Personality depersonalization

This phenomenon refers to deviations in the sphere of self-awareness, including both the self-awareness disorder and its cognitive form. Normally, each person delineates his own "I" from the whole surrounding world, somehow evaluating himself, his physical data, the level of knowledge and moral and moral values, his place in society. Depersonalization is a special psychopathological state of change in the subjective attitude towards one's own "I". The subject has a feeling of uniqueness, activity and indivisibility of his personality, the naturalness of her self-expression is lost. He constantly compares himself with the former with himself, analyzes his thoughts, actions, behavior. The results of the subject's self-examination do not console - the acuity and clarity of the perception of the surrounding reality have disappeared, it is practically not of interest to him, his actions have become natural, they have become automatic, the imagination, the flexibility of the mind, and the imagination have disappeared. Such hypertrophied reflexion causes the subject considerable psychological discomfort, he feels himself isolated, aware of the changes that have taken place with him and is very painful about it.

With depersonalization there is a rupture of the reflexively conditioned transition of the real world into the subjective, transformed by the consciousness of that personality, that is, the formation of self-consciousness is interrupted. A person observes his own life detached, often feeling the qualitative changes in his personality, his inability to control his actions, his own body's lack of control. Characterized by the phenomenon of a split personality. A concomitant state is derealization - a complete or partial disturbance of the sensory perception of the surrounding reality, relating exclusively to qualitative changes.

The detachment from one's own self and the temporary disconnection of the emotional component of perception for a short time is considered a normal reaction of the human psyche to acute stress, a psychic anesthesia that allows to survive a traumatic event, abstract from emotions, analyze the situation and find a way out of it. However, the depersonalization / derealization syndrome can drag on for a long time - for weeks, months, years, no longer depend on the affective background and exist autonomously. And this is pathology. Clinical manifestations of the syndrome are observed in the symptom-complexes of psychoses, neuroses, progressive mental and general diseases. Violation of self-perception can exist for a long time as a reaction to a traumatic event outside the diseases of the central nervous system and a completely healthy, but unduly impressionable and vulnerable person.

[1], [2], [3], [4], [5], [6]

Epidemiology

Until now, there is no single approach and a clear interpretation of the phenomenon of depersonalization. Representatives of various psychiatric schools use this term to refer to various symptom-complexes of mental disorders. Some within the framework of depersonalization consider only the alienation of mental processes, in other cases the term is used more widely - include violations of the concept of the body scheme, mental automatisms, deja vu and veme vu. Therefore, the comparison of observations of researchers is very relative.

Most psychiatrists agree that it is almost impossible to diagnose depersonalization in children. The manifestation of the majority of cases belonging to manifestations of the phenomenon is attributed to the age interval from 15 to 30 years.

The formation of self-awareness occurs in the adolescent period, so the younger generation is at risk. However, depressive episodes in adolescents with symptoms of depersonalization are almost never accompanied. The greatest number of cases of such disorders among the youngest patients are the manifestation of mildly progressive schizophrenia, are observed in epileptics, and also teenagers abusing psychoactive substances.

In adults, the symptoms of depersonalization are more common in depressive disorders.

Opinions of children's psychiatrists differ very significantly, some see rudimentary symptoms from the age of three in children with schizophrenia, others can diagnose pathology closer to ten years.

The gender component is also significant. Some authors did not notice a significant difference between men and women, others, in particular German psychiatrists, note a significant predominance of female patients - four women per male.

The possibility of short-term episodes of depersonalization in the majority of the population (estimated at about 70%) is recognized, and in this case there is no gender-based separation. But the prolonged course of the syndrome is twice as common in women.

[7], [8], [9], [10], [11]

Causes of the syndrome of depersonalization

As an independent nosological unit, this syndrome is considered as a form of neurasthenia, but it is extremely rare in isolated form. More often it is part of the symptomatic complex of schizophrenia, epilepsy, obsessive-phobic or compulsive disorder, depression, and can be of organic origin. In patients suffering from depersonalization, a non-rugged organic cerebral deficiency is often found. In these cases, the patient is diagnosed with an existing disease.

