Treatment of depersonalization (depersonalization syndrome)

Depersonalization-derealization syndrome is a type of neurotic disorder in which a person periodically exhibits symptoms of depersonalization and derealization. Depersonalization is a feeling of loss of one’s own “I”, loss of connection with reality. The surrounding events seem unreal; the person seems to be watching his life from the outside. Derealization is a disturbance of perception in which the world around us seems unreal, uncolorful, and is often accompanied by memory impairment and the appearance of déjà vu.

Difficulties in diagnosing depersonalization arise because the term can be used to refer to a symptom, syndrome, and disorder. As a syndrome, depersonalization develops against the background of various mental disorders. In mentally healthy people, the syndrome occurs as a reaction to a traumatic situation. If clinical manifestations of depersonalization are the only manifestations of the disorder and have a protracted course, then we can assume depersonalization-derealization syndrome as an independent disorder.

The syndrome can develop in people of any age category and regardless of gender. Most often, the disorder begins in early childhood and adolescence, very rarely after 25 years.

A person with depersonalization-derealization syndrome eventually withdraws from close people. The state of depersonalization can last from a few minutes to several years. As a rule, in the initial stages of development of the disorder, spontaneous temporary disappearance of the manifestations of the syndrome is possible.

Most often, the syndrome is characterized by the following symptoms:

• Distortion of the passage of time;
• Deja vu and jamevu;
• A feeling of unreality of the surrounding world, life “like in a dream” or “in a movie”;
• Alienation from oneself and society;
• Dulling of feelings and emotions;
• Loss of self;
• Concern about the “unnaturalness” of your behavior and thoughts.

The listed symptoms and negative experiences cause the patient a strong fear that he will not be able to return to normal life. Due to dulling of emotional reactions, he begins to doubt his own mental health and may consider himself inferior.

Depersonalization and derealization can manifest themselves in the form of symptoms of other mental illnesses (phobias, panic, depressive and post-traumatic stress disorder, schizophrenia, bipolar affective and borderline personality disorder, etc.) and neurological pathologies (convulsions, brain tumors, post-concussion syndrome, metabolic disorders, migraine, Meniere's disease). The independent course of depersonalization-derealization syndrome can be assumed if it develops independently of other diseases and has a protracted or recurrent course and negatively affects areas of life.

In the presence of recurrent symptoms, if a person is able to concentrate and distract himself from his subjective feelings with other thoughts or actions, derealization-depersonalization syndrome has minimal impact on the quality of life. If treatment is prescribed in a timely manner, it is possible to completely get rid of the disorder.

General information

Depersonalization is usually called dissociative identity disorder , expressed in a violation of self-perception and alienation from one’s own “I” mental properties. Depersonalization occurs in approximately 1-2% of people and leads to a sideways perception of one’s own actions - when a person feels that he cannot control them, everything seems unreal and unfamiliar, this state turns into the phenomenon of derealization .
Typically, patients complain that they cannot control their mental activity and body, its parts, since they are qualitatively changed towards unreality, remoteness and automation. Depersonalization or absence of emotions can only be a manifestation of mental disorders such as schizophrenia , schizotypal , bipolar , panic , phobic , post-traumatic, obsessive-compulsive , depressive disorder , or the symptoms are so pronounced and aggravated that they represent a separate clinical variant of dissociative disorder - depersonalization syndrome - derealization , which is assigned the code MBK-10: F48.1.

Brief historical background

Depersonalization is a concept in social science that means depersonalization, the actual feeling of loss of “I”. The French psychiatrist Jean Esquirol first described depersonalization syndrome back in 1838, and in 1840 Moreau de Tours drew attention to the symptoms of alienation of one’s own personality and body in some of the patients examined. A more extensive study was carried out by Kriesgaber and described about 40 clinical cases in a monograph. The term “depersonalization” to denote alienation from one’s own “I” or its loss was proposed by the French philosopher Dugas in 1898, who also summarized all the data on this mental disorder.

When there are signs of loss of feelings and changes in one’s own “I”, giving way to feelings of emptiness, illusoryness caused by depersonalization, they speak of cenesthesia .

