Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions , where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization , which involves a sense of detachment from the external world rather than from oneself.
100-590: Depersonalization-derealization disorder refers to chronic depersonalization, classified as a dissociative disorder in both the DSM-4 and the DSM-5 , which underscores its association with disruptions in consciousness, memory, identity, or perception. This classification is based on the findings that depersonalization and derealization are prevalent in other dissociative disorders including dissociative identity disorder . Though degrees of depersonalization can happen to anyone who
200-612: A benzodiazepine has been proposed to be useful for DPDR patients with anxiety . Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia ). However, clinical trials have not been conducted. Some studies have found repetitive transcranial magnetic stimulation (rTMS) to be helpful. One study examined 12 patients with DPDR that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment. Five of
300-1298: A dissociative disorder . Patients must meet the following criteria to be diagnosed per the DSM-5: The ICD-11 has relisted DPDR as a disorder rather than a syndrome as previously, and has also reclassified it as a dissociative disorder from its previous listing as a neurotic disorder . The description used in the ICD-11 is similar to the criteria found in the DSM-5. Individuals with DPDR are described as having persistent/recurrent symptoms of depersonalization/derealization, have intact reality testing, and symptoms are not better explained by another psychiatric/neural disorder, substance, medication, or head trauma. Symptoms are severe enough to cause distress or impairment in functioning. DPDR differentials include neurologic and psychiatric conditions as well as side effects from psychoactive substances or medications. Depersonalization-derealization disorder may be prevented by connecting children who have been abused with professional mental health help. Some trauma specialists strongly advocate for increasing inquiry into information about children's trauma history and exposure to violence, since
400-462: A selective serotonin reuptake inhibitor and is the first drug of choice at the depersonalisation research unit at King's College London. Interest in DPDR has increased over the past few decades, leading to a large accumulation of literature on dissociative disorders. There has been a shift towards the use of research studies, rather than case studies to understand depersonalization. However, there remains
500-1181: A traumatic event , or an episode of another mental illness . Insidious onset may reach back as far as can be remembered (early childhood), or it may begin with smaller episodes of lesser severity that become gradually more intense and more disabling. Some patients report persistent depersonalization and/or derealization throughout the day, nearly everyday. Depersonalization exists as both a primary and secondary phenomenon. The most common comorbid disorders are depression and anxiety, although cases of depersonalization disorder without symptoms of either do exist. Comorbid obsessive/compulsive behaviors may exist as attempts to deal with depersonalization, such as checking whether symptoms have changed and avoiding behavioral and cognitive factors that exacerbate symptoms. Many people with personality disorders such as schizoid personality disorder , schizotypal personality disorder , and borderline personality disorder will have experiences of depersonalization. Patients with complex dissociative disorders, including dissociative identity disorder , experience high levels of depersonalization and derealization. The word depersonalization itself
600-592: A combination of artificial exposure to light and rescheduling, as these have been shown to augment phase-shifting. The short-term use of hypnotic medication has shown efficacy in reducing insomnia related to jet lag. In a study, zolpidem improved sleep quality and reduced awakenings for people travelling across five to nine time zones. The potential adverse effects of hypnotic agents, like amnesia and confusion, have led some doctors to advise patients to test such medications prior to using them for treating jet lag. Several cases using triazolam to promote sleep during
700-583: A construct and scales are now available to map its dimensions in time and space. A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response in stress . Individuals high on the absorption subscale, which measures a subject's experiences of concentration to the exclusion of awareness of other events, showed weaker cortisol responses. Depersonalization can arise from
800-517: A cramped space with little chance to move around, a low-oxygen environment, and dehydration caused by dry air and limited food and drink. It does not necessarily involve the shift in circadian rhythms that cause jet lag. Travel fatigue can occur without crossing time zones, and it often disappears after one day accompanied by a night of good quality sleep. Jet lag is a chronobiological problem, similar to issues often induced by shift work and circadian rhythm sleep disorders . When travelling across
900-440: A depersonalized state for the duration of a typical panic attack. However, in some cases, the dissociated state may last for hours, days, weeks, or even months at a time. In rare cases, symptoms of a single episode can last for years. Diagnostic criteria for depersonalization-derealization disorder includes persistent or recurrent feelings of detachment from one's mental or bodily processes or from one's surroundings. A diagnosis
1000-554: A desirable state, particularly by those that have experienced it under the influence of mood-altering recreational drugs . It is an effect of dissociatives and psychedelics , as well as a possible side effect of caffeine , alcohol , amphetamine , cannabis , and antidepressants . It is a classic withdrawal symptom from many drugs. Benzodiazepine dependence , which can occur with long-term use of benzodiazepines, can induce chronic depersonalization symptomatology and perceptual disturbances in some people, even in those who are taking
