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What is depersonalization disorder?
Depersonalization disorder is characterized by an unpleasant state of impaired perception, in which external objects or parts of the body are sensed as altered, unreal, detached or automatic. The patient realizes the subjective nature of his sensation. The symptom of depersonalization is fairly widespread as a minor symptom in other syndromes, but depersonalization disorder occurs infrequently.
In DSM-IIIR, the depersonalization disorder is classified under the rubric of dissociative disorders, together with the various dissociative states discussed in the last section. In ICD-10, the depersonalization-derealization syndrome is classified under the heading "Other neurotic disorders".
Describing the sensations of their own unreality and the unreality of the perceived, the patients also say that their emotions are dulled, and the actions seem to be mechanical. They no longer experience such strong emotions as love, hate, anger or pleasure; Paradoxically, they complain that this lack of feelings is extremely unpleasant. An adequate awareness of the subjective nature of their sensations remains. With depersonalization disorder, these symptoms are intense and are accompanied by mild anxiety, shallow depression, deja vu and altered perception of time. Some patients complain of a sensory disorder that affects not the entire body, but one part (for example, the head, wore a limb), which can be described as a feeling that this organ is made of cotton wool. Two thirds of the patients are women. Symptomatology usually occurs suddenly, often in relaxation after strenuous exercise or mental arousal (Shorvon et al., 1946). The onset is often in adolescence or in the early years of adulthood, and in half the cases - up to the age of 30 (Shovron et al., 1946). Having arisen, this disorder often continues for many years, although with periods of partial or complete remission.
Before you can diagnose a depersonalization disorder, you must carefully look for a primary disorder, such as an organic syndrome (including temporal epilepsy), schizophrenia, depressive disorder, obsessive disorder, conversion or dissociative disorder, generalized and phobic anxiety disorders. Severe and persistent depersonalization symptoms also occur in schizoid personality disorder. In most patients who suffer from depersonalization, one of these disorders is found; The primary syndrome is rare.
The more carefully the primary disorder is searched, the fewer cases of the primary depersonalization disorder will be identified. Ackner (1954a, b) investigated a number of patients and found that all of these cases could be attributed to organic, depressive, anxious or hysterical syndromes or to schizoid personality disorder. In addition to a possible connection with schizoid personality disorder, no other specific constitutional factors have been identified. Lader (1969) suggested that these symptoms represent a limitation of the inflow of sensory information, which serves to reduce the intolerable level of anxiety, and described as a striking example of a patient who was undergoing physiological examination at that time. Since the disease often begins when the patient is in a state of relaxation or fatigue, this mechanism, if it is important, can not function unchanged in all cases.
Most cases are secondary, and the forecast is determined by the primary state. Uncommon primary primary depersonalization disorder was not systematically observed; Clinical experience shows that if it lasts for more than a year, then it has a bad long-term prognosis.
Since most depersonalization disorders are secondary, treatment should usually be directed to the primary condition. In a small group of primary depersonalization disorders, it is advisable to try to use anxiolytic drugs, as it helps some patients. If there is a positive effect, the advantages of their long-term use should be compared with the risk of drug dependence. If there are no valid reasons to believe that in this case the benefit exceeds the possible harm, then drug therapy is not applied. Behavioral therapy is ineffective.
Psychotherapy does not really matter, but patients who often suffer extreme distress can be helped by supportive interviews. It is also necessary to do everything necessary to reduce the stressful events in their lives. However, the doctor must accept that he does not have significant opportunities to alleviate the symptoms of the primary impersonation disorder; Many patients will receive nothing but moral support and persuasion to endure, while continuing to lead, as far as possible, ordinary life. These patients often seek help again and again, but despite their obvious suffering, it is important to resist the temptation to pile one inefficient method of treatment on another.