Group and individual therapy

For various disorders of adequate perception of one’s own body, it is important to combine individual work with group exercises. This approach provides the following advantages:

• important insights when one-on-one communication with a psychotherapist has reached a dead end;
• the opportunity to look at the problem from the outside;
• development of empathy, friendly support;
• receiving strength to fight the disease from people facing the same problem;
• association with someone who has already returned to society to a normal lifestyle;
• getting more resources and help to prevent relapse.

Groups can also be attended after the end of the main course of treatment as consolidative therapy or a preventive measure.

Pathogenesis

The development of depersonalization is based on defense mechanisms, with the exception of some types of schizophrenia that cause alienation of the “I”, somatopsychic dissociation and mental anesthesia .

Typically, a disorder of the sense of one’s own body and personality is preceded by strong emotional shocks and stress , while the person tries to get rid of excessive negative stimuli, experiences and traumatic memories, to assess the situation soberly, impartially, unemotionally, so to speak, by distancing himself from his feelings and not analyzing them. The reaction is quite normal for the human psyche, but its long-lasting, painful course over many years indicates the pathological nature of the condition, which usually depends on the characteristics of etiogenesis and genetic predisposition.

Most often, the nature of depersonalization is transient, temporary, caused by stress, an excess of feelings, an overabundance of new information, while the state of “alienation” can pass in a matter of minutes. With a long, protracted course, at the beginning of the development of the pathology, “bright spots” may also appear - a kind of way out of the state with the disappearance of symptoms for several hours, then all the unusual feelings of alienation return.

The basis of the biochemical mechanisms of the development of depersonalization is the brain's response to a stress reaction in the form of abundant synthesis of endorphins , which have a high affinity for opioid receptors associated with dissociation reactions when using narcotic alkaloids of opium . In this case, there is a strong activation of opioid receptors and a change in the feedback mechanism responsible for neurochemical homeostasis from negative to positive, which causes cascade changes in groups of other receptor systems. As a result of blocking the pleasure center anhedonia , while the functional abilities of the limbic system, which is responsible for emotions, are switched off in response to chaotic stimulation and, in addition to the occurrence of a depersonalization-derealization reaction, depressive symptoms develop.

How is treatment carried out?

At the early stage of apathetic depression, treatment can be carried out independently or with the help of loved ones who control the process. Relatives should help change the environment to gain new emotions. The easiest way to do this is if the cause of apathetic depression lies in everyday problems and banal fatigue. Men and women who shared their experiences described successful attempts to overcome emotional decline. They were helped by travel, vacations, and a change in the circle of people they communicated with.

But it is best to immediately see a specialist who will monitor the progress of treatment and prescribe auxiliary means. The antidepressants luoxetine or citalopram will be helpful in such situations. These drugs relieve a person of depression, giving vitality.

The Korsakov Clinic helps everyone who turns to them for help with apathetic depression. Therefore, there is always a way out, regardless of the situation!

Classification

Depersonalization disorder is divided into spatial, temporal and status. In addition, depersonalization can be autopsychic, when the perception of one’s own “I” and personality as a whole is disturbed, allopsychic - disturbances in perception are focused on the outside world, and somatopsychic - arising when there is a disorder in the perception of parts of one’s body, its structure diagram (for example, the patient seems to have split head), functionality and features.

Autopsychic depersonalization

Feelings of alienation can be quite strong and painful; with an autopsychic type of disorder, one’s own “I” seems unnatural, changed as if in a fog or in a dream. In addition, autopsychic depersonalization is characterized by a feeling of “emptiness in the head,” a complete absence of thoughts and memories, but without a feeling of taking away thoughts. This condition is considered pathological and requires psychological and pharmacological correction.

Allopsychic depersonalization

When allopsychic depersonalization occurs, a person subjectively feels that the world around him has changed, he is located remotely - as in an aquarium, or in a fairy tale, movie, or theatrical performance. Everything around is changed, ghostly, flat, colorless, lifeless, uninteresting, objects can be perceived as reduced or enlarged (micro- and macropsia) and even voices, sounds become distant, indistinct and dull. Derealization not only causes feelings of being outside the body, but everything else seems unreal and alien.

