Syndrome of derealization

It is believed that more than half of the human population, even if only for a short time, experiencing acute stress, includes such a mechanism of psychological defense as the perception of what happened to someone else and / or in another reality, which allows you to abstract yourself from emotions, analyze the situation and find out from it. However, people are impressionable and emotional, with hyperbolic perception, vulnerable and unstable psyche can stay in this state for a long time, and this is pathology. Such manifestations are found in the symptom-complex of many mental and organic diseases, however, they can exist for a long time as a separate syndrome of depersonalization / derealization outside of the psyche.

The state of perception of the surrounding reality, relations with other people, both from the auditorium or from sleep, is detached, in the psychiatric practice, derealization is called. It is mainly considered as one of the types of depersonalization - allopsychic. In this case, the emotional component of perception of the environment, nature, music, works of art is partially or completely dulled.

Directly with the derealization, the individual almost always controls himself and his actions, is quite sane and adequate, understands that he is not healthy, therefore it is much more difficult for him to endure such a state for a long time than for "real psychs" who have an imaginary world view.

Is derealization dangerous?

Short-term detachment from occurring events happens, apparently, in many, goes by itself and does not pose a danger, since it does not have a significant effect on vital activity.

The depersonalization / derealization syndrome acts as a kind of shield, preserving the human psyche from more serious injuries, however, a prolonged distorted attitude leads to memory impairment, development of depression and more severe consequences. Moreover, a person is aware of his condition and is not always able to return to reality independently, which often causes him to speculate about a mental illness or defeat of the central nervous system.

The manifestation of the majority of cases of this nervous disorder, according to foreign studies, occurs at a young age, mainly in the 14-16 years and coincides with the moment of the formation of the personality, sometimes this happens in early childhood. Sex does not matter. Very rarely with such problems are people who have crossed the 25-year boundary (one of twenty), single cases occur in adulthood. Such early manifestation also represents a certain danger for the adaptation of the individual in society.

Causes of the derealization

The syndrome of depersonalization / derealization develops against the background of mental exhaustion, caused, as a rule, by a whole complex of causes against the background of a strong or long-acting stress factor.

This is facilitated by certain personality characteristics. People who are prone to this syndrome often have overstated claims, overestimate their capabilities, do not take into account any objective circumstances, but, not having received the desired and not feeling the strength for further struggle, are shut off from reality. True, not on their own. Exhausted psyche creates a protective barrier to prevent a more serious violation of mental health or the development of vascular crises.

Constant dissatisfaction of needs, apparent or real underestimation of their successes by teachers, management, relatives, awareness of the impossibility to reach a certain level contribute to the fact that there is a derealization in depression. Propensity to prolonged fixation on negative events, hypotension increases the likelihood of developing the syndrome.

This condition is often associated with neurasthenia, anxiety neurosis and other neurotic disorders. Long stay under the influence of stressful circumstances, chronic fatigue and the inability to restore strength, psycho-traumatic situations in childhood (indifference or, on the contrary, excessive severity of parents, bullying in the family or among peers, death of a loved one to whom the individual was very attached), forced or conscious loneliness can lead to the fact that as a defensive reaction, derealization develops with a neurosis.

Vegeto-vascular dystonia, in which the central nervous system suffers, the tone of the vessels and the work of the internal organs are disturbed, is a factor that increases the likelihood of the development of derealization. A person suffering from a disorder of the autonomic nervous system can be shielded from reality due to even a banal worldly mess. Derealization with VSD leads the patient to deep stress, usually after the first attack, he begins to expect the next, and this expectation is justified. Disease necessarily requires treatment to interrupt this vicious cycle.

Sometimes there is a derealization from lack of sleep, especially regular. In this case, do not panic ahead of time, you need to order your daily routine. Attacks must pass.

The same applies to the onset of symptoms of the syndrome with prolonged sitting in front of the computer monitor on forums, in social networks, playing computer games. Usually such pastime is complicated by lack of sleep, visual and nervous overwork, stresses during games, sedentary lifestyle and banal hypoxia from insufficient exposure to fresh air. In addition, young people often lead this way of life, substituting the real world and relations with fictional ones. Derealization from the Internet, from the computer, is a very real threat to the mental health of young people who spend a lot of time at the monitor, having fun and communicating in the virtual world with the indifferent connivance of adults (just do not pester them!).

