Depersonalization And Schizophrenia: Connections And Differences
Anyone may experience depersonalization. This symptom involves being an outside observer of one's body, identity, and thoughts. When these experiences persist or interfere with daily functioning and relationships, occurring as depersonalization schizophrenia symptoms or other mental health disorders, they may cause considerable distress. Depersonalization may occur in association with many conditions, including schizophrenia, dissociative disorders, and anxiety disorders.
Some people who experience depersonalization may have similar experiences in relation to their sense of self as those on the schizophrenia spectrum. However, there are differences in the symptoms, cognitive functioning, and neurobiological features of schizophrenia spectrum disorders and dissociative disorders.
What is depersonalization as a mental illness?
According to the American Psychological Association (APA), depersonalization refers to a state in which the self is perceived as unreal.
Those who experience depersonalization may experience a sense of estrangement from the external world, rendering thoughts and experiences a distant, dreamlike quality.
Depersonalization may occur in various psychiatric disorders, including depression, anxiety, and schizophrenia. When associated with pre-psychotic stages, experiencing depersonalization has been suggested to be linked with the process of emerging delusions.
Symptoms of depersonalization as a mental illness
Depersonalization symptoms may include:
- A sense of being outside looking in
- A sense of being detached from your body, thoughts, and identity
- Emotional and physical numbness
Depersonalization can be an associated feature of schizophrenia, especially during the initial or acute phase of schizophrenia, in which psychotic symptoms like hallucinations and delusions may be present. Depersonalization has also been linked with preceding the appearance of first-episode psychosis.
In addition to depersonalization, a person may experience derealization. Depersonalization and derealization have similar features but differ in certain aspects. Derealization primarily refers to one's experience concerning one's environment, whereas depersonalization may focus more on the self.
What is derealization?
Depersonalization may occur in connection with a sense of derealization, which may involve perceiving reality as unreal or strange. Associated with traumatic or stressful experiences, derealization can also be a feature of schizophrenia.
Symptoms of derealization
- A sense of being in a dream, a movie, detached from the world, or looking through a screen, glass, or fog
- Perceived distortions in the environment, sense of time, space, and distance
- A sense of emotional detachment
- A sense of meaninglessness
The self-disorder model
Some researchers have described the self-disorder model as an attempt to unify methods for conceptualizing schizophrenia's positive symptoms, negative symptoms, and disorganized symptoms, encapsulating their features and charting their development.
The model refers to symptoms that may be considered "differing manifestations of an underlying disorder" that relate to a sense of self accompanied by one's grasp of reality. This model has recently been revised, distinguishing between primary and secondary factors in treating schizophrenia symptoms.
The self-disorder model also acknowledges the overlapping symptoms of schizophrenia spectrum disorders with other conditions involving dissociation, including depersonalization disorder. In doing so, the model recognizes common features. However, researchers also note that "shared disturbances with other disorders relating to "core-self experiences’ may take many forms and "follow several distinct pathways."
What is dissociation?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), dissociation involves a "disruption of and discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior."
Anyone can occasionally experience dissociation, as the experience itself is not tied to a mental health condition. However, when experiences occur frequently or cause distress, dissociation may be assessed as related to psychological conditions.
What are dissociative mental health disorders?
Dissociative disorders are conditions that impact memory, identity, emotion, perception, behavior, and one's idea of self. The three primary types of dissociative disorders are dissociative identity disorder (DID), dissociative amnesia, and depersonalization-derealization disorder.
Symptoms of dissociative mental health disorder
Dissociative symptoms may include:
- A sense of disconnection from one's thoughts, memories, feelings, behavior, and sense of self.
- Difficulty being able to recall specific times, events, or people with whom one has had significant interactions
- Out-of-body experiences, such as the sense that you are watching yourself
- Depression, anxiety, and distress
- Detachment and disconnection from emotions
- A nebulous sense of identity
Depersonalization disorder
The APA characterizes depersonalization disorder as "one or more episodes of depersonalization severe enough to impair social and occupational functioning." Its features may include a "sensation of self-estrangement, a sense that one’s extremities have changed in size, a sense of being mechanical, a perception of oneself as if from a distance, and, in some cases, a belief that the external world is unreal (derealization)." This sense of depersonalization may have a quick onset.
