How to Manage Depersonalization in Schizophrenia Treatment Treating depersonalization in people with schizophrenia involves treating schizophrenia, the root cause of this symptom first, says George Keepers, MD , a professor of psychiatry at Oregon Health & Science University School of Medicine in Portland and lead author of the American Psychiatric Association’s practice guidelines for the treatment of schizophrenia . Schizophrenia treatment includes a combination of antipsychotic medications and cognitive behavioral therapy for psychosis (CBTp). It also often involves psychosocial interventions like supported employment and social skills training, lifestyle changes, and self-care .e60dc2a1-f33c-4a05-9b50-8e3e8e5976293eebe356-d519-4506-8120-94b3cadd02bc “Successful treatment of psychosis will generally resolve experiences of depersonalization,” Dr. Keepers says. Some schizophrenia treatments and coping strategies that can be particularly helpful for managing depersonalization are: Medication The mainstay treatment for schizophrenia is antipsychotic medication. These medications treat symptoms of psychosis (a detachment from reality that can happen with schizophrenia) such as hallucinations and delusions.e60dc2a1-f33c-4a05-9b50-8e3e8e59762940d3ba55-e92a-4521-97b5-bdf7bcff88af Cognitive Behavioral Therapy for Psychosis CBTp is another crucial component of treatment. Research suggests CBTp can reduce the distress related to symptoms like depersonalization and improve day-to-day functioning. Some individuals experience depersonalization because they don’t have strategies or tools for how to navigate difficult situations, and therapy teaches new skills, Crawford says.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294550d44d-cd5a-46f1-8201-3c2481124d83 Grounding Techniques Gonzales teaches her patients grounding techniques to help them stay rooted in reality. Grounding techniques are strategies that activate the five senses: taste, touch, smell, hearing, and sight. Some effective examples are smelling a candle with a strong scent, holding an ice cube, or eating sour candy, because these intense sensations can help refocus your attention on the present moment. “It really brings you back into your own body,” she says. Other ways to keep yourself grounded, says Gonzales, include asking yourself questions, such as “Where am I?” or “Who am I?” or “What is the date today?”e60dc2a1-f33c-4a05-9b50-8e3e8e5976291789b1c9-9326-4fe6-84ed-69602383a406
Depersonalization is a common symptom of schizophrenia . Depersonalization-derealization disorder, which also involves a related form of dissociation called derealization, affects about 16 percent of people with schizophrenia, according to research.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a00a6744-b888-4409-88a4-0a1311a44e6a “It’s an experience of feeling detached from your mind, feelings, sensations — kind of like a sense of unreality,” says the clinical psychologist Lauren Gonzales, PhD , an assistant professor of medical psychology at Columbia University Irving Medical Center in New York City and the director of CBT for psychosis services at the New York State Office of Mental Health. “People often describe it as feeling like you’re an outside observer, looking in at yourself.” Here’s what to know about the symptoms and causes of depersonalization, and how to manage it if you or a loved one experiences this symptom.
What Is Depersonalization, and What Does It Look Like in People With Schizophrenia? Symptoms Depersonalization is a state of mind in which individuals feel disconnected from themselves.e60dc2a1-f33c-4a05-9b50-8e3e8e59762907a5ed69-6c5c-4cde-b83c-52eb87f6c73c “It’s as though you’re watching yourself navigate the world, like you’re watching a movie,” says the adult and child psychiatrist Christine Crawford, MD , an assistant professor of psychiatry at Boston University Chobanian & Avedisian School of Medicine and the associate medical director at the National Alliance on Mental Illness. Symptoms can include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762907a5ed69-6c5c-4cde-b83c-52eb87f6c73ce60dc2a1-f33c-4a05-9b50-8e3e8e597629d66e9f56-70a4-4f59-8e51-e9dbcf88a014 Disconnection from your thoughts, feelings, and body Feeling robot-like Emotional and physical numbness Distrusting your memories An inability to describe or identify with your emotions or experiences Feeling like you’re observing your life from outside your body or that you’re living in a dreamworld Sadness or anxiety In schizophrenia, depersonalization may appear in different ways. For instance, you or a loved one with schizophrenia may feel disengaged, overwhelmed by strange physical sensations, or fail to recognize oneself in a mirror.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e4eea636-2f30-442e-9cb0-288716778da3 “People describe this kind of permeability of solid objects: like things appear as if they’re melting — but it’s not necessarily a hallucination, it’s more a sense of unreality,” Dr. Gonzales says, citing research from a project called Psychosis Outside the Box , in which researchers documented firsthand accounts of psychosis and symptoms of depersonalization. Someone experiencing depersonalization may also seem completely preoccupied, despite being in the same room with you or in the middle of a conversation, Dr. Crawford says. “It’s like something is playing out in their head and they’re trying to work it out,” says Crawford. “And because they’re so preoccupied by that internal experience, they are detached from what’s happening in their present, current moment.” Earlier research has suggested that depersonalization may happen more frequently, more intensely, and for longer periods of time in the early stages of schizophrenia, and that it declines as the disorder becomes chronic. More research on larger groups of people is needed to confirm this finding, however.e60dc2a1-f33c-4a05-9b50-8e3e8e59762990b209d0-c835-4f71-8bc3-c34d36019b0d Depersonalization is especially common among those who’ve experienced trauma . In some people, trauma has impacted the brain so much that it protects the person by detaching from the body, says Crawford. Estimates suggest 25 to 54 percent of people who have a history of interpersonal abuse experience depersonalization.e60dc2a1-f33c-4a05-9b50-8e3e8e597629956f525e-7dfe-444b-b97e-c1a55ad6730e
What Causes Depersonalization in Schizophrenia? Causes As mentioned, depersonalization frequently occurs as a defense mechanism in response to trauma, either in the immediate moment or due to a traumatic memory. “It comes from a very helpful, adaptive, and protective place,” Gonzales says. “It’s your body and brain’s way of protecting you and taking a break when you don’t have anything else to regulate your emotional experience.” If, for example, someone is overwhelmed by an interaction with another person that reminds them of trauma they experienced, this may trigger an episode of depersonalization in which their brain steps away from the experience as an act of self-preservation.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294216b5fe-1021-48df-80e2-3fbec50e8059 Research also suggests that people with schizophrenia who experience “passivity phenomena,” or the feeling that your actions, thoughts, or perceptions are being controlled externally by someone or something else, are more likely to experience depersonalization.e60dc2a1-f33c-4a05-9b50-8e3e8e597629974ca8d6-0667-4d95-ac34-a22bc9f3f3da Some other possible causes of depersonalization symptoms are:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e8419158-cbc1-4580-be5a-4503bbdcb6fe Extreme stress from personal or work-related situations Persistent anxiety or depression Illicit drug use
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