Depersonalization

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

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Depersonalization is a psychological state of emergency. People who suffer from it see their life from the outside like a movie. Your own body, your feelings, but also other people and objects appear strange to you. The origin of the separation from oneself and the environment often lies in previous traumatic experiences. Read all the important information about depersonalization and derealization here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F42F48

Depersonalization: description

Depersonalization describes an alienation from oneself. Affected people have a disturbed self-perception and feel detached from their ego. In the case of derealization, on the other hand, those affected are plagued by the impression that their environment is not real. Depersonalization and derealization often occur together and are therefore referred to as depersonalization and derealization syndrome or summarized under the term depersonalization.

Almost everyone experiences such symptoms in their life in a mild form and for a limited time. However, depersonalization disorder means that those affected suffer from it over a long period of time or repeatedly in episodes.

Depersonalization is a disorder that has so far received little research. In many cases it is overlooked. Sometimes she hides behind another mental disorder, sometimes those affected do not dare to go to the doctor with these symptoms because they are afraid that he will not take them seriously or think they are crazy.

Depersonalization: who is affected?

It is estimated that around one to three percent of the population are affected by depersonalization disorder. Very often it appears as a symptom of other mental disorders. These include depression, phobic disorders, obsessive-compulsive disorder, and the borderline disorder. As an independent disorder, it is often diagnosed in adolescence. In their study of students in Rhineland-Palatinate, researchers at the University Medical Center Mainz came to the conclusion that 12 percent of students experience symptoms of depersonalization. Depersonalization syndrome occurs roughly equally in men and women.

Depersonalization: symptoms

Depersonalization and derealization can occur in different degrees of severity. A mild form of depersonalization can also be observed in everyday life when people are under extreme stress or after alcohol abuse. The changed perception due to exhaustion is short-lived and does not need to be treated.

Decreased pain perception

Life-threatening situations that put the body under severe stress can trigger prolonged symptoms of depersonalization. In psychologically stressful or painful situations, depersonalization reduces the perception of pain. It is thus a protective mechanism of the psyche against strongly unpleasant sensations.

Alienation and Unreal Reality

If the symptoms persist for several years or keep recurring, it is a mental disorder. The main characteristics of depersonalization are the feeling of alienation in relation to oneself and the perceived unreality of reality. Those affected no longer know who they are. Some no longer recognize themselves in the mirror. Your body is as if detached from them. They also describe this state as a feeling of lifelessness. When people feel internally split into a part that acts and one that observes, experts speak of an out-of-body experience.

Often those affected perceive not only themselves but also their environment to be changed. This perception is so unreal that people find it difficult to put into words. They often describe their vision as blurred or like a dream. People can appear lifeless, objects can be perceived as larger or smaller, and noises can be heard distorted.

Automated actions

When doing activities, they do not see themselves as the executing person. They are aware of their actions, but it is as if they were standing next to them and watching each other. Since those affected have no internal reference to their actions, they perceive them as strange and automated.

Emotional emptiness

Often depersonalization is accompanied by a feeling of inner emptiness. Affected people do not react to emotional events. They show neither joy, sadness nor anger. They therefore often appear cool and absent. These symptoms are very similar to those of a depressed mood and are difficult to distinguish from one another. Depersonalization can also appear as a symptom of depression. Conversely, however, depression can also occur as a result of symptoms of depersonalization.

Memory problems

People who have had traumatic experiences often no longer remember these experiences or only partially remember them. The depersonalization then serves as a protective shield and does not allow negative memories to penetrate into the consciousness. Memory problems occur quickly under stress. Often times, events cannot be classified by those affected because their perception of time is distorted.

Reality reference

In contrast to people with psychosis, people with depersonalization syndrome know that the changed perception is due to their illness. People with psychotic states, on the other hand, are convinced that their view of the world is real. For example, they believe that other people can manipulate their thoughts and feelings. Individuals with symptoms of depersonalization realize that it is not the world that has changed, but that something is wrong with their perception. This knowledge increases the level of suffering and frightens those affected.

Brooding and fears

Fear of going crazy is a common consequence of depersonalization and derealization. Symptoms of detachment from oneself and the environment make people deeply insecure. Likewise, fears, compulsions and depression are often associated with depersonalization. Many do not speak about their problems for fear of not being taken seriously.

Depersonalization: causes and risk factors

Experts attribute the development of depersonalization and derealization to the interplay of various factors. It is believed that predisposition affects whether the mental disorder occurs or not. So far there is no evidence of a hereditary component.

Experts believe that people with an increased level of basic anxiety are more prone to depersonalization and derealization. As with many mental disorders, causes are often found in childhood and adolescence. Stress and traumatic experiences are the most common triggers for depersonalization.

Direct triggers for depersonalization

As a specific trigger of depersonalization, stress plays a central role. In particular, traumatic experiences can trigger depersonalization. Serious illnesses, accidents or even professional and violent interpersonal crises can be the beginning of depersonalization. In unbearable situations it can happen that people move away from themselves and the event inwardly. Experts believe that this response is a protective mechanism when other coping strategies are inadequate. Those affected are then only physically present, but they are not present in their thoughts. Depersonalization is often described as the calm after the storm. It is only when the stress subsides that the symptoms of depersonalization appear.

