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Depersonalisation and Derealisation

(Feeling 'Unreal' or 'Not There')

During depersonalisation, people will experience changes in self-awareness, which might include feeling as if their thoughts and actions are not their own, perhaps as far as experiencing the sensation as watching themselves from the outside.  Derealisation occurs when people feel dissociated from their environment.  The experience might include perceiving objects as unsolid, diminished in size or two-dimensional; and the self as perhaps being inside some glass-like container or peering at the world through a fog, with the world unreachable and meaningless.

These feelings are quite common.  Some research suggests that up to 50% of ‘normal’ adults experience one or both of these problems occasionally and that, as a psychiatric condition it might affect up to 3% of the general population.  In the situation where the effect is occasional and mild the process might last for seconds or a few minutes and, rarely, several hours.  The problem will tend to start and stop fairly abruptly and sometimes, when mild, can be hard to distinguish from anxiety symptoms such as floating, dizziness or ‘cotton wool’ in the head.

However, there is other research that suggests that either of these situations can be the precursor to a panic attack or an aspect of the anxiety peak reached in a panic attack.  Early research on this subject suggested that depersonalisation and derealisation could be the body’s way to ‘cut off’ from severe anxiety feelings; also that some sufferers did not report excessive anxiety before an attack.  It was also speculated that a great deal of introspection – much involvement with how this person was feeling all the time –  laid the ground for the problem. As involvement of all the senses in some other activity seems to reduce dp problems, this seems to be a reasonable suggestion.

Research also reports that, when severe, a main psychiatric condition, these periods of unreality may last for weeks or months, causing much distress; and that when depersonalisation occurs at a disorder level, sufferers have been known to self-mutilate.  However there is an interesting observation in one article that, at disorder level, depersonalisation can occur in response to severe trauma or self-mutilation.  Obviously a lot more research needs to be done.

On this subject, the iop site suggests that self-mutilation might be in response to sensory problems such as numbness where the sufferer may be experiencing a lack of tactile responses and, presumably, self-mutilates as an extreme way to be able to feel his or her body.   This site also states that depersonalisation sufferers may experience ringing in the ears or the sensation that the volume has increased in every day activity around them.

Anecdotal evidence within the charity suggests that many people, during periods of heightened anxiety find ‘normal’ light and sound too much for them, so it would be interesting to know if this is a specific aspect of dp or simply another symptom of severe anxiety from which dp might develop.

With the situation of weeks suffering as described above, it is very likely that a person would become anxious or depressed, so it might not always be possible to ascertain which came first – the depersonalisation or the anxiety/depression.

Depersonalisation Disorder can be the main psychiatric condition or can occur as part of another mental disorder such as panic disorder, depression and OCD or a neurological problem such as epilepsy.  It has also been suggested that it can occur in healthy individuals who have taken drugs such as cannabis and Ecstasy and/or excessive alcohol.  Anecdotal evidence around the charity suggests that the latter is probably correct.

When it is the prime condition, it is possible that the disorder can become chronic in up to 50% of cases and may not respond well to treatment. It seems to affect twice as many men as women and rarely occurs in people over forty years of age.

Treatment options seem unclear but will probably involve some form of psychotherapy when this is the prime disorder.  It is suggested that when this is not the prime disorder, the depersonalisation problems ease as the main problem is dealt with.  One article seen suggests that depersonalisation and derealisation are the result of a serotonin imbalance, but does not go into the efficacy of current serotonin reuptake inhibitors (SRI’s) as a possible treatment.   Ecstasy seems also to work on serotonin levels, bringing on an almost opposite effect to depersonalisation, but has, as mentioned, been flagged up as a possible cause of the condition, besides its more commonly known dangers. It would seem that much more needs to be understood about pharmacological treatments and abuses.

Years ago, depersonalisers were recommended to carry a ‘dp kit’ around with them.  This was to include several small items that had strong links with this person’s life, like a baby’s shoe or a photograph.  Heavily textured items like sandpaper or fur were also recommended as the theory was that any strong tactile sensation focuses the mind and draws the person back as in: ‘this is here, therefore so am I’.  Manipulating objects such as plastic or metal balls, rings or keys also had its adherents as did having a very familiar person nearby who could be touched or hugged.

The Institute of Psychiatry, Denmark Hill, South London, England has a Depersonalisation Research Unit, set up in 1998, and is reported to distribute information to doctors and sufferers.

Their website is:  http://www.iop.kcl.ac.uk/IoP/Departments/PsychMed/index.stm


Source material:

British Psychological Society, ‘Depersonalisation’
www.bps.org.uk/publications/thepsychologistdet.cfm?ID=186

The Institute of Psychiatry website

I.M. Marks, ‘Fears, Phobias and Rituals, Oxford University Press inc. 1987

University of Tasmania, ‘Depersonalisation Disorder’
www.healthsci.utas.edu.au/psychiatry/disper_dis.htm

Unreal, ‘Depersonalisation and Derealisation’,
www.kbk73.dial.pipex.com/depder.htm

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