![]() One striking feature of the de-affectualisation is that it is not usually accompanied by an objectively blunted affect such as that seen in schizophrenia ( Reference AcknerAckner, 1954 Reference TorchTorch, 1978 Reference Sierra and BerriosSierra & Berrios, 1998). Threatening sense of unfamiliarity or unreality in the environment, perceptual anomalies may be present, other people may feel like actors in a playĭiminution, loss or alteration of bodily sensations, sense of disembodiment there may be a raised pain threshold This loss of emotional reactivity may be particularly disturbing for the patient and those around them, and can have serious adverse effects on intimate relationships.ĭisturbing sense of being ‘separate from oneself’, observing oneself as if from outside, feeling like a robot or automaton Another frequent theme is a reduction or loss of emotional responses: ‘my emotions are gone, nothing affects me’, ‘I am unable to have any emotions, everything is detached from me’. ![]() A reduction in, or complete absence of, bodily feelings is often described (‘as if I were a phantom body’, ‘my hands seem not to belong to me’), as are reduced intensity in the experience of thirst, hunger and physical pain. Even though the world does not necessarily look unreal, it is nevertheless experienced as ‘less interesting and less alive than formerly’. External reality may also be strangely altered: it may appear somehow artificial – as if ‘painted, not natural’, or ‘two-dimensional’ or ‘as if everyone is acting out a role on a stage, and I’m just a spectator’. Others describe feeling ‘half-asleep’ or ‘as if my head is full of cotton wool’, with associated difficulties in concentration. ![]() Self-reports emphasise the strange and disturbing quality of the depersonalisation experience: some patients report feeling ‘like a robot’, ‘different from everyone else’ and ‘separate from myself’ (this last should be understood metaphorically rather than taken to imply autoscopic experience). A systematic comparison of historical and current cases ( Reference Sierra and BerriosSierra & Berrios, 2001) confirms that the disorder shows a reliable phenomenological consistency. Reference Mayer-GrossMayer-Gross (1935) includes an array of patient self-reports, which are strikingly similar to descriptions given by patients attending the Maudsley depersonalisation clinic ( Reference Phillips, Sierra and HunterPhillips et al, 2001 a Reference Baker, Hunter and LawrenceBaker et al, 2003). Reflecting this, two major case series have recently been published ( Reference Baker, Hunter and LawrenceBaker et al, 2003 Reference Simeon, Knutelska and NelsonSimeon et al, 2003 b), comprising 204 and 117 cases respectively.Īlthough empirical studies of depersonalisation are a recent development, there are some rich phenomenological descriptions in older literature (e.g Reference SchilderSchilder, 1928 Reference Mayer-GrossMayer-Gross, 1935 Reference Shorvon, Hill and BurkittShorvon et al, 1946 Reference AcknerAckner, 1954), and these remain invaluable to any present-day clinician attempting to understand the condition. Other work ( Reference StewartStewart, 1964 Reference Simeon, Gross and GuralnikSimeon et al, 1997) suggests that depersonalisation might be the third most common psychiatric symptom after anxiety and low mood.Īlthough such studies do not always distinguish between primary and secondary depersonalisation, it does seem likely that the primary disorder is considerably more common than previously thought. In psychiatric populations, depersonalisation is encountered with surprising frequency: one survey ( Reference Brauer, Harrow and TuckerBrauer et al, 1970) found that it occurred in 80% of a sample of psychiatric in-patients, and was chronic and disabling in a fifth of this group. However, epidemiological reviews ( Reference Bebbington, Marsden and BrewinBebbington et al, 1997 Reference Hunter, Sierra and DavidHunter et al, 2004) conclude that clinically significant depersonalisation may affect 1–2% of the general population, with a gender ratio of about 1:1. More commonly, depersonalization-derealization phenomena occur in the context of depressive illnesses, phobic disorder, and obsessive-compulsive disorder’ ( World Health Organization, 1992: p. ‘the number of individuals who experience this disorder in a pure or isolated form is small.
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