Depersonalization disorder: who am I really?

“My thoughts don’t seem like my own”, “Who am I?”, “I don’t recognize myself in the mirror”. These types of experiences frequently occur in people with depersonalization disorder. Likewise, it is very recurrent among those who go through a period of high anxiety and stress.

The search for one’s own identity and our place in the world is a constant. We have all asked ourselves at some point who we are, where we come from and where we are going. It’s something normal. However, in depersonalization disorder it occurs much more frequently and intensely.

Something we must understand first is that most of the time We are faced with what is clinically known as a dissociative disorder.. It is a mental condition where the person experiences failures in memory, consciousness, identity and perception.

What is depersonalization?

Depersonalization disorder is characterized by persistent or recurrent episodes of separation from one’s own body or mental processes, as an alien observer of one’s own life. It also usually causes the feeling of being totally disconnected from the environment that surrounds the subject, which is known as derealization.

The first time this condition was described was at the end of the 19th century.also seeing that it tended to appear along with other realities such as panic disorders or depression.

Studies such as the one carried out at the London Institute of Psychiatry reveal something interesting. What the person experiences is a very intense emotional reaction. In fact, In magnetic resonance imaging, great activity is seen in the cerebral insula.One suffers a feeling of unreality, strangeness or a distancing from oneself in general.The person with depersonalization may feel separated from their entire being (e.g., “I am nobody,” “I have nothing of myself”).This can even cause you to not accept your own emotions, thoughts, sensations, etc.

Patients often describe it as a robotic, automaton-like sensation, lacking control over one’s speech or movements.

Causes of the appearance of depersonalization/derealization disorder

Generally, the trigger for the appearance of this disorder is a very intense emotional episode. Some of the events that enhance it are the following:

Failures in perception, a characteristic of derealization

The environment may be seen as artificial, colorless, or lifeless. Derealization is normally accompanied by subjective visual distortions. These can be blurred vision, increased visual acuity, expanded or reduced visual field, two-dimensionality…

There may also be alterations in the distance or size of objects. Macropsia is one of these effects, and consists of seeing objects larger than they really are. Micropsy, on the other hand, is the complete opposite. We see objects smaller than they really are.

Exclusionary criteria

It must be made clear that, for this disorder to be diagnosed, the alterations mentioned above They cannot be the result of the intake of drugs, medications or an illness (like epilepsy).

Nor should these alterations be a criterion for schizophrenia, panic disorder, major depression, acute stress disorder or post-traumatic stress disorder.

Subjective characteristics of depersonalization disorder

People with depersonalization disorder may have difficulty describing their symptoms. Furthermore, they have the feeling that they are going crazy. Another common experience is the fear of suffering irreversible brain damage.

Another common symptom is the subjective alteration of the sense of time. (e.g., too fast, too slow). Likewise, there is also a subjective difficulty in vividly remembering past memories (and feeling part of them). On the other hand, they also often feel something similar to a saturation of the head. , tingling or feeling faint are also not uncommon.

Furthermore, it is not uncommon to find different degrees of anxiety or depression in people who suffer from episodes of depersonalization.. Something curious that has been observed is that these people tend to react physiologically more intensely to emotional stimuli.

These physiological changes occur due to the activation of the hypothalamic-pituitary-adrenal axis, the inferior parietal lobe and the circuits of the limbic prefrontal cortex.

How is the diagnosis of depersonalization disorder made?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), The person diagnosed with depersonalization/derealization disorder must meet the following diagnostic criteria:

TO. Presence of persistent or recurrent experiences of depersonalization, derealization

Depersonalization: experiences of unreality, distancing, of being an external observer with respect to one’s thoughts, feelings, sensations, body or actions. Derealization: experiences of unreality or distancing with respect to the environment. For example, people or objects are experienced as unreal, dream-like, hazy, lifeless, or visually distorted).

B. During experiences of depersonalization or derealization, the reality tests remain intact.

c. Symptoms include clinically significant discomfort or impairment in social, work, or other areas. important of the operation.

D. The alteration cannot be attributed to the physiological effects of a substance. For example drug, medication or other medical condition (e.g. epilepsy).

AND. The alteration is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or another dissociative disorder.

How does depersonalization disorder develop and what is the course?

On average, depersonalization/derealization disorder begins to manifest at age 16, although the disorder may begin in early or mid-childhood. In fact, most remember having had symptoms already in this phase.

More than 20% of cases appear after the age of 20 and only 5% after the age of 25Onset in the fourth decade of life or later is very unusual. Onset may be extremely sudden or gradual. The duration of depersonalization/derealization episodes can vary widely, from brief (hours or days) to long (weeks, months, or years).

A chronic clinical condition

Given the rarity of the disorder’s onset after age 40, underlying medical conditions may exist in these cases. These conditions can be brain injuries, seizure disorders, or sleep apnea.

The course of the disease is often chronic. While in some people the intensity of symptoms can increase and decrease considerably, others report a constant level of intensity that, in extreme cases, can be recurrent for years or decades. On the other hand, the increase in the intensity of the Symptoms can be caused by stress, worsening mood or anxiety symptoms, new stimulating circumstances, and physical factors such as lighting or lack of sleep.

Also, something important should be noted: Not all people who present some of these symptoms will develop the disorder.

Treatment

The therapeutic strategy for depersonalization disorder usually involves two basic strategies: pharmacological (with psychotropics such as naloxone) and psychotherapeutic.

Thus, cognitive-behavioral therapies have a good success rate in these cases. The objective will be to strengthen the patient’s connection with himself.

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