Depersonalized
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Depersonalization is a
dissociative Dissociatives, colloquially dissos, are a subclass of hallucinogens that distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...
phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Those affected often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from
delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...
s, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from
derealization Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted, or in other ways falsified. Other symptoms include feeling as if one's environment lacks spontan ...
, which involves a sense of detachment from the external world rather than from oneself.
Depersonalization-derealization disorder Depersonalization-derealization disorder (DPDR, DDD) is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached fro ...
refers to chronic depersonalization, classified as a
dissociative disorder Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. ...
in both the
DSM-4 The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
and the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
, which underscores its association with disruptions in consciousness, memory, identity, or perception. This classification is based on the findings that depersonalization and derealization are prevalent in other dissociative disorders including dissociative identity disorder. Though degrees of depersonalization can happen to anyone who is subject to temporary anxiety or stress, chronic depersonalization is more related to individuals who have experienced a severe
trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...
or prolonged stress/anxiety. Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including dissociative identity disorder and "
dissociative disorder not otherwise specified Other specified dissociative disorder (OSDD) and Unspecified dissociative disorder are two diagnostic categories for dissociative disorders (DDs) defined in the fifth edition (DSM-5) of the ''Diagnostic and Statistical Manual of Mental Disorders' ...
" (DD-NOS). It is also a prominent symptom in some other non-dissociative disorders, such as
anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...
s,
clinical depression Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Intro ...
,
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
,
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
,
schizoid personality disorder Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, ...
,
hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...
or endocrine disorders,
schizotypal personality disorder Schizotypal personality disorder (StPD or SPD), also known as schizotypal disorder, is a cluster A personality disorder, cluster A personality disorder characterized by thought disorder, paranoia, a characteristic form of social anxiety, dereali ...
,
borderline personality disorder Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, an acute fear of Abandonment (emotional), abandonment, and intense emotiona ...
,
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...
,
migraine Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...
s, and
sleep deprivation Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either Chronic (medicine), chronic ...
; it can also be a symptom of some types of neurological
seizure A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
, and it has been suggested that there could be common aetiology between depersonalization symptoms and panic disorder, on the basis of their high co-occurrence rates. In
social psychology Social psychology is the methodical study of how thoughts, feelings, and behaviors are influenced by the actual, imagined, or implied presence of others. Although studying many of the same substantive topics as its counterpart in the field ...
, and in particular
self-categorization theory Self-categorization theory is a theory in social psychology that describes the circumstances under which a person will perceive collections of people (including themselves) as a group, as well as the consequences of perceiving people in group terms ...
, the term ''
depersonalization Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of ...
'' has a different meaning and refers to "the stereotypical perception of the self as an example of some defining social category".


Description

Individuals who experience depersonalization feel divorced from their own personal self by sensing their body sensations, feelings, emotions, behaviors, etc. as not belonging to the same person or identity. Often a person who has experienced depersonalization claims that things seem unreal or hazy. Also, a recognition of a
self In philosophy, the self is an individual's own being, knowledge, and values, and the relationship between these attributes. The first-person perspective distinguishes selfhood from personal identity. Whereas "identity" is (literally) same ...
breaks down (hence the name). Depersonalization can result in very high
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
levels, which further increase these perceptions. Depersonalization is a subjective experience of unreality in one's self, while
derealization Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted, or in other ways falsified. Other symptoms include feeling as if one's environment lacks spontan ...
is unreality of the outside world. Although most authors currently regard depersonalization (personal/self) and derealization (reality/surroundings) as independent constructs, many do not want to separate derealization from depersonalization.


History

In 1904,
Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies seen as originating from conflicts in t ...
described his own experience of depersonalization experience at the Athens' Acropolis. He described the incident 32 years later, in 1936. He interpreted his experience as an unconscious psychological defense, in which he was repressing feelings of guilt for outliving his father, whose cause of death remained unknown. In his case study of the Wolf Man, Freud emphasized that depersonalization and derealization serve psychologically defensive functions. A young Russian man known as the "Wolf Man" experienced derealization, which is the sensation of being separated from his surroundings by a veil. This description of being separated from one's surroundings by a veil is reminiscent of
derealization Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted, or in other ways falsified. Other symptoms include feeling as if one's environment lacks spontan ...
. This symptom was accompanied by fear of wolves. Freud's case description revolves around the man's dream of white wolves in a tree peering at him through an open window.


