied by somatic complaints of back pain, headache, myalgia, patients require treatment and examination, massive somatopsychic depersonalization often leads to delusional disorders developing against the background of persistent anxiety. Delusional depersonalization is expressed by hypochondriacal delirium of varying severity, sometimes amenable to dissuasion, in other cases - not. Hypochondriacal-nihilistic delirium at the level of Cotard's syndrome is characteristic.

Depersonalization in neurosis

It is within the framework of neurotic disorder that depersonalization/derealization syndrome is singled out as a separate nosological unit, that is, its isolated form is recognized as a form of neurosis.

This diagnosis is made when the patient is excluded from having somatopsychic diseases. The main diagnostic difference of the neurotic level of depersonalization is the preservation of consciousness, understanding of the abnormality of one's sensations and suffering from this. In addition, after a long time, patients with neurotic disorder do not show progression of the disease - the development of personality changes and defects, mental retardation. Patients often adapt to living with their defect, while demonstrating considerable pragmatism and forcing healthy family members to obey their rules. Depersonalization practically disappears over time, although its attacks can periodically resume against the background of events that disturb the patient.

In isolated depersonalization, typical clinical signs of depression are usually absent - a constantly depressed mood (it is nothing), acute melancholy, motor retardation. Patients are talkative, active, sometimes even too much, their face is frozen, without facial expressions, but does not express suffering, eyes are wide open, the gaze is intent, unblinking, revealing strong nervous tension.

Depersonalization of neurotic origin is always preceded by acute or chronic stress or other psychogenic provocation.

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Depersonalization in schizophrenia

A distorted perception of the boundaries between the patient's personality and the surrounding world is typical for schizophrenics. As a rule, they are erased. Patients often feel the disappearance of the mental "I" and the surrounding world, their own body or its parts, merging with the world (total depersonalization). In acute schizoaffective disorder, the alienation of one's own "I" occurs at the height of oneiroid or affective-delusional paroxysm.

Depersonalization is part of the symptom complex in different types of schizophrenia and is represented by all its forms, most often autopsychic and allopsychic, less often - somatopsychic. The development of depersonalization-derealization syndrome in schizophrenia may not be preceded by a stress provocation.

The loss of the emotional component, insensibility does not bother schizophrenics too much, the specific direction of mental anesthesia is also absent, patients describe their sensations as a feeling of absolute inner emptiness. In addition to mental anesthesia, schizophrenics experience automatism of thoughts and movements, which are not accompanied by emotional reactions. Sometimes, a split personality or reincarnation is observed.

Clinically, this manifests itself in difficulties in contacting people around them; patients lose understanding of people's actions and speech addressed to them. The world is perceived as alien, their actions and thoughts are also subjectively felt as alien, not belonging to them.

Allopsychic depersonalization is manifested by the sensation of brighter colors, louder sounds. Patients highlight small and insignificant details of objects and events as more important than the whole object.

It is sometimes difficult for a patient to describe his feelings; he resorts to pretentious comparisons, vivid metaphors, is verbose, repeats the same thing, expressing his thoughts in different verbal expressions, trying to convey his experiences to the doctor.

Depersonalization in schizophrenia blocks the productive symptoms of the disease and may indicate a sluggish process. The acute course of schizophrenia corresponds to the transition of depersonalization to a state of mental automatism.

In general, depersonalization in schizophrenics is considered a negative symptom. The consequences of months-long depersonalization symptoms were the emergence of emotional-volitional disorders, obsessive relationships, and fruitless philosophizing.

Relatively short periods of depersonalization in some patients with paranoid schizophrenia ended without an increase in psychotic disorders, but after 6-8 weeks, patients began to experience acute attacks of paranoia.

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Depersonalization in the context of depression

In the classification of depressive syndromes, six main types are distinguished, one of them is depressive-depersonalization, which differs significantly in the structure of symptoms from all others and is characterized by massive auto- and somatopsychic depersonalization, pushing into the background and obscuring melancholy and anxiety.

In this case, patients do not complain of a bad mood, attributing the melancholy state of hopelessness to feelings of personal rejection, depressive symptoms recede into the background, since the patient is worried about the possibility of going crazy and it is the depersonalization symptoms that he describes to the doctor, displaying verbosity, intricate expressions characteristic of schizophrenics, omitting the symptoms of depression. Often patients with depressive-depersonalization syndrome are active, not apathetic, but rather excited, although their facial expression is mournful.

This syndrome is resistant to therapy, characterized by a long course (sometimes about 10 years or more). The symptomatic structure complicates the correct diagnosis, it is easily confused with schizophrenia, asthenic syndrome and hypochondria, which can lead to the prescription of ineffective drugs.

Patients with depersonalization-depressive syndrome are the most dangerous in terms of the emergence and implementation of suicidal intentions. Incorrect use of antidepressants with a pronounced stimulating effect is not only ineffective, but also poses a risk of suicide attempts during moments of exacerbation of the affect of melancholy. Even with treatment with anxiolytics, there is a risk of suicide during the period of possible intensification of symptoms of personal alienation.

In addition to the already mentioned syndrome, in which depersonalization/derealization plays a leading role, other syndromes can also be accompanied by alienation of one's "I" and loss of the sense of the surrounding reality. Depressive syndromes are classified not only by clinical manifestations, but also by the degree of expression of melancholy and anxiety, which helps to choose the appropriate antidepressant that has the necessary effect.

