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.
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.