Depersonalization

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F48.1 Depersonalization and derealization syndrome
ICD-10 online (WHO version 2019)

Depersonalization or experience of depersonalization generally describes a state of self- alienation in which there is a loss or impairment of personality awareness. Affected people experience themselves as strange or unreal.

distribution

Depersonalization often occurs in combination with derealization and is therefore often combined with this. It is estimated that around every second person has experienced such phenomena at least once in their life below the disease threshold. Above the threshold - if, according to the diagnostic criteria, there is a disorder with disease value - the prevalence is much lower, but by no means rare. The lifetime prevalence is around 2% and does not differ according to gender.

An evaluation of extensive health insurance data from 2006 also showed that the disorder was largely underdiagnosed and misdiagnosed. A comparison with repeatedly determined prevalence data indicated that only about 1% of those affected by depersonalization syndrome had received the relevant diagnosis.

Symptoms

The symptoms of depersonalization disorder ( English depersonalisation disorder ) are varied and for those affected often difficult to put into words. The core symptoms include:

  • Emotional numbness : Affected people feel that they do not feel anything, or that their feelings are "flat" or unreal. Your perception of people or objects "often leaves you cold", that is, watching a sunset, perceiving pain or touching your partner does not trigger emotions.
  • Change in body experience : one 's own body or parts of the body are perceived as changed (lighter / heavier, larger / smaller), as lifeless or as not belonging to oneself. Your own reflection or your own voice can appear strange. Some people affected feel like they are just "a head without a body" or just "eyes without a body".
  • Change in visual perception : Many people affected have the feeling of "standing next to themselves", as if they were viewing their environment from a different perspective (from far away, from outside their body, through a camera or as if on a film screen, etc.) see.
  • Feeling that one's own movements or mental processes are automatical or robotic: movements can be carried out willingly and in a controlled manner without any problems, but those affected often do not feel that a consciously carried out movement belongs to their own voluntary decision to carry out this movement. You have e.g. B. not the feeling of moving your hand, but feeling that the hand - as if remote controlled - "moves".
  • Changes in memory processes: memories can be perceived as pale, indistinct or distant: an event that occurred only a few hours ago can be felt in the memory as if it had been years ago. In traumatizing and extreme stressful situations, consciousness can be so narrow that what is experienced is only stored fragmentarily and incoherently in the memory. This can mean that those affected cannot later verbally describe such experiences. A déjà vu experience is usually also accompanied by a feeling of alienation, as despite the strong impression of a repeated experience, more detailed memory content, such as about the point in time or the context of the presumed earlier experience, is missing.

In addition, the auditory or tactile perception, the sense of taste or the perception of time can be disturbed less often . Furthermore, there may be feelings of “thoughtlessness”, the inability to visualize or aurally imagine something, or increased introspection. An increased pain threshold up to analgesia can also occur.

It can also be that there is a feeling of unreality in relation to the environment. This is known as derealization . Objects, people or the entire environment are experienced as strange, unfamiliar, unreal, robotic, distant, artificial, too small or too big, colorless or lifeless. Many of those affected state that they experience their environment as “under a cheese dome” or “wrapped in cotton wool”. Sometimes the environment can appear two-dimensional to the person concerned, like a film.

The duration of the experiences of alienation can range from a few seconds to several hours or days. However, it is also possible (as in the case of primary depersonalization disorder ) that the symptoms persist and become chronic .

Despite the many different forms of expression, what all alienation experiences have in common is that those affected perceive them as unpleasant and unsettling. Those affected have the feeling that something is different than it was before the depersonalization experiences occurred and is different from what it should be. They often suffer from fears of “going crazy” or even just fear of being “considered crazy” by others when they talk about their experiences.

Demarcation

Depersonalization experiences also occur in healthy people, e.g. B. when very tired , after stress-inducing or life-threatening situations, during spiritual experiences ( meditation , trance ) or under the influence of hallucinogenic drugs . The various sources state a lifetime prevalence in the non-clinical population of between 30 and 50%. One can speak of a disorder in connection with depersonalization if certain other factors are added (such as an increased intensity and frequency of the experiences of alienation or the connection with another psychological disorder (see secondary depersonalization disorder )).