Most specialists tend to believe that the depersonalization / derealization syndrome develops under the influence of the stress factor in interaction with the features of the individual model of the subject's response to the traumatic situation. Practically in all known cases, the appearance of symptoms of this violation of self-consciousness was preceded by the presence of severe anxiety, fear, anxiety in the patient. And in women, stress was most often associated with situations that threatened the lives of their child, and for men - their own. Although quite often the reason for the outbreak was less significant events.

The causes of the syndrome, like many other mental illnesses and abnormalities, are not exactly established. It is believed that the most mild form of depersonalization, which belongs to the first type, is caused mainly by external factors - stressful situations and related nervous stress in individuals who are in the borderline mental states, with intoxication substance, cerebral insufficiency of organic origin is not heavy degree. The first type of syndrome is susceptible to infantile personalities prone to hysteria and phobias, children and adolescents. At the same time, earlier forms of self-consciousness associated with the self-feeling of the individual are lost. The disorder proceeds in the form of paroxysms, periodically arising against the background of a completely healthy mental state.

Depersonalization of the second type has a more severe course and is due to internal causes. Often observed with sluggish schizophrenia, in persons, mentally excitable, prone to hypertrophied reflexion and stuck. This type is more susceptible to males in the period of the formation of personality - late puberty and adolescence. For the development of this type of syndrome requires a certain maturity of self-awareness, often the first type smoothly flows as you grow up in the second. Patients subjectively feel a loss of personal specificity, with a pronounced picture, the patient develops a feeling of complete loss of his "I", social communications are lost.

The third type (psychic anesthesia) also has an endogenous origin and occupies an intermediate position between the two already described. It occurs in people of mature age predominantly female with a diagnosis of endogenous depression, less often in psychopaths and people with cerebral deficiency of organic genesis. It manifests itself as a loss of the emotional component and is accompanied by symptoms of depersonalization.

A significant risk factor for the occurrence of the syndrome is certain personality traits of the individual. People who are exposed to this syndrome often have overestimated claims, overestimate their capabilities, do not take into account any objective circumstances, and, not having received the desired and not feeling the strength for further struggle, are shut off from their own "I", feel that they have lost their previous personal qualities . The tendency to prolonged fixation on negative events and self-analysis, suspicion increases the likelihood of the syndrome. It is believed that the depleted psyche of such a subject creates a protective barrier to prevent a more serious violation of mental health or the development of vascular crises. Protracted protracted process, when the situation is not resolved on its own, turns into a pathology requiring medical intervention.

[12], [13], [14], [15]

Risk factors

Given all of the above, the most likely risk factors for the symptoms of depersonalization are:

• hereditary predisposition to pathological anxiety, constitutionally conditioned low stress resistance;
• acute or chronic overstrain of the body;
• lack of sleep, chronic fatigue and the inability to restore strength;
• forced or conscious loneliness, rejection in the family, in the circle of peers;
• vegetovascular dystonia;
• cervical osteochondrosis;
• alcoholism, drug addiction (including addiction to caffeinated beverages and drugs that cause drug dependence), gambling;
• diseases of the central nervous system;
• mental disorders;
• somatic diseases affecting the hormonal balance and metabolism;
• hormonal and psychological nuances associated with age-related crises, pregnancy;
• physical or psychoemotional violence in childhood;
• observation of scenes of violence.

In patients with depersonalization of the history of their illnesses from the very childhood have much in common: frequent acute tonsillitis in childhood, which resulted in its chronic form; inflammation of the gallbladder, frequent complaints of intestinal spasms, later - lumbago and myositis, especially in the cervical region, myalgia; discomfort in the spine and epigastrium, behind the sternum in the heart; often observed hyperplasia of the thyroid gland and the like. Even minor exciting events caused them to jump in blood pressure, sleep disorders and other vegetative symptoms. They were often visited by obsessive terrible thoughts with time turning into a phobia.