1100-532: A drug used to reverse the intoxicating effects of opioid drugs, can successfully treat depersonalization disorder. According to the study: "In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization." The anticonvulsant drug lamotrigine has shown some success in treating symptoms of depersonalization, often in combination with
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#17331059198131200-416: A flight reported dramatic global amnesia . Jet lag may affect the mental health of vulnerable individuals. When travelling across time zones, there is a "phase-shift of body temperature, rapid-eye-movement sleep, melatonin production, and other circadian rhythms". A 2002 study found that relapse of bipolar and psychotic disorders occurred more frequently when seven or more time zones had been crossed in
1300-663: A hypersensitivity towards threats and fears of losing control . A 2010 study found evidence that some users participating in virtual reality (VR) may be more likely to experience dissociation after use. Users reportedly experienced higher levels of a lessened sense of presence in reality after exposure to VR. However, it was noted that the effects of exposure were likely to rapidly disappear after returning to objective reality. Additionally, individuals who reported higher preexisting dissociation levels as well being more easily immersed or absorbed in imagination overall were found to be linked to higher increases in dissociative symptoms after
1400-597: A lack of solid consensus on its definition and scales used for assessment. Salami and colleagues argued that studies of electrophysiological depersonalization-derealization markers are urgently needed, and that future research should use analysis methods that can account for the integration of interoceptive and exteroceptive signals. The Depersonalisation Research Unit at the Institute of Psychiatry in London conducts research into depersonalization disorder . Researchers there use
1500-526: A movie, for example) may also provide temporary relief. Some other factors that are identified as relieving symptom severity are diet or exercise, while alcohol and fatigue are listed by some as worsening their symptoms. Occasional, brief moments of mild depersonalization can be experienced by many members of the general population; however, depersonalization-derealization disorder occurs when these feelings are strong, severe, persistent, or recurrent and when these feelings interfere with daily functioning. DPDR
1600-525: A nonthreatening way, leading to an improvement on several standardized measures. A standardized treatment for DPDR based on cognitive behavioral principles was published in the Netherlands in 2011. Tentative evidence supports the use of opioid antagonists (naloxone) and other medications like benzodiazepines or methylphenidate . Evidence suggests the beneficial use of lamotrigine adjunct to an SSRI but not as monotherapy. A combination of an SSRI and
1700-409: A number of time zones, a person's body clock (circadian rhythm) will be out of synchronisation with the destination time, as it experiences daylight and darkness contrary to the rhythms to which it was accustomed. The body's natural pattern is disturbed, as the rhythms that dictate times for eating, sleeping, hormone regulation , body temperature variation , and other functions no longer correspond to
1800-412: A person's circadian rhythm is out of sync with the time zone they are in, and is a typical result from travelling rapidly across multiple time zones (east–west or west–east). For example, someone travelling from New York to London , i.e. from west to east, feels as if the time were five hours earlier than local time, and someone travelling from London to New York, i.e. from east to west, feels as if
1900-441: A rate of 2.4% in a single-point Canadian sample. In clinical populations, prevalence rates range from 1% to 16%, with varying rates in specific psychiatric disorders such as panic disorder and unipolar depression. Co-occurrence between depersonalization/derealization and panic disorder is common, suggesting a possible common etiology. Co-morbidity with other disorders does not influence symptom severity consistently. Depersonalization
2000-481: A reduced neural response in emotion-sensitive regions, as well as an increased response in regions associated with emotional regulation. In a similar test of emotional memory , depersonalization disorder patients did not process emotionally salient material in the same way as did healthy controls. In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing. Studies are beginning to show that
2100-458: A result of their phase-shifted sleeping time. Light is the strongest stimulus, or zeitgeber , for realigning a person's circadian cycle, and the key to quick adaptation is therefore timed light exposure based on the traveller's sleep pattern, chronotype , and plans. Timed light exposure can be effective to help people match their circadian rhythms with the expected cycle at their destination; it requires strict adherence to timing. Light therapy
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#17331059198132200-506: A role in self-awareness. Disruption to this system can potentially cause a feeling of detachment from surroundings. Several studies have shown that patients with peripheral vestibular disease are also more likely to have dissociative symptoms when compared to healthy individuals. Dissociative symptoms are sometimes described by those with neurological diseases, such as amyotrophic lateral sclerosis , Alzheimer's , multiple sclerosis (MS), etc., that directly affect brain tissue. Diagnosis