Although those affected may also perceive their environment changed, the reality check remains intact during the depersonalization experience. Those affected do not have any delusions (as opposed to psychotic disorders such as schizophrenia ) and correctly assess themselves and their environment in their everyday tasks and have control over their actions. Depersonalization changes the depersonalized person's subjective view of the quality of their own perception , but there is no change in their view of the quality of the object of perception. If affected z. For example, if you have the feeling of seeing people and objects like holograms projected into the room , you still know that these people and objects are real and not holograms.

Diagnostic criteria

According to DSM-5 (2013)

According to DSM-5 , the following conditions must be met for a diagnosis of a depersonalization / derealization disorder :

A. The existence of ongoing or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, of being detached or of experiencing oneself as an outside observer with regard to one's own thoughts, feelings, perceptions, the body or actions (e.g. changes in perception, disturbed sense of time, unreal or absent self, emotional and / or physical dullness).
2. Derealization: Experiences of unreality or of being detached from the environment (e.g. people or objects are experienced as unreal, as in a dream, as in a fog, lifeless or optically distorted).
B. During the depersonalization or derealization experiences, the reality check remains intact.
C. The symptoms are clinically meaningful to cause distress or impairment in social, professional, or other important functional areas.
D. The disorder is not the result of the physiological effect of a substance (e.g. substance with potential for abuse, drug) or a medical disease factor (e.g. seizure).
E. The disorder cannot be better explained by another mental disorder such as schizophrenia, panic disorder, major depression, acute stress disorder, post-traumatic stress disorder, or any other dissociative disorder.

According to ICD-10

The ICD-10 contains the following criteria for depersonalization and derealization syndrome . Either 1 or 2 or both must be true for a diagnosis:

  1. Depersonalization : Those affected complain of a feeling of being removed, of being “not right here”. You complain z. For example, that their sensations, feelings and inner self-esteem are detached, strange, not their own, uncomfortably lost, or that their feelings and movements seem to belong to someone else, or they feel like they are in a play.
  2. Derealization : Those affected complain of a feeling of unreality. You complain z. B. about the fact that the environment or certain objects look strange, distorted, dull, colorless, lifeless, monotonous and uninteresting, or they perceive the environment as a stage on which everyone plays.
  • The insight that the changes were not entered from outside by other people or forces is retained.

This diagnosis should not be made if the symptom occurs in the context of another mental disorder, [...], as a result of intoxication with alcohol or other psychotropic substances, in schizophrenia [...], an affective disorder, an anxiety disorder or in other conditions ( such as marked tiredness, hypoglycaemia or immediately before or after an epileptic seizure). These symptoms occur in the course of many mental disorders and are then best coded as a second diagnosis or as an additional diagnosis to another main diagnosis.

Derealization can also occur on its own relatively rarely. In this case, it is assigned to the depersonalization disorder category according to both ICD-10 and DSM-5.

course

The disease usually breaks out in adolescence or early adulthood (mean: at 16 years of age). However, the disease can also start more rarely in childhood or in later years, but in only about 5% after the age of 25.

The beginning can be sudden or creeping. If the disorder occurs in episodes, the duration can vary widely: between short episodes that last hours or days, and prolonged episodes over weeks, months or years.

About a third of the cases show a permanent episodic course, a further third an initially episodic and later sustained (continuous) course, and in the remaining third a sustained (continuous) course from the beginning.

The intensity of the symptoms can either fluctuate or remain unchanged over a long period of time (in extreme cases over years). If it fluctuates, typical triggers for aggravation are stress, deterioration in mood, increase in anxiety, new or over-excited surroundings, or lack of sleep.

Primary and secondary forms

According to the diagnostic rules of the ICD-10 and DSM-5, a depersonalization disorder should only be the main diagnosis if it does not occur as a symptom in the context of another disorder. This is why the literature sometimes distinguishes between primary and secondary depersonalization.

Primary depersonalization describes the independent depersonalization disorder, which cannot be assigned to another disorder as an accompanying symptom. Secondary depersonalization stands for a depersonalization that occurs as a symptom of another superordinate disorder. According to previous findings (as of 2016), there are no significant differences between primary and secondary depersonalization in terms of severity and severity.

