Depersonalization
This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths.
He interpreted his experience as an unconscious psychological defense, in which he was repressing feelings of guilt for outliving his father, whose cause of death remained unknown.
[16][17] It can also accompany sleep deprivation (often occurring when experiencing jet lag), migraine, epilepsy (especially temporal lobe epilepsy,[18] complex-partial seizure, both as part of the aura and during the seizure[19]), obsessive-compulsive disorder, severe stress or trauma, anxiety, the use of recreational drugs[20] —especially cannabis, hallucinogens, ketamine, and MDMA, certain types of meditation, deep hypnosis, extended mirror or crystal gazing, sensory deprivation, and mild-to-moderate head injury with little or full loss of consciousness (less likely if unconscious for more than 30 minutes).
[17] A similar and overlapping concept called ipseity disturbance (ipse is Latin for "self" or "itself"[23]) may be part of the core process of schizophrenia spectrum disorders.
[clarification needed][24] A study of undergraduate students found that individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited a more pronounced cortisol response in stress.
Individuals high on the absorption subscale, which measures a subject's experiences of concentration to the exclusion of awareness of other events, showed weaker cortisol responses.
Common immediate precipitants include instances of severe stress, depressive episodes, panic attacks, and the consumption of psychoactive substances such as marijuana and hallucinogens.
[39] Experiences of depersonalization/derealization occur on a continuum, ranging from momentary episodes in healthy individuals under conditions of stress, fatigue, or drug use, to severe and chronic disorders that can persist for decades.
[19] Several studies, but not all, found age to be a significant factor: adolescents and young adults in the normal population reported the highest rate.
In general infantry and special forces soldiers, measures of depersonalization and derealization increased significantly after training that includes experiences of uncontrollable stress, semi-starvation, sleep deprivation, as well as lack of control over hygiene, movement, communications, and social interactions.
Studies spanning from 1992 to 2020 have highlighted abnormalities in primary somatosensory cortex processing and insula activity as contributing factors to depersonalization experiences.
[5] Additionally, abnormal EEG activities, notably in the theta band, suggest potential biomarkers for emotion processing, attention, and working memory, though specific oscillatory signatures associated with depersonalization are yet to be determined.
[5][17] Furthermore, vestibular signal processing, crucial for balance and spatial orientation, is increasingly recognized as a factor contributing to feelings of disembodiment during depersonalization experiences.
[5] Potential involvement of serotonergic, endogenous opioid, and glutamatergic NMDA pathways has also been proposed, alongside alterations in metabolic activity in the sensory association cortex, prefrontal hyperactivation, and limbic inhibition in response to aversive stimuli revealed by brain imaging studies.
[17] In addition to this, research suggests that individuals with depersonalization often exhibit autonomic blunting, characterized by reduced physiological responses to stressors or emotional stimuli.
This blunting may reflect a diminished capacity to engage with the external world or to experience emotions fully, contributing to the subjective sense of detachment from oneself.
[2] Additionally, dysregulation of the HPA axis, which governs the body's stress response system, is frequently observed in individuals who experience depersonalization.
[5] Depersonalization is a classic response to acute trauma, and may be highly prevalent in individuals involved in different traumatic situations including motor vehicle collision and imprisonment.
Pharmacotherapy remains a primary avenue of treatment, with medications such as clomipramine, fluoxetine, lamotrigine, and opioid antagonists being commonly prescribed.
[2][17] Salami and colleagues argued that studies of electrophysiological depersonalization-derealization markers are urgently needed, and that future research should use analysis methods that can account for the integration of interoceptive and exteroceptive signals.
In a 2020 article in the Journal Nature, Vesuna, et al. describe experimental findings which show that layer 5 of the retrosplenial cortex is likely responsible for dissociative states of consciousness in mammals.
