Symptoms of depersonalization disorder

The first signs are manifested as a feeling of a sharp qualitative change of today's self in relation to his former. Manifest the disorder severely immediately after severe stress, sometimes in premorbid anxiety disorder is observed, gradually evolving into depersonalization. In the initial stage in most patients, according to Yu.V. Nuller, somatopsical symptoms predominated, with the addition of psychic anesthesia. In this period, patients, along with symptoms of depersonalization, were experiencing anxiety, anguish, sometimes a strong fear or obsessive thoughts that contradict the moral and moral criteria of the patient, frightening him and delivering him anguish. Often, the symptomatology of depersonalization prevailed in the morning, and the symptoms of anxiety disorder intensified toward night.

Over time, mental suffering subsided, the course of the disease became more monotonous, the symptoms of derealization joined in. Part of the patients had supervalued or delusional ideas about the presence of their unrecognized somatic disease, they looked for its manifestations, mainly, they were complaints of various discomfortable sensations, more often - of myalgia. In fact, patients with isolated perceptual disorders are very healthy in a physical sense with people with good immunity, rarely sick even with ARI.

The depersonalization syndrome is manifested, first of all, by the intensification of introspection, the sharpened and deep "self-digging", the comparison with its former state and other people. Constant comparison of his new state with the former, as a rule, causes a sense of loss of personal individuality, naturalness of perception. The patients complain that the emotional fullness, natural perception and feelings left the life, they became soulless "living dead", automata. The perception of reality and self is also distorted in it - derealization and depersonalization are rarely isolated, much more often go hand in hand. In the same patient there are symptoms of alienation not only from his "I", but also the perception of the surrounding world is disturbed - he loses his colors, becomes flat, extraneous, faceless and indistinct.

Normally, all personal psychological manifestations of a person - sensory and bodily sensations, mental representations have a subjective coloring of "my personal" sensations and perceptions. With depersonalization, the same mental manifestations are felt as "not mine," automatic, devoid of personal belonging, the activity of one's own "I" is lost.

Light forms are manifested in complaints of detachment, a sense of change, a twilight consciousness, an unclear perception, a lack of emotions - joy, pity, sympathy, anger. With more severe forms of manifestation of depersonalization, patients complain that they do not feel alive, that they have turned into robots, zombies, their personality has disappeared. Later, there may be a split personality. The subject feels that two people with diametrically opposite personal characteristics live in it, they exist and operate in parallel, autonomously from each other. The owner's "I" knows both of them, but does not control their actions.

Total depersonalization occurs when the patient notes the complete loss of his "I", ceases to oppose himself to the surrounding world, dissolving in it, completely losing self-identification. This, the most severe, stage of the disease is also subdivided into functional (reversible) and defective (irreversible), occurring as a result of organic damage to the brain or a disease leading to the development of such a defect.

Various attempts have been made to classify depersonalization both according to clinical symptoms and developmental features. At present, its species are distinguished according to the prevailing symptomatology into autopsychic, allopsychic (derealization), and somatopsychic depersonalization, although in the pure form they practically do not occur. We will discuss their features in more detail below.

According to ontogeny, depersonalization is divided into three types. The first develops at a younger age under the influence of external provoking factors. Its specificity is a sense of loss of sensory (developing first) forms of self-awareness - self-sense of one's personality, body and its parts, its mental and physical activity, the unity of its own "I". This includes the alienation of thoughts and actions, automatisms, splitting personality. At the peak of depersonalization of the first type, the patient feels the complete disappearance of his "I", turning it into "nothing". It is accompanied by derealization, occurs with diseases of the central nervous system, borderline and schizoaffective disorders, in cyclotimics. It is supplemented with symptoms of neurasthenia - fears, dizziness, sweating, anguish and anxiety, obsessive states. Usually occurs in the form of periodic and not very frequent attacks against the background of long, quite stable periods of enlightenment.

The second type is characterized by changes in cognitive (more ontogenetically late forms of self-awareness). The patient feels deep changes in his personality, ceases to perceive the people around him, avoids contact. Patients complain about the loss of ideological and moral values, a feeling of complete devastation, depersonalization. Manifestations of somatopsychic and allopsychic derealization are also more pronounced and excruciating. This species often develops in people suffering from simple schizophrenia and schizophrenic psychopathy. It is accompanied by painful reflexion, hypochondriac delirium, progresses and leads to personal changes.

