Do you know that certain people during certain times feel various bizarre changes in their self-awareness where they tend to feel that their thoughts and actions are not their own, but somebody else’s (Depersonalization)?
On the other hand there are some people who may tend to feel dissociated from their environment, perceiving objects as unsolid, diminished in size or two-dimensional and their own self residing inside some glass-like container or peering at the world through a fog with the outside world seems unreachable and meaningless (De-realization)?
Sounds strange for sure, but these situations aren’t uncommon at all in the modern world. In fact, certain research studies have shown that up to 50% of ‘normal’ adult population go through one or both of these problems ‘occasionally’ and that as a psychiatric condition it could affect up to 3% of the general population.
Depersonalization and De-realization are two types of dissociative disorders, which are often used interchangeably, owing to the several similar features they share and confusing factors of differentiation. However, most healthcare professionals consider these two conditions as a single diagnosis called Depersonalization-Derealization Disorder and by this article we are going to identify the characteristic properties owned by each of them, for the sole purpose of making an accurate diagnosis and deciding on the modality of treatment.
What is Depersonalization?
Being a type of dissociative disorders, which result in disruptions in one’s memory, consciousness, identity or perception, Depersonalization is defined as a condition where a person experiences ‘detachment’ from his own self as if he is not the person consisting of a set of feelings, thoughts, emotions and physical activity. The affected individual will have feelings about a set of properties that are normal to any human being, but does not belong to him anymore. For an example, a depersonalized person will often have complaints like ‘I know that it is my arm which is moving, but this is not really my arm, but someone else’s.
Even though the exact etiology of this condition is not very clear, traumatic situations and negative life events (war, abuse, and accidents) are known to be playing major roles in the predisposition. Also, substance-induced depersonalization is known to occur as a result of Alcohol, Antihistamines, Antipsychotics, Anti-Anxiety medications, Benzodiazepines, Caffeine, Carbamazepine etc.
Most affected people will present with feelings of distorted perceptions of the body where he will feel as if he is a robot or living in a dream where some people may even complain of symptoms suggestive of depression, anxiety, or panic attacks. Some cases of depersonalization can be mild and last for a very short period of time where some can be chronic and give rise to recurrences which will often result in disturbances in day to day activities.
Additionally, depersonalization is usually associated with other psychiatric conditions such as anxiety disorder, schizophrenia and borderline personality disorder.
The diagnosis of Depersonalization will often be made with a complete history from the patient along with a thorough physical examination where imaging and laboratory tests might be helpful to rule out medical conditions which may give rise to similar signs and symptoms.
Most cases of depersonalization will get resolved spontaneously over time where severe or recurrent cases might need medical interventions including psychotherapy (cognitive behavioural therapy, interpersonal therapy) and medication such as anti-depressants, anti-psychotics and anxiolytics.
In addition to that, Clinical hypnosis might be indicated in some patients to achieve relaxation, concentration, and focused attention, making people to identify their thoughts, feelings, and emotions which might have become suppressed in the level of consciousness.
What is Derealization?
Derealization, is defined as a sensation of detachment and experienced by certain individuals as if the environment around them does not exist. This will often result in a continuous struggle between a person’s mind and body which may sometimes lead to a chronically disturbed mind and body connection (detachment from the reality).
As far as the etiology of this condition is concerned, short-term de-realization usually occurs as a consequence of substance abuse, drug-withdrawal or as a symptom of schizophrenia, bipolar disorder or dissociative identity disorder.
Often accompanied by abnormal visual and auditory sensations, the affected person will complain of visual distortions such as widened or narrowed visual field, blurriness or two-dimensional views where the world around will seem to be like a living dream or a movie projected on a screen.
An attack of de-realization will usually last for about 15-20 minutes, but can recur without any prior notice and persist even for hours to weeks.
The modality of treatment for Derealization is similar to that of Depersonalization which mainly includes anti-psychotics, anxiolytics and anti-depressants based on the other associated mental conditions.
The line of differentiation in these two conditions lie in the aspects of the type of detachment they cause, their social application and how the disorder is connected to physical injuries. In fact, Depersonalization is a state of hyper awareness of one’s own body where the affected individual behaves as if he is a spectator watching himself, being outside the body whereas De-realization is a state where a person feels as if he is detached from the entire world around him
Furthermore, being a psychological condition, depersonalization often accompanies anxiety disorders and is associated with various physical symptoms such as excessive cold sweating, but as a rule does not originate in central nervous system-related injuries.
On the other hand Derealization can be a result of various physical injuries to the central nervous system including trauma to the head.
A person suffering from feelings of depersonalization is not usually socially alienated whereas the one with Derealization will often be noted as a socially alienated individual. In fact, a person with symptoms of depersonalization is fit enough to maintain various social relationships where the ones with Derealization can hardly maintain any social relationship because of the perception that the outside world is thought to be detached from their body.
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