[16], [17], [18], [19], [20]

Pathogenesis

The mechanism of the development of the depersonalization / derealization syndrome is launched in a predisposed (hypersensitive individual, anxious, hypochondriacal) individual with a whole complex of causes acting against the background of mental exhaustion, which threatens the disorganization of the mental process or vascular catastrophes. Short-term depersonalization is protective, which is recognized by all specialists in the field of psychiatry. The protective role is replaced by a pathological one, when the protection takes a prolonged course and becomes the basis of a painful condition that can last months or even years.

The presumed pathogenesis of depersonalization is currently considered at the neurophysiological level as an increase in response to the stress of synthesis of β-endorphins (endogenous opiates) in neurones of the pituitary gland or an increase in the activation of opioid receptors, which disrupts the neurochemical equilibrium and triggers a cascade of changes in other receptor systems. The synthesis of γ-aminobutyric acid is disrupted, which leads to a change in the activity of neurotransmitters regulating positive emotions and moods - an increase in the level of dopamine in the striatum, serotonin, oppressive neurons of the hippocampus. Histamine structures are affected.

It is assumed that the pleasure center (anhedonia) and the limbic system, responsible for the organization of emotional and motivational behavior, can be disconnected.

Confirms the involvement of the endogenous opiate structure in the pathogenesis of depersonalization the therapeutic effect of the use of naloxone, a drug that blocks opioid receptors.

[21], [22], [23], [24], [25], [26], [27], [28], [29]

Symptoms of the syndrome of depersonalization

The French psychiatrist L.Dyuga (one of the authors of the term "depersonalization") interpreted this state as a sense of loss of his own existence, and not his loss, noting that the sense of "I" is lost only in a faint and comatose state, at the time of an epileptic fit, the phase of a deep sleep, and also at the moment of severe obscuration of consciousness (amenia).

The main symptom of depersonalization  is a subjective sensation of the patient that his "I" acquires an alien, detached character. A person observes his thoughts, actions, parts of his body detached, his personality is not connected with the outside world. The environment that was perceived earlier (as the patient well remembers) natural and friendly, becomes decorative, flat, sometimes hostile.

How long does depersonalization last?

The answer to this question depends entirely on the nature of the origin of the phenomenon. Personal detachment as a natural protective reaction is short-lived - from several hours to several days, depending on the strength of the stress factor and the depth of the trauma.

The syndrome can develop against the background of diseases of the psyche or the nervous system, acquire a painful permanent or recurrent form and last for years. Naturally, it is not necessary to wait long for depersonalization to pass independently. If the condition worries you for more than a week, and there are no improvements, it is necessary to be examined and, possibly, to undergo treatment. Even a single, but protracted episode requires attention. A series of short-term episodes is also undesirable to be ignored.

The manifestation of psychosis has in most cases a sudden acute onset immediately after a traumatic event, sometimes preceded by anguish and anxiety. After a few months, the severity of the course of the disease becomes dull, and it becomes more monotonous.

In the initial stage, treatment can be most effective. If the patient has not consulted a doctor or the treatment has not helped, the illness turns into a chronic one. Yu.L. Nuller noted that many of his patients suffered a depersonalization-derealization disorder for a very long time - ten to fifteen years or more.

Many patients got used to their condition, developed a certain way of life and strictly followed it, involving and subordinating their family members to their disease. The patients occupied all their time with scrupulously planned activities, to which, as they said, they did not experience the slightest interest, for example, visiting excursions, performances, walking long walks and other activities, positioned by the patients as formal, however necessary, because they do so all. Periodically they visited the doctor, complained that they could no longer live like that, nevertheless, when they were offered to try out a new method of treatment or go to hospital, they refused under any pretexts or simply disappeared for a while. The doctors had the impression that they did not really want to get rid of their habitual pathology and change their lives.

Complications and consequences

The protective role of the short-term phenomenon of alienation, the emergence of mental anesthesia as a reaction to deep stress is unquestionable. This condition allows you to survive a mental trauma with the least loss for the central nervous system. However, in this case, the depersonalization / derealization syndrome does not last long and ceases on its own with the elimination of the stressor effect.