Epidemiology

Despite the distressing nature of symptoms, estimating the prevalence rates of depersonalization is challenging due to inconsistent definitions and variable timeframes. Depersonalization is a symptom of anxiety disorders, such as
panic disorder Panic disorder is a mental disorder, specifically an anxiety disorder, characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath ...
. It can also accompany
sleep deprivation Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either Chronic (medicine), chronic ...
(often occurring when experiencing
jet lag Jet lag is a temporary physiological condition that occurs when a person's circadian rhythm is out of sync with the time zone they are in, and is a typical result from travelling rapidly across multiple time zones (east–west or west–east). ...
),
migraine Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...
,
epilepsy Epilepsy is a group of Non-communicable disease, non-communicable Neurological disorder, neurological disorders characterized by a tendency for recurrent, unprovoked Seizure, seizures. A seizure is a sudden burst of abnormal electrical activit ...
(especially
temporal lobe epilepsy In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and b ...
, complex-partial seizure, both as part of the
aura Aura most commonly refers to: * Aura (paranormal), a purported field of luminous multi-colored radiation around a person or object * Aura (symptom), a symptom experienced before a migraine or seizure * Halo (religious iconography), glory, or aure ...
and during the
seizure A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
), obsessive-compulsive disorder, severe stress or trauma,
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
, the use of recreational drugs especially
cannabis ''Cannabis'' () is a genus of flowering plants in the family Cannabaceae that is widely accepted as being indigenous to and originating from the continent of Asia. However, the number of species is disputed, with as many as three species be ...
,
hallucinogens Hallucinogens, also known as psychedelics, entheogens, or historically as psychotomimetics, are a large and diverse class of psychoactive drugs that can produce altered states of consciousness characterized by major alterations in thought, mo ...
,
ketamine Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) a ...
, and
MDMA 3,4-Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy (tablet form), and molly (crystal form), is an empathogen–entactogenic drug with stimulant and minor Psychedelic drug, psychedelic properties. In studies, it has been used ...
, certain types of
meditation Meditation is a practice in which an individual uses a technique to train attention and awareness and detach from reflexive, "discursive thinking", achieving a mentally clear and emotionally calm and stable state, while not judging the meditat ...
, deep
hypnosis Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychological ...
, extended mirror or
crystal gazing Crystal gazing or crystallomancy is a method for seeing vision (spirituality), visions achieved through trance induction by means of gazing at a crystal, commonly in the form of a crystal ball. Traditionally, it has been seen as a form of divina ...
,
sensory deprivation Sensory deprivation or perceptual isolation is the deliberate reduction or removal of stimuli from one or more of the senses. Simple devices such as blindfolds or hoods and earmuffs can cut off sight and hearing, while more complex devices can ...
, and mild-to-moderate
head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...
with little or full
loss of consciousness Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an awareness of self and environment or to respond to any human or environmental stimulus. Unconsciousness may occur as the re ...
(less likely if unconscious for more than 30 minutes).
Interoceptive exposure Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle ten ...
is a non-pharmacological method that can be used to induce depersonalization. In the general population, transient depersonalization and derealization are common, having a
lifetime prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
between 26 and 74%. A random community-based survey of 1,000 adults in the US rural south found a 1-year depersonalization prevalence rate at 19%. Standardized diagnostic interviews have reported prevalence rates of 1.2% to 1.7% over one month in UK samples, and a rate of 2.4% in a single-point Canadian sample. In clinical populations, prevalence rates range from 1% to 16%, with varying rates in specific psychiatric disorders such as panic disorder and unipolar depression. Co-occurrence between depersonalization/derealization and panic disorder is common, suggesting a possible common etiology. Co-morbidity with other disorders does not influence symptom severity consistently. Depersonalization is reported 2–4 times more in women than in men, but depersonalization/derealization disorder is diagnosed approximately equally across men and women, with symptoms typically emerging around the age of 16. A similar and overlapping concept called
ipseity disturbance A self-disorder, also called ipseity disturbance, is a psychological phenomenon of disruption or diminishing of a person's minimal self ''–'' the fundamental sense that one's experiences are truly one's own. People with self-disorder feel tha ...
(ipse is Latin for "self" or "itself") may be part of the core process of
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
spectrum disorders. However, specific to the schizophrenia spectrum seems to be "a ''dis''location of first-person perspective such that self and other or self and world may seem to be non-distinguishable, or in which the individual self or field of consciousness takes on an inordinate significance in relation to the objective or intersubjective world" (emphasis in original). For the purposes of evaluation and measurement, depersonalization can be conceived of as a construct and scales are now available to map its dimensions in A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the
Dissociative Experiences Scale The Dissociative Experiences Scale (DES) is a psychological self-assessment questionnaire that measures dissociative symptoms. Background It contains twenty-eight questions and returns an overall score as well as four sub-scale results. DES is ...
exhibited a more pronounced
cortisol Cortisol is a steroid hormone in the glucocorticoid class of hormones and a stress hormone. When used as medication, it is known as hydrocortisone. Cortisol is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal corte ...
response in stress. Individuals high on the absorption subscale, which measures a subject's experiences of concentration to the exclusion of awareness of other events, showed weaker cortisol responses.


