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depersonalization

 
Dictionary: de·per·son·al·i·za·tion   (dē-pûr'sə-nə-lĭ-zā'shən) pronunciation
 
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n.
    1. The act of depersonalizing.
    2. The state of being depersonalized.
  2. Psychology. A state in which the normal sense of personal identity and reality is lost.

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Psychoanalysis: Depersonalization
 
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The term "depersonalization" refers to the appearance of subjective impressions of change affecting the person or the surrounding world. Their intensity varies, ranging from a simple feeling of dizziness to painful feelings of physical transformation, from the fleeting feeling of estrangement to the impression that the world has become unrecognizable, dead, or uninhabited. Moments of depersonalization can occur during the customary development of any individual or within overtly pathological clinical settings.

The concept of depersonalization is not directly present in the work of Sigmund Freud. In "Psychoanalytic notes on an autobiographical account of a case of paranoia (dementia paranoides)" (1911c [1910]), the elements of depersonalization perceptible in the subject's memory—themes of physical transformation, nerves of voluptuousness, the "hastily improvised men"—are not treated as such by Freud. Similarly the themes of depersonalization found in the Wolf Man—the "veil" that is torn during successive washings—are not referred to as such even though they are analyzed in depth (1918b [1914]). It is possible that it was only after the development of his concept of narcissism and the reorganization of the concept of the ego it contained that Freud became aware of depersonalization, in "The Uncanny" (1919h) and later in "A Disturbance of Memory on the Acropolis" (1936a). In both cases it is through feelings affecting the perception of the outside world that the topic is addressed, that is through the question of "derealization," which can be considered the result of a type of depersonalization.

Paul Schilder was one of the first authors to take an interest in depersonalization. He saw it as a function of the libido's withdrawal of cathexis from the image of the body. Paul Federn believed it corresponded to an alteration of the distribution of narcissistic libido throughout the body and its boundaries. Hermann Nunberg associated it with the loss of a significant object. Clarence Oberdorf emphasized the polymorphism of the clinical situations in which it could be observed and Andrew Peto investigated the role of the precocious loss of introjection. Maurice Bouvet, in an important study entitled "Dépersonalisation et relation d'objet," demonstrated the similarity of structure between states of depersonalization in their various clinical forms and treated "depersonalization as a state of weakened ego structure." He insisted on the importance of a "rapprochement" with the object, that is a decrease in the creation of psychic distance to the object, whereby the object returns to the position it held in the subject's unconscious fantasies. He also pointed out the character of the object relation that made it a narcissistic object since "the maintenance of the ego structure . . . depends on its unconditional and absolute possession." Bouvet also noted the importance of the conflict between the need to introject the object and the fear of this introjection.

Bibliography

Bouvet, Maurice. (1967). Œuvres psychanalytiques. I: La Relation d'objet: névrose obsessionnelle, dépersonnalisation. Paris: Payot.

Denis, Paul. (1981). J'aime pasêtre un autre. L'inquiétante étrangeté chez l'enfant. Revue française de psychanalyse, 65,3.

Freud, Sigmund. (1919h). The uncanny. SE, 17: 217-256.

——. (1936a). A disturbance of memory on the Acropolis. SE, 22: 239-248.

Stewart, Walter A. (1964). Depersonalization. Journal of the American Psychoanalytic Association, 12, 171-186.

Further Reading

Jacobson, Edith. (1959). Depersonalization. Journal of the American Psychoanalytic Association, 7, 581-610.

Renik, Owen. (1978). The role of attention in depersonalization. Psychoanalytic Quarterly, 47, 588-605.

Rosenfeld, Herbert. (1947). Analysis of a schizophrenic state with depersonalization. International Journal of Psychoanalysis, 28, 130-139.

—PAUL DENIS

 
World of the Mind: depersonalization
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States of depersonalization have been recognized over a long period and there are some eloquent descriptions in the writings of mystics, saints, and poets such as Wordsworth. The condition began to attract the interest of non-medical psychologists towards the end of the 19th century. The modern era began with a number of contributions from Paul Schilder (1928, 1935) and Willy Mayer-Gross (1935).

Depersonalization is a mental state in which the individual perceives himself to be detached and physically separated from his own body and his own mental activities. In this experience the self is felt to be divided into an observed and an observing self. When attacks are consistent or frequent, feelings of unreality and associated experiences cause great distress. Depersonalization may occur in association with a wide range of mental disorders, depression, schizophrenia, obsessive–compulsive neurosis, and a range of organic disorders including temporal lobe epilepsy and other cerebral diseases, taking drugs such as cannabis, LSD, Ecstasy or sudden withdrawal from stimulating drugs such as dextroamphetamine.