Secondary depersonalization phenomena can occur to varying degrees in a variety of psychological and neurological disorders:

Ingesting psychoactive substances such as alcohol , cannabis, and certain drugs can also cause depersonalization.

Depersonalization can occur as a symptom of schizophrenia , but must be differentiated from the other forms of depersonalization, as the person affected usually has no insight into the disease (see demarcation in the diagnostic criteria ).

Causes and Triggers

As with other mental disorders, no single triggering factor can usually be named as a sufficient cause for a depersonalization disorder. If depersonalization is understood as the reaction of those affected to past or current life situations, then these affected persons must also have a special predisposition to mind-altering disorders in order to develop a depersonalization disorder, since other people do not react with depersonalization to comparable life situations.

Individual depersonalization experiences or phases are triggered by extremely stress-inducing and life-threatening experiences (such as a car accident). For this reason, so-called near - death experiences and other out-of-body experiences are also understood as depersonalization.

Drug use (e.g. cannabis , ecstasy , alcohol ), certain types of poisoning , emotional neglect , premenstrual syndrome and lack of sleep can also be considered as causes .

When clarifying the cause in each individual case, it must also be checked whether the depersonalization disorder occurs as a symptom of another disorder (see secondary depersonalization disorder ). In the latter case, the causes of the underlying disorder should first be investigated.

Explanatory models

Since the intensification of research on depersonalization in the 1990s, the following explanatory models have emerged within various scientific disciplines.

Neurophysiological Theory

VS Ramachandran has made several suggestions since 2009 that the neural representation of self-perception could be analogous to the representation of the perception of others. Just as the behavior of other living beings is presented in a neuronal manner, one's own behavior can also be presented in a neuronal manner. The proposal was triggered u. a. through the discovery of so-called mirror neurons . These react when observing actions, e.g. B. a kick, just as with the self-execution of the action. Ramachandran thought it plausible that the neural mechanisms of external and self-representation developed in parallel during evolution. According to this concept of self-awareness, Ramachandran then suggested that phenomena of depersonalization and derealization could be traced back to deviations in neuronal connections to mirror neuron systems.

Neurochemical Theories

It is assumed that several neurotransmitter systems are involved in the development and maintenance of depersonalization , which are involved in the regulation of the global balance of neural information flows, etc. a. play an important role in stress reactions.

Serotonergic Systems

The likelihood of symptoms increases by substances known as serotonin - agonists act as m-CPP , cannabis , LSD and ecstasy . However, it is not known whether there are deviations in serotonergic systems during depersonalization that is not triggered by substances. Furthermore, there are no reliable data available on whether drug influencing these systems is therapeutically plausible (as of 2016).

Glutamatergic Systems

It is known that the NMDA antagonist ketamine can produce effects that correspond to depersonalization. It is assumed that this is caused by disturbances in the flow of information that is widespread in the brain, in which the neurotransmitter glutamate is involved. However, it is not known whether there are deviations in glutamatergic systems during depersonalization that is not triggered by ketamine. Furthermore, there are no reliable data available on whether drug influencing these systems is therapeutically plausible (as of 2016).

Opioid receptors

The assumption that depersonalization can lead to a dysregulation of the body's own ( endogenous ) opioid transmitter systems was supported by several, smaller pilot studies. Opioid antagonists such as naloxone , naltrexone and nalmefene showed a tendency to reduce symptoms. The therapeutic use of naltrexone was recommended as a trial in individual cases in 2014. (See section Opioid Antagonists below )

Panic disorder theory

The cognitive behavioral model (cognitive-behavioral model) of Hunter u. a. (2003) is based on the assumption that a depersonalization disorder can arise from the exaggerated evaluation of normally temporary states of depersonalization.

The model is strongly based on cognitive models for anxiety disorders, such as Clark's (1986) model for panic disorder . In this model, it was suggested that common symptoms of anxiety, such as a change in heart rate, dizziness, or difficulty concentrating, are the starting point for panic disorder. While healthy people see these symptoms as common anxiety symptoms, patients mistakenly see them as a danger (for example, “I'm going to have a heart attack”). This increases the fear and thus the fear-related sensations, which in turn lead to even more fear. This sets in motion a vicious circle .