Causes

Depersonalization can arise from a variety of factors, of both a psychological and physiological nature. Common immediate precipitants include instances of severe stress, depressive episodes,
panic attack Panic attacks are sudden periods of intense fear and Comfort, discomfort that may include palpitations, otherwise defined as a Tachycardia, rapid, Arrhythmia, irregular Heart rate, heartbeat, Hyperhidrosis, sweating, chest pain or discomfort, s ...
s, and the consumption of psychoactive substances such as
marijuana Cannabis (), commonly known as marijuana (), weed, pot, and ganja, List of slang names for cannabis, among other names, is a non-chemically uniform psychoactive drug from the ''Cannabis'' plant. Native to Central or South Asia, cannabis has ...
and
hallucinogen Hallucinogens, also known as psychedelics, entheogens, or historically as psychotomimetics, are a large and diverse class of psychoactive drugs that can produce altered states of consciousness characterized by major alterations in thought, mo ...
s. Additionally, there exists a correlation between frequent depersonalization and childhood interpersonal trauma, particularly cases involving emotional maltreatment. A case-control study conducted at a specialized depersonalization clinic included 164 individuals with chronic depersonalization symptoms, of which 40 linked their symptoms to illicit drug use. Phenomenological similarity between drug-induced and non-drug groups was observed, and comparison with matched controls further supported the lack of distinction. The severity of clinical depersonalization symptoms remains consistent regardless of whether they are triggered by illicit drugs or psychological factors.


Pharmacological

Depersonalization has been described by some as a desirable state, particularly by those that have experienced it under the influence of mood-altering
recreational drugs Recreation is an activity of leisure, leisure being discretionary time. The "need to do something for recreation" is an essential element of human biology and psychology. Recreational activities are often done for enjoyment, amusement, or plea ...
. It is an effect of
dissociatives Dissociatives, colloquially dissos, are a subclass of hallucinogens that distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...
and
psychedelics Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary mental states (known as psychedelic experiences or "trips") and a perceived "expansion of consciousness". Also referred to as classic halluci ...
, as well as a possible side effect of
caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
,
alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...
,
amphetamine Amphetamine (contracted from Alpha and beta carbon, alpha-methylphenethylamine, methylphenethylamine) is a central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, an ...
,
cannabis ''Cannabis'' () is a genus of flowering plants in the family Cannabaceae that is widely accepted as being indigenous to and originating from the continent of Asia. However, the number of species is disputed, with as many as three species be ...
, and
antidepressants Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sexu ...
. It is a classic withdrawal symptom from many drugs.
Benzodiazepine dependence Benzodiazepine dependence (BZD dependence) defines a situation in which one has developed one or more of either tolerance, withdrawal symptoms, drug seeking behaviors, such as continued use despite harmful effects, and maladaptive pattern of su ...
, which can occur with long-term use of benzodiazepines, can induce chronic depersonalization symptomatology and perceptual disturbances in some people, even in those who are taking a stable daily dosage, and it can also become a protracted feature of the
benzodiazepine withdrawal syndrome Benzodiazepine withdrawal syndrome (BZD withdrawal) is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stop ...
. Lieutenant Colonel Dave Grossman, in his book '' On Killing'', suggests that military training artificially creates depersonalization in soldiers, suppressing
empathy Empathy is generally described as the ability to take on another person's perspective, to understand, feel, and possibly share and respond to their experience. There are more (sometimes conflicting) definitions of empathy that include but are ...
and making it easier for them to kill other human beings. Graham Reed (1974) claimed that depersonalization occurs in relation to the experience of falling in love.