2300-531: A specialized depersonalization clinic included 164 individuals with chronic depersonalization symptoms, of which 40 linked their symptoms to illicit drug use. Phenomenological similarity between drug-induced and non-drug groups was observed, and comparison with matched controls further supported the lack of distinction. The severity of clinical depersonalization symptoms remains consistent regardless of whether they are triggered by illicit drugs or psychological factors. Depersonalization has been described by some as
2400-417: A stable daily dosage, and it can also become a protracted feature of the benzodiazepine withdrawal syndrome . Lieutenant Colonel Dave Grossman , in his book On Killing , suggests that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill other human beings. Graham Reed (1974) claimed that depersonalization occurs in relation to
2500-630: A symptom of some types of neurological seizure , and it has been suggested that there could be common aetiology between depersonalization symptoms and panic disorder, on the basis of their high co-occurrence rates. In social psychology , and in particular self-categorization theory , the term depersonalization has a different meaning and refers to "the stereotypical perception of the self as an example of some defining social category". Individuals who experience depersonalization feel divorced from their own personal self by sensing their body sensations, feelings, emotions, behaviors, etc. as not belonging to
2600-402: A traveller becomes fully adjusted to a new time zone; it takes on average one day per time zone crossed to reach circadian reentrainment . Jet lag is especially an issue for airline pilots , aircraft crew, and frequent travellers. Airlines have regulations aimed at combating pilot fatigue caused by jet lag. The term jet lag is used because before the arrival of passenger jet aircraft , it
2700-474: A variety of factors, of both a psychological and physiological nature. Common immediate precipitants include instances of severe stress , depressive episodes , panic attacks , and the consumption of psychoactive substances such as marijuana and hallucinogens . Additionally, there exists a correlation between frequent depersonalization and childhood interpersonal trauma , particularly cases involving emotional maltreatment. A case-control study conducted at
2800-403: Is episodic in only one-third of individuals, with each episode lasting from hours to months at a time. Depersonalization can begin episodically, and later become continuous at constant or varying intensity. Onset is typically during adolescence, although some patients report being depersonalized as long as they can remember, and a small minority report a later onset (by age 40). According to
2900-510: Is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization . Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving
3000-650: Is a classic response to acute trauma , and may be highly prevalent in individuals involved in different traumatic situations including motor vehicle collision and imprisonment . Psychologically depersonalization can, just like dissociation in general, be considered a type of coping mechanism, used to decrease the intensity of unpleasant experience, whether that is something as mild as stress or something as severe as chronically high anxiety and post-traumatic stress disorder . The decrease in anxiety and psychobiological hyperarousal helps preserving adaptive behaviors and resources under threat or danger. Depersonalization
3100-548: Is a non-pharmacological method that can be used to induce depersonalization. In the general population, transient depersonalization and derealization are common, having a lifetime prevalence between 26 and 74%. A random community-based survey of 1,000 adults in the US rural south found a 1-year depersonalization prevalence rate at 19%. Standardized diagnostic interviews have reported prevalence rates of 1.2% to 1.7% over one month in UK samples, and
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3200-408: Is a popular method used by professional athletes to reduce jet lag. Timed correctly, the light may contribute to an advance or delay of the circadian phase to match the destination. The US Centers for Disease Control and Prevention (CDC) recommends mobile apps for the correct timing of light exposure and avoidance, when to use caffeine , and when to sleep. In addition to timed light exposure,
3300-546: Is an overgeneralized reaction in that it doesn't diminish just the unpleasant experience, but more or less all experience – leading to a feeling of being detached from the world and experiencing it in a more bland way. An important distinction must be made between depersonalization as a mild, short-term reaction to unpleasant experience and depersonalization as a chronic symptom stemming from a severe mental disorder such as PTSD or dissociative identity disorder . Chronic symptoms may represent persistence of depersonalization beyond
3400-665: Is based on the self-reported experiences of the person followed by a clinical assessment. Psychiatric assessment includes a psychiatric history and some form of mental status examination . Since some medical and psychiatric conditions mimic the symptoms of DPDR, clinicians must differentiate between and rule out the following to establish a precise diagnosis: temporal lobe epilepsy , panic disorder , acute stress disorder , schizophrenia , migraine , drug use , brain tumor or lesion . No laboratory test for depersonalization-derealization disorder currently exists. As patients with dissociative disorders likely experienced intense trauma in
3500-414: Is dependent on the underlying cause, whether it is organic or psychological in origin. If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as amyotrophic lateral sclerosis , Alzheimer's disease , multiple sclerosis (MS), or any other neurological disease affecting
3600-508: Is exacerbated as the body is not in sync with the environment – a double desynchronisation , which has implications for health and mood. Delayed sleep phase disorder is a medical disorder characterised by delayed sleeping time and a proportionately delayed waking time due to a phase delay in the internal biological master clock. Specific genotypes underlie this disorder. If allowed to sleep as dictated by their endogenous clock these individuals will not have any ill effects as
