You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Of all psychiatric symptoms, depersonalization is one of the most tenacious and difficult to alter, either through psychotherapeutic or pharmacologic approaches. This alteration of the state of awareness of self would seem to be either a very primitive undifferentiated or a very complex function. Certainly the anatomo-physiological pathways for this alteration of consciousness are not clear. What is clear is that feelings of depersonalization are more widely experienced than is generally appreciated. It has been claimed, in fact, that this phenomena is the third most frequent symptom seen in hospitalized patients, exceeded in frequency only by anxiety and depression.1 it occurs as frequently in non-hospitalized emotionally disturbed patients. Often such feelings will only become apparent after very careful interviewing, since patients will not very often report these feelings spontaneously.
Depersonalization encompasses “all those states in which the individual becomes aware of changes in himself, bodily or mental or both, that lead to feelings of strangeness in himself”.2 Sometimes the patient complains of feeling numb, empty, strange, changed, or dead inside, or of not being able to feel any inner experiences. There is often the feeling of not being one's self or functioning in a mechanical, automaton or robot-like fashion. Things and events and even people, seem unreal (derealization). Frequently used descriptive phrases include such expressions as “foggy feelings,” “like being asleep or in a dream,” “make believe,” “a cloud or veil separates me from the world,” “like playing a part in a play.” Depersonalization has been compared to “playing dead,” although this characterization raises such questions as to the influence of volition and control, conscious or unconscious, and active role-playing.
One prime characteristic of depersonalization is the special form of alteration of consciousness or state of awareness. This is manifested by a disturbance in the perception