The third (intermediate in severity between the two types mentioned above) is a sense of loss of the emotional component. In the initial stages, the patient notices an emotional insufficiency, with the development of the state, emotions are lost more and lead to a lack of mood as such. Autopsychic, first of all, depersonalization (mental anesthesia) can be accompanied by alienation of one's body, its needs. The surrounding world is also perceived as colorless and alien.

There is a comorbidity of depersonalization with other disorders, which can occur and are isolated without symptoms of personal alienation. For example, depression, anxiety disorder, phobias, obsessive states, panic attacks can be accompanied by a phenomenon of alienation - a protective reaction is activated in the form of depersonalization / derealization syndrome. Although comorbid disorders do not always occur. In some patients, self-awareness disorders deepen gradually, smoothly and without the symptoms of other disorders. Such patients sufficiently indeterminately talk about the loss of their own "I", claiming that they act automatically, and with their psychic "I" nothing is more connected, and it does not concern them at all.

Anxiety and depersonalization

Genetically determined pathological anxiety is one of the main risk factors for the development of depersonalization in practically healthy people. Specialists note that the appearance of a patient's complaints about the alienation of his own "I" in any form is preceded by heightened anxiety, prolonged anxiety. Affected people of this disorder are sensitive, vulnerable, impressionable, sensitive not only to their own suffering, but also to the suffering of other people and animals.

Simultaneously, the people around them were evaluated (before the onset of symptoms), as energetic people with leadership qualities, who could get pleasure, enjoy the beauty of nature, good books and "infect" with their good mood around them. At the same time, their strong anxious reaction to trouble was also noticeable.

Depersonalization in anxiety disorder, that is, with constant anxiety, for which there are no real causes, is part of the symptom complex, like panic attacks. Such components can be observed all together, and some components may be absent.

Anxiety disorder manifests itself constantly and unreasonably with a feeling of restlessness, when the patient's limbs become cold, the mucous membrane of the oral cavity dries up and the head hurts, and the pain is diffuse, covering the head from both sides, the chest feels pressure, breathing and swallowing is difficult, symptoms can be observed digestive disorders. The diagnosis of anxiety disorder is put to people who complain that such symptoms do not go away for several weeks.

The phenomenon of depersonalization does not appear in all patients with anxiety disorder, it is more often observed in patients with a panic form. However, in its background, the alarm is increasing. The patient realizes his condition, it worries even more, makes you worry about the safety of your mind. Anxiety disorder is the main and it is necessary to treat it. In such cases, the patient is prescribed drugs with a pronounced anti-anxiety action - anxiolytics. It is noticed that after the relief has been cut off, the depersonalization resistance to medicamental treatment also disappears, and the patient's condition quickly stabilizes.

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

Panic attacks and depersonalization

Vegetosovascular dystonia is a fairly common condition, which is often "cheated" by various incomprehensible and not always amenable symptoms of nervous system disorders. One of the manifestations of the VSD is panic attacks, when outside the situation presenting a real danger, spontaneously arises wild, uncontrollable fear. Panic disorder or cardiac neurosis, as this condition is also called, is accompanied by severe weakness (swollen legs), a sharp increase in the pulse, increased blood pressure, shortness of breath, tremor (often very strong - teeth chatter, impossible to hold the object) of limbs and / or the whole body, paresthesias, dizziness due to hypoxia (pre-occlusive condition), increased sweating, nausea, or even vomiting. Panic attack is an acute stress for the body, therefore in some people this condition is accompanied by a syndrome of depersonalization / derealization. Which, of course, increases the panic attack, scares the patient himself, causes a new panic attack.

Depersonalization in VSD, in principle, is not life-threatening symptom and arises as a protective reaction, however, greatly reduces the quality of life of a person. If in the initial stage the alienation does not last long, several minutes - until the attack passes, then in the started cases the attacks become more frequent, and depersonalization practically leaves no room for a normal world view.

Depersonalization in panic attacks is resistant to treatment. First of all, you need to eliminate panic attacks and their causes are causing. In this case, training with a therapist is indispensable. After eliminating panic attacks, depersonalization passes by itself.

Consolation for people who are prone to panic attacks and anxiety disorder, which also often occurs in patients with vegetovascular dystonia - they are not sick with schizophrenia, they do not have psychoses, they do not go crazy and do not go down.