Fleeting, short-lived symptoms of depersonalization may also occur in normal subjects. In contemporary usage the secondary disorders are excluded from the illness named as 'primary depersonalization'. This diagnosis is confined to chronic states of unreality. The transient states of normal subjects mentioned above are also excluded since they are neither distressing nor predictive of future breakdown into severe and disabling forms of depersonalization.

Most cases of depersonalization commence in adolescence or under the age of 35 years and usually pursue a chronic course with some measure of fluctuation in severity.

The experience of depersonalization has a number of components which overlap to some extent and interact with each other. A central feature is the patient's complaint that he feels unreal, deprived of his previous traits as a person in a world which appears distant, alien, and dreamlike. He has become a stranger to himself, excluded from his environment and from events in his community. He doubts his own identity. Such experiences are intensified by the patient's reflection in a mirror which seems unfamiliar. When his own name is spoken the sense of unreality intensifies. He fears a sudden failure of memory and lapse into total blankness.

A second prominent feature is the blunting of emotion or its total absence. The patient can experience neither love nor hate, neither pain nor pleasure. He complains of having become a stranger to himself and there are long periods in which he feels dead, loveless, and a mere automaton. Yet emotional responses are preserved and he exhibits natural affective reactions; facial expressions may appear lively and responsive when he is exposed to emotional stimulation.

A third feature is the presence, in a substantial proportion of individuals, of a cluster of changes of perception. Objects in the environment may appear unique, enlarged or minute. Other features include the déjà vu phenomenon (the illusory sense of having previously experienced percepts recorded in current experience) and panoramic memory, in which patients report recapitulation in their minds of a succession of, or all of, the experiences in a large part of their lifespan. These features are reminiscent of disturbance in the activity of the limbic system due to a structural lesion such as that in temporal lobe epilepsy and other neurological lesions. Penfield and Jasper (1947) reported that stimulating the exposed temporal lobe during neurosurgery could generate depersonalization, among other effects. But the EEG is almost invariably normal.

These findings have led to a number of hypotheses as possible neurological causes of depersonalization. The best known is the view of Mayer-Gross (1935) that depersonalization is a preformed defensive functional response of the brain which provides protection under circumstances of acute danger. The findings of Noyes et al. (1977), described more fully below, showed that a high proportion of those who narrowly escaped death from drowning, collisions with vehicles, or other perils have reported unreality feelings, déjà vu, and panoramic memory and related experiences which are consistent with such a theory.

The detailed investigations of the developmental history of depersonalized patients provide evidence of adverse experiences during maturation and growth to the personality, such as traumas and deprivations experienced, in other words 'meaningful historical connections'. These events and their effects can be interpreted as having contributed to shaping the personality and laying the foundations for the onset of symptoms in adolescence, or later, such that defeats or losses produce Achilles' heels in the personality. However, a proportion of patients with depersonalization disorder appear on investigation to have been of normal premorbid personality. This then is a disorder in which theories of causation have to be formulated with the aid of psychodynamic, as well as organic, causes (Roth and Harper 1962, Roth 1996). We have yet to learn how to combine such seemingly disparate explanations.

Noyes et al. (1977) have published observations of a number of individuals who have escaped death from drowning, collision with other vehicles, or other imminent threats, and their findings have relevance for theories of the nature and significance of depersonalization states. Confronted with imminent destruction the outside world seems unreal and alien; they experience déjà vu phenomena and also a rapid succession of vivid memories drawn from several parts of their previous lifespan. Feelings of unreality of the self remain. Emotional responses are displaced in the threatened self to the observing self, leaving the executive self free to engage in cool, prompt, and effective avoidance behaviour. This hypothetical explanation of the findings of Noyes et al. (1977) suggests that the chances of survival of their subjects may have been achieved by protection of the executive self in each case through dissociation from potentially disruptive levels of anxiety.

No information is available about the long-term fate of such persons but some support is provided for the hypothesis that depersonalization disorder is a maladaptive exaggeration and prolongation of a preformed defensive response of the brain to the threat of destructive anxiety caused by sudden danger. Such hypotheses are not necessarily in conflict with theories of causation which include the role of personality factors and the developmental process in the formative years which helped to shape its vulnerable facets.

Depersonalization disorder has in the past proved consistently resistant to both pharmacological and psychological treatments. The situation appears a little more promising in the light of recent investigations. One clinical trial reported six patients with primary depersonalization who were described as having responded with a remission from their distressing symptoms but the long-term outcome has not been reported and double-blind control studies need to be investigated (Hollander et al. 1990). Some success with behavioural therapy has also been reported in some isolated cases of depersonalization.

