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Derealisation & Depersonalisation
Derealization & Depersonalization

See also: UNREAL - Depersonalisation / Derealisation web site.

These two symptoms are very commonly reported during benzodiazepine withdrawal. It may therfore be useful to give some definitions of these terms.

SOME DEFINITIONS

Derealisation:
A feeling of disconnection from the world around you. A dreamlike state.

Depersonalisation:
A feeling of disconnection from one's sense of self. The classic manifestation is looking in the mirror and not connecting the image you see with your internal sense of self. Depersonalisation is linked to derealisation, in that it occurs most often in heightened states of derealisation. David Woolfe.

Depersonalisation:
Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self estrangement, in changes of body image or in a feeling that one does not control his own actions and speech, seen in depersonalisation disorder, schizophrenic disorders and schizotypal personality disorders. Some do not draw a distinction between depersonalisation and derealisation, using depersonalisation to include both. Online Medical Dictionary.

Derealisation:
An experience where the person perceives the world around him/her to be unreal. The experience is linked to depersonalisation. Glossary On-Line: Psychiatry. Priory Lodge Education Limited.

Derealisation & Depersonalisation:
"While derealisation is a sense of the world being unreal, depersonalisation is the experience of oneself not being real, one's body being alien, of being an onlooker in relation to one's body. Both are psychiatric symptoms and they often appear together." Molnos, A. (1998): A Psychotherapist's Harvest.

Depersonalisation:
A change in an individuals self-awareness such that they feel detached from their own experience, with the self, the body and mind seeming alien.

Terms commonly used to describe depersonalisation: unreal, disembodied, divorced from oneself, apart from everything, unattached, alone, strange, weird, foreign, unfamiliar, dead, puppet-like, robot-like, acting a part, "like a lifeless, two dimensional, 'cardboard' figure", made of cotton-wool, having mechanical actions, remote, automated, a spectator, witnessing ones own actions as if in a film or on a TV programme, not doing ones own thinking, observing the flow of ideas in the mind as independent.

Derealisation:
A change in an individual's experience of the environment, where the world around him/her feels unreal and unfamiliar. Terms commonly used to describe derealisation: spaciness, like looking through a grey veil, a sensory fog, spaced-out, being trapped in a glass bell jar, in a goldfish bowl, behind glass, in a Disney-world dream state, withdrawn, feeling cut off or distant from the immediate surroundings, like being a spectator at some strange and meaningless game, objects appear diminished in size, flat, dream-like, cartoon-like, artificial; objects appear to be unsolid, to breathe, or to shimmer; 'as if my head were inside a Coke bottle and I'm viewing the world through the thick glass at the bottom'.

Depersonalisation Syndrome:
Transient feelings of unreality are quite normal in healthy individuals. Alternatively, they can be a co-symptom of psychiatric or physical illness, in which case they will often disappear when the sufferer recovers from their primary illness. When the feelings arise, however, as the central problem of a persistent and debilitating disorder, they are diagnosed by psychologists and psychiatrists as Depersonalisation Syndrome, Depersonalisation Disorder or Depersonalisation Neurosis. Periods of unreality can last for days, weeks and months at a time. As a result of this sustained distress, the sufferer can rapidly become deeply depressed and anxious. It can then be difficult to establish whether this is a result of, or the cause of the depersonalisation.

Dissociation:
The clinical name given to a category of illnesses mainly affecting memory, identity and consciousness which also includes depersonalisation.

"Intense anxiety can cause a sense of unreality in how we feel about ourselves, others, or the world. We feel 'different' or 'changed' (depersonalization), or other people and our surroundings seem far away and 'unreal' (derealization). While psychiatrists do not consider these symptoms to be psychotic reactions, individuals who suffer depersonalization and derealization often feel as if they are going mad." Dr Peter Breggin

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ABOUT DEPERSONALISATION

From: About Depersonalisation, Section of Cognitive Neuropsychiatry,
Institute of Psychiatry, King's College London

What is depersonalisation?
Depersonalisation is both a symptom and an illness. It was first described by Ludovic Dugas, a French Psychiatrist writing at the turn of the century. It occurs in almost all the major psychiatric disorders including severe anxiety, panic disorder, depression, post-traumatic stress disorder, obsessive compulsive disorder, schizophrenia, as well as neurological conditions such as migraine and epilepsy. Normal people can experience it during states of fatigue, fear or meditation, or after ingestion of drugs such as cannabis and 'Ecstasy'. It can also exist, more rarely, in a pure form: 'Primary Depersonalisation'.

According to the American Psychiatric Association's diagnostic criteria, 'Depersonalisation Disorder' is characterised by persistent or recurrent episodes of: "... detachment or estrangement from one's self. The individual may feel like an automaton... There may be the sensation of being an outside observer on one's own mental processes... Various types of sensory anaesthesia, lack of affective response... are often present". Derealisation (the sense that the external world is strange or unreal) may also be present.

What is it like?
Many sufferers describe it as 'terrifying', 'like losing your sense of being alive', 'a living death', 'like being detached from your own body, your loved ones, your feelings...' People say that it is as if their mind is full of cotton wool; they pray that they will wake up and it will all be clear once more. Many describe de-realisation: as if the world around them is like a movie or that they are separated from other people by an invisible pane of glass. When such unpleasant feelings persist without explanation, the person may be judged to be suffering from depersonalisation disorder. It can be brought on by severe stress or emotional turmoil but may also appear out of the blue, and apparently suddenly.

How common is it?
A third of undergraduates said they had experienced some of the symptoms at some time in a response to a questionnaire. One hospital survey found 12% of psychiatric patients suffered severe and persistent depersonalisation.

What is the cause?
There are many theories: depersonalisation might be induced by overwhelming anxiety or an early traumatic event. In these circumstances, becoming detached from one's body may seem a useful means of distancing oneself from the trauma, but in some people, the depersonalisation then becomes autonomous and a problem in it's own right. Neurological theories include a disruption or neurotransmitter imbalance in the parts of the brain which integrate oncoming sensory information with our internal representation of the Self (the temporal lobes). A specific part of the temporal lobe, the amygdala, responsible for processing emotion, may be crucial.

Treatment
There is no clearly identified treatment for depersonalisation; almost everything has been tried from in-depth psychotherapy, through electroconvulsive therapy, to antipsychotic and antidepressant medication. Sometimes, treatment of the underlying condition abolishes the symptom. Encouraging results have been achieved with the antidepressant drugs known as the selective serotonin re-uptake inhibitors, including fluoxetine (Prozac). Newer drugs which act on specific serotonin and noradrenaline receptors may prove to be helpful.