Depersonalization Disorder

Image courtesy of Super OfficeOpens in new window Depersonalization disorder is a dissociative disorderOpens in new window characterized by persistent or recurrent episodes of depersonalization, sufficiently severe to cause marked distress in the absence of other psychiatric disorders.

Depersonalization is a fascinating and intriguing phenomenon which becomes, for those who experience it, a significant source of distress and alienation, and poses a direct challenge to long-held, unquestioned assumptions regarding their existence and identity.

Symptoms

The person in a state of depersonalization often feels like an outside observer of his or her own activities and thoughts. Sensory anesthesia or the sensation of not being in complete control of one’s actions may occur, is egodystonic and nondelusional, and may be accompanied by lack of emotions.

DerealizationOpens in new window, evidenced by altered perception and sense of reality of the external world, frequently accompanies depersonalization. Anxiety disorders, depression, and schizophrenia frequently are accompanied by symptoms of depersonalization.

Organic disorders including temporal lobe epilepsy, migraine, and marijuana abuse may produce depersonalization (Hollander E, et al. Left hemispheric activation in depersonalization disorder: a case report. Biol Psychiatry 1992: 31:1157-11620).

Depersonalization has been reported in temporal lobe epilepsy and temporal lobe migraine. Significant depersonalization has been reported 30 minutes after smoking high-potency marijuana cigarettes (Mathew RJ, et al. Depersonalization after marijuana smoking, Biol Psychiatry 1993;33:431-441).

Depersonalization is known to occur in children and normal adults. It is more common in women. Most often it occurs in the third and fourth decades, usually lasts from 2 to 3 years, and disappears spontaneously. Depersonalization is sometimes called feeling of unreality.

The Construction of Depersonalization

It was the psychologist Ludovic DugasOpens in new window who first introduced the word depersonalization into the psychiatric literature.

Dugas (1894) first came across depersonalization whilst exploring the psychopathology of déjà-vu and related experiences, which at the time were designated by the generic name of ‘false memories’. Thus, Dugas wrote:

In 1894, when dealing with false memories, I had not yet knowledge of depersonalization. Not realizing its novelty, I missed [the phenomenon] when I first met it (1898a) p. 424.

Soon enough, however, Dugas published a series of papers on the subject (1898b, 1912, 1915, 1936) and wrote a monograph entitled La Dépersonnalisation, which he co-authored with the French neurologist Maurice Moutier (Dugas and Moutier, 1911).

Dugas defined depersonalization as

In fact, he thought of the condition as resulting from a dysfunction of a putative mental faculty, which Dugas termed ‘personalization’, whose function was to ‘personalize’ mental events: “Personalization is the act of psychical synthesis, of appropriation or attribution of states to the self” (Dugas and Moutier, 1911).

Dugas acknowledge that he had taken the term depersonalization from an intriguing paragraph found in H.F. AMiel’s Journal Intime. The Swiss philosopher (1821 – 1881) had written in his personal diary: “All is strange to me; I am depersonalized, detached, cut adrift.” (Amiel, 1933; p. 275).

This seems to have been interpreted by Dugas as a literal description of Amiel’s mental experiences. However, contextualized reading makes it unclear to what extent his descriptions of alienation were metaphorical rather than full-blown depersonalization experiences. For example, a few paragraphs later, Amiel clarifies: “It seems to me that my mental transformations are but Philosophical experiences.” (my italics) p. 275.

Since the condition was first described (half a century before it was named), during the first half of the nineteenth century, depersonalization has been found to be commonplace in psychiatric patients. For example, Schilder 1935), who wrote extensively on depersonalization believed it to be present, at some stage, in ‘almost every neurosis’.

A similar view led a panel of clinicians to conclude that, after anxietyOpens in new window and depressionOpens in new window, depersonalization was the most frequent symptoms seen in psychiatry (Stewart, 1964), while others emphasized its frequent occurrence in association with neurological conditions (Brock & Wiesel, 1942).

Such ubiquitous nature led early writers to believe that depersonalization must be related to functions relevant to the understanding of both normal and abnormal mentation: “the syndrome is related to so many urgent questions of medical and normal psychology that it is worth studying in a large number of patients” (Mayer-Gross, 1935).

Coinciding with the rise of interest in the study of altered mental states of consciousness during the 1960s and 1970s, there was a significant increase in the number of publications dealing with theoretical, philosophical as well as empirical research on depersonalization. It became well established for example, that fleeting experiences of depersonalization were commonplace among teenagers, as well as in people facing life-threatening situations.

In turn, empirical studies on large samples of patients confirmed the view that depersonalization was indeed highly prevalent among psychiatric in-patients, as well as in patients with depressionOpens in new window, anxiety disordersOpens in new window and schizophreniaOpens in new window (Brauer et al., 1970; Hunter et al., 2004). However, unlike the case with equally ubiquitous symptoms such as anxiety and depressed mood, the high prevalence of depersonalization was taken to mean that it was so non-specific as to lack any clinical relevance.

A profusion of literature emphasizing depersonalization in its non-specific guise, seems to have had the effect of eclipsing clinical observations, which suggested that, just as it was the case with depression or anxiety, depersonalization did become, in some cases, a chronic, distressing and incapacitating condition in its own right (Shorvon, 1946).