Temporary depersonalization is a relatively common phenomenon. It has therefore been suggested that putting too much emphasis on such temporary symptoms can lead to panic anxiety - such as when interpreted as signs of going "crazy", losing control, becoming invisible, or having brain damage. The fear then intensifies the depersonalization. This in turn increases the fear, which sets in motion a vicious cycle that can sustain depersonalization as a permanent disorder.

A nationwide study in the UK in 2012 supported this model insofar as when comparing personality traits during childhood in cases of later depersonalization at the age of 36, only the fear factor during childhood was significantly correlated with the later disorder .

Psychoanalytic Theory

In the tradition of psychoanalysis according to Sigmund Freud , depersonalization is described as a disorder in which a protective defense mechanism is assumed to be the cause . This is assigned a defensive function, which allows the patient to fend off painful, frightening or otherwise unbearable feelings and thoughts by evaluating them as not belonging to the person. At the same time, however, the existence of such experiences in one's own self, which appear to be alien, is perceived as a disruption of the I experience, which in turn triggers uneasiness and fears.

Brain research

By imaging both functional and were anatomical detected deviations in the brain in patients with depersonalization disorder. An underfunction was observed in the left anterior insular cortex , which has important functions in emotional experiences and in perceiving one's own body ( interoception ). If the symptoms of the disorder had improved in the period up to a later measurement, the activity in the islet cortex also increased. In contrast, no such recovery of activity in the islet cortex was observed in patients with no improvement in symptoms by the second measurement .

treatment

In the case of secondary depersonalization, the focus is on treating the underlying disease. For the treatment of primary depersonalization there is so far (as of 2016) no therapy that has become established.

Pharmacotherapy

So far (as of 2016) there is no drug that is approved for the treatment of depersonalization derealization disorder . However, there are several that have been investigated. Some proved to be partially effective and were recommended in 2014 by the relevant medical societies in Germany for a possible trial application in individual cases. Of course, this only applies to drugs that have already been approved for other applications ( off-label use ).

Lamotrigine

There are contradicting results on the effectiveness of lamotrigine in this disorder, which so far (as of 2016) have prevented a clear assessment.

Opioid antagonists

Positive effects in the treatment of symptoms of depersonalization were recorded in a non-placebo-controlled study by the administration of infusions of the opioid antagonist naloxone . In the majority of cases, a clear improvement and in a small number of patients even a complete elimination of the symptoms was achieved. The effects could last for over 24 hours. Another study showed a similar effect from naltrexone .

In an uncontrolled study of veterans with post-traumatic stress disorder, a significant decrease in emotional numbness and other symptoms of post-traumatic stress disorder when using nalmefene was observed in just under half of the subjects . A similar effect could be brought about in a small uncontrolled study with naltrexone . However, this effect was less pronounced. However, it was confirmed by a similar German study from 2015.

In 2014, the relevant medical societies in Germany recommended the therapeutic use of naltrexone as an attempt in individual cases as a clinical consensus point (KKP) .

psychotherapy

Traditionally, depersonalization has been considered particularly difficult to treat in psychotherapy. So far, there are no qualitatively sufficient studies that prove the effectiveness of any form of psychotherapy in depersonalization.

Cognitive behavioral therapy

In more recent approaches to cognitive behavioral therapy , the connection between depersonalization and fear is in the foreground. In most cases, the patient's experiences of alienation are classified as extremely threatening (catastrophic attribution). The consequences of this assessment are persistent fear, compulsive self-observation, and fearful-avoidant behavior. The cognitive-behavioral therapeutic approach therefore consists in giving the patient an opportunity to reevaluate the experiences of depersonalization and thereby deprive them of the appearance of the threatening and catastrophic. The exact diagnosis as well as a detailed explanation of the patient ( psychoeducation ) about the depersonalization disorder can make a decisive contribution to this goal , as they can relieve the patient of various fears (e.g. the fear of going crazy; the fear that "the brain not working properly ”; the fear of being the only person with such experiences).

