Derealization

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Derealization (DR) is an alteration in the perception or experience of the external world so that it seems strange or unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional colouring and depth.[1] It is a dissociative symptom of many conditions, such as psychiatric and neurological disorders, and not a standalone disorder. It is also a transient side effect of acute drug intoxication, sleep deprivation, and stress.

Derealization is a subjective experience of unreality of the outside world, while depersonalization is unreality in one's sense of self. Although most authors currently regard derealization (surroundings) and depersonalization (self) as independent constructs, many do not want to separate derealization from depersonalization.[2] The main reason for this is nosological, because these symptoms often co-occur, but there is another reason of great philosophical importance, namely, that the phenomenological experience of self, others, and world is one continuous whole. Thus, feelings of unreality may blend in and the person may puzzle over deciding whether it is the self or the world that feels unreal to them.

Chronic derealization may be caused by occipital–temporal dysfunction.[3] These symptoms are common in the population, with a lifetime prevalence of up to 74% and between 31 and 66% at the time of a traumatic event.[4]

Contents

[edit] Description

The detachment of realization can be described as an immaterial substance that separates a person from the outside world, such as a sensory fog, a pane of glass, or a veil. Individuals may complain that what they see lacks vividness and emotional colouring. Emotional response to visual recognition of loved ones may be significantly reduced. Feelings of déjà vu or jamais vu are common. Familiar places may look alien, bizarre, and surreal. Such perceptual abnormalities may also extend to the senses of hearing, taste, and smell.

Another symptom of this condition can be constant worrying or strange thoughts that people find hard to switch off. Derealization builds up slowly with the underlying anxiety attached to these disturbing thoughts, but shows itself suddenly, often after a panic attack, and is then difficult or impossible to ignore. This type of anxiety can be crippling to the affected and may lead to avoidant behaviour. Those who experience this phenomenon may feel concern over the cause of their derealization. It is often difficult to accept that such a disturbing symptom is simply a result of anxiety, and the individual may often think that the cause must be something more serious. This can, in turn, cause more anxiety and worsen the derealization.

[edit] Causes

Derealization can accompany the neurological conditions of epilepsy, migraine, and mild head injury.[5] There is a similarity between visual hypo-emotionality, a reduced emotional response to viewed objects, and derealization. This suggests a disruption of the process by which perception becomes emotionally coloured. This qualitative change in the experiencing of perception may lead to reports of anything viewed being unreal or detached.[3]

Derealization can also be caused by vestibular disorders such as labyrinthitis and vestibular neuronitis because the brain is receiving mixed signals from the vestibular nerves due to damage or infection, and so causes the brain to function slower and create feelings of unreality.

Cannabis, psychedelics, antidepressants, caffeine, and nicotine can all produce feelings resembling derealization, particularly when taken to excess. It can also result from alcohol withdrawal or benzodiazepine withdrawal.[6]

Derealization can also be a symptom of severe sleep disorders, and mental disorders like depersonalization disorder, borderline personality disorder, bipolar disorder, schizophrenia, and anxiety disorders.[7]

Interoceptive exposure can be used as a means to induced derealization, as well as the related phenomenon depersonalization.[8]

[edit] See also

[edit] References

  1. ^ American Psychiatric Association (2004) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0890420246.
  2. ^ Radovic, F., Radovic, S.(2002). "Feelings of Unreality: A Conceptual and Phenomenological Analysis of the Language of Depersonalization". Philosophy, Psychiatry, & Psychology 9: 271–279.
  3. ^ a b Sierra M, Lopera F, Lambert MV, Phillips ML, David AS (2002). "Separating depersonalisation and derealisation: the relevance of the "lesion method"". J. Neurol. Neurosurg. Psychiatr. 72 (4): 530–2. PMID 11909918. 
  4. ^ Hunter EC, Sierra M, David AS (2004). "The epidemiology of depersonalisation and derealisation. A systematic review". Social psychiatry and psychiatric epidemiology 39 (1): 9–18. doi:10.1007/s00127-004-0701-4. PMID 15022041. 
  5. ^ Lambert MV, Sierra M, Phillips ML, David AS (2002). "The spectrum of organic depersonalization: a review plus four new cases". The Journal of neuropsychiatry and clinical neurosciences 14 (2): 141–54. PMID 11983788. 
  6. ^ Mintzer MZ; Stoller KB, Griffiths RR (November 1999). "A controlled study of flumazenil-precipitated withdrawal in chronic low-dose benzodiazepine users". Psychopharmacology (Berl) 147 (2): 200–9. doi:10.1007/s002130051161. PMID 10591888. 
  7. ^ Simeon D, Knutelska M, Nelson D & Guralnik O. (2003) Feeling unreal: a depersonalization disorder update of 117 cases. 'Journal of Clinical Psychiatry 64 (9): 990-7 PMID 14628973
  8. ^ Lickel J, Nelson E, Lickel A H, Deacon Brett (2008). "Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study". Journal of Cognitive Psychotherapy: An International Quarterly 22: 4.
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[edit] External articles

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