Higher levels of a lessened sense of reality and being easily immersed can occur. Causes
The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. It has been thought that depersonalization can be caused by a biological response to dangerous or life-threatening situations which causes heightened senses and emotional numbing. Psychosocial
There is growing evidence linking physical and sexual abuse in childhood with the development of dissociative disorders. Childhood interpersonal trauma – emotional abuse in particular – is a significant predictor of a diagnosis of DPDR. Compared to other types of childhood trauma, emotional abuse has been found to be the most significant predictor both of a diagnosis of depersonalization disorder and of depersonalization scores, but not of general dissociation scores. Some studies suggest that greater emotional abuse and lower physical abuse predict depersonalization in adult women with post-traumatic stress disorder (PTSD). Patients with high interpersonal abuse histories (HIA) show significantly higher scores on the Cambridge Depersonalization Scale, when compared to a control group. Earlier age of abuse, increased duration and parental abuse tend to correlate with severity of dissociative symptoms. Besides traumatic experiences, other common precipitators of the disorder include severe stress, major depressive disorder, panic attacks, and psychoactive substances. People who live in highly individualistic cultures may be more vulnerable to depersonalization, due to threat hypersensitivity and an external locus of control. Neurobiology
There is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the basis of emotional experience.
Psychoeducation involves counseling regarding the disorder, reassurance, and emphasis on DPDR as a perceptual disturbance rather than a true physical experience. Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (SSRI), benzodiazepines, stimulants and opioid antagonists (ex: naltrexone). Cognitive behavioral therapy
An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. A standardized treatment for DPD based on cognitive behavioral principles was published in the Netherlands in 2011. Medications
Neither antidepressants nor antipsychotics have been found to be useful; additionally, antipsychotics can worsen symptoms of depersonalisation. Tentative evidence supports use of naloxone and naltrexone, as well as gabapentin.A combination of an SSRI and a benzodiazepine has been proposed to be useful for DPD patients with anxiety.Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). However, clinical trials have not been conducted. Repetitive transcranial magnetic stimulation (rTMS)
Some studies have found repetitive transcranial magnetic stimulation (rTMS) to be helpful. One study examined 12 patients with DPD that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment. Five of the participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. Treating patients with rTMS specifically at the TPJ may be an alternative treatment.