The phenomenon of depersonalization is of special interest in virtue of a number of its features. It is connected with mental changes associated with defence against sudden danger and threat and dissociation of consciousness. Its features constitute a close opposite of those in ecstasy which involves the expansion and enrichment of self-regard and a passionate enthusiasm which sees the world as apparelled in celestial light.

Fresh creations in the arts and original ideas in science have been described in recent years as occurring in such states of mind. Depersonalization and ecstasy appear to be the product of activity at opposite ends of some functional system in the mind and the brain (Jamison 1993) which might shed light on both, and lead to greater understanding and improved methods of treatment of depersonalization in particular.

(Published 2004)

— Martin Roth

    Bibliography
  • Hollander, E., Leibowitz, M. R., DeCaria, C., Fairbanks, J., Fallon, B., and Klein, D. F. (1990). 'Treatment of depersonalization with serotonin reuptake blockers'. Journal of Clinical Psychopharmacology, 10.
  • Jamison, Kay Redfield (1993). Touched with Fire.
  • Mayer-Gross, W. (1935). 'On depersonalisation'. British Journal of Medical Psychology, 15.
  • Noyes, R., Hoenk, P., Kuperman, S., and Slymen, D. J. (1977). 'Depersonalisation in accident victims and psychiatric patients'. Journal of Nervous and Mental Disorders, 164.
  • Penfield, W., and Jasper, H. (1947). 'Highest level seizure'. Association for Research in Nervous and Mental Diseases Proceedings, 26.
  • — —   — —  (1954). Epilepsy and the Functional Anatomy of the Human Brain.
  • Roth, M. (1996). 'The panic-agoraphobic syndrome: a paradigm of the anxiety group of disorders'. In Andreasen, N. C., and Woods, A. H. (eds.), John Nemiah Festschrift, American Journal of Psychiatry, 153.
  • — —  and Harper, M. (1962). 'Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome, part II: practical and theoretical considerations'. Comprehensive Psychiatry, 3.
  • Schilder, P. (1928). 'Depersonalisation'. In Introduction to Psychoanalytic Psychiatry.
  • — —  (1935). 'The image and appearance of the human body'. Psyche. Monograph, 4.

 
Wikipedia: Depersonalization
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Depersonalization (or depersonalisation) can be referred as a malfunction or anomaly of the mechanism in which an individual has awareness or perception of his or her own self. It is a feeling of watching oneself act, while having no control over a situation.[1] It can be considered desirable, such as in the use of recreational drugs, but it usually refers to the severe form found in anxiety and, in the most intense cases, panic attacks. A sufferer feels that he or she has changed and the world has become less real, vague, dreamlike, or lacking in significance. It can sometimes be a rather disturbing experience, since many feel that, indeed, they are living in a "dream".

Depersonalization is a subjective experience of unreality in one's sense of self, while derealization is unreality of the outside world. Although most authors currently regard depersonalization (self) and derealization (surroundings) as independent constructs, many do not want to separate derealization from depersonalization.[2] The main reason for this is nosological, because these symptoms often co-occur, but there is another reason of great philosophical importance, namely, that the phenomenological experience of self, others, and world is one continuous whole. Thus, feelings of unreality may blend in and the person may puzzle over deciding whether it is the self or the world that feels unreal to them.

Chronic depersonalization refers to depersonalization disorder, which is classified by the DSM-IV as a dissociative disorder. Though depersonalization-derealization feelings can happen to anyone who is under temporary severe anxiety/stress, chronic depersonalization is more related to individuals who have experienced a severe trauma or prolonged stress/anxiety, see depersonalization disorder.) Depersonalization-derealization is the single most important symptom in the spectrum of dissociative disorders, including Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. It is a very prominent symptom also in some other, non-dissociative, disorders - such as anxiety disorders, clinical depression, bipolar disorder, obsessive-compulsive disorder, migraine, sleep deprivation, and some types of epilepsy.