If the attacks of depersonalization after the elimination of the psychotraumatic situation are repeated and exist already autonomously from stress, the process should not be allowed to go by its own accord. There are cases when depersonalization passes by itself, like any other disease. But you do not need to count on it yet. After all, any problem is easier to solve in the initial stage.

Often in people suffering from attacks of depersonalization, excessive perfectionism develops, they grow with unshakable habits, rituals, they find it increasingly difficult to return to their former life. The process involves family members, friends and relatives, which can lead to the severance of family ties, isolation of the patient.

Even not connected with progressive mental illnesses the condition is not always self-eliminated. Constant reflection leads to the development of obsessions, which in the course of time acquire the character of impulsive actions.

Patients can become amorphous, indifferent to themselves, their appearance, work. Social connections, independence are lost, the likelihood of committing criminal acts, suicide is high. The patient at first critical of the situation, understands its unnaturalness, it gives him a lot of suffering and can lead to depression or the emergence of aggression to others or himself.

Therefore, if the seizures recur or persistent depersonalization is formed, it is better to seek the help of competent specialists. Perhaps a complete recovery, if the syndrome was a consequence of stress, arose against a background of neurosis, and the treatment was started in a timely manner.

Depersonalization, manifested as a symptom of a serious progressive mental illness, has consequences and complications of the disease, and in most cases it is referred to negative symptoms and manifestations of disease resistance to treatment. Nevertheless, even in this case, timely treatment can improve the situation

[30]

Diagnostics of the syndrome of depersonalization

Patients usually turn to the doctor with complaints about a sudden change in the perception of their personality, their moral appearance, their desires, aspirations, attachments or their bodies, loss of feelings and loss of confidence in their feelings. And they emphasize that they understand what it seems to them. In the descriptions appear expressions: "as if", "seemingly", "I see one thing, but it is perceived as quite different." They are usually difficult to describe the symptoms, because the sensations are often indistinct and fantastic, while the patient realizes the bias of their own sensations.

The patient can be assigned clinical laboratory tests to determine the overall level of his health status, urine analysis to detect traces of toxic substances.

Ultrasound, electroencephalography, magnetic resonance tomography is done to detect organic disorders, especially if some of the complaints do not fit into the clinical picture of the syndrome, the beginning of depersonalization with any provoking factor can not be linked, or the manifestation of the disease occurred late, for example, after the patient's forty years.

The main diagnostic tool is a test for depersonalization, which is a list of the main signs of the syndrome. The patient is asked to answer questions about what symptoms he is experiencing. The most famous questionnaire (the Nuller scale), which includes a variety of symptoms of derealization and depersonalization, is compiled by the well-known psychiatrists Yu.L. Nuller and E.L.Genkina. The test is conducted by a specialist, evaluating the patient's answers in scores. When a patient attains more than 32 points, the doctor may suspect that he has a disorder.

Diazepam test allows you to clarify the diagnosis. This method is considered reliable for distinguishing the depersonalization / derealization syndrome from anxiety disorder and depression. Developed by Professor Nuller, is the reaction of patients to the jet infusion into the vein of diazepam. The dose of the drug varies from 20 to 40 mg and depends on the age of the patient and the severity of the disorder.

In patients with depression, the clinical picture against the background of diazepam practically does not change, the drug causes drowsiness and retardation.

With an anxiety disorder, almost instantly, even during the introduction, symptoms of the disorder go through, sometimes even a slight euphoria appears.

With the syndrome of depersonalization / derealization, the reaction occurs later for 20 minutes or half an hour after the administration of the drug. There is complete or partial elimination of symptoms: patients feel the appearance of feelings and perception of the colorful real world.

The patient is examined the level of depression, the safety of the intellect and the ability to think, accentuation of character. Applying psychodiagnostic techniques, a family history, relations with relatives, psychotraumatic situations in the life of the patient, resistance to stress and anxiety level are studied.