A 2005 study of 21 patients individually treated with cognitive behavioral therapy showed significant improvements in dissociation , anxiety, and depression , as well as general functions, both after the end of therapy and six months later. 29% of the patients no longer met the criteria for depersonalization disorder after the end of therapy.

Mindfulness Based Therapy

One study found opposing trends (inverse correlation ) between the severity of depersonalization and certain aspects of mindfulness . This was taken as an indication that mindfulness-based psychotherapy procedures could be helpful.

Transcranial magnetic stimulation

Several pilot studies looked at the use of repetitive transcranial magnetic stimulation (rTMS) in depersonalization, stimulating different targets. This research approach has grown in importance in recent years, as advanced, computer-controlled stimulation increasingly offers more options and the treatment has no or hardly any negative side effects.

In the first study, a patient was stimulated on the right prefrontal cortex , which resulted in a significant improvement.

A series of 6 applications to the left dorso-lateral prefrontal cortex resulted in a 28% decrease in the degree of symptoms in one case.

After a series of stimulations on the right temporoparietal junction cortex for 3 weeks, a decrease in symptoms was observed in 6 of 12 patients. After a further 3 weeks, an average of 68% symptom relief was found in 5 of these. All of the core symptoms of depersonalization were significantly reduced, but most of all the changes in body experience.

The ventro-lateral prefrontal cortex comprises Brodmann areas 47, 45, and 44 (here left side - in the studies opposite, the opposite right side was excited by rTMS).

In a 2014 study, 17 patients were randomly divided into two groups. One group received a 15-minute stimulation of the right ventro-lateral prefrontal cortex, the other of the right temporoparietal transition cortex. Significant improvements in symptoms were seen in both groups.

In a 2016 study, seven patients in whom drug therapy attempts were unsuccessful received up to 20 treatments over 10 weeks. Symptoms decreased significantly, averaging 44%. Two patients were found to be "fully responsive", four as "partially responsive" and one as "non-responsive". The ability to react was usually evident during the first 6 treatments. The authors concluded that a controlled clinical study on this method was now indicated.

history

As early as 1872 the symptoms were described by the Hungarian-French doctor Maurice Krishaber (1836-1883). The term was introduced in 1898 by the French psychiatrist Ludovic Dugas . According to his own statements, he took it from an entry in the diaries of the French philosopher Henri-Frédéric Amiel . The entry of July 8, 1880 states:

«À présent je puis considérer l'existence à peu près comme d'outre-tombe, comme d'au delà; je puis sentir en ressuscité; tout m'est étrange: je puis être en dehors de mon corps et de mon individu, je suis dépersonnalisé , détaché, envolé. »

Depersonalization in the movie

The film Numb is about a man who suffers from depersonalization.