Depersonalization and derealization are interconnected, because they make the patient feel that events are not happening to him, some aspects of memory and the ability to control the body, feelings and emotions are lost, depression sets in and life loses color, although criticality and objectivity remain.

The causes of derealization can be sensory deprivation, fatigue, and even periods of falling asleep and waking up - as part of the hypnagogic and hypnapompic phenomenon.

Complications

Relatively mild complications of the derealization-depersonalization syndrome include the development in the patient of a functional neurocognitive deficit—difficulty in focusing attention on specific tasks or remembering, which often reduces performance and productivity.

If the syndrome is accompanied by mental disorders, they may be resistant to standard treatment.

The importance of depersonalization and derealization is often underestimated. But regardless of concomitant mental disorders, the disorder has a protracted course. When the syndrome occurs against the background of paroxysmal or phasic psychosis, it significantly increases the duration of the attack and increases the risk of a suicide attempt.

Causes

In addition to psychogenic stress, for example, from overwork from an extremely large amount of information received, emotional distress, psycho-traumatic situations (rape, sexual seduction, beatings, humiliation, disasters, death or serious illness of loved ones, one’s own serious illness, war, captivity, torture), there are also other reasons for the development of depersonalization:

• alcohol poisoning;
• traumatic brain injuries;
• manifestation of temporal lobe epilepsy and some postictal conditions or preictal aura;
• hallucinogen intoxication ;
• taking dissociative drugs - NMDA receptor antagonists can even provoke a persistent full-blown disorder, for example the use of Ketamine , Dextromethorphan , Phencyclidine , as well as marijuana - causes characteristic symptoms after detoxification of the body;
• Iatrogenesis – erroneous diagnosis of an anxiety or depressive mental disorder in patients and the prescription of psychotropic drugs - antidepressants and antipsychotics that dull emotions or, on the contrary, an insufficiently assessed level of anxiety and depression and, accordingly, insufficiently prescribed drug therapy can lead to depersonalization; Therefore, the NODID Institute, a national organization whose activities are focused on the study of diseases provoked by drugs - Drug-Induced Disorders, is engaged in the development of effective methods for treating depersonalization-derealization in the USA.

Treatment and prognosis in Re-Alt

The nature and duration of depersonalization disorder directly depends on the cause of its occurrence and the presence of concomitant diseases; treatment tactics also depend on these factors. If the disorder arose against the background of short-term stress and the patient sought help in a timely manner, complete recovery is possible. In some cases, depersonalization becomes chronic and resistant to treatment.

At the Re-Alt mental health center, we treat depersonalization-derealization syndrome. Treatment is carried out on an outpatient basis, starting with a moderate degree of the disorder - inpatient. If it is necessary to differentiate the syndrome from a somatic disease, additional tests and examinations are prescribed by specialized specialists. The duration of therapy depends on how long ago the disease began and compliance with medical prescriptions.

Treatment of derealization-depersonalization syndrome is aimed at relieving stress factors that could potentially trigger the development of the disorder. The method of psychotherapy is selected based on the causes of the syndrome. Cognitive-behavioral psychotherapy is aimed at helping the patient cope with obsessive thoughts and learn to perform tasks that distract from derealization. Sensory methods influence the patient’s senses, helping him reconnect with himself and feel the reality of his surroundings at the moment. Psychodynamic therapy fights internal conflicts, establishing harmonious relationships with oneself and the surrounding reality. Drug treatment is used mainly to relieve concomitant disorders that can provoke the development of depersonalization and derealization.

You can receive treatment for depersonalization-derealization syndrome in Moscow at the Re-Alt mental health center. which is located from the Kropotkinskaya metro station, at the address Moscow, Vsevolozhsky lane, 2, s. 2. You can make an appointment online or by phone.