Dissociative identity disorder (DID)
Dissociative identity disorder can be described by the presence of one or more "distinct identities or personality states" that take control and manifest in the individual's behavior. Previously referred to as multiple personality disorder, DID is often associated with severe traumatic experiences, especially in connection with childhood trauma. Due to the possibility of false memories, DID can be a controversial diagnosis.
Schizotypal personality disorder (SPD)
Those with depersonalization-derealization disorder (DRD) have been described as having similar experiences in relation to their sense of self as those on the schizophrenia spectrum. However, there are differences in the symptoms, cognitive functioning, and neurobiological features of DRD and schizophrenia spectrum disorders.
Schizotypal personality disorder (SPD), for example, is associated with cognitive impairments that include executive dysfunction related to some regions of the brain. Symptoms of DRD, on the other hand, are perceptual and unrelated to impairments in intellectual or executive functioning.
The positive symptoms of schizophrenia may include hallucinations and delusions. Some people also experience auditory verbal hallucinations. While dissociative disorders do not have the same symptoms of delusions associated with schizophrenia, some people who experience dissociation also experience auditory verbal hallucinations.
The Dissociative Experiences Scale and the Cambridge Depersonalization Scale
Known as the Dissociative Experiences Scale-II (DES-II), the DES-II self-report questionnaire is used as a screening tool to assess the presence of psychotic disorders and schizophrenia. The scale measures dissociated experiences involving derealization, depersonalization, and amnesia. However, due to the challenges in conceptualizing disassociation, new measures have been implemented to score dissociative experiences, including the Dissociative Experiences Measure.
The Cambridge Depersonalization Scale is another tool for measuring dissociative symptoms, characterizing their "quality, frequency, and duration." One controlled and cross-sectional study of 48 patients with paranoid schizophrenia* evaluated the differences in depersonalization-derealization among people with initial and multiple episodes and their contributing factors. The study employed the Cambridge Depersonalization Scale and the subscale of the Dissociative Experiences Scale.
The study’s findings suggest that depersonalization and derealization experiences are more likely to occur in those in the early stages of schizophrenia, decreasing in frequency, quality, and intensity as the condition becomes chronic. *Paranoid schizophrenia is no longer listed in the DSM-5 as a subcategory.
Safeguarding mental health and managing symptoms of depersonalization and schizophrenia
Reaching out for help can be challenging. Speaking to a therapist may be grounding in times of stress, as they can support you in managing symptoms and reducing stress. However, not everyone finds it convenient to attend in-person sessions.
Consider online therapy when experiencing depersonalization derealization disorder
If you face barriers to in-person therapy, you might consider an online platform like BetterHelp. Online platforms allow clients to have sessions with a licensed therapist by phone, video, or in-app messages, which may be beneficial when you need your therapist to connect with you as soon as possible after a stressful day. In addition, online platforms often offer unique resources, such as journaling prompts and weekly support groups, which can also be used from home.
Effectiveness of telehealth intervention for depersonalization schizophrenia
A clinical trial evaluated the effectiveness of telehealth psychoeducational intervention for those with schizophrenia and their family members. The study consisted of 30 participants with schizophrenia who reported experiencing less stress and more social support after taking part in the three-month program.
Takeaway
What is depersonalization derealization disorder?
Depersonalization-derealization disorder is a mental health condition that makes someone feel that they are outside of their body and everything around them is not real. It is a disturbing condition, as it makes someone feel like they are living in a dream. The disorder exists on a spectrum, and depersonalization phenomena can vary in severity. Professionals use tools like the Cambridge Depersonalisation Scale to evaluate the extent of symptoms. They also typically investigate whether other depersonalization disorders or other mental health conditions could explain the symptoms better.
Is depersonalization a symptom of schizophrenia?
A comparative study of schizophrenia patients indicated that depersonalization symptoms are more likely to occur in those diagnosed with schizophrenia spectrum disorders. Depersonalization and derealization may occur well before the initial episode of acute psychosis. Dissociative phenomena are common in psychosis, but schizophrenia is typically defined by its positive and negative symptoms.
The present study found elevated disassociative experience scores on the Dissassociative Experiences Scale but found no correlation between dissociation and the positive symptoms subscale of the Positive and Negative Symptom Scale, a tool commonly used to aid in diagnosing schizophrenia. Researchers determined that depersonalization and derealization appear with greater frequency and intensity in the early stages of the disorder, gradually decreasing as the psychotic disorder becomes chronic.