Contents

Description

Individuals who experience depersonalization feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to the same person or identity.[3] Often a person who has experienced depersonalization claims that life "feels like a movie" or things seem unreal or hazy. Also a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increases these perceptions.[4]

One way to describe the physical manifestation of the feeling is to compare it to a film technique called the vertigo shot or dolly zoom. In this technique, the subject of the picture stays fixed within the shot while the surrounding background is pulled away, providing a sense of vertigo or detachment. People may perceive this feeling in a cyclical manner, where the feeling is experienced back-to-back in succession.[citation needed]

Prevalence

The symptom of depersonalization is the third most common psychological symptom, after feelings of anxiety and feelings of depression.[5] Depersonalization can also accompany sleep deprivation (often occurring when suffering from jet lag), migraine, obsessive-compulsive disorder, stress, and anxiety; it is a symptom of anxiety disorders, such as panic disorder.[6] Interoceptive exposure is a non-pharmacological method that can be used to induce depersonalization.[7]

A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response. Individuals high on the absorption subscale, which measures experiences of concentration to the exclusion of awareness of other events going on around them, showed weaker cortisol responses.[8]

Non-psychological causes

Depersonalization may also be a desirable effect, such as in the case of recreational drugs. It is a side effect of dissociatives and psychedelics, as well as caffeine, alcohol, cannabis, and minocycline.[9][10][11][12][13] It is a classic withdrawal symptom from many drugs.[14][15][16][17]

Benzodiazepine dependence which occurs with long term use of benzodiazepines can induce chronic depersonalization symptomatology and perceptual disturbances in some people, even in those who are taking a stable daily dosage, and it can also become a protracted feature of the benzodiazepine withdrawal syndrome.[18][19]

Treatment

Treatment is dependent on the underlying cause, whether it is organic or psychological in origin. If depersonalization is a symptom of neurological disease, then diagnosis and treatment of the specific disease is the first approach. Depersonalization can be a cognitive symptom of such diseases as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), neuroborreliosis (Lyme disease), or any other neurological disease affecting the brain. For those suffering from depersonalization with migraine, lamotrigine and nortriptyline have been proven helpful.[citation needed]

If depersonalization is a symptom of psychological causes such as developmental trauma, the treatment depend on the diagnosis. In case of dissociative identity disorder or DDNOS as a developmental disorders, in which extreme developmental trauma interferes with formation of a single cohesive identity, it requires proper psychotherapy, and - in the case of additional (co-morbid) disorders such as eating disorders - team of specialists treating such an individual. It can also be a symptom of borderline personality disorder, which can be treated in the long term with proper psychotherapy and psychopharmacology.[20]

The treatment of chronic depersonalization is considered in depersonalization disorder.

A study has recently been completed at Columbia University in New York City which has shown positive effects of transcranial magnetic stimulation (TMS) in the treatment of depersonalization disorder. Currently, however, the FDA has not yet approved TMS for the treatment of DP.

A recent Russian study has shown that naloxone, a drug that is used to reverse the intoxicating effects of opioid drugs, can be used to successfully treat depersonalization disorder. According to the study: "In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization." Source: http://jop.sagepub.com/cgi/content/abstract/15/2/93

Popular culture

  • Existentialists use the term in a different context. The treatment of individuals by other people as if they were objects, or without regard to their feelings, has been termed depersonalization. Determinism has been accused of this. See also objectification.
  • R. D. Laing used depersonalization to mean a fear of the loss of autonomy in interpersonal relationships by the ontologically insecure.
  • In the memoir Girl, Interrupted, Susanna Kayson describes her experience in a mental institution, where she later bit into her hand because she had "to see if she had bones"; she was later diagnosed with a depersonalization attack.
  • In the Bret Easton Ellis novel American Psycho and the 2000 film adaptation of the same name, the protagonist, serial killer Patrick Bateman, remarks repeatedly through first-person narration his feelings of depersonalization. Throughout the story, Bateman experiences at some point or another most, if not all, the symptoms of DPD: he frequently experiences panic attacks, hallucinations, random fits of crying, and confusion over his personality (or lack thereof), the latter exacerbated by his compulsion to "fit in" and the inability of his acquaintances to tell him and others apart. Bateman occasionally addresses his ailment directly, including a monologue where he laments, "There wasn't a clear, identifiable emotion within me, except for greed and, possibly, total disgust. I had all the characteristics of a human being—flesh, blood, skin, hair—but my depersonalization was so intense, had gone so deep, that the normal ability to feel compassion had been eradicated, the victim of a slow, purposeful erasure. I was simply imitating reality, a rough resemblance of a human being, with only a dim corner of my mind functioning."
  • Adam Duritz, lead singer and songwriter for the Berkeley, California based band, Counting Crows, suffers from a form of Depersonalization disorder.