Symptoms of depersonalization

Symptoms of depersonalization boil down to loss of emotions and emotional coldness, detachment from one’s own thoughts and body, in some cases even detachment from the real world around us. The clinical picture may also contain symptoms such as:

• erasure of personal properties and characteristics, their complete or partial disappearance;
• lack of emotions and increasingly rare manifestation of “subtle emotions”, despite maintaining the ability to express them;
• lack of warm feelings and emotional coldness towards loved ones;
• perception of the surrounding environment - “flat”, “dead”, “fuzzy”, seems dull and located somewhere behind the glass;
• dullness, joylessness and colorlessness of the surrounding world against the background of dulled color perception of patients;
• inability to react emotionally to natural phenomena, plants and animals;
• art, music or other creative activities are not capable of influencing a person or causing any emotional reaction;
• lack of memory and thoughts in the head (although the ability to remember is not lost);
• a constant feeling of jamevu, which is the opposite of deja vu and is caused by a feeling of the unknown and unusualness of phenomena that have previously happened to this person;
• inability to experience resentment, anger, compassion, joy due to their dullness;
• the patient does not have a mood as a concept; a feeling of bad mood is considered a good tendency towards recovery;
• all actions are performed automatically, since one’s own body seems to be an automaton;
• painful mental anguish can be caused by the loss of the ability to feel;
• distortion of the perception of time - patients may feel that it has slowed down or stopped altogether;
• pretentiousness of speech, reasoning and inability to describe one’s own experiences and unusual sensations;
• there are difficulties with figurative representation and imaginative thinking;
• pain, tactile, temperature, taste, proprioceptive sensitivity is dulled, there is no sensation of the position and condition of the body, its weight, size, ability to dream, feelings of hunger and satiety;
• the success of professional, social and other areas of activity is reduced.

Typically, depersonalization takes on a dramatic nature of experiences, but thanks to the preservation of consciousness, a person is able to realize the unreality of emotional and physical changes. Many patients do not lose the ability to show love and express emotions, but their pretentiousness and unusualness against the background of detachment only causes distance from their relatives and does not find understanding among them.

If psychopathological manifestations arise within the framework of a depressive, schizotypal or other personality disorder, then such signs are classified as negative symptoms, a positive productive picture - melancholy and sadness become a predictor of recovery, and indifference and resistance to any external factors become a negative result. Patients do not pose a threat to themselves and to society, since they do not lose touch with reality, are quite adequate and sane, and their symptoms are quite stable and do not progress.

To identify even mildly expressed signs of depersonalization-derealization, an online test is a quick solution. It is built taking into account the scale developed by Nuller, which assesses the level of perception of loved ones, nature, surroundings, works of art, etc. The results can reveal mild, moderate, moderately severe and severe degrees of manifestations.

Treatment of personality depersonalization disease

The treatment process is selected individually in each case, taking into account the patient’s specific reactions and the characteristics of the body’s functioning. Includes drug therapy and work with psychotherapists. Medicines are prescribed only after determining the causes of depersonalization and a diagnostic examination.

Emotional depersonalization

A type of depersonalization, which is characterized by a partial or complete loss of emotional perception and, as a result, a lack of reactions to current events. Sometimes they are expressed in a monotonous form, which is why people around them are not always able to understand the patient.

It is important to note that the loss of emotions extends not only to the positive spectrum (joy, love), but also to the negative aspects (bitterness, disappointment). The result is manic-depressive syndrome. Or a phenomenon called “psychic anesthesia” occurs. According to statistics, the emotional type of depersonalization occurs with the development of a disease of the third category. However, this does not exclude the possibility of development in other types of disorders.

Often the disorder manifests itself in people with heightened emotional reactivity. Previously expressed emotions are preserved in their memory: love for loved ones and friends, joyful moments, experiences. But now nothing evokes emotional responses. Works of art or music do not evoke past admiration or any thoughts. The person becomes indifferent to past activities and hobbies. The mood also cannot be classified into any category: neither negative nor emotional. The surrounding world does not cause any interest, because it loses its expressiveness in front of a person suffering from depersonalization.

With the somatic manifestation of the disease, pain may occur, food loses its taste, tenderness and touch no longer cause any emotional reactions. The disease also has a negative impact on intellectual activity, thinking and memory. After a short period of time, a person no longer remembers what goals and objectives he set for himself. And although the very fact of the events remains in the memory, it no longer has an emotional connotation.

In practice, the onset of mental anesthesia is diagnosed in adults (most often females) on the basis of a developing depressive state. In addition, such behavior can be a side effect of long-term use of prescribed psychotropic medications.