According to the degree of affect, depressive syndromes are divided into three types:

1. Anergic - the patient in this case does not have a high level of anxious tension and melancholy, the mood is moderately depressed, motor and mental activity is slightly reduced, some lethargy is observed. The patient complains of a loss of strength, lack of energy, does not show initiative and does not feel keen interest in anything, looks for a reason to refuse any activity, doubts its expediency, expresses self-doubt. The patient sees everything in a rather gloomy light, he pities himself, feels like a loser in comparison with other people, the future seems so bleak that it is no longer a pity to die, however, the patient does not show suicidal activity. In this case, the patient may experience autopsychic depersonalization, obsessive thoughts, sleep disorders. Clinically manifested by a decreased affective background, lack of appetite (however, patients eat, albeit without pleasure), hypotension.
2. Melancholy or simple depression – is expressed in more distinct attacks of melancholy, especially in the evening, noticeable inhibition of mental and motor activity, the presence of intentions to commit suicide, obsessive thoughts of a suicidal nature are possible. Outwardly, in milder cases, anxious tension may be unnoticeable. Severe forms are accompanied by vital melancholy, obsessive thoughts about one's own inferiority. Depersonalization is expressed in emotional dullness, causing mental suffering, somatopsychic symptoms are represented by the absence of a feeling of hunger and the need for sleep. The patient loses weight, sleeps poorly, his heart rate increases.
3. The basis of the anxiety-depressive syndrome is a pronounced component of intense anxiety combined with melancholy, often vital. A severely depressed mood is clearly noticeable, its daily changes are observed - in the evening, the symptoms of anxiety and melancholy usually intensify. The patient often behaves excitedly and restlessly, less often falls into an "anxious stupor" up to a complete lack of movement. Depressive ideas have a guilty nature, hypochondria is often observed. Obsessive-phobic disorder, symptoms of autopsychic and / or somatic depersonalization are possible. Somatic symptoms are manifested by anorexia (weight loss), constipation, senestopathies, giving rise to the development of obsessions and fears of a hypochondriacal nature.

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Depersonalization in osteochondrosis

Deficiency of nutrition of brain tissues appears with degeneration of intervertebral discs in the cervical spine. Cerebral insufficiency occurs against the background of cerebrovascular accident in advanced cases of osteochondrosis, when altered intervertebral discs no longer provide adequate cushioning in these areas, and the mobility of the vertebrae becomes pathological.

The growth of marginal osteophytes leads to partial displacement and compression of the vertebral artery, which causes oxygen starvation of the brain. Hypoxia can result in the development of depersonalization-derealization disorders. In this case, it is necessary to treat osteochondrosis and restore the impaired blood supply, with the improvement of which the symptoms of depersonalization will disappear by themselves.

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Depersonalization in clonazepam withdrawal syndrome

This drug is not the only one that can cause mental disorders as side effects or a psychogenic reaction to its withdrawal. Clonazepam belongs to the group of benzodiazepines and, in principle, any of them can cause depersonalization. This drug has a powerful anticonvulsant effect, it is often prescribed to epileptics. Thanks to clonazepam, they have epileptic seizures.

The spectrum of the drug's action is very wide. It effectively relieves anxiety, calms and helps to fall asleep, relaxing muscles and having an antispasmodic effect. Clonazepam helps to eliminate panic, overcome phobias, and normalize sleep. Most often, it is used once or in a very short course (when it is not about epilepsy) to relieve acute symptoms. The drug is very powerful, is slowly excreted from the body and is addictive. The reaction to clonazepam is individual for everyone, but on average, it can be used without consequences for no more than ten to fourteen days.

The drug is a prescription drug and should not be taken without a doctor's approval at all. Clonazepam does not treat neurotic or anxiety disorders, but only relieves painful symptoms, making the patient's life easier and making him more sane, ready for further therapy and sessions with a psychotherapist. Both its use and withdrawal should be done only according to the scheme prescribed by the doctor.

Withdrawal syndrome is formed after the onset of addiction with a sudden cessation of intake. It occurs on the first or second day after the drug is discontinued and has the form of a permanent, rather than paroxysmal defect. The syndrome reaches its maximum height in the second or third week, and this condition can last up to several months. Taking clonazepam during withdrawal syndrome leads to the disappearance of symptoms, a sharp improvement in the condition up to euphoria. However, this should not be done, since the improvement will be followed by a new round of painful symptoms.

Depersonalization can occur as part of withdrawal from any benzodiazepine drug, but clonazepam, due to its potent action and long elimination period, causes more severe depersonalization than other drugs.

In the treatment of other personality disorders with symptoms of depression, initially occurring without depersonalization, it may arise due to the use of antipsychotics or antidepressants from the group of selective serotonin reuptake inhibitors as a side effect of treatment. Such effects occur with incorrect diagnosis or underestimation of the severity of the condition and the development of an exacerbation with the emergence of depersonalization.

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Depersonalization of activity

One of the psychopathological phenomena of impaired self-awareness is the feeling of loss of meaning in one's activity. It refers to the first early type of depersonalization. The subject perceives his activity as alien, meaningless, and of no use to anyone. Its necessity in this context is not realized, no prospects are visible, and motivation is lost.

A person can freeze in one place for a long time, staring with an unseeing gaze, although he has some things to do, sometimes urgent. The activity of the personal "I" becomes very low, often completely lost. The patient loses the desire not only to work, study, create, he stops performing ordinary household activities - taking care of himself: does not wash, does not wash, does not clean. Even favorite activities lose their former appeal for him. Sometimes people do everything necessary, go for walks, visit friends and social events, but at the same time complain that they are not interested in this, they just observe the necessary formalities so as not to stand out from the crowd.

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