From the Guidelines
Depersonalization is a psychological condition characterized by feeling detached from one's thoughts, feelings, body, or surroundings, often accompanied by emotional numbness, altered sense of time, and a perception of the world as unreal or dreamlike. This condition can manifest as a symptom in various anxiety disorders, including panic attacks, as noted in the study by Lewis-Fernández et al. 1. According to this study, depersonalization/derealization symptoms are experienced at varying frequencies across different cultural groups, with some groups like Puerto Ricans reporting higher rates of these symptoms during panic attacks.
Key Characteristics of Depersonalization
- Feeling detached from oneself or the world
- Emotional numbness
- Altered sense of time
- Perception of the world as foggy or dreamlike
- Can occur briefly during stress, anxiety, or trauma, or persist as a disorder (Depersonalization/Derealization Disorder)
Cultural Variations in Depersonalization
The study by Lewis-Fernández et al. 1 highlights the importance of cultural context in understanding depersonalization and other symptoms of panic attacks. For example, in some cultural syndromes like ataque de nervios among Latin Americans, depersonalization/derealization symptoms are prominent, along with other culture-specific symptoms such as trembling, uncontrollable crying or screaming, and aggressive or suicidal behavior.
Management and Treatment
While there is no specific FDA-approved medication for depersonalization, treatment often involves psychotherapy, particularly cognitive-behavioral therapy, to address underlying anxiety and stress management techniques like grounding and mindfulness practices to help individuals reconnect with their physical sensations and present environment. Medications like SSRIs may be prescribed if depersonalization is linked to depression or anxiety disorders, as suggested by the general management of anxiety disorders 1.
Underlying Mechanisms
Depersonalization is thought to occur due to a disruption in the brain's normal integration of sensory information, emotions, and self-awareness, potentially as a protective mechanism during overwhelming stress. Understanding this mechanism is crucial for developing effective treatments that target the root causes of depersonalization, rather than just its symptoms.
From the Research
Definition of Depersonalization
- Depersonalization refers to a state of mind characterized by a profound feeling of detachment from one's sense of self 2.
- It often co-occurs with derealization, which involves a feeling of detachment from the surrounding environment 2.
- Depersonalization disorder is a chronic and distressing condition with a prevalence in the general population between 0.8 and 2% 3.
Characteristics of Depersonalization Disorder
- The disorder has an approximately 1:1 gender ratio with onset at around 16 years of age 4.
- The course of the disorder is typically long term and often continuous 4.
- Mood, anxiety, and personality disorders are often comorbid with depersonalization disorder, but none predict symptom severity 4.
- The most common immediate precipitants of the disorder are severe stress, depression, and panic, and marijuana and hallucinogen ingestion 4.
Neurobiological Findings
- Neurochemical findings have suggested possible involvement of serotonergic, endogenous opioid, and glutamatergic NMDA pathways in depersonalization disorder 4.
- Brain imaging studies have revealed widespread alterations in metabolic activity in the sensory association cortex, as well as prefrontal hyperactivation and limbic inhibition in response to aversive stimuli 4.
- Depersonalization disorder has also been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation 4, 2.
Treatment Options
- There are few studies assessing the use of pharmacotherapy in depersonalization disorder, and medication options that have been reported include clomipramine, fluoxetine, lamotrigine, and opioid antagonists 4, 3, 5.
- Cognitive-behavioral therapy (CBT) may be an effective treatment for depersonalization disorder, with medium effect sizes observed in a self-controlled cross-over study 6.
- However, more research is needed to establish the efficacy of CBT and other treatments for depersonalization disorder, including the use of randomization and larger sample sizes 5, 6.