Depersonalization "Ask The Expert"

 

Here you may ask questions and receive responses from qualified professionals who are experienced with depersonalization disorder. 

Our first guest, Elena Bezzubova, is a Russian psychiatrist (M.D., 1980) with 20 years clinical, teaching and academic experience. She has taught clinical psychiatry, clinical psychology, literature-psychiatry-psychology and social psychology. Her primary academic topics include depersonalization (Ph.D. 1987), philosophy-psychiatry interrelations, and existential psychiatry. In 1999-2000 she was an International Fellow (International Fellowship in Medical Education) at the University of California Irvine (UCI) and Yale University. She is currently a Clinical Assistant Professor at UCI and Clinical Associate, Southern California Psychoanalytic Institute. She is involved in international activity in philosophy and psychiatry and is available to see patients in person in Southern California.  (RP 98, Medical Board of California)

Questions gathered on Mondays through Thursdays will be addressed the following weekend, time permitting. 

Disclaimer: Responses to questions are the opinion of a qualified professional, based on content of the query and/or additional information provided by those seeking information. These responses are not to be interpreted as formal diagnoses, nor will visiting experts, nor depersonalization.info, be responsible for any actions or circumstances arising out of the posting of any information contained herein.

Feel free to send your question to us at : info@depersonalization.info

 

I'm wondering if any meds that are used for treating mental illnesses other then Depersonalization Disorder may make the DP worse for those of us who experience it as a symptom of other disorders. Specifically, I'm taking anafranil (150mg) for panic attacks and OCD and my psychiatrist is considering putting me on a small dose of lithium since he suspects I'm bipolar; I'm wondering if the lithium will upset the dp more then it already is (24/7 for about a month, but in varying degrees). I'm sure, though, that the rest of the people on this board would like to know about any other psychiatric meds that they should watch out for. I know that everyone has different reactions to meds, but are there any that consistently cause problems? 
ANSWER: There isn't really sufficient data yet to give a clear picture of which prescription medications might cause depersonalization. The data rather vary. Imipramine may provoke experience phenomenologically similar to depersonalization (typically accompanied by anxiety), though some psychiatric approaches successfully use imipramine to treat depersonalization (again typically accompanied by anxiety). Carbamazepine sometimes may help to diminish depersonalization presentations of a certain type (often linked to depression), but some patients taking carbamazepine for other reasons (often mood disorders) could develop side-effects which would exhibit depersonalization-like symptoms. This "two-ended-dialectic" also works for some stimulants—the very substances which could induce depersonalization-like-experience in some cases might help to combat the forms depersonalization that exhibit apathy and low energy.  

Nevertheless based on my clinical observation stimulants might be seen as drugs that should be studied further regarding depersonalization disorder.  

A combination of clomipramine (Anafranil) and Lithium is used widely in Europe and well-known in North America. For psychiatric schools, a combination of antidepressants and mood stabilizer is the traditional way to deal with depression & depersonalization. (This combination is the basis of the so-called "Newcastle cocktail." The third part of this cocktail is not available currently in the USA.) As with other mood stabilizers, lithium, in general seems to benefit patients with depersonalization.  

In conclusion— back to your question. You articulated an absolute medical imperative. That is, everyone is different and has different reactions to medication. So my comments here based completely with that in mind. 
I hope you can offer some help. My husband and I are due to visit a psychotherapist here in London tomorrow but I'd like to gather as much information as I can on the topic. Obviously it's hard for you to get a complete picture without knowing or seeing him, but here goes: my husband had an episode a few weeks ago where he felt his emotions wipe themselves, like a hard drive in a computer. He then went to a clinic in the States, where they diagnosed him with Dissociative Identity Disorder and that they said he had the rare genetic type that was incurable. Naturally he is devastated – shell-shocked, and so am I (especially as he worries he will never get his old self back, as he says this has happened before and he never came back to himself then). To me, from the bits I've read on the Net, it sounds more like Depersonalization Disorder. Perhaps a mix. But to say there is no hope and that I should get out of the marriage while I can - as it'll only get worse, and also as he may feel overcome one day and just walk out - is devastating.

As I say, we're seeking further advice - neither of us can go on like this, and my husband needs some sort of life back. As it is he's lost his job (he always had real trouble keeping one down; luckily the ones he did have have been well paid) and feels like a blank. Any advice would be most appreciated. 

ANSWER: Thank you for inquiry. I hope that your visit to the psychotherapist was helpful and opened some positive perspective for your husband and you.