Depersonalization and obsessive thoughts

The syndrome in its essence does not exist in objective reality, but in the consciousness of the subject and, therefore, is an obsession. Certainly, the state is unpleasant and frightening, causing obsessive thoughts about impending madness. A person who once experiences depersonalization begins to think about her, and the next episode does not make you wait.

Some representatives of the human race have a predisposition to similar neurotic disorders. They are usually prone to unmotivated anxiety and panic attacks. Such subjects have enough of the slightest psychotrauma, which others would simply not have noticed to feel themselves beyond their own personality. Unstable consciousness is carried away from danger, so as not to collapse completely.

But since a person in a state of depersonalization understands that his sensations are deceiving, he has obsessive thoughts about loss of reason, fear of recurrence of the episode, a great desire to get rid of frustration and panic that this is forever.

Doctors and people who overcome depersonalization, advise to change the habitual thinking, and, perhaps, the way of life, gradually get rid of obsessive thoughts and do not get hung up on the problem. To do this, there are many psychotherapeutic techniques and medication, and - do not neglect the advice of people who have coped with the problem.

Symptoms such as obsessive thoughts and depersonalization can be observed in mental illnesses, injuries, tumors, and other brain lesions. People with obsessive-compulsive disorder are subject to depersonalization. To exclude such pathologies, it is necessary to undergo a comprehensive examination.

[6], [7], [8], [9]

Nahualism and depersonalization

In the historical sense, the origin of Nah-Wa'hl Ism (from the word Nagual - the second "I", the guardian spirit, hidden from the eyes of outsiders) goes back to ancient Indian religious teaching, shamanism, however, at the present time, as his preachers say, with religion nothing in common.

In Castaneda, thanks to which the term "nagualism" became widely known, he refers to a hidden, inconspicuous side of the human consciousness, which is difficult to identify with the verbal definitions.

Modern nagualism represents a certain direction of self-knowledge, declaring the primacy of self-education in oneself the ability to rely on oneself and the foundation of one's self-will. In the practices of nagualism, a special meaning is attached to the formation of one's own volitional intentions of personality, since it is believed that all other acting principles of consciousness are determined by external conditions - ontogeny, phylogeny, cultural environment and collective psyche.

The philosophy of nagualism is very liberal and recognizes the right to the existence of different points of view on the world, even the most senseless and pathological. There are many truths, each person has his own, so he has the right to build his life, obeying his own views. Every person lives in his subjective reality. Philosophy is quite complicated, besides, every guru presents it with his bills.

Practices of nagualism, for example, stopping internal dialogue, include reaching states resembling the depersonalization / derealization syndrome. The attacks of opponents of this trend and their accusations of developing this mental disorder are perhaps greatly exaggerated and groundless, since the attainment of a state of detachment from emotions occurs at the will of the practitioner. It is doubtful that the result achieved, to which he aspired, may frighten him.

Practices of self-improvement include self-observation, the isolation of their own automatisms and the causes that led to behavioral stamps. It assumes sincere acceptance of the results of introspection, regardless of their correspondence to their own ideas about themselves. Ultimately, this should lead to the creation of the will of a practitioner of his own consciousness independent of external influence.

Perhaps people who are prone to reflection and susceptible to depersonalization syndrome, the mastering of these practices will also be able to get rid of the fear of insanity, of obsessive thoughts about repetition of seizures, which is the main danger of depersonalization, to accept one's condition and change habitual thinking. Of course, the creation of an independent consciousness must be achieved only by a volitional effort without the involvement of narcotic substances, which were used by ancient Indian shamans.

Emotional depersonalization

Depersonalization distortions of sensory perceptions are accompanied by a partial or complete loss of the emotional component of the mental process (mental anesthesia). And it is lost as the ability to experience pleasant and joyful feelings, which is characteristic of a depressive disorder, and negative emotions - anger, anguish, dislike. The phenomenon of mental anesthesia is most clearly represented in depersonalization of the third type, but its components may be present in other types of disorder. Moreover, the division is very conditional.

Depersonalization often occurs in excessively emotional subjects. They remember that they loved their loved ones and friends, rejoiced and worried about them, and now they treat them almost indifferently. Music, paintings, nature no longer cause the former admiration, the feelings are as if dulled, however, the very ability to express emotions is preserved. Although there is nothing to express already. The mood itself becomes neither good nor bad. The external world of such patients is also not full of colors and expressiveness.

With somatopsychic depersonalization, painful, tactile, gustatory sensations are dulled - no tasty food, gentle touches, pain cause any emotions.

