Depersonalization-derealization disorder

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Depersonalization-derealization disorder
Other namesDepersonalization disorder, derealization disorder
Specialty Psychiatry, clinical psychology
Symptoms Feeling detached from oneself (depersonalization), feeling detached from one's surroundings (derealization)
Usual onsetAdolescence
DurationEpisodic, chronic
Risk factors childhood trauma, substance abuse
TreatmentPsychotherapy
Prognosis Usually positive [1]
Frequency1–2% (general population) [2]

Depersonalization-derealization disorder (DPDR, DDD) [3] [4] is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. [5] Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted. [5]

Contents

Depersonalization-derealization disorder is thought to be caused largely by interpersonal trauma such as early childhood abuse. [6] [7] Adverse early childhood experiences, specifically emotional abuse and neglect have been linked to the development of depersonalization symptoms. [8] Feelings of depersonalization and derealization are common from significant stress or panic attacks. [6] Individuals may remain in a depersonalized state for the duration of a typical panic attack. However, in some cases, the dissociated state may last for hours, days, weeks, or even months at a time. [9] In rare cases, symptoms of a single episode can last for years. [10]

Diagnostic criteria for depersonalization-derealization disorder includes persistent or recurrent feelings of detachment from one's mental or bodily processes or from one's surroundings. [11] A diagnosis is made when the dissociation is persistent, interferes with the social or occupational functions of daily life, and/or causes marked distress in the patient. [3]

While depersonalization-derealization disorder was once considered rare, lifetime experiences with it occur in about 1–2% of the general population. [12] [13] The chronic form of the disorder has a reported prevalence of 0.8 to 1.9%. [14] [15] While brief episodes of depersonalization or derealization can be common in the general population, the disorder is only diagnosed when these symptoms cause substantial distress or impair social, occupational, or other important areas of functioning. [16] [17]

Signs and symptoms

The core symptoms of depersonalization-derealization disorder are the subjective experience of "unreality in one's self", [18] or detachment from one's surroundings. People who are diagnosed with depersonalization also often experience an urge to question and think critically about the nature of reality and existence. [16]

Individuals with depersonalization describe feeling disconnected from their physicality; feeling as if they are not completely occupying their own body; feeling as if their speech or physical movements are out of their control; feeling detached from their own thoughts or emotions; and experiencing themselves and their lives from a distance. [19] [20] While depersonalization involves detachment from one's self, individuals with derealization feel detached from their surroundings, as if the world around them is foggy, dreamlike, or visually distorted. Individuals with the disorder commonly describe a feeling as though time is passing them by and they are not in the notion of the present. In some cases, individuals may be unable to accept their reflection as their own, or they may have out-of-body experiences. [19] Additionally some individuals experience difficulty concentrating and problems with memory retrieval. These individuals sometimes lack the "feeling" of a memory where they are able to recall a memory but feel as if they did not personally experience it. [21] [22] These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious. [16] The inner turmoil created by the disorder can also result in depression. [17]

First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment. [15] The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety and obsession, which contributes to the worsening of symptoms. [23]

Factors that tend to diminish symptoms are comforting personal interactions, intense physical or emotional stimulation, and relaxation. [24] Distracting oneself (by engaging in conversation or watching a movie, for example) may also provide temporary relief. Some other factors that are identified as relieving symptom severity are diet or exercise, while alcohol and fatigue are listed by some as worsening their symptoms. [25]

Occasional, brief moments of mild depersonalization can be experienced by many members of the general population; [13] however, depersonalization-derealization disorder occurs when these feelings are strong, severe, persistent, or recurrent and when these feelings interfere with daily functioning. [16] [17] DPDR is most commonly experienced as chronic and continuous. However, for a minority who have DPDR as an episodic condition, duration of these episodes is highly variable with some lasting as long as several weeks. [26] [27]

Causes

The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. It has been thought that depersonalization can be caused by a biological response to dangerous or life-threatening situations which causes heightened senses and emotional numbing. [15]