Early neglect

Researchers have found that particularly emotional neglect in childhood promotes depersonalization. These victims received too little attention from their parents, were humiliated or not noticed. The lack of support from the social environment can lead to unfavorable coping strategies. The first symptoms of alienation from oneself and the environment can appear in childhood. The severity of the depersonalization depends on the intensity and duration of the negative experiences.

Lifestyle as a risk factor

Individuals who neglect their physical and mental health can experience symptoms of depersonalization. In addition, depersonalization can result from the use of illegal drugs or alcohol intoxication. Insufficient sleep and insufficient fluid intake can also cause symptoms of depersonalization or exacerbate existing symptoms.

Depersonalization: examinations and diagnosis

As the first point of contact, you can turn to your family doctor. If depersonalization syndrome is suspected, they will conduct a physical examination. This is because depersonalization can also occur as a result of physical illnesses such as epilepsy or migraines. The doctor must also rule out that the symptoms occur as a side effect of medication or as a result of withdrawal. Drugs can also create feelings of alienation. The family doctor will refer you to specialists for the exact diagnosis and treatment.

To diagnose depersonalization, a psychiatrist or psychotherapist conducts a detailed discussion with the patient. With the help of clinical questionnaires, the doctor or therapist can determine whether it is actually a question of depersonalization or whether there are other mental disorders.

The doctor or therapist could ask the following questions about the diagnosis of depersonalization disorder:

• Do you sometimes feel like a stranger to yourself?
• Do you sometimes have the impression that you are looking at yourself from the outside?
• Does your environment sometimes seem unreal to you?
• Do you sometimes feel that other people or objects are not real?

According to the international classification of mental disorders (ICD-10), a diagnosis of depersonalization and derealization syndrome requires at least either depersonalization or derealization:

• Depersonalization Syndrome: Those affected perceive their feelings and experiences as alien to them, detached from themselves, removed, lost or as belonging to someone else. They also complain about the feeling of "not being right here".
• or that
• Derealization syndrome: Those affected perceive their surroundings, objects or other people as unreal, distant, artificial, colorless or lifeless.

In addition, those affected must be aware that the changed perception is not generated from outside, but comes from their thoughts.

Depersonalization: treatment

Research into depersonalization and derealization is still in its infancy. There are no studies on the effectiveness of therapies and drugs. Medicines have therefore not yet been approved for the therapy of depersonalization. Healing in the sense of complete freedom from symptoms is most likely with weak depersonalization. In severe cases, the goal is to alleviate symptoms or shorten the periods in which depersonalization occurs. The method of choice for treatment is psychotherapy.

Reduce fears

At the beginning of the therapy, the therapist explains to the patient in detail about the psychological disorder (psychoeducation). The person affected experiences that his or her suffering is taken seriously and that his distorted perception is not a sign of "madness" but part of an illness. The patient learns to question negative and catastrophic thoughts and to replace them with realistic assessments. An important goal of therapy is to reduce fears and thus to relieve the person psychologically.

Stress management and coping strategies

Another component in therapy is dealing with stress. In many patients, stress leads to symptoms of depersonalization. They move out of their bodies and thus remove themselves from their surroundings and the problems. This process runs automatically after a while.With the help of a diary, the patient should note which situations trigger the symptoms of depersonalization. This overview helps those affected to better recognize patterns and processes of the disease.

Together with the therapist, the patients develop other strategies to cope with difficult situations. The person concerned has to learn not to avoid frightening situations any longer. Once the person gains confidence in other coping strategies, they no longer need to move away from themselves or the situation. Lifestyle changes can help recovery. Insufficient sleep, nutrition, and lack of fluid intake exacerbate the symptoms.

If symptoms of alienation occur, for example, biting into a chilli pod or clapping loudly can help you find your way back to reality. Distraction can also be a helpful method. Conversations or sporting activities should turn your thoughts into reality. Distraction also prevents fears from building up. Through these and other strategies, patients learn to control symptoms of depersonalization.

Relaxation exercises are not recommended for depersonalization, as too much rest can cause symptoms. Calming activities, such as walks, are therefore more suitable for recreation.

Addressing the causes

In many cases, traumatic experiences are the cause of depersonalization. In order to deal with trauma, the patient should first have learned how to deal with the symptoms well. It is also important that the person affected can perceive, express and control their emotions to a certain extent. The traumatic causes can only be dealt with after the stabilization phase.

Depersonalization: disease course and prognosis

The first symptoms of depersonalization usually appear in adolescence or even in childhood. The onset in late adulthood is very rare and strengthens the suspicion of an organic cause. Depersonalization can occur chronically as well as in episodes. The course depends on the one hand on when the depersonalization started and on the other hand, whether it is treated adequately. The earlier the mental disorder occurs, the worse the prognosis. No treatment requires a mild form of depersonalization and derealization. In this case, healing occurs automatically after a short time.

If the symptoms are severe, those affected usually suffer from symptoms of depersonalization and derealization for a long time. With the help of psychotherapy, however, they can learn to better control the symptoms. In addition, those affected can positively influence the course by reducing stress. On the other hand, the symptoms of depersonalization worsen under psychological stress.

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