Autopsychic depersonalization

A characteristic feature of this type of depersonalization is a complete lack of awareness of one’s own “I”, and there is also no emotional component. Among the main complaints are the following: a person ceases to perceive his own thoughts, reactions to ongoing events and interactions with other people remain without emotion, and sometimes are completely absent.

Autopsychic depersonalization involves the loss of natural self-awareness, a sense of one’s own Self. All reactions come down to an automatic reaction. However, a person is aware of pathological changes, so there is no feeling that his consciousness is guided by higher powers. Despite the automaticity of all actions, a person fully understands that they are initiated by himself.

The development of pathological psychological anesthesia is also considered characteristic, since a person completely and to a greater extent loses any kind of emotional response (positive or negative). Similarity of reactions is found regardless of the situation. As a rule, most patients worry precisely because of the loss of emotional response.

All events and experiences are perceived as if they were happening to another person. The patient begins to observe the ongoing changes and events from the outside, taking the passive side. When the condition seriously deteriorates, the personality splits into several components. There is a feeling that someone else lives in a person besides him. Inconsistency in actions, reactions, and different ways of thinking appear.

This form of the disease is also characterized by panic and anxiety, which arises as a result of awareness of a mental disorder that has a destructive role in his life. There is also a reverse reaction, when a person does not want to admit the fact of the presence of a disease, as well as spreading pathological forms. Most often this happens due to the fear that the person is beginning to lose consciousness.

In psychiatric practice, one can often find another development of the situation when the disease proceeds more smoothly. The disease progresses gradually, without sudden jumps. Among the most common complaints of patients is the loss of their own self, and there is also a feeling that the person is becoming a similar copy of himself and observing his life from the outside.

Since autopsychic depersonalization causes serious damage to the emotional sphere and normal communication with other people, the patient often begins to minimize contact with relatives and friends. There are difficulties in remembering which activities were favorite; often a person can freeze in one groove for an indefinite period of time.

A severe form of the disease most often occurs in patients suffering from other mental disorders, for example, schizophrenia and cerebral pathologies.

Depersonalization of VSD

Among the main symptoms of the development of depersonalization in VSD, the following aspects can be distinguished:

1. Getting insufficient oxygen
2. Prevalence of depression
3. Temperature increase
4. Dizziness occurs frequently
5. Migraines of varying degrees of intensity.

As a rule, the development of dystonia often provokes a feeling of constant fatigue and weakness. In addition to complaints of impaired self-awareness, pain in the limbs also occurs. Most patients who have suffered from VSD for more than a year react especially acutely to weather changes.

The principles of treatment depend on the degree of development of the disease. Most often, inpatient treatment is carried out if uncontrollable fear develops, not a single medication helps in the fight against migraines, and self-control does not bring any results. In a critical situation, specialists can prescribe strong antipsychotics, sedatives, and tranquilizers.

To enhance the positive effect of treatment, it is also recommended to use additional therapeutic methods:

1. Completion of complex massage activities
2. Physiotherapeutic activities
3. Acupuncture
4. Use of antidepressants.

No less important is working with qualified psychologists who are able to help the patient solve the problem, stabilize his condition, and also find out the main causes of depersonalization.

Somatopsychic depersonalization

According to the theory of Yu.L. Nuller, somatopsychic depersonalization most often begins to develop in the initial period of the disease in its acute form. Among the most characteristic side symptoms that patients most often complain about is the lack of sensation of their own body or individual parts. Often ideas arise that the arms or legs have changed their shape or size.

Often the patient has the idea that he is missing clothes, they do not feel their touch on the body. However, objective sensitivity is not diagnosed, since the person continues to feel pain signals and the touch of another person. But the process takes place detachedly without any emotions. In addition, no physiological changes are detected in the limbs. Despite the fragmentation in their own sensations, patients understand reality and that their body has remained unchanged in shape.

The manifestation of a somatopsychic type of disorder can also include an absolute loss of the feeling of hunger or satiety. This is due to the fact that the previously most favorite dish no longer gives any satisfaction or positive emotions, so often a person becomes completely indifferent to eating and most often completely forgets to eat at the appointed time. As a result, not only the cyclical functioning of the body is disrupted, but side diseases associated with the functioning of the gastrointestinal tract may occur.