3700-725: Is growing evidence linking physical and sexual abuse in childhood with the development of dissociative disorders . Childhood interpersonal trauma – emotional abuse in particular – is a significant predictor of a diagnosis of DPDR. Compared to other types of childhood trauma, emotional abuse has been found to be the most significant predictor both of a diagnosis of depersonalization disorder and of depersonalization scores, but not of general dissociation scores. Some studies suggest that greater emotional abuse and lower physical abuse predict depersonalization in adult women with post-traumatic stress disorder (PTSD). Patients with high interpersonal abuse histories (HIA) show significantly higher scores on
3800-670: Is increasingly recognized as a factor contributing to feelings of disembodiment during depersonalization experiences. Research suggests that abnormal activity in the left hemisphere may play a role, although abnormalities in right hemisphere brain activity, responsible for self-awareness and emotion processing, may also contribute to depersonalization symptoms. Higher activity in the right parietal lobe's angular gyrus has been linked to more severe depersonalisation, supporting this idea. Potential involvement of serotonergic , endogenous opioid , and glutamatergic NMDA pathways has also been proposed, alongside alterations in metabolic activity in
3900-547: Is linked only to the distance travelled along the east–west axis. A ten-hour flight between Europe and southern Africa does not cause jet lag, as the direction of travel is primarily north–south. A four-hour flight between Miami, Florida , and Phoenix, Arizona , in the United States may result in jet lag, as the direction of travel is primarily east–west. There are two separate processes related to biological timing: circadian oscillators and homeostasis . The circadian system
4000-523: Is located in the suprachiasmatic nucleus (SCN) in the hypothalamus of the brain. The other process is homeostatic sleep propensity, which is a function of the amount of time elapsed since the last adequate sleep episode. The human body has a master clock in the SCN and peripheral oscillators in tissues. The SCN's role is to send signals to the peripheral oscillators, which synchronise them for physiological functions. The SCN responds to light information sent from
4100-467: Is made when the dissociation is persistent, interferes with the social or occupational functions of daily life, and/or causes marked distress in the patient. While depersonalization-derealization disorder was once considered rare, lifetime experiences with it occur in about 1–2% of the general population. The chronic form of the disorder has a reported prevalence of 0.8 to 1.9%. While brief episodes of depersonalization or derealization can be common in
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4200-526: Is most commonly experienced as chronic and continuous. However, for a minority who have DPDR as an episodic condition, duration of these episodes is highly variable with some lasting as long as several weeks. The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. It has been thought that depersonalization can be caused by a biological response to dangerous or life-threatening situations which causes heightened senses and emotional numbing. There
4300-487: Is often dependent on a combination of physical and mental characteristics that are affected by jet lag. This is often a common concern at international sporting events like the Olympics and FIFA World Cup . However many athletes arrive at least 2–4 weeks ahead of these events, to help adjust from any jet lag issues. Travel fatigue is general fatigue, disorientation, and headache caused by a disruption in routine, time spent in
4400-401: Is reported 2-4 times more in women than in men, but depersonalization/derealization disorder is diagnosed approximately equally across men and women, with symptoms typically emerging around the age of 16. A similar and overlapping concept called ipseity disturbance (ipse is Latin for "self" or "itself") may be part of the core process of schizophrenia spectrum disorders. However, specific to
4500-779: Is subject to temporary anxiety or stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including dissociative identity disorder and " dissociative disorder not otherwise specified " (DD-NOS). It is also a prominent symptom in some other non-dissociative disorders, such as anxiety disorders , clinical depression , bipolar disorder , schizophrenia , schizoid personality disorder , hypothyroidism or endocrine disorders, schizotypal personality disorder , borderline personality disorder , obsessive–compulsive disorder , migraines , and sleep deprivation ; it can also be
4600-402: Is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization". This description refers to personalization as a psychical synthesis of attribution of states to the self. Early theories of the cause of depersonalization focused on sensory impairment. Maurice Krishaber proposed depersonalization was
4700-467: The aura and during the seizure ), obsessive-compulsive disorder , severe stress or trauma, anxiety , the use of recreational drugs —especially cannabis , hallucinogens , ketamine , and MDMA , certain types of meditation , deep hypnosis , extended mirror or crystal gazing , sensory deprivation , and mild-to-moderate head injury with little or full loss of consciousness (less likely if unconscious for more than 30 minutes). Interoceptive exposure
4800-474: The hypothalamic-pituitary-adrenal axis , the area of the brain involved in the "fight-or-flight" response. Patients demonstrate abnormal cortisol levels and basal activity. Studies found that patients with DPDR could be distinguished from patients with clinical depression and posttraumatic stress disorder . The vestibular system may also play a role in DPDR. The vestibular system helps control balance, spatial orientation, motor coordination, but also plays