Emotional stupor refers to thinking, memories, past experiences. They become faceless, their emotional fullness disappears. The memory of the patient is preserved, but the past events, images, thoughts remain without emotional components, so the patient seems that he does not remember anything.

Mental anesthesia, mainly occurs in adults (more often female) against a background of depressions of endogenous origin (obsessive-compulsive disorder, neurosis and paroxysmal schizoaffective disorder), and also as a side effect of depression caused by taking antipsychotics. Cases of development of emotional derealization in psychopaths and in patients with organic lesions of the central nervous system are practically not found. Emotional depersonalization develops, as a rule, against a background of long and sufficiently deep discrete anesthetic depressions (occurring in the form of seizures and rarely taking a continuous course). To noticeable personality changes does not.

[10], [11], [12], [13]

Autopsyhical depersonalisation

With this type of disorder, patients lose the sensation of their mental "I", its emotional component disappears. They complain that they do not feel their thoughts, they can not adequately, as before, react to surrounding people and events. From this, patients experience a lack of spiritual comfort, nevertheless, they know who they are, but they do not recognize themselves. In most cases, patients with such a disorder even manage to adapt to their condition to a certain extent.

Autopsychic depersonalization is characterized by loss of naturalness of personal manifestations of patients who feel their thoughts and actions at the level of automatism. Nevertheless, patients do not have a feeling that they are controlled by some external force. They consider their actions to be mechanical and formal, but still their own.

For this type of disorder is characterized by pathological mental anesthesia - loss of emotions, the ability to empathize, compassion, love, rejoice and mourn. In most cases it is soullessness that causes subjective feelings about the loss of feelings as part of their personality.

The events to which he is a party are felt as if they were happening to someone else. A person becomes an outside observer of his own life. In severe cases, there may be a split personality, the patient complains that there are two people living in him, differently thinking and acting, not subject to him. Unreality of such sensations is realized and usually very scares the patient.

There can be anxious, panic disorders about what is happening, caused by the assumption of the development of mental illness, brain pathologies. Some, on the contrary, do not want to admit even to themselves that they are not all right, apparently panically afraid to learn about the alleged loss of reason.

In other patients, everything goes more smoothly, without catastrophic reactions. The condition deepens smoothly without sudden exacerbations. Patients complain that their personal qualities have been lost, only a copy remains of their mental "I", and the "I" itself has disappeared and therefore nothing touches them or touches them.

People with autopsychic depersonalization often stop talking with friends and relatives; they can not remember what they like; often freeze in one place and in one pose, as if they do not know what to do next; complain of partial amnesia; do not show emotion.

A marked predominance of autopsychic depersonalization or an isolated variant of it is most often found in schizophrenics with various forms of the disease, however, it can also be observed in organic cerebral pathologies.

Allopsychic depersonalization

This kind is also called derealization or a violation of the perception of the surrounding reality. The state arises suddenly and is manifested by the perception of the surrounding world in one plane, seeing it as in a picture or photograph, often black and white or cloudy. The sharpness of color, sound sensations is lost. The environment seems to be "flat", "dead", or perceived dulled, as if through glass, in the head - the absence of thoughts, in the soul - emotions. In general, it is difficult for the patient to catch in what mood he is, because he is not - neither bad nor good.

There may be problems with memory, the patient often does not remember the recent events - where he went, with whom he met, what he ate, and whether he ate at all. There are paroxysms, when the patient feels that he has seen or experienced everything that is happening (deja vu), or never seen (vimeu vju).

The present time for such patients usually flows slowly, some complain about the feeling that it stopped altogether. But the past is perceived as one short moment, as the emotional color of past events is erased from memory.

There may be difficulties if you need to think abstractly, associative links are broken. The disturbance of perception of external reality is often accompanied by sensations of changes in the qualitative characteristics of one's own personality and / or of one's own body. The experience of detachment of the patient's "I" from the surrounding reality comes to the fore, the real world seems to be a tightened translucent film, covered with haze, separated or decorative. Patients complain that the surrounding reality "does not reach" them.

Such patients often turn to ophthalmologists with complaints about visual disorders, they usually do not have any specific disease of the eyes.

In a more in-depth and thorough interview, the doctor can establish that the patient complains not of a deterioration of the immediate vision. He is worried about the vagueness of the environment, its unrecognizability, lifelessness. Patients complain of unusual and unpleasant sensations in the eyes, head, nose.