Psychosocial

There is growing evidence linking physical and sexual abuse in childhood with the development of dissociative disorders. [26] Childhood interpersonal trauma – emotional abuse in particular – is a significant predictor of a diagnosis of DPDR. [28] Compared to other types of childhood trauma, emotional abuse has been found to be the most significant predictor both of a diagnosis of depersonalization disorder and of depersonalization scores, but not of general dissociation scores. [29] Some studies suggest that greater emotional abuse and lower physical abuse predict depersonalization in adult women with post-traumatic stress disorder (PTSD). [30] Patients with high interpersonal abuse histories (HIA) show significantly higher scores on the Cambridge Depersonalization Scale, when compared to a control group. [31] [8] Earlier age of abuse, increased duration and parental abuse tend to correlate with severity of dissociative symptoms. [26] [32] Besides traumatic experiences, other common precipitators of the disorder include severe stress, major depressive disorder or panic attacks. [33] People who live in highly individualistic cultures may be more vulnerable to depersonalization due to a hypersensitivity towards threats and fears of losing control. [34]

A 2010 study [35] found evidence that some users participating in virtual reality (VR) may be more likely to experience dissociation after use. Users reportedly experienced higher levels of a lessened sense of presence in reality after exposure to VR. However, it was noted that the effects of exposure were likely to rapidly disappear after returning to objective reality. Additionally, individuals who reported higher preexisting dissociation levels as well being more easily immersed or absorbed in imagination overall were found to be linked to higher increases in dissociative symptoms after the VR exposure. This study offered evidence towards a link between imaginative processes of the brain and dissociative experiences.

Neurobiology

Animated image showing prefrontal cortex, which is thought to play a role in DPDR Prefrontal cortex (left) animation.gif
Animated image showing prefrontal cortex, which is thought to play a role in DPDR

There is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the basis of emotional experience. [36] In an fMRI study of DPDR patients, emotionally aversive scenes activated the right ventral prefrontal cortex. Participants demonstrated a reduced neural response in emotion-sensitive regions, as well as an increased response in regions associated with emotional regulation. [37] In a similar test of emotional memory, depersonalization disorder patients did not process emotionally salient material in the same way as did healthy controls. [38] In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing. [39]

Studies are beginning to show that the temporoparietal junction has a role in multisensory integration, embodiment, and self-other distinction. [40] Several studies analyzing brain MRI findings from DPDR patients found decreased cortical thickness in the right middle temporal gyrus, reduction in grey matter volume in the right caudate, thalamus, and occipital gyri, as well as lower white matter integrity in the left temporal and right temporoparietal regions. However, no structural changes in the amygdala were observed. [41] [42] [43]

A PET scan found functional abnormalities in the visual, auditory, and somatosensory cortex, as well as in areas responsible for an integrated body schema. [44]

One study examining EEG readings found frontal alpha wave overactivation and increased theta activity waves in the temporal region of the left hemisphere. [45]

Image showing temporoparietal junction, a portion of the brain also thought to play a role in DPDR Temporoparietal junction diagram.jpg
Image showing temporoparietal junction, a portion of the brain also thought to play a role in DPDR

It is unclear whether genetics plays a role; however, there are many neurochemical and hormonal changes in individuals with depersonalization disorder. [6] DPDR may be associated with dysregulation of the hypothalamic-pituitary-adrenal axis, the area of the brain involved in the "fight-or-flight" response. Patients demonstrate abnormal cortisol levels and basal activity. Studies found that patients with DPDR could be distinguished from patients with clinical depression and posttraumatic stress disorder. [46] [47]

The vestibular system may also play a role in DPDR. The vestibular system helps control balance, spatial orientation, motor coordination, but also plays a role in self-awareness. Disruption to this system can potentially cause a feeling of detachment from surroundings. Several studies have shown that patients with peripheral vestibular disease are also more likely to have dissociative symptoms when compared to healthy individuals. [48]

Dissociative symptoms are sometimes described by those with neurological diseases, such as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), etc., that directly affect brain tissue. [49]