I understood from your letter that your husband is going through painful and devastating mental experiences, and that both of you are upset and concerned about his mental well-being, your emotional reaction to it, and the future of your relationship. Understandably, one would need considerably more information about your husband’s experiences to come to any specific diagnosis or therapeutic suggestions. It is always risky to make any clinical judgments by correspondence but I will try to do what I can if you would describe your husband’s symptoms in more detail.

You might want to follow up by providing the following information:

  1. Your husband's current complaints with a detailed description of what he is experiencing.
  2. How did the current episode appear— under what circumstances, emotional triggers, psychological traumas, tiredness, etc. How long did the episode last, and how has the experience changed during the episode.
  3. What is the history? Please add a detailed description of any earlier episodes in your husband’s life.
However "impossible" it feels right now, try to stay calm and hopeful. Many medical problems are very difficult to cure. Nature is still the most miraculous element in mental health— with time, the most torturing states might be resolved spontaneously. This of course does not mean that there is no need for psychiatrists. They are your first and main resource to reach recovery. This just to encourage you to keep hope and to keep looking for help for your husband and yourself. 
Hello,

My question pertains to the origin of DP. Do they know if is due to a chemical response in our body and what part of the brain is effected. Also because many of us have a obsessive and anxiety component does cognitive therapy help. Finally have there been any studies done to determine why relapses occur after successful recoveries?

Thanks you for your help. 

ANSWER: The problem of origin is a kind of universal medical puzzle. The origin of depersonalization is a special puzzle. Some types of depersonalization occur after psychological trauma or stress. Particular types of depersonalization might be provoked by some medications or chemical substances or drugs. Other types are related to depression or obsessive-compulsive disorders (OCD). There can also be signs of depersonalization in the course of such disorders as schizophrenia, bipolar disorder, characterological disorder, and some others. So there is no simple answer in terms of the specific origins of depersonalization.  

You are correct about the link between depersonalization, anxiety and obsessions. Some doctors believe that this chain could work as a vicious circle. Also, patients with depersonalization often have a highly developed sense of self-reflection and self-analysis. In a way (at least theoretically, in vitro) it does look like good ground for cognitive therapy. But practically (in vivo) the results of cognitive therapy are not sufficiently better than the results of other therapeutic techniques.  

The question about relapses is close to the question about the origin. It is a natural aspect of many medical conditions, including depersonalization, to return and reappear. On the other hand, there is another phenomenon of medical conditions (which sometimes happens in regards to depersonalization) —that is, for the condition to disappear spontaneously, without any reliable relation to treatment.  

But please keep in mind that the facts noted above should not by any means be interpreted as pessimistic. Appropriate treatment, over an appropriate period of time has helped many patients. It is crucial to work with a physician you feel attuned to, and in whom you have complete confidence

I am 17 years old and I have read the symptoms of depersonalization. I have most of them. I've had them for a few months but I have not told anybody, hoping this would go away on its own. It has actually gotten worse, so now I want to tell my parents. My question is, where exactly do I get help for this? Do I go to my regular doctor, and what will happen? What can they do for me?

Thank you.

ANSWER: It is a good idea to share your experience with your parents. Usually the first step to get help with depersonalization is to consult a psychiatrist, preferably the one who has some expertise in the subject. Depersonalization is not a very "popular" medical category, so it is better to have a doctor who is familiar with this disorder. Of course if you feel confident to deal with your "regular doctor" (primary care or family practice, probably) you could start from consulting him or her.

You sound like an attentive and responsible patient, well-suited to the process of treatment. Hopefully you will get good help and will feel better soon

I stumbled upon your site; but then again nothing is by accident. As I read on, I felt myself getting anxious, slipping deeper into the fog that I am already in. This indicates to me that I am indeed getting close to the source of my affliction. Whenever I feel that I am getting close to exposing the falseness of my ego or becoming enlightened, authentic, here it comes. Full-blown and strong as if a separate entity (my ego, I suspect) is defensive about being exposed for fear of losing it's identity or life.

I grew up with a father who was always working and when he was present, he focused on my inability to be poised, beautiful and thin. My mother, a controlling, overprotective woman struggling with some sort of bipolar, multiple disorder herself, spent her time putting me down, being overcritical, comparing me to others and manipulating me to fulfill her lost life. I lost my identity very early in life. When I look at pictures from the past, I see hollow eyes. A body with no identity - just going through the motions to make it through another day. I was smart enough to know that at my fragile state and young age, I was no match for my mother.

I am a survivor contrary to my words of depression, my thoughts of defeat. I have survived all these years protecting "me" deep inside like a precious jewel until the time was ready for me to come out. I did this by retreating, isolating and slipping into dysmorphia and an eating disorder in an attempt to please either of my parents since beauty was so valued by them.

