What are the difficulties in understanding yourself

psychology : Living in the wrong movie

When Laura Bergmann (name changed) walks out of the house, it is not she who walks across the street. It's this strange body that does it all on its own. At least that's how it seems to her. Laura Bergmann has had a depersonalization disorder for two years. The overwhelming feeling of alienation from your own body even affects your own sensations: “I know when the body is in pain. But these are not my pains, they do not affect me. ”Just like one's own body, the outside world usually appears surreal and inaccessible with illness. That is why one speaks of the "depersonalization and derealization syndrome". In addition, events often seem to happen in slow motion or in fast motion. However, these are not delusions, because those affected know that the cause lies in their own perception. That is precisely why they are often afraid of losing their minds. But when they go to the doctor, the disorder is often misunderstood and instead diagnosed with depression, for example. The disease is neither new nor rare. It was described in psychiatric literature as early as the mid-19th century. Recent studies have shown that one to two percent of people in Western countries have symptoms of depersonalization disorder. As a result, there could be more than a million people affected in Germany.

Marijuana also triggers states of alienation

However, anyone who has ever experienced a state of depersonalization for a short time need not worry. Such temporary experiences are not uncommon. They occur mainly when there is great tension, but sometimes also in moments of exhaustion. Drugs like marijuana also typically trigger states of alienation, which are usually perceived as pleasant.

Depersonalization, on the other hand, is less harmless if it occurs as an accompanying symptom of mental illnesses such as panic attacks and anxiety disorders or some neurological complaints such as migraines and dizziness. However, one speaks of a depersonalization disorder only when frequent or continuous feelings of alienation cause the greatest suffering. Most of the time, the disease develops in adolescence. In some cases there is a certain trigger, such as a panic attack or a drug experience (usually a "bad trip"), after which the feelings of alienation do not want to go away. The Cambridge Depersonalization Scale, a questionnaire developed by the psychiatrist Mauricio Sierra-Siegert together with his colleague German Berrios, has proven itself in diagnosing the disorder.

Protective mechanism of the brain

Sierra-Siegert is convinced that the disease is based on a protective mechanism in our brain. He regards depersonalization as the counterpart to the fight-or-flight response for dangerous situations in which fight or flight is not possible. Then the brain switches to autopilot mode, so to speak, and lets us continue to function in this way without being paralyzed by feelings of fear. A vivid example of this is provided by reports of survivors of major accidents or acts of violence collected by researchers at the University of Iowa in 1977. Almost three quarters of those questioned reported symptoms of depersonalization in the face of death, such as the following description: “I heard the glass shattering as if in slow motion. I felt like I was floating and leaving reality. In this state I had no control over my body, but everything seemed to run in harmony. ”When this useful mechanism becomes permanent, a depersonalization disorder arises. Typically this happens when people are stuck in a difficult life situation and feel helpless. When the disorder sets in, they often get into a vicious circle because the symptoms make them feel even more helpless.

The state of depersonalization can also be seen in the fact that those affected show unusual and usually weaker physical reactions than healthy comparators when they see disturbing images. It seems that, on the one hand, they tend to have strong feelings of fear, which, on the other hand, are largely eliminated by the depersonalization. A look into the brain shows that certain areas of the prefrontal cortex are overactive, one of the tasks of which is to control emotions. These areas send inhibitory signals to the brain's emotional centers such as B. the anterior insular cortex and the amygdala. As a result, those affected not only feel dull and indifferent, but they also lose the emotional coloring of the world. Usually, even the smallest things trigger an emotional response in us that signals what we are comfortable with and what we should rather avoid. If this emotional response is missing, then the world no longer seems to have anything to do with us - it appears unreal.

Always on alert

Regions in the anterior parietal lobe of the brain, on the other hand, are responsible for the feeling of alienation in relation to one's own body. The angular gyrus, for example, has the task of comparing the extent to which our actions correspond to our intentions. If our actions go differently than intended, the angular gyrus will sound the alarm. In patients with depersonalization disorder, it appears to be in a constant state of alarm. This could explain why it seems to them that they have no control over their actions.

The fact that we normally perceive ourselves as a single person here and now in the world is obviously due to a highly complex interplay of different brain regions. If it is disturbed, reality can slip away from us from one day to the next. So it is no wonder that the experience makes many of those affected existentially insecure. “I wonder whether the normal state is the real illusion,” ponders Bergmann. Nevertheless, she wants nothing more than “to finally feel like a person again”.

Relief from behavior therapy and medication

With the current treatment options, she has a good chance of at least achieving significant relief. Behavioral therapy helps patients better understand their illness and break out of the vicious circle of fear. They can also work through the fears and self-esteem problems that often underlie depersonalization disorder. In many cases, additional treatment with medication makes sense. Since different neurotransmitters are involved in the brain processes of depersonalization, there are very different groups of active substances to choose from. A combination of antiepileptic drugs and antidepressants as well as opioid antagonists or anxiety relievers have a good effect. However, the various remedies only work on some of those affected. Therefore you have to try out for each patient individually what will help him or her best. In studies, transcranial magnetic stimulation also has an effect. Magnetic coils stimulate the brain regions affected by the depersonalization through the skull. However, research into depersonalization disorder and the search for treatment options is only just beginning. Psychiatrist Sierra-Siegert is nevertheless confident: "The disease is slowly emerging from its shadowy existence."

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