Diagnosis

Assessment

Diagnosis is based on the self-reported experiences of the person followed by a clinical assessment. Psychiatric assessment includes a psychiatric history and some form of mental status examination. Since some medical and psychiatric conditions mimic the symptoms of DPDR, clinicians must differentiate between and rule out the following to establish a precise diagnosis: temporal lobe epilepsy, panic disorder, acute stress disorder, schizophrenia, migraine, drug use, brain tumor or lesion. [19] No laboratory test for depersonalization-derealization disorder currently exists. [11] As patients with dissociative disorders likely experienced intense trauma in the past, concomitant dissociative disorders should be considered in patients diagnosed with a stress disorder (i.e. PTSD or acute stress disorder). [50]

The diagnosis of depersonalization disorder can be made with the use of the following interviews and scales:

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

In the DSM-5, the word "derealization" was added to "depersonalization disorder" and renamed "depersonalization/derealization disorder" ("DPDR"). [3] It remains classified as a dissociative disorder. [3]

Patients must meet the following criteria to be diagnosed per the DSM-5: [3]

  1. Presence of persistent/recurrent episodes of depersonalization/derealization
  2. Ability to distinguish between reality and dissociation during an episode (i.e. patient is aware of a perceptual disturbance)
  3. Symptoms are severe enough to interfere with social, occupational, or other areas of functioning
  4. Symptoms are not due to a substance or medication
  5. Symptoms are not due to another psychiatric disorder

International Classification of Diseases 11th Revision (ICD-11)

The ICD-11 has relisted DPDR as a disorder rather than a syndrome as previously, and has also reclassified it as a dissociative disorder from its previous listing as a neurotic disorder. [4] The description used in the ICD-11 is similar to the criteria found in the DSM-5. Individuals with DPDR are described as having persistent/recurrent symptoms of depersonalization/derealization, have intact reality testing, and symptoms are not better explained by another psychiatric/neural disorder, substance, medication, or head trauma. Symptoms are severe enough to cause distress or impairment in functioning. [4]

Differential diagnoses

DPDR differentials include neurologic and psychiatric conditions as well as side effects from psychoactive substances or medications. [12] [56]

Neurologic

Psychiatric

Consequence of psychoactive substance use

Prevention

Depersonalization-derealization disorder may be prevented by connecting children who have been abused with professional mental health help. [57] [58] Some trauma specialists strongly advocate for increasing inquiry into information about children's trauma history and exposure to violence, since the majority of people (about 80%) responsible for child maltreatment are the child's own caregivers. [59] Trauma-specific intervention for children may be useful in preventing future symptoms. [60]

Treatment

Treatment of DPDR is often difficult and refractory. Some clinicians speculate that this could be due to a delay in diagnosis by which point symptoms tend to be constant and less responsive to treatment. [12] Additionally, symptoms tend to overlap with other diagnoses. [48] Some results have been promising, but are hard to evaluate with confidence due to the small size of trials. [61] However, recognizing and diagnosing the condition may in itself have therapeutic benefits, considering many patients express their problems as baffling and unique to them, but are not, in fact, and are recognized and described by psychiatry. [62] However, symptoms are often transient and can remit on their own without treatment. [26]

Treatment is primarily pharmacological. [63] Self-hypnosis training can be helpful and entails training patients to induce dissociative symptoms and respond in an alternative manner. [64] Psychoeducation involves counseling regarding the disorder, reassurance, and emphasis on DPDR as a perceptual disturbance rather than a true physical experience. [12] Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (SSRI), benzodiazepines, stimulants and opioid antagonists (ex: naltrexone). [12]

Cognitive behavioral therapy

An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. [63] A standardized treatment for DPDR based on cognitive behavioral principles was published in the Netherlands in 2011. [65]

Medications

Tentative evidence supports the use of opioid antagonists (naloxone) and other medications like benzodiazepines or methylphenidate. Evidence suggests the beneficial use of lamotrigine adjunct to an SSRI but not as monotherapy. [63]

A combination of an SSRI and a benzodiazepine has been proposed to be useful for DPDR patients with anxiety. [66]

Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). However, clinical trials have not been conducted. [67]

Repetitive transcranial magnetic stimulation (rTMS)

Some studies have found repetitive transcranial magnetic stimulation (rTMS) to be helpful. [68] [69] [70] One study examined 12 patients with DPDR that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment. Five of the participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. [68] Treating patients with rTMS specifically at the TPJ may be an alternative treatment. [68]

