Despersonalization Disorder

Depersonalization disorder (DPD) is a dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. Diagnostic criteria include persistent or recurrent experiences of feeling detached from one's mental processes or body.^[1] The symptoms include a sense of automation, going through the motions of life but not experiencing it, feeling as though one is in a movie, loss of conviction with one's identity, feeling as though one is in a dream, feeling a disconnection from one's body; out-of-body experience, a detachment from one's body, environment and difficulty relating oneself to reality.
Occasional moments of mild depersonalization are normal;^[2] strong, severe, persistent, or recurrent feelings are not. A diagnosis of a disorder is made when the dissociation is persistent and interferes with the social and occupational functions necessary for everyday living. Depersonalization disorder is thought to be largely caused by severe traumatic lifetime events including childhood sexual, physical, and emotional abuse; accidents, war, torture, panic attacks and bad drug experiences. It is unclear whether genetics play a role; however, there are many neurochemical and hormonal changes in individuals suffering with depersonalization disorder. ^[3]
As the core symptoms of the disorder are thought to protect the victim from negative stimuli, depersonalization disorder can be conceptualized as a defense mechanism. Depersonalization disorder is often comorbid with anxiety disorders, panic disorders, clinical depression and bipolar disorder.
Although depersonalization disorder is an alteration in the subjective experience of reality, it is not related to psychosis, as sufferers maintain the ability to distinguish between their own internal experiences and the objective reality of the outside world. During episodic and continuous depersonalization, sufferers are able to distinguish between reality and fantasy, and their grasp on reality remains stable at all times.

Symptoms
The core symptom of depersonalization disorder is the subjective experience of unreality, and as such there are no clinical signs. Common descriptions are: watching oneself from a distance; out-of-body experiences; a sense of just going through the motions; feeling as though one is in a dream or movie; not feeling in control of one's speech or physical movements; and feeling detached from one's own thoughts or emotions.^[5] 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. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious.
Some of the more common factors that exacerbate dissociative symptoms are negative stimuli, stress, subjective threatening social interaction, and unfamiliar environments. Factors that tend to diminish symptoms are comforting interpersonal interactions, intense physical or emotional stimulation, and relaxation.^[6] Some factors are identified as relieving symptom severity such as diet or exercise; alcohol and fatigue are listed by others as worsening symptoms.^[7]
Fears of going crazy, brain damage, and losing control are common complaints. Individuals report occupational impairments as they feel they are working below their ability, and interpersonal troubles since they have an emotional disconnection from those they care about. Neuropsychological testing has shown deficits in attention, short-term memory and spatial-temporal reasoning.^[8] Depersonalization disorder is associated with cognitive disruptions in early perceptual and attentional processes.^[9]