Situational

Experiences of depersonalization/derealization occur on a continuum, ranging from momentary episodes in healthy individuals under conditions of stress,
fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
, or drug use, to severe and chronic disorders that can persist for decades. Several studies found that up to 66% of individuals in life-threatening accidents report at least transient depersonalization during or immediately after the accidents. Several studies, but not all, found age to be a significant factor:
adolescents Adolescence () is a transitional stage of human physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with ...
and
young adults In medicine and the social sciences, a young adult is generally a person in the years following adolescence, sometimes with some overlap. Definitions and opinions on what qualifies as a young adult vary, with works such as Erik Erikson's stages ...
in the normal population reported the highest rate. In a study, 46% of college students reported at least one significant episode in the previous year. In another study, 20% of patients with minor head injury experience significant depersonalization and derealization. In
general infantry G.I. is an informal term that refers to "a soldier in the United States armed forces, especially the army". It is most deeply associated with World War II, but continues to see use. It was originally an initialism used in U.S. Army paperwork f ...
and
special forces Special forces or special operations forces (SOF) are military units trained to conduct special operations. NATO has defined special operations as "military activities conducted by specially designated, organized, selected, trained and equip ...
soldiers, measures of depersonalization and derealization increased significantly after
training Training is teaching, or developing in oneself or others, any skills and knowledge or fitness that relate to specific useful competencies. Training has specific goals of improving one's capability, capacity, productivity and performance. I ...
that includes experiences of uncontrollable stress, semi-starvation,
sleep deprivation Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either Chronic (medicine), chronic ...
, as well as lack of control over
hygiene Hygiene is a set of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
, movement,
communications Communication is commonly defined as the transmission of information. Its precise definition is disputed and there are disagreements about whether Intention, unintentional or failed transmissions are included and whether communication not onl ...
, and
social interaction A social relation is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more conspecifics within and/or between groups. The group can be a language or ...
s.


Biological

Studies have linked dysregulation of the
immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
with depersonalisation. Researchers compared protein expression in serum samples of individuals with depersonalisation/derealization disorder (DPDR, DDD) and healthy controls, and found that many key proteins involved in maintaining
homeostasis In biology, homeostasis (British English, British also homoeostasis; ) is the state of steady internal physics, physical and chemistry, chemical conditions maintained by organism, living systems. This is the condition of optimal functioning fo ...
were present at altered levels. Decreased levels of C-reactive protein (CRP), complement C1q subcomponent subunit B, and apolipoprotein A-IV, and increased levels of alpha-1-antichymotrypsin (SERPINA3) were observed in patients with DPDR. Furthermore, expressions of CRP and SERPINA3 were found to be linked with the ability to inhibit cognitive interference of DPDR.