[31], [32], [33], [34]

Differential diagnosis

Based on the survey data, a final diagnosis is made. Define the prevailing symptoms of the syndrome: depersonalization or derealization, its appearance. Organic and somatic pathologies, alcohol and drug use, the consequences of drug therapy are excluded. The main diagnostic criterion of the disorder is that the patients do not lose the ability to realize that their feelings are subjective, that the objective reality does not correspond to their perception and is in full consciousness.

Onyeroid, amenia, derealization-depressive syndrome requires precise differentiation, since the correct diagnosis prescribes the prescription of medicines and the success of treatment.

Bitter Kotara (central to it is nihilism in relation to their own lives, and generally all around) is characterized by symptoms that are more similar to the delusional state of depersonalization, which in severe cases reaches this height. Nevertheless, during the periods of enlightenment, individuals with depersonalization go on contact and realize that they exist.

Delirious nonsense and hallucinations of any etiology resemble a severe depersonalization disorder in terms of symptoms, however, delirium episodes are characterized by such a vivid symptom of arousal and confusion that in most cases their differentiation is not difficult. The greatest difficulty is presented by cases of hypokinetic delirium, when the patient is relatively calm.

The most difficult is the differentiation of the syndrome of depersonalization / derealization with schizophrenia or schizoid personality disorder. This is facilitated by the emotional coldness of the patients, the loss of warm feelings even to close people, the difficulty of dressing in the word form of their feelings and experiences, which can be mistaken for fruitless elaborate pretentious speech constructions.

Diagnostic marker can be information about the occurrence of events preceding the onset of the syndrome: with neurotic origin, there is always a link to the stress factor, and in schizophrenia it usually does not.

[35], [36], [37], [38]

Treatment of the syndrome of depersonalization

In cases where psychic or somatic pathology is the cause of the symptoms of depersonalization / derealization, the only way out is to treat the underlying disease. With its cure or the achievement of a stable remission, the symptoms of depersonalization disappear, and, first of all, as a rule, they are.

Details on how to treat depersonalization, read here.

The condition developing as an independent neurotic syndrome on the background of acute or prolonged stress, arises suddenly and plunges a person, at least, into confusion. Naturally, we are not talking about a state that lasted several minutes or hours, but about regular attacks or a stable disorder, that is, about pathology.

Much depends on the severity of the disorder and the state of the psyche. There are cases when the depersonalization syndrome has safely passed independently, however, it is not worth it to hope for yourself. It is necessary to act and to take advantage of the recommendations of psychologists, as well as people who have experienced such a state and who know first hand about which line of behavior to choose to part with the disorder and possibly even avoid the use of psychotropic drugs.

Prevention

To prevent the onset of the syndrome and its recurrence, those who have already experienced such a condition are usually recommended to lead a healthy and open lifestyle, in some cases it would be good to change the place of residence and the circle of friends.

However, the main thing is to change oneself, to take a more positive view of the world, to soberly assess their capabilities and set realistic goals. If this alone does not work, it is recommended to take a course of rational psychotherapy.

It is good to do something for the soul - better sports, you can - dancing, preferably in the team. The feasible physical exertions contribute to the development of internal substances of antidepressant action.

[39], [40], [41], [42], [43], [44]

Forecast

Depersonalization, not associated with progredient mental illnesses - epilepsy, schizophrenia and organic pathology of the central nervous system, in most cases is resolved safely.

Of course, people who applied for help in the first days of a pathological condition, have a better chance to get out of the situation without consequences. Sometimes it is enough to have a few conversations with a therapist to fully recover.

In some cases, usually - neglected, the syndrome acquires a chronic and resistant to treatment character. Very much depends on the patient himself, if he wants to get rid of psychological discomfort, tries to distract himself, focusing his attention on rational thoughts and actions, then the prognosis is much more favorable. In some, the syndrome acquires a permanent recurrent nature. However, with isolated depersonalization of neurotic genesis, significant personality changes are not observed.

If the patient has pronounced personality changes and develops a pronounced productive psychotic symptomatology, then a less favorable and depersonalized prognosis may lead to social maladaptation, partial or total loss of ability to work and independence.

[45], [46], [47], [48], [49], [50]