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Depersonalization/derealization – understanding, assessment & treatment

I wrote in a blog posting on February 12th that Depersonalization Disorder is relatively common - 1 to 2% of the general population - but that it is rarely recognized. As with so many psychological disorders, it can be helpful to see Depersonalization Disorder as an extreme version of a normal, healthy set of psychological mechanisms. Imagine that I am walking down the street and I come across a dreadful car accident. There are bodies, screams, blood, devastation. If I lose control and start wailing at the sheer horror of it all, I am going to be useless. There seems to be an inner psychological mechanism that can switch off or damp down emotional reactions in this kind of situation, so that I can act effectively and rapidly to help those who are in such desperate need. It may only be sometime later, when the demand for immediate action is past, that my emotional responses kick in and I start to feel the scale of the trauma I have been helping with. Now imagine that this mechanism occurs at other times too. So much of my connection with the world, my memories, relationships, even myself is crucially coloured by my emotional responses. If I feel nothing when I meet my wife or watch a favourite film or see a sunset, what sense do I make of that? I may start to feel more and more detached - from my own body, other people, memories, surroundings - as if I or the world has become unreal. Add understandable anxiety or demoralization, which may well further aggravate the switch-off mechanism, and there is a potent breeding ground for huge psychological distress.

The fine Depersonalisation Research Unit in London has developed a cognitive behavioural model based on this understanding (Hunter, Phillips et al. 2003). Their self-help book "Overcoming Depersonalization & Feelings of Unreality" is potentially hugely helpful for those wanting to understand and ease this disorder. The book primarily focuses on cognitive behavioural treatment of depersonalization, but it also has a useful section on medication - including a description of how to use lamotrigine, the drug the team have found most helpful for depersonalization symptoms so far (Sierra 2008). Visit their Depersonalisation Research Unit website for recent details of their work, answers to frequently asked questions, and a freely downloadable assessment questionnaire - the Cambridge Depersonalization Scale (see links below). In their paper on this scale using a small case series of patients (Sierra and Berrios 2000), the authors report typical scores for Depersonalization Disorder (113), Temporal Lobe Epilepsy (44), and other Anxiety Disorders (20). Each of the scale's 29 questions is scored by adding the scores for frequency and duration - giving a possible score for each question ranging from 0 to 10, and a possible total score from 0 to 290.

Daphne Simeon of New York's Mount Sinai School of Medicine's Depersonalization and Dissociation Research Program has also written research papers and recently - with Jeffrey Abugel - had a good book published "Feeling Unreal: Depersonalization Disorder and the Loss of the Self". There are also a number of self-help style websites with discussion groups, links and other information. See below for links to Depersonalization.com, Depersonalization Home, and DPSelfhelp.com.

Baker, D., E. Hunter, E. Lawrence, A. David. (2007) "Overcoming depersonalization & feelings of unreality." London: Robinson. [AbeBooks] [Amazon UK]
Cambridge Depersonalization Scale from the Institute of Psychiatry Depersonalisation Research Unit. Accessed February 15, 2008.
Depersonalization.com. www.depersonalization.info/main.html Accessed February 15, 2008.
Depersonalization Home. http://www.depersonalization-home.com/ Accessed February 15, 2008.
Depersonalisation Research Unit, Institute of Psychiatry at the Maudsley, Kings College London. www.iop.kcl.ac.uk/departments/?locator=911&context=main Accessed February 15, 2008.
DPSelfhelp.com. www.dpselfhelp.com/index.php?categoryid=1 Accessed February 15, 2008.
Hunter, E. C., M. L. Phillips, et al. (2003). "Depersonalisation disorder: a cognitive-behavioural conceptualisation." Behav Res Ther 41(12): 1451-67. [PubMed]
Sierra, M. (2008). "Depersonalization disorder: pharmacological approaches." Expert Rev Neurother 8(1): 19-26. [PubMed]
Sierra, M. and G. E. Berrios (2000). "The Cambridge Depersonalization Scale: a new instrument for the measurement of depersonalization." Psychiatry Res 93(2): 153-64. [PubMed]
Simeon, D., J. Abugel. (2006). "Feeling Unreal: Depersonalization Disorder and the Loss of the Self". USA: OUP. [AbeBooks] [Amazon UK]

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