Prognosis

Michal et al. (2016) analyzed a case series on 223 patients suffering from DPDR and agreed that the condition tended to be long-lasting. [71] However, while no medication has been confirmed to successfully treat the condition, psychotherapy might help. In some cases, recovery can take place organically, without formal treatment. [72]

Epidemiology

Men and women are diagnosed in equal numbers with depersonalization disorder. [25] A 1991 study on a sample from Winnipeg, Manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. [73] A 2008 review of several studies estimated the prevalence between 0.8% and 1.9%. [66] This disorder is episodic in only one-third of individuals, [25] with each episode lasting from hours to months at a time. Depersonalization can begin episodically, and later become continuous at constant or varying intensity. [25]

Onset is typically during adolescence, although some patients report being depersonalized as long as they can remember, and a small minority report a later onset (by age 40). [24] [25] According to the DSM-5-TR, less than 20% of patients with the disorder first experience symptoms after age 20 years; 80% or more have their onset in the first 2 decades of life - childhood and adolescence. The onset can be acute or insidious in nature. With acute onset, some individuals remember the exact time and place of their first experience of depersonalization and/or derealization. This may follow a prolonged period of severe stress, a traumatic event, or an episode of another mental illness. [25] Insidious onset may reach back as far as can be remembered (early childhood), or it may begin with smaller episodes of lesser severity that become gradually more intense and more disabling. Some patients report persistent depersonalization and/or derealization throughout the day, nearly everyday.

Relation to other psychiatric disorders

Depersonalization exists as both a primary and secondary phenomenon. [74] The most common comorbid disorders are depression and anxiety, [16] although cases of depersonalization disorder without symptoms of either do exist. Comorbid obsessive/compulsive behaviors may exist as attempts to deal with depersonalization, such as checking whether symptoms have changed and avoiding behavioral and cognitive factors that exacerbate symptoms. Many people with personality disorders such as schizoid personality disorder, schizotypal personality disorder, and borderline personality disorder will have experiences of depersonalization. Patients with complex dissociative disorders, including dissociative identity disorder, experience high levels of depersonalization and derealization. [75]

History

The word depersonalization itself was first used by Henri Frédéric Amiel in The Journal Intime. The 8 July 1880 entry reads:

I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift. Is this madness? [76]

Depersonalization was first used as a clinical term by Ludovic Dugas in 1898 to refer to "a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization". This description refers to personalization as a psychical synthesis of attribution of states to the self. [77]

Early theories of the cause of depersonalization focused on sensory impairment. Maurice Krishaber proposed depersonalization was the result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself". One of Carl Wernicke's students suggested all sensations were composed of a sensory component and a related muscular sensation that came from the movement itself and served to guide the sensory apparatus to the stimulus. In depersonalized patients, these two components were not synchronized, and the myogenic sensation failed to reach consciousness. The sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words. Pierre Janet approached the theory by pointing out his patients with clear sensory pathology did not complain of symptoms of unreality, and that those who have depersonalization were normal from a sensory viewpoint. [77]

Psychodynamic theory formed the basis for the conceptualization of dissociation as a defense mechanism. Within this framework, depersonalization is understood as a defense against a variety of negative feelings, conflicts, or experiences. Sigmund Freud himself experienced fleeting derealization when visiting the Acropolis in person; having read about it for years and knowing it existed, seeing the real thing was overwhelming and proved difficult for him to perceive it as real. [78] Freudian theory is the basis for the description of depersonalization as a dissociative reaction, placed within the category of psychoneurotic disorders, in the first two editions of the Diagnostic and Statistical Manual of Mental Disorders. [79]

It can be argued that because depersonalization and derealization are both impairments to one's ability to perceive reality, they are merely two facets of the same disorder. Depersonalization also differs from delusion in the sense that the patient is able to differentiate between reality and the symptoms they may experience. The ability to sense that something is unreal is maintained when experiencing symptoms of the disorder. The problem with properly defining depersonalization also lies within the understanding of what reality actually is. [80] In order to comprehend the nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again. [81]