Derealization may occur with cervical osteochondrosis. This is due to the fact that the disorders occurring in this section of the spine, violate the blood supply to the brain, the innervation of the arteries. Pathological processes in vertebral structures lead to such complications as vegetative vascular dystonia, which proceeds with the depersonalization / derealization syndrome and panic attacks. Treatment of the underlying disease greatly improves the patient's condition and allows you to get rid of painful symptoms.

Alcoholism and derealization are closely related. More than 13% of alcoholics are susceptible to this syndrome. Even with one-time alcohol intoxication, ion exchange suffers, the sensitivity of serotonergic receptors changes, γ-aminobutyric acid metabolism, other processes in the cortex and subcortical structures of the brain are disrupted. And only chronic alcohol intoxication and does cause irreversible changes in the structures of the brain.

Other psychoactive substances can also induce symptoms of depersonalization / derealization syndrome. These include caffeine, antihistamines, hypnotics and sedatives, antipsychotics and antidepressants (serotonin reuptake inhibitors), anticonvulsants and hallucinogenic drugs, even such drugs as indomethacin and minocycline have seen similar abilities.

Therefore, derealization is absolutely not surprising after smoking grass or using other drugs - LSD, opiates, during the withdrawal from anesthesia.

In addition to those already listed, the risk factors for the appearance of this disorder are:

• Sluggish and paroxysmal-progredient schizophrenia;
• circular psychosis;
• epileptic parsisms;
• dissociative disorders;
• organic pathologies of the brain;
• adolescence, pregnancy;
• physical or psychoemotional violence in childhood;
• monitoring of scenes of violence;
• rejection in the family, in the circle of co-workers;
• low stress resistance;
• hereditary predisposition to pathological anxiety.

[1]

Pathogenesis

In the mechanism of the development of the depersonalization / derealization syndrome, there are still many "white spots". In the prodromal period, patients always experience increased anxiety, anxiety, and mental stress. Syndrome is susceptible to hypersensitive to emotion-related situations, anxious individuals who are acutely sensitive to stressful situations. The loss or decrease of the emotional component of mental activity develops as a protective reaction to events that threaten the disorganization of the mental process or vascular catastrophes. When protection takes a protracted course, it itself becomes the basis of the pathological process.

It is assumed that in response to stress in the pituitary neurons, the synthesis of β-endorphins (endogenous opiates) is increased. Increased activation of opioid receptors disrupts neurochemical equilibrium and triggers a cascade of changes in other receptor systems. This leads to disruptions in the production of γ-aminobutyric acid, a change in the activity of neurotransmitters regulating positive emotions and mood. It has been established that derealisation and serotonin, norepinephrine, dopamine are associated. Patients are supposed to turn off the pleasure center (anhedonia) and the limbic system responsible for the organization of emotional and motivational behavior.

[2], [3]

Symptoms of the derealization

In all known cases of seeking help from specialists, patients in the survey noted that the development of the disorder is preceded by the intensification of nervous tension and anxiety.

The first signs of this state arise suddenly and can be expressed in such sensations as perception of the surrounding world in one plane, seeing it as in a picture or photograph, often black-and-white or cloudy. The sharpness of color, sound sensations is lost The surrounding situation seems to be "flat", "dead", or perceived dulled, as if through glass, in the head - the absence of thoughts, in the soul - emotions. In general, it is difficult for the patient to catch in what mood he is, because he is not - neither bad nor good.

There may be problems with memory, the patient often does not remember the recent events - where he went, with whom he met, what he ate, and whether he ate at all. There are paroxysms, when the patient feels that he has seen or experienced everything that is happening (deja vu), or never seen (vimeu vju).

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

There may be difficulties when you need to think abstractly.

Derealization is rarely found in its pure form, it is almost always accompanied by symptoms of depersonalization, that is, a disorder in the perception of one's own personality and / or of one's own body. These phenomena are similar in that in both cases the perception of the surrounding world is disturbed, but the accents are placed somewhat differently.

