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Ask the Mental Health Expert Archives 2001-2004

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Dissociative States

Q. Somato-dissociative states are well-known. However, if one experiences an "out-of-body" state for weeks, is that considered to be a more serious condition? How do clinicians measure the seriousness of dissociative states?

A. What you are describing is usually termed a depersonalization experience. Depersonalization experiences appear to be quite common; e.g., about half of all adults may have experienced a single, brief episode, usually under extreme stress or danger. (In younger populations, transient depersonalization experiences may be associated with substance abuse or intoxication). These transient states (lasting minutes, hours, or perhaps a day or two) do not necessarily indicate a psychiatric disorder.

However, when depersonalization becomes persistent or recurrent, is accompanied by significant distress or impairment in function; and is not due to some other psychiatric or medical disorder, we usually diagnose Depersonalization Disorder (DD). This may involve "...a persistent or recurrent...feeling of detachment or estrangement from one's self...the individual may feel like an automaton or...[like]...an outside observer of one's mental processes, one's body, or parts of one's body." (DSM-IV).

There have not been a great many studies of DD. However, Simeon et al (Am J Psychiatry 1997 Aug;154(8):1107-13) studied 19 women and 11 men with DD, using the self-rated Dissociative Experiences Scale (DES), which is one way of gauging severity of dissociation. An age- and sex-matched normal comparison group was also studied. The mean age at onset of depersonalization disorder was 16.1 years (SD = 5.2). The illness had a chronic course that was usually continuous but sometimes episodic. Severe distress and high levels of interpersonal impairment were characteristic. Unipolar mood and anxiety disorders were common, but none emerged as specifically related to the depersonalization. A wide variety of co-morbid personality disorders was noted: avoidant, borderline, and obsessive-compulsive were most common. Although not highly traumatized, the subjects with depersonalization disorder reported significantly more childhood trauma than the normal comparison subjects.

DD tends to be quite refractory to treatment, though it may respond to SSRI type medication, such as fluoxetine or sertraline. Prolonged dissociative symptoms always raise the question of covert neurological or medical illness, such as complex partial seizures, temporal lobe tumor, etc. Thus, a thorough medical/neurological assessment is indicated prior to making a final diagnosis of DD.

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April 2002

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