Society and culture

Depersonalization disorder has appeared in a variety of media. The director of the autobiographical documentary Tarnation , Jonathan Caouette, had depersonalization disorder. The screenwriter for the 2007 film Numb had depersonalization disorder, as does the film's protagonist played by Matthew Perry. Norwegian painter Edvard Munch's famous masterpiece The Scream may have been inspired by depersonalization disorder. [82] In Glen Hirshberg's novel The Snowman's Children, main female plot characters throughout the book had a condition that is revealed to be depersonalization disorder. [83] Suzanne Segal had an episode in her 20s that was diagnosed by several psychologists as depersonalization disorder, though Segal herself interpreted it through the lens of Buddhism as a spiritual experience, commonly known as "Satori" or "Samadhi". [84] The song "Is Happiness Just a Word?" by hip hop artist Vinnie Paz describes his struggle with depersonalization disorder. Adam Duritz, of the band Counting Crows, has often spoken about his diagnosis of depersonalization disorder. [85]

See also

Related Research Articles

Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is one of multiple dissociative disorders in the DSM-5, ICD-11, and Merck Manual. It has a history of extreme controversy.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization, which involves a sense of detachment from the external world rather than from oneself.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

Schizotypal personality disorder, also known as schizotypal disorder, is a cluster A personality disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classification describes the disorder specifically as a personality disorder characterized by thought disorder, paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs. People with this disorder feel pronounced discomfort in forming and maintaining social connections with other people, primarily due to the belief that other people harbor negative thoughts and views about them. Peculiar speech mannerisms and socially unexpected modes of dress are also characteristic. Schizotypal people may react oddly in conversations, not respond, or talk to themselves. They frequently interpret situations as being strange or having unusual meanings for them; paranormal and superstitious beliefs are common. Schizotypal people usually disagree with the suggestion that their thoughts and behaviors are a 'disorder' and seek medical attention for depression or anxiety instead. Schizotypal personality disorder occurs in approximately 3% of the general population and is more commonly diagnosed in males.

Conversion disorder (CD), or functional neurologic symptom disorder (FNsD), is a functional disorder that causes abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals with CD present with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, which are not consistent with a well-established organic cause and can be traced back to a psychological trigger.

<span class="mw-page-title-main">Hallucinogen persisting perception disorder</span> Medical condition

Hallucinogen persisting perception disorder (HPPD) is a non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs, including but not limited to psychedelics, dissociatives, entactogens, tetrahydrocannabinol (THC), and SSRIs. Despite being designated as a hallucinogen-specific disorder, the specific contributory role of psychedelic drugs is unknown.

Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.

Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.

Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings either verbally or nonverbally, especially when talking about issues that would normally be expected to engage emotions. In this condition, expressive gestures are rare and there is little animation in facial expression or vocal inflection. Additionally, reduced affect can be symptomatic of autism, schizophrenia, depression, post-traumatic stress disorder, depersonalization derealization disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Clouding of consciousness, also called brain fog or mental fog, occurs when a person is slightly less wakeful or aware than normal. They are less aware of time and their surroundings, and find it difficult to pay attention. People describe this subjective sensation as their mind being "foggy".

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

Thought blocking is a neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic. Persons undergoing thought blocking may utter incomprehensible speech; they may also repeat words involuntarily or make up new words. The main causes of thought blocking are schizophrenia, anxiety disorders, petit mal seizures, post-traumatic stress disorder, bradyphrenia, aphasia, dementia and delirium.

<span class="mw-page-title-main">Cotard's syndrome</span> Delusion that one is dead or non-existent

Cotard's syndrome, also known as Cotard's delusion or walking corpse syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Statistical analysis of a hundred-patient cohort indicated that denial of self-existence is present in 45% of the cases of Cotard's syndrome; the other 55% of the patients presented with delusions of immortality.

Other specified dissociative disorder (OSDD) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder, and the reasons why the previous diagnoses were not met are specified. "Unspecified dissociative disorder" is given when the clinician does not give a reason. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". Under the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was known as "Dissociative disorder not otherwise specified" (DDNOS).

The Multiscale Dissociation Inventory (MDI) is a comprehensive, self-administered, multiscale instrument developed by Paul F. Dell. It is designed to assess the domain of dissociative phenomena. The MDI measures 14 major facets of pathological dissociation and uses 23 scales to diagnose dissociative disorders.

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