The alienation of feelings of one's own self or depersonalization is divided into autopsychic (violation of personal identification) and somatopsychic (full or partial rejection of one's own body and its vital functions).

For example, in autopsychic depersonalization, a person ceases to detect personality traits peculiar to him, does not recognize his own essence. He notices the disappearance of warm feelings towards relatives and friends, dislike and anger towards enemies, ceases to take offense, empathize, yearn for, nothing pleases him or upsets him. The patient defines his actions as automatic. The events to which he is a party are felt as if they were happening to someone else. A person becomes an outside observer of his own life. In severe cases, there may be a split personality, the patient complains that there are two people living in it, differently thinking and acting. Alienation of one's self is realized and usually scares the patient.

Somatic depersonalization is manifested by a decrease in sensitivity to pain, hunger, heat and cold, and touch. A person does not feel the weight of his body, does not feel how his muscles work, joints.

Derealization is also a form of depersonalization, with it the subjective perception of the external environment of the individual is disrupted. Isolated, each type of syndrome practically does not exist, the symptoms of the same patient are usually interspersed. Derealization and depersonalization are not in vain combined into one syndrome, because it is usually impossible to distinguish them from each other in one patient. Just some symptoms are more pronounced, and others - may not be. Dullness or loss of emotions is observed in all cases, is fully realized by the individual, causes him suffering and fear of complete loss of reason.

Alarming, stuck in anticipation of negative personal events are more susceptible to the development of the syndrome. Such people often develop vegetovascular dystonia, which also increases the likelihood of withdrawal, "falling out" of life. Anxiety and derealization are two symptoms that accompany each other.

Against the background of strong anxiety, the expectation of any negative development of events and a completely mentally healthy person may have a similar syndrome. In people with mental illness, the derealization disorder can be a symptom in the structure of mental pathology, both insignificant and dominant.

Derealization and schizophrenia have a similar symptomatology. In both cases, contact with reality is broken, and its subjective perception changes. Schizophrenics, as a rule, often perceive everything as brighter, colorful, music sounds more expressive for them, real events are perceived as a play with colorful decorations. Some, sometimes quite insignificant, properties of familiar things are often distinguished by them and perceived as very important. Nevertheless, depersonalization and / or derealization cause the patient a lot of unpleasant sensations. Schizophrenics often feel themselves outside of their time, outside their bodies, moving into another body. Sometimes it is difficult to distinguish the symptoms of schizophrenia from the manifestations of the syndrome.

Depersonalization / derealization in schizophrenics is more severe and severe, often in combination with delusions and hallucinations. Delusional form of the phenomenon can be expressed in reincarnation, division into physical and mental units, the splitting of the personality, the disappearance of the external world or the personality of the patient.

Depersonalization / derealization can be a symptom of many mental illnesses and can be observed for many years.

The syndrome of derealization, considered as a neurotic disorder, can have a short-term, paroxysmal and permanent character.

Short-term manifestations of derealization develop after acute psychotraumatic situation, under the influence of fatigue, lack of sleep and other factors. They last for several minutes and their protective role is beyond doubt. They can never happen again and they do not belong to pathologies.

Pathological derealization can have a paroxysmal and protracted permanent character.

In the first case, a brief attack of derealization represents a separate attack of spatial disorientation and is replaced by a normal state. At the time of the attack, visual distortions of reality usually appear (vague contours of objects, tunnel vision - clearly visible before the eyes, lateral vision is vague, divergent circles of irregular shape before the eyes, colors disappear, everything turns gray or black and white); auditory distortions (ringing in the ears, sounds are heard as though in cotton wool, ears are pawned, the tempo of the sounds slows down, individual sounds are perceived excessively sharply); disrupted spatial orientation (you can forget the familiar road, do not know the familiar place, and so on). These are the most common symptoms, but they can observe distortions of different external aspects, sometimes hallucinatory phenomena occur. At the time of an attack that begins and recedes suddenly, a person is lost, upset, starts to choke, loses coordination.

