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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