It is important to note that fulfilling any biological needs does not bring any satisfaction or relief, so often the patient begins to remember the need to perform some action when absolutely necessary, when the body begins to give signals.

For example, when taking a bath, complaints often arise that a person does not feel moisture on his skin or whether the water is used: hot or cold. Often the patient is not able to determine whether he has slept, since the feeling of rest is constantly absent. When visiting a psychotherapist, some people claim that they have gone without sleep for six months.

Somatic disorders cannot be avoided. Most often they are expressed in painful sensations in the back, spine, and headaches of varying intensity. At the slightest suspicion of depersonalization, the patient is subjected to a competent and comprehensive examination, since if the diagnosis is not dealt with, this can lead to the appearance of hypochondriacal delusions and split personality.

Tests and diagnostics

During the examination of the patient, it is very important to find out all the circumstances surrounding the occurrence of symptoms and study the complaints. To make a diagnosis of emotionlessness, a general health assessment and drug testing must also be performed.

In people with depersonalization, specific neurological and biochemical changes can be identified, which include:

• oxidative stress;
• functional disorders of the pituitary-adrenal system (including disorders of the synthesis of cortisol and ACTH );
• disruption of the activity of serotonin receptors, gamma-aminobutyric acid, opioid, cannabinoid and other receptors;
• changes in brain activity in different parts of the hemispheres relative to the norm, which can be recorded during functional MRI.

Indicativeness of the diazepam test for depersonalization

To distinguish depersonalization syndrome from depression , schizotypal and anxiety disorders, it is recommended to undergo a diazepam test. Intravenous bolus injection of diazepam at a dose of 20-40 mg (the dose is selected depending on the age and health status of the patients) can demonstrate three types of body reactions:

• depressive type symptoms persist - patients become drowsy and quickly fall asleep;
• an alarming type response causes a quick reaction, mild euphoria , a person feels like “on pins and needles” - anxiety and depression disappear;
• depersonalization-type reaction - at least 20-30 minutes pass before a positive response occurs - the symptoms of depersonalization disappear or a partial reduction occurs: everything around becomes brighter and clearer, certain feelings arise.

Cognitive behavioral therapy

To treat a woman or man, cognitive behavioral therapy is often used. This approach is aimed at helping the patient get rid of rituals associated with the constant assessment of his shortcomings. During the treatment process, self-reflection is necessary:

• tracking your condition;/li>
• recording the occurrence of negative thoughts;/li>
• overcoming negativity.

Cognitive behavioral therapy is aimed at making the patient fully aware of his condition and the dangerous consequences for health. This is the main condition for successful recovery. This method can be combined with medications or other types of therapy.

Diet for depersonalization and derealization

Diet number 12

• Efficacy: therapeutic effect after 2-3 weeks
• Terms: 21 days or more
• Cost of food: 1590-1680 rubles per week

Patients with depersonalization-derealization syndrome lose their taste for life, and sometimes they cannot get enough food and even feel hungry, so it is very important to ensure that the patient’s diet is complete and balanced. It's best to set a strict schedule and measure out portions to avoid overeating or developing other negative eating habits. The diet is usually based on dishes such as:

• porridge with dried fruits, omelettes, toast with delicious fillings (tomatoes, cheeses, cottage cheese, avocado, salmon, eggs, ham, etc.) - an excellent breakfast for every day;
• stewed vegetables, cream soups, steamed and boiled dishes with meat are an indispensable basis for a lunch meal;
• berries, fruits and fresh juices, salads made from them, natural sweets and nuts are suitable for a delicious afternoon snack and snack;
• dinner can be made light and cook baked fish or grilled dietary meat, bake vegetables or serve them as a salad;
• Before going to bed, it is recommended to drink a low-fat fermented milk drink or a glass of warm milk with honey.

In case of increased anxiety, depression and mental lability, it is recommended to avoid caffeine-containing drinks, alcohol, as well as foods high in simple carbohydrates, which can dramatically change mood due to surges in blood sugar. This list includes sweets, sweet water, bakery and confectionery products.