Depersonalization (psychology)

The term "depersonalization" refers to a psychological disorder considered as one of the dissociative disorders. It is characterized by repeated episodes in which an individual experiences a sensation of being disconnected or separate from their own body and thoughts.

People who suffer an episode of depersonalization sometimes describe it as feeling observed from outside their own bodies or as if they were in a dream, or hearing their voice but feeling it is alien to them. The descriptive term most used with the disorder is that of unreality, even though contact with reality is maintained. An episode of depersonalization may last from several seconds to several years. Experts usually consider depersonalization as a symptom of or related to other disorders.

Background

Documented events of depersonalization date back to the early 1820s, when physicians began to write of patients complaining of its symptoms. The term "depersonalization," however, was not coined until the 1890s, when French psychologist Ludovik Dugas first used the term in an article published in the late 1890s. In turn, Dugas adopted the word from a contemporary, Henri Frederic Amiel, who reported a long-lasting sense of estrangement and the feeling that his own voice and self were alien to him.

In the nineteenth century, scholars such as French psychologists Pierre Janet, German anatomist Carl Wernicke, and Hungarian physician Maurice Krishaber, wrote influential texts on the disorder. Many twentieth-century psychiatrists studied the phenomenon, expression, and treatment of depersonalization from different medical and humanist approaches. Karl Jaspers and Honorio Delgado wrote from an angle that encompassed the medical field as well as theology and philosophy. In 1911, Dugas published his seminal book La Depersonalization. Depersonalization was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952. Although it is listed as a disorder, some experts have argued it is, in reality, a syndrome—that is, a group of associated symptoms that appear simultaneously.

Although undoubtedly the disorder existed prior to the nineteenth century, it was not until this era that physicians began to gather and catalog symptoms reported by patients, including mixtures of anxiety, depression, and fatigue, noting their relationship to persistent feelings of unreality and other sensory distortions. In time, these texts formed part of an important body of medical literature on the subject.

Some, like Krishaber, related depersonalization to the sense organs. Dugas, on the other hand, discounted this, and defined it as a type of apathy or indifference. For Janet, it was related to disorders such as phobias, compulsions, and obsessions. In fact, depersonalization is still often accompanied by excessive anxiety or compulsive-obsessive behaviors. In the first half of the twentieth century, Sigmund Freud discussed it as a sort of defense mechanism and John Case Nemiah contrasted it with the feeling of déjà vu, the feeling of something up to then unknown being sensed as familiar, as a phenomenon opposite to depersonalization.

Overview

Depersonalization is often related to several other symptoms. The disorder may be caused by conditions such as post-traumatic stress disorder (PTSD), some forms of epilepsy, anxiety disorder, and depression.

Depersonalization is especially connected to derealization. Derealization is a disorder quite similar to depersonalization, with the significant difference that this phenomenon extends the sense of unreality beyond the physical self, to the world around it. However, the disorder is often referred to as depersonalization-derealization disorder. One of the most salient symptoms of depersonalization is a distorted perception of the body. An individual may feel as if they are a robot or as in a dream. They often state they believe they are becoming insane or at the edge of falling into a serious mental disease. The disorder may last long enough that it affects the sufferer’s daily activities. For most people, however, the symptoms are mild and do not last long. In fact, Freud famously wrote about experiencing a fleeting episode of unreality.

Experts have explained that depersonalization is usually the consequence of a violent or stressful event, such as a history of abuse, an episode of violence, surviving an accident or catastrophe, or any similar events suffered or witnessed by the individual. Cases of depersonalization as a disorder unrelated to any external triggering circumstance are very rare.

Depersonalization appears relatively frequently in the fields of psychology, psychiatry, and neurology. Nevertheless, perfectly healthy individuals may also experience episodes of depersonalization in ordinary situations of emotional and physical stress, exhaustion, insomnia, and others.

Because it is frequently described as an alteration of self-consciousness in which mental clarity remains, depersonalization is also studied from other fields, such as philosophy, theology, and cognitive studies. The individual affected by depersonalization feels themself to be as separate from the body, estranged and distant from the self, as a mere observer of their own mental processes and bodily activities.

Thinkers have long written about mental events that fall into such dissociative states. The practice of thinking about thinking, or of "observing" one’s own thoughts through process, for example, relates to a field known as metacognition. Individuals suffering an episode of depersonalization express experiencing a sense of unreality while in constant touch with reality. French philosopher Rene Descartes experimented with inducing himself into such mental states long before the medical field first wrote about it.

There are different forms to treat depersonalization. Usually, a mental health professional will assess if there is an underlying cause such as PTSD, depression, or anxiety. Psychotherapeutic treatment may be accompanied by appropriate medication. Experts have explained that an acute state of self-consciousness exacerbates symptoms of depersonalization and derealization. When someone feels at risk of a depersonalization episode, they often increase their self-awareness, potentially worsening the symptoms.

Therefore, psychological treatment includes the factors that contribute to and maintain this sense of estrangement from the self, the immediate environment, and the world in general. It applies techniques designed to help the patient cope with PTSD, depression, or other underlying disorders. Depersonalization symptoms often disappear by themselves or after effective treatment.

Bibliography

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Briere, John N., and Catherine Scott. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation and Treatment. Sage, 2014.

Chefetz, Richard A. Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real. Norton, 2015.

"Depersonalization-Derealization Disorder." Mayo Clinic, 12 Jan. 2024, www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/symptoms-causes/syc-20352911. Accessed 31 Jan. 2025.

"Dissociative Disorders." NHS, 14 Aug. 2023, www.nhs.uk/mental-health/conditions/dissociative-disorders/. Accessed 31 Jan. 2025.

Hill, Daniel, and Allan N. Schore. Affect Regulation Theory: A Clinical Model. Norton, 2015.

Kolk, Bessel van der. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin, 2015.

Naziroglu, Fugen, et al. Overcoming Depersonalization Disorder: A Mindfulness Acceptance Guide to Conquering Feelings of Numbness and Unreality. New Harbinger, 2010.

Sierra, Mauricio. Depersonalization: A New Look at a Neglected Syndrome. Cambridge UP, 2012.

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