With allopsychic depersonalization, patients are often poorly oriented on the terrain, sometimes even in familiar and familiar surroundings, do not recognize on the street when meeting good acquaintances, poorly determine the distance, time, color and shape of objects. And, often they can reason like this: I know that the object is blue (red, yellow), but I see it in gray.

Attacks deja vu or jamais vu are characteristic for organic cerebral pathology, also such paroxysms appear periodically in epileptics. The same concerns "never heard" and "already heard.

Deployed disorders with prevalence of symptoms of derealization develop mainly in young people or middle-aged patients. In elderly patients, allopsychic depersonalization is practically not observed.

[14]

Somatopsychic depersonalization

Yu.L. Nuller noted that this type of disorder is usually observed in the initial acute period of the disease. Typical complaints of patients who are diagnosed with somatic depersonalization are that they do not feel their body or its separate parts. Sometimes it seems to them that any part of the body has changed size, shape or even disappeared.

Often it seems to patients that their clothes have disappeared, they do not feel it themselves, while patients do not suffer from an objective sensitivity disorder - they feel touches, pain from a prick, a burn, but somehow detached. All parts of the body are also in order, their proportions have not changed, and the patients realize this, but feel completely different.

The manifestations of somatic psychic depersonalization include the absence of hunger, taste of food and pleasure from the process, as well as a feeling of satiety. Even the most beloved dish does not give pleasure, its taste is not felt, therefore they often forget to eat, eating for such patients becomes a painful process, which they try to avoid. The same applies to the dispatch of natural needs. Patients do not feel relief and satisfaction from these processes.

They complain that they do not feel the temperature of the water, that it is wet, of air - dry, wet, warm, cold. The patient sometimes can not tell if he has slept, because he does not feel rested. Sometimes they claim that they did not sleep for six months or two or three months.

Accompany this type of disorder and somatic complaints of pain in the spine, headache, myalgia, patients require treatment and examination, massive somatopsychic depersonalization often led to delusional disorders that develop against a background of persistent anxiety. Delusional depersonalization is expressed by hypochondriac delirium of varying degrees of severity, sometimes amenable to dissonance, in other cases - not. Characteristic hypochondriacal nihilistic nonsense at the level of Kotar's syndrome.

Depersonalization in neurosis

It is within the framework of the neurotic disorder that the depersonalization / derealization syndrome is isolated into a separate nosological unit, that is, its isolated form is recognized as a form of neurosis.

Such a diagnosis is made when the patient is excluded from somatopsychic diseases. The main diagnostic difference between the neurotic level of depersonalization is the preservation of consciousness, the understanding of the anomaly of their sensations and the suffering from it. In addition, after a long time in patients with neurotic disorder, there is no progression of the disease - the development of personality changes and defects, mental retardation. Patients often adjust to live with their defect, while showing considerable pragmatism and forcing them to obey their rules of healthy family members. Depersonalization with time practically disappears, although her attacks can periodically renew against the background of disturbing patient events.

With isolated depersonalization, there are usually no typical clinical signs of depression - constantly low mood (it is none), acute melancholy, motor retardation. Patients are talkative, mobile, sometimes too much, their face is frozen, without facial expressions, but does not express suffering, eyes wide open, eyes fixed, unblinking, showing strong nervous tension.

Depersonalization of neurotic origin is always preceded by acute or chronic stress or another psychogenic provocation.

[15], [16], [17], [18], [19]

Depersonalization in schizophrenia

Distorted perception of the boundaries between the personality of the patient and the surrounding world is characteristic of schizophrenics. As a rule, they are erased. Patients often feel the disappearance of the mental "I" and the surrounding world, their own body or its parts, merging with the world (total depersonalization). In acute schizoaffective disorder, the alienation of one's own "I" occurs at the height of the onyroid or affectively delusional paroxysm.

Depersonalization is part of the symptom complex with different types of schizophrenia and is represented by all its forms, more often autopsical and allopsychic, less often somatopsychic. Development of depersonalization-derealization syndrome in schizophrenia can be preceded by stressor provocation.

The loss of the emotional component, insensibility does not worry too much schizophrenics, the specific direction of mental anesthesia is also absent, the patients describe their feelings as a feeling of absolute inner emptiness. In addition to mental anesthesia in schizophrenics, there is an automaticity of thoughts and movements, the emotional accompaniment of which is absent. Sometimes there is a split personality or reincarnation.