4900-632: The immune system with depersonalisation. Researchers compared protein expression in serum samples of individuals with depersonalisation/derealization disorder (DPDR, DDD) and healthy controls, and found that many key proteins involved in maintaining homeostasis were present at altered levels. Decreased levels of C-reactive protein (CRP) , complement C1q subcomponent subunit B , and apolipoprotein A-IV, and increased levels of alpha-1-antichymotrypsin (SERPINA3) were observed in patients with DPDR. Furthermore, expressions of CRP and SERPINA3 were found to be linked with
5000-514: The retina . It is hypothesised that peripheral oscillators respond to internal signals such as hormones, food intake, and "nervous stimuli". The implication of independent internal clocks may explain some of the symptoms of jet lag. People who travel across several time zones can, within a few days, adapt their sleep–wake cycles with light from the environment. However, their skeletal muscles , liver , lungs , and other organs will adapt at different rates. This internal biological de-synchronisation
5100-422: The sensory association cortex , prefrontal hyperactivation , and limbic inhibition in response to aversive stimuli revealed by brain imaging studies. In addition to this, research suggests that individuals with depersonalization often exhibit autonomic blunting , characterized by reduced physiological responses to stressors or emotional stimuli. This blunting may reflect a diminished capacity to engage with
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#17331059198135200-526: The temporoparietal junction has a role in multisensory integration, embodiment, and self-other distinction . Several studies analyzing brain MRI findings from DPDR patients found decreased cortical thickness in the right middle temporal gyrus , reduction in grey matter volume in the right caudate , thalamus , and occipital gyri , as well as lower white matter integrity in the left temporal and right temporoparietal regions. However, no structural changes in
5300-401: The "Wolf Man" experienced derealization, which is the sensation of being separated from his surroundings by a veil. This description of being separared from one's surroundings by a veil is reminiscent of derealization . This symptom was accompanied by fear of wolves. Freud's case description revolves around the man's dream of white wolves in a tree peering at him through an open window. Despite
5400-447: The "feeling" of a memory where they are able to recall a memory but feel as if they did not personally experience it. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious. The inner turmoil created by the disorder can also result in depression . First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from
5500-678: The Acropolis in person; having read about it for years and knowing it existed, seeing the real thing was overwhelming and proved difficult for him to perceive it as real. Freudian theory is the basis for the description of depersonalization as a dissociative reaction, placed within the category of psychoneurotic disorders, in the first two editions of the Diagnostic and Statistical Manual of Mental Disorders . It can be argued that because depersonalization and derealization are both impairments to one's ability to perceive reality, they are merely two facets of
5600-572: The Athens' Acropolis. He described the incident 32 years later, in 1936. He interpreted his experience as an u nconscious psychological defence , in which he was repressing feelings of guilt for outliving his father, whose cause of death remained unknown. in In his case study of the Wolf Man, Freud emphasized that depersonalization and derealization serve psychologically defensive functions. A young Russian man known as
5700-522: The Cambridge Depersonalization Scale, when compared to a control group. Earlier age of abuse, increased duration and parental abuse tend to correlate with severity of dissociative symptoms. Besides traumatic experiences, other common precipitators of the disorder include severe stress , major depressive disorder or panic attacks . People who live in highly individualistic cultures may be more vulnerable to depersonalization due to
5800-483: The DSM-5-TR, less than 20% of patients with the disorder first experience symptoms after age 20 years; 80% or more have their onset in the first 2 decades of life - childhood and adolescence. The onset can be acute or insidious in nature. With acute onset, some individuals remember the exact time and place of their first experience of depersonalization and/or derealization. This may follow a prolonged period of severe stress,
5900-464: The VR exposure. This study offered evidence towards a link between imaginative processes of the brain and dissociative experiences. There is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the basis of emotional experience. In an fMRI study of DPDR patients, emotionally aversive scenes activated the right ventral prefrontal cortex . Participants demonstrated
6000-475: The ability to inhibit cognitive interference of DPDR. Depersonalization involves disruptions in the integration of interoceptive and exteroceptive signals, particularly in response to acute anxiety or trauma-related events . Studies spanning from 1992 to 2020 have highlighted abnormalities in primary somatosensory cortex processing and insula activity as contributing factors to depersonalization experiences. Additionally, abnormal EEG activities, notably in
6100-757: The accidents. Several studies, but not all, found age to be a significant factor: adolescents and young adults in the normal population reported the highest rate. In a study, 46% of college students reported at least one significant episode in the previous year. In another study, 20% of patients with minor head injury experience significant depersonalization and derealization. In general infantry and special forces soldiers, measures of depersonalization and derealization increased significantly after training that includes experiences of uncontrollable stress, semi-starvation, sleep deprivation , as well as lack of control over hygiene , movement, communications , and social interactions . Studies have linked dysregulation of
