Depersonalization Disorder

Depersonalization is a state in which the individual experiences some alteration in their perception of the self.  It is often accompanied by derealization, the sense that the environment is unreal or markedly changed. Those experiencing depersonalization may describe it as being out of their body in some fashion. For example, many trauma survivors describe some variation of looking at themselves/their body from a distance during episodes of abuse. Some may describe feeling more like a machine or robot than a person. Most also report a sense of emotional detachment or  emotional numbing.

Depersonalization is a common experience in the general adult population and not always linked to trauma. It also occurs under such circumstances as sleep deprivation, the use of certain anesthetics and in reaction to stressful situations such as public speaking or being in a traffic accident. Episodes of depersonalization usually last only a few moments but they may occur repeatedly.

Depersonalization as a symptom may occur in panic disorder , borderline personality disorder , post-traumatic stress disorder (PTSD), acute stress disorder , or another dissociative disorder. The individual is not given the diagnosis of depersonalization disorder if the episodes of depersonalization occur only during panic attacks or following a traumatic stressor.

Depersonalization disorder is another of the dissociative disorders classified by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream).

To meet the criteria for a disorder, depersonalization must be longstanding and not occurring exclusively during the course of another mental disorder, such as schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder, and  not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). Individuals with depersonalization disorder often report problems with concentration, memory and perception. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What causes depersonalization disorder? Like all dissociative disorders, it is usually related to childhood trauma. Recent research suggests that emotional abuse may be especially linked to depersonalization disorder. Simeon et al. (2001) conducted a study of depersonalization disorder published in the American Journal of Psychiatry and abstracted here:

The Role of Childhood Interpersonal Trauma in Depersonalization Disorder

Daphne Simeon, M.D., Orna Guralnik, Psy.D., James Schmeidler, Ph.D., Beth Sirof, M.A., and Margaret Knutelska, M.A. OBJECTIVE: In contrast to trauma’s relationship with the other dissociative disorders, the relationship of trauma to depersonalization disorder is unknown. The purpose of this study was to systematically investigate the role of childhood interpersonal trauma in depersonalization disorder.

METHOD: Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison subjects who were free of lifetime axis I and II disorders and of comparable age and gender were administered the Dissociative Experiences Scale and the Childhood Trauma Interview, which measures separation or loss, physical neglect, emotional abuse, physical abuse, witnessing of violence, and sexual abuse.

RESULTS: Childhood interpersonal trauma as a whole was highly predictive of both a diagnosis of depersonalization disorder and of scores denoting dissociation, pathological dissociation, and depersonalization. Emotional abuse, both in total score and in maximum severity, emerged as the most significant predictor both of a diagnosis of depersonalization disorder and of scores denoting depersonalization but not of general dissociation scores, which were better predicted by combined emotional and sexual abuse. The majority of the perpetrators of emotional abuse were either or both parents. Although different types of trauma were modestly correlated, only a few of these relationships were statistically significant, underscoring the importance of comprehensively considering different types of trauma in research studies.

CONCLUSIONS: Childhood interpersonal trauma and, in particular, emotional abuse may play a role in the pathogenesis of depersonalization disorder. Compared to other types of childhood trauma, emotional maltreatment is a relatively neglected entity in psychiatric research and merits more attention.

The prognosis for recovery from depersonalization disorder is good. Most people recover completely, particularly those who developed the disorder in connection with traumas that can be explored and resolved in trauma therapy.

Kathleen Young Psy.D.

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References:

Simeon, D., Guralnik, O., Schmeidler, J., & Knutelska, M. (2001). The role of childhood interpersonal trauma in Depersonalization Disorder. American Journal of Psychiatry, 158(7), 1027-1033.

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19 Responses to Depersonalization Disorder

  1. Hi Kathleen,

    Thanks for a very thorough description of depersonalization disorder. Though I’ve worked some with childhood trauma, I haven’t seen much in dissociative disorders in my own practice, which is surprising actually. You’ve inspired me to do a little more research on the subject.

    Lisa Brookes Kift, MFT
    The Toolbox at http://LisaKiftTherapy.com

  2. Peter says:

    Dear Dr. Young,
    Having recently been diagnosed with Complex PTSD, I also discovered that I was suffering from Depersonalization Disorder as well. Often, without even realizing it, I would just “go away.” Having suffered through repeated physical and emotional abuse until the age of seven-teen probably had a great deal to do with it. Even now at age forty two, I still “go away.” It is a horrible when I am looking at myself from what seems to be a few feet away. I am only an observer. I cannot be seen or heard. Recently, I was watching myself in the kitchen. I had a small, very sharp paring knife in my hand. I felt the urge to just plunge the knife in into my chest. And then I “snapped back” into my body, knife in hand, with the thought of self harm still present. I dropped the knife and took a step back and just started to cry. It was a difficult moment. While this certainly was an extreme example, I discovered through therapy that I’ve been doing this a great deal without even realizing it. My therapist and I are working hard to prevent further episodes but it seems now like an almost impossible task. It seems to be a part of me that I am not willing to let go. However I haven’t given up hope.
    Thanks for all your excellent information on this website.

