Norwegian painter Edvard Munch’s haunting expressionist painting, “The Scream” has often been used to describe the distorted way in which a person with depersonalization disorder (DPD) experiences their environment and themselves. DPD is characterized by periods of feeling powerfully disconnected or detached from one’s own body and thoughts. Sufferers sometimes describe these periods as “dream-like,” and feel as though they are watching themselves from outside their body. Luckily, people with the disorder remain cognizant of reality, even while experiencing the sensation of DPD. Thus, they are aware that things are not necessarily as they perceive them to be. Episodes of depersonalization can last anywhere from a few minutes to many years, and is often comorbid with depression and anxiety disorders. DPD has also been linked to obsessive-compulsive behaviors, which are often employed by sufferers as a coping mechanism to help them feel more ‘connected’ to their environment.
The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:
- Persistent or recurrent feelings of being detached from one’s mental processes or body; as if an observer;
- During depersonalization, reality testing is intact;
-Depersonalization causes significant distress, and impairment in social, occupational, or other functioning; and
-Depersonalization is not the result of another disorder, substance use, or general medical condition.
The DSM-IV-TR specifically recognizes three possible manifestations of depersonalization disorder: Derealization (experiencing the external world as strange or unreal); Macropsia or micropsia (an alteration in the perception of object size or shape); and a sense that other people seem unfamiliar or mechanical. While acknowledging that a number of genetic and environmental factors might play a role in the development of the disorder, most mental health professionals believe that DPD is usually triggered by abuse, trauma and/or drug use. Thus, DPD can be best understood as an extreme defense mechanism, which is triggered in an effort to ward off additional negative stimuli.
There are currently no hard and fast rules with respect to the treatment of DPD. The goal of most treatment plans is to pinpoint the particular stressors that trigger the episodes of disassociation, and determine ways to lessen their impact. Therefore, mental health practitioners usually employ a combination of psychotherapy, cognitive therapy and medication (which is usually administered for the purpose of treating underlying anxiety, and not DPD directly).
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