Clinically, this is manifested in the difficulties of contacting with surrounding people, the patients lose their understanding of people's actions and speech addressed to them. The world is perceived aloof, its actions and thoughts are also subjectively perceived as alien, not belonging to them.

Allopsychic depersonalization is manifested by a feeling of brighter colors, loud sounds. Patients distinguish small and minor details of objects, events as the most important than the whole object.

Describe your feelings to the patient sometimes is not easy, he resorts to pretentious comparisons, vivid metaphors, verbose, repeats the same thing, wrapping an idea in different verbal expressions, trying to convey to the doctor their experiences.

Depersonalization in schizophrenia blocks the productive symptoms of the disease and can speak of a slow process. The acute course of schizophrenia corresponds to the transition of depersonalization to a state of mental automatism.

In general, depersonalization in schizophrenics is classified as negative symptoms. The consequences of many months of depersonalization symptoms were the emergence of emotional-volitional disorders, obsessive relationships, fruitless wiserness.

Relatively short periods of depersonalization in some patients with paranoid schizophrenia ended without an increase in psychotic disorders, but after 6-8 weeks, patients began acute attacks of paranoia.

[20], [21], [22], [23], [24]

Depersonalization in the background of depression

In the classification of depressive syndromes, six main types are distinguished, one of them is depressive-depersonalization, essentially differing in structure of the sypmatics from all others and characterized by massive auto- and somatic psychophilic depersonalization, pushing to the background and obscuring depression and anxiety.

In this case, patients do not complain of a bad mood, attributing the melancholy state of despair to feelings of personal rejection, depressive symptoms recede into the background, as the patient is alarmed by the possibility of going insane and it is the depersonalization symptomatology he describes the doctor, displaying verbosity, the intricate expressions characteristic of schizophrenics, omitting symptoms of depression. Often patients with depressive-depersonalizatsionnym syndrome are mobile, not apathetic, but rather excited, although their facial expressions are mournful.

This syndrome is resistant to therapy, characterized by a prolonged course (sometimes about 10 years or more). Symptomatic structure complicates the formulation of the correct diagnosis, it is easily confused with schizophrenia, asthenic syndrome and hypochondria, which can lead to the appointment of ineffective drugs.

Patients with a depersonalization-depressive syndrome are the most dangerous in relation to the occurrence of them and the implementation of suicidal intentions. Incorrect use of antidepressants with a pronounced stimulating effect is not simply not effective, but represents the danger of the occurrence of the likelihood of attempting suicide in moments of exacerbation of affective depression. Even in the treatment with anxiolytics, there is a risk of suicide in the period of possible intensification of symptoms of personal alienation.

In addition to the already mentioned syndrome, in which depersonalization / derealization has a leading role, other syndromes can also be accompanied by the alienation of their "I" and the loss of a sense of the surrounding reality. Depressive syndromes are classified not only by clinical manifestations, but also by the degree of severity of anxiety and anxiety, which helps to choose the appropriate antidepressant that provides the necessary action.

By degree of affect, depressive syndromes are divided into three types:

1. Anergic - the patient in this case does not have a high level of anxious tension and melancholy, the mood is moderately reduced, motor and mental activity is reduced slightly, some lethargy is observed. The patient complains of the decline of strength, lack of energy, lacks initiative and lacks keen interest in anything, looks for excuse to give up any activity, doubts its feasibility, expresses uncertainty in its abilities. The patient seems to be in a rather gloomy light, he feels sorry for himself, feels like a loser in comparison with other people, the future seems bleak enough that he does not regret to die, however, the patient does not show suicidal activity. In this case, the patient may experience autopsychic depersonalization, obsessive thoughts, sleep disturbances. Clinically manifested by a decreased affective background, lack of appetite (however, patients eat, though without pleasure), hypotension.
2. Melancholia or simple depression is expressed in more distinct bouts of longing, especially towards evening, a marked inhibition of mental and motor activity, the presence of intentions to end life, there may be obsessive thoughts of a suicidal nature. Outwardly, in more mild cases, anxiety may not be noticeable. Heavy forms, accompanied by vital anguish, obsessive thoughts about their own inferiority. Depersonalization is expressed in emotional dullness, causing mental suffering, somatopsychic symptoms are represented by the absence of hunger and the need for sleep. The patient grows thin, sleeps poorly, his heart rate increases.
3. The basis of anxiety-depressive syndrome is a pronounced component of intense anxiety combined with longing, often vital. The severely depressed mood is clearly visible, its diurnal changes are observed - by the evening the symptoms of anxiety and longing usually increase. The patient more often behaves excitedly and restlessly, less often falls into "anxious stupor" until the complete absence of movements. Depressive ideas have the character of guilt, often there is hypochondria. Perhaps obsessive-phobic disorder, the symptoms of autopsychic and / or somatic depersonalization. Somatic symptoms are manifested anorexia (weight loss), constipation, senestopathy, giving rise to the development of obsessions and fears of hypochondriacal character.