    • Hi Peter-

      I appreciate you reading along and commenting. Yes, some of these issues do co-exist, often. I am glad to hear you are working with a therapist to address all that goes along with complex trauma.

      I am especially glad to hear that you have not given up hope! That is certainly a message I strive to get across in this Blog: healing from complex trauma is possible!

  3. Nico Quarterm says:

    Dear Dr. Kathleen Young, I am 20 years old and have recently come to realize that I suffered from a dissociative disorder for at least three terrible years of my life a few years back. It is so great to find information about this disorder because I used to just think I had gone insane for a while. I never really told anyone about it, and no one really seemed to understand the reality I lived in. Thank you for talking about this issue, it is one that is so close to my heart.
    -Nico

    • I am so glad you are finding the information useful, Nico! I like to tell people that they are not “insane” but rather coping in the best way they could with “insane” circumstances!

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  5. John Hawkins says:

    I am a very confused nonfunctional being. I can understand things through my distorted perception- lack of vividness and concentration- This has been going on for about a good year and only gets worse by the day and more incidents. This is the most difficult thing I have ever going through in my life. I don’t know where the inner-strength within my self keeps me up. Even though I have know motivation,bad fatigue, and recently the biggest problems of fading memory. I lost connection with my past and it feels like I just now awakened to a new world with a new mind set. I just cant learn to live with it, everyday it hits me that I need help. My thoughts are “why don’t you just tell everybody so some one can help you.” Its not that simple. This condition is complicated and hard to explain to the common functional person who’s emotions are not bland as minds. I feel like a helpless animal, like know one knows what I am saying and they pass on acknowledging(they got there own problems to deal with). Impure,disturbing,and disgusting thoughts race through my head. I cant cope with immediate circumstances I feel overwhelmed. I have a fear that this is not the real world, something brought me here, and they are in my head or either watching me from a distance. My other fear is that I only live one life and I cant get these years back. On top of that I wonder if I will be abnormal all my life. The reason for this letter is to let it go into the hands of a professional hoping for help while I am still in the beginning stage of this condition and I am not the only person.

    • Hi John-

      I hope you can see from the articles and comments here that you are not alone. Help is definitely available; the sooner you begin the sooner you can sort all of this out. I have some good therapy referral resources listed on my side bar.

  6. Garrett says:

    Depersonalization is so understudied. Some body needs to step up and fund a program. It’s pretty sad that when you go to a psychiatrist they dont even know what it is!

  7. Jeff says:

    I suffer from ongoing depersonalization and derealization since taking an SNRI called Pristiq once. This was the first time I had ever tried a psych med and it caused me to absolutely freak out. Really the only way I can describe it. Intense suicidal thoughts and shear panic. I ended up in the ER where they gave me Adivan. Prior to this I was a fully functioning adult who was experiencing some job related stress. This has been the single most frightening time in my life. It has been 7 months now and I am finally off of the Adivan/Valium which brought on more trauma.
    I am working with a trauma Psy.D. who I really hope can help. I want my life back and an afraid that I will have to get used to this existence.
    Thanks for raising awareness.

  8. Rohan says:

    Dear Dr. Young,
    I am myself suffering from this disorder I guess.. When I think about myself ( which I continuously do ) I feel very strange, as if If it is me ! and If it is me , it is really strange.. feels like I am coming and going into dreams, I have hold on reality but I feel uneasy about this.. thoughts like … ” is this me ? ” “this is me but… ” “what is this” ? Sometimes..this feeling goes but it is present most of the time..

    I am 23, and The strange thing is this disorder first happened to me when I was mere 1o and was taking a shower.. I was seeing myself in a mirror and thinking these stuff.. and suddenly I felt so strange.. I shook my head and just got out of it..

    It never disturbed me on its own, I started enjoying it.. I used to think like that once a month or twice a year and by shaking my head I used to come out of it until recently I did this act again ..and I feel like I could not come out this time.. it has started disturbing me … 24 x 7 .. sometimes..it goes away though not completely and I feel a bit relieved but mostly I feel hung.. help me out pls…

    I once talked a neurospecialist about this and he prescribed me Tryptomer and then Sertalin..
    I guess it did not help..

    pls help me out..

    • Rohan-

      I would encourage you or anyone experiencing distressing symptoms to seek the services of a therapist with expertise in dissociation, especially depersonalization.

      Although I can provide information here at my blog it is of course no substitute for psychological services.

      If you would like ideas about how to find resources in your area you can feel free to email me: drkathleenyoung at hushmail.com

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  12. rom says:

    I have been having moments of what I think are depersonalization. It started after recreational use of ecstasy. When I look in the mirror I often see my face dissolve like I was on acid or something. In addition I get”rushes” butterflies, tingles, and zaps in my head. I think it might be a result of serotonin syndrome. when i feel this way if i look into the mirror all the symptoms seem to increase. I wonder why that is. Is it because I am alerted more to the fact (by the mirror) that I am dping? thanks for any help and your efforts here!

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