Fueled by an eating disorder for 30 years - it becomes my only relief and torturer. I prefer pain, because if I feel, I can pretend I am alive. All of my senses are numb. My thinking cloudy, my memory very selective and my fears great. I have run the gamut of drugs, Paxil, Prozac, Luvox, Wellbutrin and now Zoloft and they all magnify and make my disorder worse.

I have done traditional therapy as well as hypnosis, sand tray, rebirthing, EMDR, meditation, past life regression, paraliminal tapes, Reiki and now I am experimenting with the Center Pointe Holosync CDs. Very interesting - they are the closest I have come to seeing movement in my disease. The irony however is that the more I work at living rather than existing, I slip deeper into this fog. It is as though I am possessed and this alternative personality is keeping me from discovering who I am. I realize that this alternate entity is my powerful ego, afraid of annihilation, but I have tried getting past it through back doors.... It is so powerful.... So AFRAID.

Everything I have tried produces the OPPOSITE effect of what it claims to do. Quite bizarre.

Do you have any additional rescues, meds, therapy, hope?

ANSWER: Thank you for your fascinating letter. You do know what you are writing about. The list of treatments you have come through is impressive. There are a lot of different medications which could give some relief in many cases. Certainly therapy is at least good support for going through life. As you are probably aware the only way to check on better regime of meds or therapy is to consult a psychiatrist in person.  

As for resources and hope - in a way depersonalization could be considered as a way to hope. Depersonalization is the state when the eternal questioning of reality, presence, and authenticity is just an attribute of the experience of personal being. A person experiences all these via her own body and soul. The way you are able to feel, guess and understand is a good basis for hope.

Hopefully you would meet a psychiatrist/therapist who would attune to your persona.  

6 months ago I had my first Panic attack. I was then Diagnosed with Hypothyroidism, and an Anxiety Disorder. I currently take Ativan, and Synthroid. I did take Paxil Cr for a while, but it did not help. I started to experience the DP about 2 months ago. I woke up one morning and things just weren't right. My DP episodes usually last about a week. then I'm normal again. It has been happening like this for months. My main symptoms are dizziness, spacey, feeling not real, feeling detached, seeing things differently. This puts me in a VERY depressive state. My main questions for you are: Would you recommend using medicine? Why do you think I get these DP feelings in short episodes? Is there anything I can do to relieve these symptoms' severity, or keep from getting them at all? I know you have a lot of questions to answer, I truly appreciate your help and insight. I felt like I had lost hope until I came across this website. Thank you~ Sincerely, Erica
ANSWER: In many cases the very cause of depersonalization is never found. It is true for many disorders. For now it is clear that you have experiences you describe instinctively and these experiences are very disturbing and destructive for you. The symptoms you depicted look like depersonalization, derealization, anxiety and there might be some agoraphobic signs. They may also be suggestive of depression. The best way to look for help is to visit a psychiatrist. He or she will help to find the most adequate medication and therapy. For the majority of depersonalization cases, medication is the basic treatment tool. What you could do to help yourself is to find a psychiatrist who will understand and help you and to be a good patient who follows treatment plan. And it is strongly important to be positive, to support yourself, and to have your hope and to strengthen this hope. Stay in touch with the site!
 
I was in therapy for a year or so to deal with some issues I had re: my life. While in therapy, I was diagnosed with DDNOS. I have DP nearly every day and have had for as long as I can remember (I am now 28). At the end of my stint in therapy, my therapist said that, after all the work we'd done, the DP should have abated by now, and she didn't know what else to do. She said that I would probably have some dissociation for the rest of my life.  

I am not on any medication, nor have I ever used any kind of illegal drugs. The only time my symptoms felt any better was when I was going to therapy every week -- I felt like my emotions started coming out, and the DP lessened a bit. Obviously I can't stay in therapy for the rest of my life -- what should my next step be? 

ANSWER: Issues of life are something we all deal with. What those issues are can have a direct effect on whether a person develops Dissociative Disorders as you’ve described. (Often DID and other Dissociative Disorders are linked to early abuse of some form). Depersonalization can be quite a persistent condition. You have an option to see a psychiatrist and to discuss your treatment plan, including therapy, with him or her or you certainly could continue the current therapy. It sounds like the therapy is being a real help which is a good sign. Depersonalization is considered a dissociative disorder, so dissociation is rather typical for this state. Therapy can be a helpful tool to work with dissociation. Perhaps instead of pessimistic reflection on life-long therapy you may focus on positive effects of therapy that could open up a better perspective. 


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