[25], [26], [27], [28], [29]

Depersonalization in osteochondrosis

Deficiency of brain tissue supply appears with degeneration of intervertebral discs in the region of the cervical spine. Cerebral insufficiency occurs against the background of cerebral blood flow disorders in neglected cases of osteochondrosis, when the altered intervertebral discs already provide adequate cushioning in these areas, and the mobility of the vertebrae becomes pathological.

The growth of marginal osteophytes leads to a partial displacement and transmission of the vertebral artery, in connection with which the oxygen starvation of the brain develops. The result of hypoxia may be the development of depersonalization-derealization disorders. In this case, it is necessary to treat osteochondrosis and restore the broken blood supply, with the improvement of which the symptoms of depersonalization are eliminated by themselves.

[30], [31], [32]

Depersonalization in the withdrawal of clonazepam

This drug is not the only one that can cause mental disorders as side effects or psychogenic reactions to its abolition. Clonazepam belongs to the benzodiazepine group and, in principle, any of them can cause depersonalization. This drug has a powerful anticonvulsant effect, it is often prescribed to epileptics. Thanks to clonazepam, they have epileptic seizures.

The spectrum of the drug is very wide. It effectively relieves the sensation of anxiety, soothes and helps to fall asleep, relaxing the muscles and providing spasmolytic action. Clonazepam helps to eliminate panic, overcome phobia, normalize sleep. Most often it is used once or very short course (when it's not about epilepsy) to relieve acute symptoms. The drug is very powerful, slowly excreted from the body and is addictive. The reaction to clonazepam is individual for all, but on average, no more than ten or fourteen days can be applied without consequences.

The drug is prescription and you can not take it without consulting with your doctor. Clonazepam does not treat neurotic or anxiety disorders, but only relieves the painful symptoms, which makes life easier for the patient and makes him more sane, ready for further therapy and training with a therapist. How to apply, and to cancel it it is necessary only under the scheme which the doctor will appoint.

The withdrawal syndrome is formed after the appearance of habituation with a sharp discontinuation of admission. It comes on the first or second day after the withdrawal of the medicine and has the form of a permanent, rather than paroxysmal defect. The maximum height of the syndrome reaches in the second or third week, and this condition can last up to several months. The admission of clonazepam during the withdrawal syndrome leads to the disappearance of symptoms, a sharp improvement in the state right up to euphoria. However, this should not be done, because the improvement will be followed by a new spiral of painful symptoms.

Depersonalization can arise within the framework of the withdrawal syndrome of any benzodiazepine drug, simply, clonazepam because of its potent action and a long period of withdrawal leads to more severe depersonalization than with the withdrawal of other medicines.

In the treatment of other personality disorders with symptoms of depression that occurred initially without depersonalization, it may occur due to the use of antipsychotics or antidepressants from the group of selective serotonin reuptake inhibitors as a side effect of the treatment. Such effects arise when the diagnosis or underestimation of the severity of the condition and the development of exacerbation with the emergence of depersonalization are incorrect.

[33], [34], [35], [36]

Depersonalization of activities

One of the psychopathological phenomena of a disturbed self-awareness is a sense of loss of comprehension of one's activity. It refers to the first early type of depersonalization. The subject perceives his activity as someone else's, meaningless, useless to nobody. Its necessity in this context is not realized, there are no perspectives, motivation disappears.

A person can stand still for a long time in one place, looking with an unseeing gaze, although he has any business, sometimes urgent. The activity of the personal "I" becomes very low, often lost at all. The patient has a desire to not just work, study, create, he ceases to perform ordinary household activities - to serve himself: he does not wash, does not erase, does not clean. Even his favorite pursuits lose his former attraction. Sometimes people do everything necessary, go for walks, visit acquaintances and social events, but complain that they are not interested in it, they just observe the necessary formalities in order not to stand out from the crowd.

[37], [38], [39], [40], [41], [42]