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#17331059198136200-491: The acronym DPAFU (Depersonalisation and Feelings of Unreality) as a shortened label for the disorder. In a 2020 article in the Journal Nature , Vesuna, et al. describe experimental findings which show that layer 5 of the retrosplenial cortex is likely responsible for dissociative states of consciousness in mammals. Depersonalization-derealization disorder Depersonalization-derealization disorder ( DPDR , DDD )
6300-561: The amygdala were observed. A PET scan found functional abnormalities in the visual , auditory , and somatosensory cortex , as well as in areas responsible for an integrated body schema. One study examining EEG readings found frontal alpha wave overactivation and increased theta activity waves in the temporal region of the left hemisphere. It is unclear whether genetics plays a role; however, there are many neurochemical and hormonal changes in individuals with depersonalization disorder. DPDR may be associated with dysregulation of
6400-468: The brain. For those with both depersonalization and migraine , tricyclic antidepressants are often prescribed. If depersonalization is a symptom of psychological causes such as developmental trauma, treatment depends on the diagnosis. In case of dissociative identity disorder or DD-NOS as a developmental disorder, in which extreme developmental trauma interferes with formation of a single cohesive identity, treatment requires proper psychotherapy, and—in
6500-412: The case of additional (co-morbid) disorders such as eating disorders —a team of specialists treating such an individual. It can also be a symptom of borderline personality disorder , which can be treated in the long term with proper psychotherapy and psychopharmacology. The treatment of chronic depersonalization is considered in depersonalization disorder . A 2001 Russian study showed that naloxone ,
6600-443: The case of short duration trips, jet lag may be minimised by maintaining a sleep-wake schedule based on the originating time zone after arriving at the destination, but this strategy is often impractical in regard to desired social activities or work obligations. Shifting one's sleep schedule before departure by 1–2 hours to match the destination time zone may also shorten the duration of jet lag. Symptoms can be further reduced through
6700-430: The condition, psychotherapy might help. In some cases, recovery can take place organically, without formal treatment. Men and women are diagnosed in equal numbers with depersonalization disorder. A 1991 study on a sample from Winnipeg, Manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. A 2008 review of several studies estimated the prevalence between 0.8% and 1.9%. This disorder
6800-444: The disorder, reassurance, and emphasis on DPDR as a perceptual disturbance rather than a true physical experience. Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (SSRI), benzodiazepines , stimulants and opioid antagonists (ex: naltrexone ). An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in
6900-434: The distressing nature of symptoms, estimating the prevalence rates of depersonalization is challenging due to inconsistent definitions and variable timeframes. Depersonalization is a symptom of anxiety disorders, such as panic disorder . It can also accompany sleep deprivation (often occurring when experiencing jet lag ), migraine , epilepsy (especially temporal lobe epilepsy , complex-partial seizure , both as part of
7000-516: The environment, nor to each other in some cases. To the degree that the body cannot immediately realign these rhythms, it is jet lagged. The speed at which the body adjusts to a new rhythm depends on the individual as well as the direction of travel; some people may require several days to adjust to a new time zone, while others experience little disruption. Crossing the International Date Line does not in itself contribute to jet lag, as
7100-434: The experience of falling in love. Experiences of depersonalization/derealization occur on a continuum, ranging from momentary episodes in healthy individuals under conditions of stress , fatigue , or drug use , to severe and chronic disorders that can persist for decades. Several studies found that up to 66% of individuals in life-threatening accidents report at least transient depersonalization during or immediately after
7200-510: The external world or to experience emotions fully, contributing to the subjective sense of detachment from oneself. Additionally, dysregulation of the HPA axis , which governs the body's stress response system, is frequently observed in individuals who experience depersonalization. This dysregulation can manifest as alterations in cortisol levels and responsiveness to stress, potentially exacerbating feelings of detachment and unreality. Depersonalization
7300-504: The film's protagonist played by Matthew Perry . Norwegian painter Edvard Munch 's famous masterpiece The Scream may have been inspired by depersonalization disorder. In Glen Hirshberg 's novel The Snowman's Children , main female plot characters throughout the book had a condition that is revealed to be depersonalization disorder. Suzanne Segal had an episode in her 20s that was diagnosed by several psychologists as depersonalization disorder, though Segal herself interpreted it through
7400-449: The frequency and consistency of bowel movements , and reduced appetite . The symptoms are caused by a circadian rhythm that is out of sync with the day–night cycle of the destination, as well as the possibility of internal desynchronisation. Jet lag has been measured with simple analogue scales, but a study has shown that these are relatively blunt for assessing all the problems associated with jet lag. The Liverpool Jet Lag Questionnaire