Psychobiological mechanisms


Proximate mechanism

Depersonalization involves disruptions in the integration of
interoceptive Interoception is the collection of senses providing information to the organism about the internal state of the body. This can be both conscious and subconscious. It encompasses the brain's process of integrating signals relayed from the body int ...
and exteroceptive signals, particularly in response to acute anxiety or trauma-related events. Studies spanning from 1992 to 2020 have highlighted abnormalities in
primary somatosensory cortex In neuroanatomy, the primary somatosensory cortex is located in the postcentral gyrus of the brain's parietal lobe, and is part of the somatosensory system. It was initially defined from surface stimulation studies of Wilder Penfield, and parallel ...
processing and insula activity as contributing factors to depersonalization experiences. Additionally, abnormal
EEG Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The bio signals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neoc ...
activities, notably in the theta band, suggest potential biomarkers for emotion processing, attention, and working memory, though specific oscillatory signatures associated with depersonalization are yet to be determined. Reduced brain activities in sensory processing units, along with alterations in visceral signal processing regions, are observed, particularly in the early stages of
information processing In cognitive psychology, information processing is an approach to the goal of understanding human thinking that treats cognition as essentially Computing, computational in nature, with the mind being the ''software'' and the brain being the ''hard ...
. Furthermore,
vestibular The Vestibular (from , "entrance hall") is a competitive examination and is the primary and widespread entrance system used by Brazilian universities to select the students admitted. The Vestibular usually takes place from November to January, ...
signal processing, crucial for balance and spatial orientation, is increasingly recognized as a factor contributing to feelings of disembodiment during depersonalization experiences. Research suggests that abnormal activity in the
left hemisphere The lateralization of brain function (or hemispheric dominance/ lateralization) is the tendency for some neural functions or cognitive processes to be specialized to one side of the brain or the other. The median longitudinal fissure separates ...
may play a role, although abnormalities in right hemisphere brain activity, responsible for self-awareness and emotion processing, may also contribute to depersonalization symptoms. Higher activity in the right parietal lobe's
angular gyrus The angular gyrus is a region of the brain lying mainly in the posteroinferior region of the parietal lobe, occupying the posterior part of the inferior parietal lobule. It represents the Brodmann area 39. Its significance is in transferring vis ...
has been linked to more severe depersonalisation, supporting this idea. Potential involvement of
serotonergic A serotonergic substance, medication, or receptor protein is one that affects neurotransmission pathways that involve serotonin, as follows: * Serotonergic drugs ** Serotonin receptor agonists ** Serotonin receptor antagonists ** Serotonin reupta ...
,
endogenous opioid Opioid peptides or opiate peptides are peptides that bind to opioid receptors in the brain; opiates and opioids mimic the effect of these peptides. Such peptides may be produced by the body itself, for example endorphins. The effects of these p ...
, and glutamatergic NMDA pathways has also been proposed, alongside alterations in metabolic activity in the sensory association cortex, prefrontal hyperactivation, and limbic inhibition in response to
aversive stimuli In psychology, aversives are unpleasant stimuli that induce changes in behavior via negative reinforcement or positive punishment. By applying an aversive immediately before or after a behavior, the likelihood of the target behavior occurring i ...
revealed by
brain imaging Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incre ...
studies. In addition to this, research suggests that individuals with depersonalization often exhibit autonomic blunting, characterized by reduced physiological responses to stressors or emotional stimuli. This blunting may reflect a diminished capacity to engage with the external world or to experience emotions fully, contributing to the subjective sense of detachment from oneself. Additionally, dysregulation of the
HPA axis The pascal (symbol: Pa) is the unit of pressure in the International System of Units (SI). It is also used to quantify internal pressure, stress, Young's modulus, and ultimate tensile strength. The unit, named after Blaise Pascal, is an SI ...
, which governs the body's stress response system, is frequently observed in individuals who experience depersonalization. This dysregulation can manifest as alterations in cortisol levels and responsiveness to stress, potentially exacerbating feelings of detachment and unreality.


Ultimate mechanism

Depersonalization is a classic response to acute
trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...
, and may be highly prevalent in individuals involved in different traumatic situations including
motor vehicle collision A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tra ...
and
imprisonment Imprisonment or incarceration is the restraint of a person's liberty for any cause whatsoever, whether by authority of the government, or by a person acting without such authority. In the latter case it is considered " false imprisonment". Impri ...
. Psychologically depersonalization can, just like dissociation in general, be considered a type of coping mechanism, used to decrease the intensity of unpleasant experience, whether that is something as mild as stress or something as severe as chronically high
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
and
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...
. The decrease in
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
and psychobiological hyperarousal helps preserving adaptive behaviors and resources under threat or danger. Depersonalization is an overgeneralized reaction in that it doesn't diminish just the unpleasant experience, but more or less all experience – leading to a feeling of being detached from the world and experiencing it in a more bland way. An important distinction must be made between depersonalization as a mild, short-term reaction to unpleasant experience and depersonalization as a chronic symptom stemming from a severe mental disorder such as
PTSD Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster, traffic collision, ...
or dissociative identity disorder. Chronic symptoms may represent persistence of depersonalization beyond the situations under threat.