Is depersonalization a psychotic episode?
Depersonalization is common in psychosis, especially in the prodromal and acute phases. The prodrome - the early stages of clinical psychosis - is often characterized by dissociative symptoms like depersonalization, which are strongest in the prodrome but become less pronounced during the acute phases of psychosis. A dissociative disorder can also cause depersonalization, but the other symptoms of psychosis are often absent.
What triggers depersonalization?
There are typically significant differences from person to person regarding triggers for depersonalization disorder, disassociative disorder, or psychotic spectrum disorders. Some common triggers include high stress, substance abuse, or other mental health conditions. Depersonalization is also thought to be a response to traumatic experiences, and reminders of such experiences might trigger depersonalization or other psychotic symptoms.
What are the four stages of depersonalization?
This likely pertains to the four salient features of depersonalization, as there is no distinct four-stage course that depersonalization follows. The four features of depersonalization include:
- A feeling of being out of one’s own body or perceiving a strangeness with their self-experience.
- Retention of insight, which means the person does not experience delusions, unlike in some other psychotic disorders. This is one of the major differences between depersonalization and acute psychosis.
- Emotional numbing, diminished self-affection, and a lack of emotional expression beyond expressing discomfort at the depersonalization.
- Unpleasant sensations that vary based on the person’s familiarity with their symptoms. Initial episodes of depersonalization are typically more distressing than subsequent episodes.
Am I dissociating or depersonalization?
Dissociation is a broad term for experiences where a person feels disconnected from their body, mind, or surroundings. Dissociation can take many forms, but depersonalization is a specific type of dissociation where a person feels as though they are observing themselves from a distance, are estranged from their body, or feel disconnected from their emotions. Depersonalization represents a significant disturbance to a person’s self-presence, and they may feel as though they have lost their sense of self.
Depersonalization can be measured on a dissociation scale and compared to clinical norms to determine the severity of symptoms. Professionals can also help determine if mental illnesses like mood or affective disorders might be underlying the symptoms. They can also likely identify underlying risk factors that contribute to your symptoms. The early symptoms of disassociation are sometimes challenging to detect. If you are concerned about disassociating or depersonalization, talking to a healthcare professional would likely be helpful.
Is depersonalization permanent?
Depersonalization is typically not permanent and typically resolves within hours or days. Those who experience depersonalization episodes often learn to recognize them and manage the distress they can cause. Those experiencing initial episodes score higher on distress scales than those who have experienced depersonalization before. Depersonalization may also happen as a response to stress or trauma, and it is possible that underlying conditions like post-traumatic stress disorder (PTSD) need to be investigated and treated before symptoms completely resolve.
Can you fully recover from depersonalization?
Many things, including traumatic stress, can cause the basic symptoms of depersonalization. Recovery from depersonalization is typically possible, but the underlying cause may need to be treated to enable full recovery. For example, if the depersonalization occurred as part of a schizophrenia onset episode, it's possible that treatments like antipsychotic medications may be required for complete symptom relief.
The self-disturbance associated with depersonalization often resolves within hours if there are few underlying factors. However, psychiatric patients who experience such symptoms may require additional treatment if underlying conditions like a psychotic or disassociative disorder are present. Depersonalization sometimes appears in the initial phases of some disorders, and clinical psychiatry sometimes views depersonalization as part of the initial prodromal phase of disorders like schizophrenia. Future research will likely further clarify the link between dissociation and psychosis.
How to stop a depersonalization episode?
If a person can recognize that a depersonalization episode is occurring, they can often use tools like grounding techniques, mindfulness, and self-care to restore a first-person perspective and feel as though their body is their own. Those who experience repeated depersonalization episodes often engage in talk therapy to learn coping and symptom-management strategies. They also often learn techniques to recover from an episode by managing self-consciousness and reflecting on what may have triggered it.
Is depersonalization psychosis?
According to the American Psychiatric Association, depersonalization is a feature of disassociative disorders and is distinct from psychosis. However, evidence suggests that depersonalization and derealization may appear in the early stages of a psychotic episode before diminishing as the episode becomes chronic. While researchers are confident there is a link between psychosis and disassociation, further investigation is required to clarify how the two are related.
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