7500-457: The general population, the disorder is only diagnosed when these symptoms cause substantial distress or impair social, occupational, or other important areas of functioning. The core symptoms of depersonalization-derealization disorder are the subjective experience of "unreality in one's self", or detachment from one's surroundings. People who are diagnosed with depersonalization also often experience an urge to question and think critically about
7600-412: The guide for calculating jet lag is the number of time zones crossed, with a maximum possible time difference of plus or minus 12 hours. If the absolute time difference between two locations is greater than 12 hours, one must subtract 24 from or add 24 to that number. For example, the time zone UTC+14 will be at the same time of day as UTC−10 , though the former is one day ahead of the latter. Jet lag
7700-431: The lens of Buddhism as a spiritual experience, commonly known as " Satori " or " Samadhi ". The song "Is Happiness Just a Word?" by hip hop artist Vinnie Paz describes his struggle with depersonalization disorder. Adam Duritz , of the band Counting Crows , has often spoken about his diagnosis of depersonalization disorder. Jet lag Jet lag is a temporary physiological condition that occurs when
7800-541: The majority of people (about 80%) responsible for child maltreatment are the child's own caregivers. Trauma-specific intervention for children may be useful in preventing future symptoms. Treatment of DPDR is often difficult and refractory. Some clinicians speculate that this could be due to a delay in diagnosis by which point symptoms tend to be constant and less responsive to treatment. Additionally, symptoms tend to overlap with other diagnoses. Some results have been promising, but are hard to evaluate with confidence due to
7900-521: The nature of reality and existence. Individuals with depersonalization describe feeling disconnected from their physicality; feeling as if they are not completely occupying their own body; feeling as if their speech or physical movements are out of their control; feeling detached from their own thoughts or emotions; and experiencing themselves and their lives from a distance. While depersonalization involves detachment from one's self, individuals with derealization feel detached from their surroundings, as if
8000-434: The nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again. Depersonalization disorder has appeared in a variety of media. The director of the autobiographical documentary Tarnation , Jonathan Caouette , had depersonalization disorder. The screenwriter for the 2007 film Numb had depersonalization disorder, as does
8100-407: The opposite of the effects of exposure to light. Melatonin receptors are situated on the suprachiasmatic nucleus, which is the anatomical site of the circadian clock. The results of a few field studies of melatonin administration, monitoring circadian phase, have provided evidence for a correlation between the reduction of jet lag symptoms and the accelerated realignment of the circadian clock. In
8200-465: The participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. Treating patients with rTMS specifically at the TPJ may be an alternative treatment. Michal et al. (2016) analyzed a case series on 223 patients suffering from DPDR and agreed that the condition tended to be long-lasting. However, while no medication has been confirmed to successfully treat
8300-440: The past, concomitant dissociative disorders should be considered in patients diagnosed with a stress disorder (i.e. PTSD or acute stress disorder ). The diagnosis of depersonalization disorder can be made with the use of the following interviews and scales: In the DSM-5 , the word "derealization" was added to "depersonalization disorder" and renamed "depersonalization/derealization disorder" ("DPDR"). It remains classified as
8400-525: The rest of society and functional impairment. The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety and obsession, which contributes to the worsening of symptoms. Factors that tend to diminish symptoms are comforting personal interactions, intense physical or emotional stimulation, and relaxation. Distracting oneself (by engaging in conversation or watching
8500-401: The result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself". One of Carl Wernicke 's students suggested all sensations were composed of a sensory component and a related muscular sensation that came from the movement itself and served to guide the sensory apparatus to
8600-456: The right type and dose of melatonin , at the right time, can help travellers shift faster and sleep better as they are transitioning between time zones. There are issues regarding the appropriate timing of melatonin use, in addition to the legality of the substance in certain countries. For athletes, anti-doping agencies may prohibit or limit its use. Melatonin can be considered to be a darkness signal, with effects on circadian timing that are
8700-417: The same disorder. Depersonalization also differs from delusion in the sense that the patient is able to differentiate between reality and the symptoms they may experience. The ability to sense that something is unreal is maintained when experiencing symptoms of the disorder. The problem with properly defining depersonalization also lies within the understanding of what reality actually is. In order to comprehend
8800-708: The same person or identity. Often a person who has experienced depersonalization claims that things seem unreal or hazy. Also, a recognition of a self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increase these perceptions. Depersonalization is a subjective experience of unreality in one's self, while derealization is unreality of the outside world. Although most authors currently regard depersonalization (personal/self) and derealization (reality/surroundings) as independent constructs, many do not want to separate derealization from depersonalization. In 1904, Freud described his own experience of depersonalization experience at