See also

Individual evidence

  1. ↑ Depersonalization in: DORSCH Lexikon der Psychologie
  2. ↑ Pschyrembel clinical dictionary , Verlag deGruyter, 267th edition 2017 ( ISBN 978-3-11-049497-6 ). (Keyword depersonalization )
  3. ↑ Working group of six specialist societies: Guideline Diagnostics and Treatment of Depersonalization-Derealization Syndrome. (PDF) AWMF guidelines , September 2014, p. 16; Retrieved August 29, 2016.
  4. ↑ The classification was adopted from M. Sierra, GE Berrios: The phenomenological stability of depersonalization: comparing the old with the new. In: The Journal of nervous and mental disease. 189 (9), 2001, pp. 629-636. PMID 11580008 . Quoted from Lukas (2003).
  5. ↑ Peter Falkai, Hans-Ulrich Wittchen, American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 413 f .
  6. ↑ Codes in the ICD-10 (according to DIMDI ): depersonalization and derealization syndrome (F48.1)
  7. ↑ Depersonalization-derealization syndrome in the ICD-10 Classification of Mental and Behavioral Disorders (WHO): Clinical descriptions and diagnostic guidelines (p. 136ff)
  8. ↑ Working group of six specialist societies: Guideline Diagnostics and Treatment of Depersonalization-Derealization Syndrome. (PDF) AWMF guidelines , September 2014, p. 17; Retrieved August 29, 2016.
  9. ↑ Berit Lukas: The feeling of being a NO-BODY. Depersonalization, Dissociation, and Trauma. Junfermann Verlag, Paderborn 2003, ISBN 3-87387-534-9 , p. 111.
  10. ^ MV Lambert, C. Senior, WD Fewtrell, ML Phillips, AS David: Primary and secondary depersonalization disorder: a psychometric study. In: Journal of affective disorders. Volume 63, Numbers 1-3, March 2001, pp. 249-256. PMID 11246104 .
  11. ↑ Daphne Simeon, Jeffrey Abugel: Feeling Unreal: Depersonalization Disorder and the Loss of the Self. Oxford University Press, New York 2006, ISBN 0-19-517022-9 , p. 63.
  12. ↑ Olaf Blanke, Nathan Faivre, Sebastian Dieguez: Leaving Body and Life Behind: Out-of-Body and Near-Death Experience. In: Steven Laureys, Olivia Gosseries, Giulio Tononi: The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology. 2nd Edition. Academic Press, Amsterdam 2015, ISBN 978-0-12-801175-1 , pp. 323-347 (English). online (accessed September 9, 2016).
  13. ^ L. Oberman, VS Ramachandran: Reflections on the Mirror Neuron System: Their Evolutionary Functions Beyond Motor Representation. In: JA Pineda (Ed.): Mirror Neuron Systems: The Role of Mirroring Processes in Social Cognition. Humana Press, 2009, ISBN 978-1-934115-34-3 , pp. 39-62.
  14. ↑ VS Ramachandran: Self Awareness: The Last Frontier. Edge Foundation web essay, January 1, 2009, tapped October 22, 2014
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  25. ↑ Working group of six specialist societies: Guideline Diagnostics and Treatment of Depersonalization-Derealization Syndrome. (PDF) AWMF guidelines , September 2014, p. 22 f .; Retrieved August 29, 2016.
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literature

Guidelines

Introductions

  • Jeffrey Abugel: Stranger To My Self: Inside Depersonalization: The Hidden Epidemic . Johns Road Publishing, 2011, ISBN 978-0-615-38523-5 .
  • Berit Lukas: The feeling of being a NO-BODY. Depersonalization, Dissociation, and Trauma. Junfermann Verlag, Paderborn 2003, ISBN 3-87387-534-9 .
  • Mauricio Sierra: Depersonalization: A New Look at a Neglected Syndrome . Cambridge University Press, 2009, ISBN 978-1-139-48942-3 .
  • Daphne Simeon, Jeffrey Abugel: Feeling Unreal: Depersonalization Disorder and the Loss of the Self . Oxford University Press, New York 2006, ISBN 0-19-517022-9 .
  • Daphne Simeon: Depersonalization disorder: a contemporary overview. In: CNS drugs. Volume 18, Number 6, 2004, pp. 343-354. PMID 15089102 (Review), PDF (accessed September 16, 2016).
  • Uwe Wolfradt: Depersonalization - self-alienation and reality disturbance . Kölner Studien Verlag, 2003, ISBN 3-936010-04-8 .

counselor

  • Anthony David, Emma Lawrence, Dawn Baker, Elaine Hunter: Overcoming depersonalization and feelings of unreality: a self-help guide to using cognitive behavioral techniques . Constable & Robinson, London 2007, ISBN 978-1-4721-0574-5 .
  • Matthias Michal: Depersonalization and Derealization: Overcoming Alienation . 2nd, revised and expanded edition. Kohlhammer, Stuttgart 2015, ISBN 978-3-17-026187-7 .
  • Fugen Neziroglu, Katharine Donnelly: Overcoming Depersonalization Disorder: A Mindfulness and Acceptance Guide to Conquering Feelings of Numbness and Unreality . Foreword: Daphne Simeon, New Harbinger Publications, Oakland CA 2010, ISBN 978-1-57224-706-2 .

Web links

Wiktionary: Depersonalization  - explanations of meanings, word origins, synonyms, translations