See also

References

  1. ^ American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0890420246.
  2. ^ Radovic, F., Radovic, S.(2002). "Feelings of Unreality: A Conceptual and Phenomenological Analysis of the Language of Depersonalization". Philosophy, Psychiatry, & Psychology 9: 271–279.
  3. ^ Depersonalization Disorder at Merck Manual of Diagnosis and Therapy Home Edition
  4. ^ Daniel. "Depersonalization disorder: A feeling of being 'outside' your body" (html). http://www.mayoclinic.com/health/depersonalization/AN00595. Retrieved on 2007-09-08. 
  5. ^ Simeon D, (2004) Depersonalisation Disorder: A Contemporary Overview. CNS Drugs 18(6): 343-354. PMID 15089102
  6. ^ Sierra-Siegert M, David AS (December 2007). "Depersonalization and individualism: the effect of culture on symptom profiles in panic disorder". J. Nerv. Ment. Dis. 195 (12): 989–95. doi:10.1097/NMD.0b013e31815c19f7. PMID 18091192. 
  7. ^ Lickel J, Nelson E, Lickel A H, Deacon Brett (2008). "Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study". Journal of Cognitive Psychotherapy: An International Quarterly 22: 4.
  8. ^ Giesbrecht, T.; T. Smeets, H. Merckelbac and M. Jelicic (2007). "Depersonalization experiences in undergraduates are related to heightened stress cortisol responses". J. Nerv. Ment. Dis. 195 (4): 282–87. doi:10.1097/01.nmd.0000253822.60618.60. PMID 17435477. 
  9. ^ Stein, M. B. (July 1989). "Depersonalization Disorder: Effects of Caffeine and Response to Pharmacotherapy". Biological Psychiatry 26 (3): 315–20. doi:10.1016/0006-3223(89)90044-9. 
  10. ^ Raimo, E. B.; R. A. Roemer, M. Moster and Y. Shan (June 1999). "Alcohol-Induced Depersonalization". Biological Psychiatry 45: 1523. doi:10.1016/S0006-3223(98)00257-1. 
  11. ^ Cohen, P. R. (2004). "Medication-associated depersonalization symptoms: report of transient depersonalization symptoms induced by minocycline". Southern Medical Journal 97 (1): 70–73. doi:10.1097/01.SMJ.0000083857.98870.98. PMID 14746427. 
  12. ^ "Medication-Associated Depersonalization Symptoms". http://www.medscape.com/viewarticle/468728_3. 
  13. ^ "Depersonalization Again Finds Psychiatric Spotlight". http://pn.psychiatryonline.org/cgi/content/full/38/16/18. 
  14. ^ Marriott, S.; P. Tyrer (1993). "Benzodiazepine dependence: avoidance and withdrawal". Drug Safety 9 (2): 93–103. doi:10.2165/00002018-199309020-00003. PMID 8104417. 
  15. ^ Shufman, E.; A. Lerner and E. Witztum (2005). "[Depersonalization after withdrawal from cannabis usage]" (in Hebrew). Harefuah 144 (4): 249–51 and 303. PMID 15889607. 
  16. ^ Djenderedjian, A.; R. Tashjian (1982). "Agoraphobia following amphetamine withdrawal". The Journal of Clinical Psychiatry 43 (6): 248–49. PMID 7085580. 
  17. ^ Mourad, I.; M. Lejoyeux and J. Adès (1998). "[Prospective evaluation of antidepressant discontinuation]" (in French). L'Encéphale 24 (3): 215–22. PMID 9696914. 
  18. ^ Ashton H (1991). "Protracted withdrawal syndromes from benzodiazepines". J Subst Abuse Treat (benzo.org.uk) 8 (1-2): 19–28. doi:10.1016/0740-5472(91)90023-4. PMID 1675688. http://www.benzo.org.uk/ashpws.htm. 
  19. ^ Terao T; Yoshimura R, Terao M, Abe K. (January 15, 1992). "Depersonalization following nitrazepam withdrawal". Biol Psychiatry 31 (2): 212–3. doi:10.1016/0006-3223(92)90209-I. PMID 1737083. 
  20. ^ Sierra M, Baker D, Medford N, et al. (2006). "Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases". Clin Neuropharmacol 29 (5): 253–8. doi:10.1097/01.WNF.0000228368.17970.DA. PMID 16960469. 
  21. ^ Grossman, Dave (1996), On Killing: The Psychological Cost of Learning to Kill in War and Society, Back Bay Books 

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Copyrights:

Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2007. Published by Houghton Mifflin Company. All rights reserved.  Read more
Psychoanalysis. International Dictionary of Psychoanalysis. Copyright © 2005 by The Gale Group, Inc. All rights reserved.  Read more
World of the Mind. The Oxford Companion to the Mind. Second Edition. Copyright © Oxford University Press, 2004. All rights reserved.  Read more
Wikipedia. This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Depersonalization".  Read more