8900-425: The schizophrenia spectrum seems to be "a dis location of first-person perspective such that self and other or self and world may seem to be non-distinguishable, or in which the individual self or field of consciousness takes on an inordinate significance in relation to the objective or intersubjective world" (emphasis in original). For the purposes of evaluation and measurement depersonalization can be conceived of as
9000-787: The situations under threat. Currently, no universally accepted treatment guidelines have been established for depersonalization. Pharmacotherapy remains a primary avenue of treatment, with medications such as clomipramine , fluoxetine , lamotrigine , and opioid antagonists being commonly prescribed. However, it is important to note that none of these medications have demonstrated a potent anti-dissociative effect in managing symptoms. In addition to pharmacological interventions, various psychotherapeutic techniques have been employed in attempts to alleviate depersonalization symptoms. Modalities such as trauma-focused therapy and cognitive-behavioral techniques have been utilized, although their efficacy remains uncertain and not firmly established. Treatment
9100-582: The small size of trials. However, recognizing and diagnosing the condition may in itself have therapeutic benefits, considering many patients express their problems as baffling and unique to them, but are not, in fact, and are recognized and described by psychiatry. However, symptoms are often transient and can remit on their own without treatment. Treatment is primarily pharmacological. Self-hypnosis training can be helpful and entails training patients to induce dissociative symptoms and respond in an alternative manner. Psychoeducation involves counseling regarding
9200-406: The stimulus. In depersonalized patients, these two components were not synchronized, and the myogenic sensation failed to reach consciousness. The sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words. Pierre Janet approached
9300-508: The theory by pointing out his patients with clear sensory pathology did not complain of symptoms of unreality, and that those who have depersonalization were normal from a sensory viewpoint. Psychodynamic theory formed the basis for the conceptualization of dissociation as a defense mechanism. Within this framework, depersonalization is understood as a defense against a variety of negative feelings, conflicts, or experiences. Sigmund Freud himself experienced fleeting derealization when visiting
9400-482: The theta band, suggest potential biomarkers for emotion processing, attention, and working memory, though specific oscillatory signatures associated with depersonalization are yet to be determined. Reduced brain activities in sensory processing units, along with alterations in visceral signal processing regions, are observed, particularly in the early stages of information processing . Furthermore, vestibular signal processing, crucial for balance and spatial orientation,
9500-420: The time were five hours later than local time. The phase shift when travelling from east to west is referred to as phase-delay of the circadian cycle, whereas going west to east is phase-advance of the cycle. Most travellers find that it is harder to adjust time zones when travelling east. Jet lag was previously classified as a circadian rhythm sleep disorder . The condition may last several days before
9600-489: The world around them as foggy, dreamlike, surreal, and/or visually distorted. Depersonalization-derealization disorder is thought to be caused largely by interpersonal trauma such as early childhood abuse . Adverse early childhood experiences, specifically emotional abuse and neglect have been linked to the development of depersonalization symptoms. Feelings of depersonalization and derealization are common from significant stress or panic attacks. Individuals may remain in
9700-468: The world around them is foggy, dreamlike, or visually distorted. Individuals with the disorder commonly describe a feeling as though time is passing them by and they are not in the notion of the present. In some cases, individuals may be unable to accept their reflection as their own, or they may have out-of-body experiences . Additionally some individuals experience difficulty concentrating and problems with memory retrieval . These individuals sometimes lack
9800-469: Was developed to measure all the symptoms of jet lag at several times of day, and has been used to assess jet lag in athletes. Jet lag may require a change of three time zones or more to occur, though some individuals can be affected by as little as a single time zone or the single-hour shift to or from daylight saving time . Symptoms and consequences of jet lag can be a significant concern for athletes travelling east or west to competitions, as performance
9900-497: Was first used by Henri Frédéric Amiel in The Journal Intime . The 8 July 1880 entry reads: I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift. Is this madness? Depersonalization was first used as a clinical term by Ludovic Dugas in 1898 to refer to "a state in which there
10000-1057: Was uncommon to travel far and fast enough to cause the condition. According to a 1969 study by the Federal Aviation Administration , aviator Wiley Post was the first to write about the effects of flying across time zones in his 1931 co-authored book, Around the World in Eight Days . The symptoms of jet lag can be quite varied, depending on the amount of time zone alteration, time of day, and individual differences. Sleep disturbance occurs, with poor sleep upon arrival or sleep disruptions such as trouble falling asleep (when flying east), early awakening (when flying west), and trouble remaining asleep. Cognitive effects include poorer performance on mental tasks and concentration ; dizziness, nausea , insomnia , confusion, anxiety , increased fatigue , headaches , and irritability ; and problems with digestion, including indigestion , changes in
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