Treatment

Currently, no universally accepted treatment guidelines have been established for depersonalization. Pharmacotherapy remains a primary avenue of treatment, with medications such as
clomipramine Clomipramine, sold under the brand name Anafranil among others, is a tricyclic antidepressant (TCA). It is used in the treatment of various conditions, most notably obsessive–compulsive disorder but also many other disorders, including hyper ...
,
fluoxetine Fluoxetine, sold under the brand name Prozac, among others, is an Antidepressant, antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used for the treatment of major depressive disorder, Anxiety disorder, anx ...
,
lamotrigine Lamotrigine ( ), sold under the brand name Lamictal among others, is a medication used to treat epilepsy and stabilize mood in bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastau ...
, and
opioid antagonist An opioid antagonist, or opioid receptor antagonist, is a receptor antagonist that acts on one or more of the opioid receptors. Naloxone and naltrexone are commonly used opioid antagonist drugs which are competitive antagonists that bind to ...
s being commonly prescribed. However, it is important to note that none of these medications have demonstrated a potent anti-dissociative effect in managing symptoms. In addition to pharmacological interventions, various psychotherapeutic techniques have been employed in attempts to alleviate depersonalization symptoms. Modalities such as trauma-focused therapy and cognitive-behavioral techniques have been utilized, although their efficacy remains uncertain and not firmly established. Treatment is dependent on the underlying cause, whether it is organic or psychological in origin. If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as
amyotrophic lateral sclerosis Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or—in the United States—Lou Gehrig's disease (LGD), is a rare, Terminal illness, terminal neurodegenerative disease, neurodegenerative disorder that results i ...
,
Alzheimer's disease Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...
,
multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...
(MS), or any other neurological disease affecting the brain. For those with both depersonalization and
migraine Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...
,
tricyclic antidepressant Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains ...
s are often prescribed. If depersonalization is a symptom of psychological causes such as developmental trauma, treatment depends on the diagnosis. In case of dissociative identity disorder or DD-NOS as a developmental disorder, in which extreme developmental
trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...
interferes with formation of a single cohesive identity, treatment requires proper psychotherapy, and—in the case of additional (co-morbid) disorders such as
eating disorders An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...
—a team of specialists treating such an individual. It can also be a symptom of
borderline personality disorder Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, an acute fear of Abandonment (emotional), abandonment, and intense emotiona ...
, which can be treated in the long term with proper psychotherapy and psychopharmacology. The treatment of chronic depersonalization is considered in
depersonalization disorder Depersonalization-derealization disorder (DPDR, DDD) is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached fro ...
. A 2001 Russian study showed that
naloxone Naloxone, sold under the brand name Narcan among others, is an opioid antagonist, a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. Effects begin within two ...
, a drug used to reverse the intoxicating effects of opioid drugs, can successfully treat depersonalization disorder. According to the study: "In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization." The anticonvulsant drug
lamotrigine Lamotrigine ( ), sold under the brand name Lamictal among others, is a medication used to treat epilepsy and stabilize mood in bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastau ...
has shown some success in treating symptoms of depersonalization, often in combination with a
selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs primarily work by blo ...
and is the first drug of choice at the depersonalisation research unit at King's College London.


Research directions

Interest in DPDR has increased over the past few decades, leading to a large accumulation of literature on dissociative disorders. There has been a shift towards the use of research studies, rather than
case studies A case study is an in-depth, detailed examination of a particular case (or cases) within a real-world context. For example, case studies in medicine may focus on an individual patient or ailment; case studies in business might cover a particular fi ...
to understand depersonalization. However, there remains a lack of solid consensus on its definition and scales used for assessment. Salami and colleagues argued that studies of
electrophysiological Electrophysiology (from ee the Electron#Etymology, etymology of "electron" ; and ) is the branch of physiology that studies the electrical properties of biological cell (biology), cells and tissues. It involves measurements of voltage change ...
depersonalization-derealization markers are urgently needed, and that future research should use analysis methods that can account for the integration of
interoceptive Interoception is the collection of senses providing information to the organism about the internal state of the body. This can be both conscious and subconscious. It encompasses the brain's process of integrating signals relayed from the body int ...
and exteroceptive signals. The Depersonalisation Research Unit at the Institute of Psychiatry in London conducts research into
depersonalization disorder Depersonalization-derealization disorder (DPDR, DDD) is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached fro ...
. Researchers there use the acronym DPAFU (Depersonalisation and Feelings of Unreality) as a shortened label for the disorder. In a 2020 article in the
Journal Nature ''Nature'' is a British weekly scientific journal founded and based in London, England. As a multidisciplinary publication, ''Nature'' features peer-reviewed research from a variety of academic disciplines, mainly in science and technology. It ...
, Vesuna, et al. describe experimental findings which show that layer 5 of the retrosplenial cortex is likely responsible for dissociative states of consciousness in mammals.


See also


References


References

* {{Authority control Dissociative disorders Symptoms and signs of mental disorders Symptoms or signs involving perceptual disturbance