In the second case, derealization is stable and may be accompanied by a variety of symptoms. Disturbance of visual perception usually becomes the main symptom, to which violations of sensory and distortion of sounds are attached. Constant derealization is usually combined with the symptoms of depersonalization - there is detachment from the body shell, emotional essence, feelings disappear. The patient observes himself and his life from the outside. Over time, symptoms may worsen, memory disorders, control over one's words and actions are added.

Derealization in a child before adolescence is almost not detected, and the vestiges of depersonalization can be determined in children over the age of three. It manifests itself in gaming reincarnation, for example, in animals, in other people. Children want to be fed with animal feed, they say that they have a ponytail and paws, go on all fours, ask to be called by other people's names. A healthy child can play like that, and the difference is that it is almost impossible to distract a sick child from such a game. He completely reincarnates.

Often in children there is a somatopsychic form of the syndrome - children do not feel hunger and thirst, they feel that their parts of the body live their life. Typically, these rudiments of symptoms are observed in children with schizophrenia or epilepsy.

Derealization in childhood can already be detected in embryo from the age of ten. Is manifested by attacks of déjà vu or veme vu. Such seizures are also characteristic of epileptics or epileptoid states.

"Adult" symptoms of derealization in adolescents form to late puberty and are manifested primarily in visual and auditory disorders. Much less frequent are disorders of taste and tactile sensations, phenomena of deja vu and zemu vu.

Teenagers often feel personal transformation with alienation of emotions, somatopsychic form of the phenomenon is represented by sensations of loss of unity of own body, changes in its proportions, absence of any parts. Adolescent age is characterized by depersonalization and derealization disorders due to the fact that during this period there is the formation of personality, rapid physical growth and physiological changes in the body, emotions ripple. In this period, the tendency to get stuck and self-rooting increases. Experts believe that such disorders in adolescence are frequent, it's just that teenagers find it difficult to express their feelings.

Some consider the syndrome of depersonalization / derealization in adolescence the first bells of progredient schizophrenia.

In adolescents suffering from epilepsy, attacks of derealization are often observed before the seizure or in place of it.

[4], [5], [6]

Complications and consequences

Derealization significantly complicates a person's life, having a significant negative impact on his interaction with others, ability to work, performing daily duties, contributes to the development of isolation of the patient. He is critical of the situation, understands its unnaturalness and sometimes loses perception of reality. Sustainable long-term derealization delivers the patient a lot of suffering and can lead to depression and suicide.

Is it derealization itself? Sometimes it passes, however, if the seizures recur or stable derealization is formed, it is better to seek the help of competent specialists. Perhaps a complete recovery, if derealization was a consequence of stress, arose against a background of neurosis, and the treatment was started in a timely manner.

Derealization, manifested as a symptom of a serious progredient mental illness, has consequences and complications of the disease, and in most cases it is referred to negative symptoms and manifestations of disease resistance to treatment. Nevertheless, even in this case, timely treatment can improve the situation.

[7], [8]

Diagnostics of the derealization

Patients usually address to the doctor with complaints about sudden change of perception of the surrounding, absence of recognition of habitual conditions, loss of feelings and loss of confidence in their feelings. They are usually difficult to describe the symptoms, because the sensations are often indistinct and fantastic, while the patient realizes the bias of their own sensations.

The patient can be assigned clinical laboratory tests to determine the overall level of his health status, urine analysis to detect traces of toxic substances.

Ultrasound, electroencephalography, magnetic resonance tomography is done to detect organic disorders, especially if some of the complaints do not fit into the clinical picture of the syndrome, or if the manifestation of the disease has occurred late, for example, after the patient's 40th birthday.

In diagnostics, a test for derealization, which is a list of all possible signs of the syndrome, is almost always used. The patient is asked to answer questions about what symptoms he is experiencing. The most famous questionnaire (the Nuller scale), which includes a variety of symptoms of derealization and depersonalization, is compiled by the well-known psychiatrists Yu.L. Nuller and E.L.Genkina. The test is conducted by a specialist, evaluating the patient's answers in scores. When a patient attains more than 32 points, the doctor may suspect that he has a disorder.

Diazepam test allows you to clarify the diagnosis. This method is considered reliable for distinguishing the depersonalization / derealization syndrome from anxiety disorder and depression. Developed by Professor Nuller, is the reaction of patients to the jet infusion into the vein of diazepam. The dose of the drug varies from 20 to 40 mg and depends on the age of the patient and the severity of the disorder.

