What is Depersonalization/Derealization Disorder?

Advances in understanding the mysteries of the brain are happening worldwide at this moment. As I type this, most medical research is “out of date” the moment it is published.

The work at the Institute of Psychiatry, Kings College, London, continues to be at the forefront of understanding this disorder; this is an excellent summary of what we know so far about Depersonalization and Derealization.

Thank you again to Dr. Mauricio Sierra and his colleagues for the endless pursuit to understand this debilitating syndrome.

From the IoP website: [I have removed a few brief paragraphs.]


“Depersonalisation Disorder (DPD) constitutes, according to the Psychiatric Diagnostic and Statistic Manual (DSM) IV, ‘a feeling of detachment or estrangement from one’s self. The individual may feel like an automaton or as if he or she is living in a dream or a movie. There may be a sensation of being an outside observer of one’s mental processes, one’s body or parts of one’s body.’ People who experience depersonalisation may, at the same time, experience de-realisation, the sense that the external world is strange or unreal.

People with a major psychiatric disorder, including severe anxiety or panic disorder, depression, post traumatic stress disorder, obsessive compulsive disorder and schizophrenia, and people with neurological conditions such as migraine and epilepsy, can experience depersonalisation as a symptom. People who do not have mental health or neurological problems can also experience depersonalisation when they are in states of fatigue, fear, stress, emotional turmoil or meditation, or after taking drugs like cannabis or Ecstasy.

The Depersonalisation Research Unit within the Section of Cognitive Neuropsychiatry carries out research to better understand depersonalisation both as an illness and a symptom.

People with DPD are recruited to studies through the only specialist clinic for depersonalisation in the UK, based at The Maudsley Hospital, where members of the Research Unit undertake clinical work. People are referred here from all over the country. The Research Unit now holds a database of information given by more than 400 people who have DPD.

There are many theories about what causes depersonalisation. It might be induced by overwhelming anxiety or an early traumatic event. In these circumstances, becoming detached from one’s body may seem a useful means of coping, but in some people, the depersonalisation then may become autonomous and a chronic disorder. Neurological theories include a disruption in the parts of the brain that integrate incoming sensory information with our internal representation of the Self (the temporal lobes). A specific part of the temporal lobe, the amygdala, which is responsible for processing emotion, may be crucial.
Two of the Unit’s completed studies using functional Magnetic Resonance Imaging (fMRI) have shown significant differences in the way people who experience DPD and the way healthy controls process emotional stimuli and remember emotional words.

The Unit’s research has also shown that people with DPD have a low skin conductance response to unpleasant stimuli: this suggests an inhibitory mechanism on emotional processing. Skin conductance is when the skin momentarily becomes a better conductor of electricity because external or internal stimuli are physiologically arousing and help create an emotional response: measuring arousal is an important component of measuring emotion.
Other studies of people with DPD have found evidence of disrupted feelings of empathy for others; differences in heart rates; and differences in levels of hormones that deal with stress.

There is not yet evidence-based treatment for depersonalisation. Over the years, in-depth psychotherapy, electroconvulsive treatment, antipsychotic medication and antidepressants have all been tested. Two of the Unit’s recent studies have yielded promising results that are being further investigated: these involved Cognitive Behaviour Therapy and, in another trial, participants took lamotrigine, an anti-convulsant medication.”

Institute of Psychiatry
Dissociation Research Unit
Department of Psychosis Studies, PO68
De Crespigny Park
London SE5 8AF


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