Download Depersonalisation Research

What is depersonalisation?
Depersonalisation is both a symptom
and an illness. It was first described by
Ludovic Dugas, a French Psychiatrist
writing at the turn of the 20th century. It
occurs in almost all the major
psychiatric disorders including severe
anxiety, panic disorder, depression,
post-traumatic stress disorder,
obsessional compulsive disorder,
schizophrenia, as well as neurological
conditions such as migraine and
epilepsy. Normal people can
experience it during states of fatigue,
fear or meditation, or after ingestion of
drugs such as cannabis and 'ecstasy'. It
can also exist, rarely, in a pure form:
'Primary Depersonalisation'.
According to the American Psychiatric
Association's Diagnostic Manual
'Depersonalisation Disorder' is
characterised by persistent or recurrent
episodes of: "... detachment or
estrangement from one's self. The
How common is it?
individual may feel like an automaton...
There may be the sensation of being an
outside observer on one's own mental
processes... Various types of sensory
anaesthesia, lack of affective
response... are often present".
Derealisation (the sense that the
external world is strange or unreal) may
also be present.
A third of undergraduates said they experienced
some of the symptoms at some time in a response
to a questionnaire. One hospital survey found
12% of psychiatric patients suffered severe and
persistent depersonalisation.
Approximately 1% of the population have
clinically significant symptoms of
depersonalisation/derealisation
What is it like?
Many sufferers describe it as
'terrifying', 'like losing your sense of
being alive', 'a living death', 'like being
detached from your own body, your
loved ones, your feelings...' People say
that it is as if their mind is full of cotton
wool; they pray that they will wake up
and it will all be clear once more. Many
describe de-realisation: as if the world
around them is like a movie or that they
are separated from other people by an
invisible pane of glass. When such
unpleasant feelings persist without
explanation, the person may be judged
to be suffering from depersonalisation
disorder. It can be brought on by severe
stress or emotional turmoil but may
also appear out of the blue, and
apparently suddenly.
What is the cause?
There are many theories: depersonalisation
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 distancing oneself from the trauma, but
in some people, the depersonalisation then
becomes autonomous and a problem in its
own right. Neurological theories include a
disruption or neuro-transmitter imbalance
in the parts of the brain which integrate
oncoming sensory information with our
internal representation of the self (the
temporal lobes). A specific part of the
temporal lobe, the amygdala, responsible
for processing emotion, may be crucial as
may another part, the insula.
Treatment?
There is no clearly identified treatment
for depersonalisation; almost
everything has been tried from in-depth
psychotherapy, through
electroconvulsive therapy, to
antipsychotic and antidepressant
medication (eg clomipramine) or
selective serotonin re-uptake inhibitors.
Sometimes, treatment of the underlying
condition (eg depression or panic
disorder) abolishes the symptom.
Studies of fluoxetine (Prozac) have
been disappointing. In our clinic we
have found that the combination of
lamotrigine (also used to treat epilepsy)
and an SSRI can help some patients but
this treatment needs to be supervised by
an experienced clinician. Other forms
of treatment have been studied but are
still in the research phase. These
include transcranial magnetic
stimulation (TMS) and drugs such as
naloxone.
Who are we?
We run an NHS clinic at the Maudsley
Hospital affiliated with The Institute of
Psychiatry (IoP), King's College,
London. The IoP is the foremost
research establishment for mental
disorders in Europe. We are the world's
first research unit dedicated to the
understanding and treatment of
Depersonalisation Disorder.
We accept referrals from
medical practitioners within the NHS
(eg from GPs and psychiatrists);
Further details on:
www.national.slam.nhs.uk.
Since we are a specialist service, such
referrals require approval by your
Primary Care Trust (PCT).
Staff at the Unit
Director: Professor A.S. David,
Professor of Cognitive
Neuropsychiatry.
Elaine Hunter
Clinical Psychologist
Further information is available at:
http://www.kcl.ac.uk/iop/depts/ps/resea
rch/neurobiologialmechanisms/deperso
nalisationresearchunit.aspx.
We are currently carrying out research
into all aspects of the disorder
including new pharmacological and
psychological treatments. If you would
like to be assessed in our clinic, please ask
your doctor to send us a referral letter on
your behalf.
For further information CONTACT
Tel: 020-7848 0138
Fax: 020-7848 0572
Or write to: Depersonalisation Research
Unit, PO Box 68, Institute of Psychiatry,
London SE5 8AF. Or email:
[email protected]
Further Reading: Overcoming
Depersonalisation and Feelings of
Unreality, A Self-Help Guide Using
Cognitive Behavioural Techniques (by
Dawn Baker, Elaine Hunter, Emma
Lawrence & Anthony David), 2007;
Constable and Robinson as part of the
consumer-friendly CBT-based
Overcoming Series.
www.constablerobinson.com/.
Depersonalization: A New Look at a
Neglected Syndrome (by Mauricio Sierra,
2009, Cambridge University Press). Visit
http://www.cambridge.org/gb/knowledge/i
sbn/item2327426/?site_locale=en_GB.
Jan 2014