In patients with depression, the clinical picture against the background of diazepam practically does not change, the drug causes drowsiness and retardation.

With an anxiety disorder, almost instantly, even during the introduction, symptoms of the disorder go through, sometimes even a slight euphoria appears.

With the syndrome of depersonalization / derealization, the reaction occurs later for 20 minutes or half an hour after the administration of the drug. There is complete or partial elimination of symptoms: patients feel the appearance of feelings and perception of the colorful real world.

The patient is examined the level of depression, the safety of the intellect and the ability to think, accentuation of character. Applying psychodiagnostic techniques, a family history, relations with relatives, psychotraumatic situations in the life of the patient, resistance to stress and anxiety level are studied.

[9], [10]

Differential diagnosis

Based on the survey data, a final diagnosis is made. Define the prevailing symptoms of the syndrome: derealization or depersonalization, its appearance. Organic and somatic pathologies, alcohol and drug use, the consequences of drug therapy are excluded. The main diagnostic criterion of the disorder is that the patients do not lose the ability to realize that their feelings are subjective, that the objective reality does not correspond to their perception and is in full consciousness.

The delirium of any etiology resembles a severe derealization disorder according to the symptoms. However, delirium is characterized by confusion, although at the very beginning for a short time patients are adequate. Basically, episodes of delirium are characterized by such a vivid symptomatology of excitement with hallucinations and delirium that their diagnosis is not difficult. The greatest difficulty is presented by cases of hypokinetic delirium, when the patient is relatively calm.

Cotard's syndrome is characterized by symptoms that are more similar to depersonalization, but the central place in it is nihilism in relation to their own lives, and in general to everything around them. Individuals with derealization are aware of the fact that they exist.

Differentiate this disorder from pseudo-reminiscence (the displacement in time of real events) and confabulation (memories of what never happened in the life of the patient).

Severopathy (groundless symptoms of organic pathologies, sensed on nervous or mental illness) differentiates from somatopsychic depersonalization.

Patients with the syndrome of depersonalization / derealization often get an incorrect diagnosis of "schizophrenia" or "schizoid personality disorder." This is facilitated by the emotional coldness of the patients, the loss of warm feelings even to close people, the difficulty of dressing in the word form of their feelings and experiences, which can be mistaken for fruitless elaborate pretentious speech constructions.

The onyeroid, in which there is no critical attitude of the patient to his own state, and the amenance, which is similar to the derealization of the state of confusion, however, is distinguished by significant disturbances in thinking and speech, the impossibility of contact with the patient, also differentiated from derealization, in which connected thought, speech and contact are preserved .

Treatment of the derealization

If the patient is diagnosed with a mental illness or a somatic pathology, against the background of which the symptoms of depersonalization / derealization have appeared, the only way out is the treatment of the underlying disease. When it is cured, or a therapeutic effect or sustained remission is achieved, the symptoms of derealization disappear, and usually they are primarily the ones.

For more details on the methods of treating derealization, see this article.

Prevention

To prevent the onset of the syndrome and its recurrence, those who have already experienced such a condition are usually recommended to lead a healthy and open lifestyle, in some cases it would be good to change the place of residence and the circle of friends.

However, the main thing is to change oneself, to take a more positive view of the world, to soberly assess their capabilities and set realistic goals. Do something for the soul - yoga, walrus, cross-stitch ... There will be new acquaintances, there will be more interesting meetings, and there will be time to save grievances for life and feel like a disadvantaged and unfortunate loser.

[11], [12], [13]

Forecast

There are cases when the depersonalization / derealization syndrome went by itself, and the patients feel better. After all, this is just a protective reaction of the body. However, it is not necessary to delay the situation, sometimes it is enough to have several conversations with the psychotherapist to fully recover. Of course, people who applied for help in the first days of a pathological condition, have a better chance to get out of the situation without consequences.

In some cases, usually - neglected, the syndrome acquires a chronic and resistant to treatment character. Very 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 the prognosis is much more favorable. In some, the syndrome acquires a recurrent character.

[14], [15]