DEPERSONALIZATION

From Big Medical Encyclopedia

DEPERSONALIZATION (Latin the de-prefix extraction, destruction + persona the personality, the person) — the psychopathological disorder of consciousness with subjective feeling of alienation of own personality realized and painfully endured by the patient; symptom of a number of mental diseases. Is followed by the aggravated introspection, complaints to difficulty of the description of the state, its characteristic as unusual, a tendency to figurative comparisons at the self-description. Is often combined with derealization (see).

The clinical picture

differs in D. big psikhopatol. variety and heterogeneity. The materialistic ontogenetic concept of consciousness of Sechenov allocating sensual and cognitive his forms allows to differentiate the main psikhopatol, the types D. which are most adequately reflecting its wedge, patterns. At the I type D. alienation extends to the most sensual («health», according to I. M. Sechenov) spheres of consciousness. Loss of feeling of activity — feeling prevails that all actions, acts, the movements, the speech are made as if automatically, in addition to own will. During the strengthening of this disturbance there is a feeling of bifurcation, patients note that in them as if in parallel there are two personalities, two rows of sincere processes develop at the same time. The most expressed state is characterized by so-called feeling of loss of existence. Patients at the same time say that they as though do not feel reality physical at all. and spiritual existence, all their life is as if a dream. The I type D. is often combined with neurotic manifestations: uneasiness, vegetative frustration, persuasive introspection (sometimes is defined as neurotic D.).

At patients the criticism completely remains, changes of the personality are not noted or are expressed unsharply. Neurotic D. is characterized by relative ease of a current with dominance of tranzitorny attacks or long low-progreduated states.

At the II type D. alienation substantially extends to later in ontogenetic sense ideatorny («cognitive», according to I. M. Sechenov) spheres of consciousness — alienation of conscious idea of the «I», feeling of loss of individual specificity, social communications. At easy degree such D. prevails the feeling of own izmenennost which is followed by feeling of difficulty of contacts with people. Patients perceive themselves not such as before, become scanty intellectually and spiritually, strangers among people. At the developed picture there is a feeling of full loss of idea of the «I». Patients complain that they as if completely lose own outlook, views, judgments, become faceless people. Haug (To. Haug, 1939) considers that this type D. differs in the greatest weight. Changes of the personality at this type D. are expressed most clearly. Introspection has supervaluable hypochiondrial character that testifies to incomplete criticism. The current has the greatest tendency to a progrediyentnost due to development of negative changes and positive frustration.

The III type D. — mental anesthesia [anesthesia psychica dolorosa, according to A. Schafer]. In psikhopatol. the relation the most characteristic phenomenon of mental anesthesia is alienation of «the highest emotions» (according to M. I. Astvatsaturov) — feelings to people, events, the nature, joy or grief, etc. In an initial stage or at easy forms of this frustration the feeling of emotional insufficiency, a prituplennost prevails. Further development of psychological anesthesia is characterized by feeling of loss of feelings — patients subjectively experience full loss of consciousness to close people, loss of ability to feel pleasure and displeasure, joy, love, hatred or grief, figuratively call themselves by «live corpses». Mental anesthesia meets most often at the next and long depressions. Anestetichesky depressions usually proceed periodically and, despite long character, seldom accept a continuous current.

The etiology and a pathogeny

D.'s Aetiology is difficult and depends on its type. In an etiology of the I type D. exogenous factors — an emotional overstrain, organic lesion of c prevail. N of page, intoxication the substances causing changes of consciousness, etc. Emergence II and III types D. is caused by hl. obr. internal causes.

In D.'s development an essential role is played by various features of the personality: at the I type — infantility, hysterical lines, tendency to fear reactions; at the II type — schizoid lines, a hyperesthesia, the increased introspection; at the III type — along with a hyperesthesia tendency to affective lability. II of type obviously prevails at youthful age, is preferential at men. III of type it is characteristic of persons of mature age, meets at women a little more often.

The diagnosis is made on the basis a wedge, manifestations. The I type D. is most characteristic of neurotic conditions and organic diseases of c. N of page, the II type — for schizophrenia, the III type — for endogenous depressions.

Should be differentiated with a syndrome of mental automatism of Kandinsky — Klerambo (see. Kandinsky-Klerambo syndrome ). Unlike the last, at D. the individual experiences feeling of alienation as purely subjective state, without feeling of perfection and outside influence.

Treatment

Treatment of diseases decides on D. by character of a basic disease and type D. Tranquilizers, neuroleptics with a small psikhofarmakol, activity and antidepressants of a broad spectrum of activity are applied.

The forecast

the Forecast of diseases with D. in most cases favorable. Only at schizophrenia (see) and organic diseases of c. the N of page when there occur the expressed negative changes or develops psychotic symptomatology, as a rule, full or partial disability is observed.


Bibliography: Sparrows V. Yu. About one of options of the juvenile schizophrenia proceeding with dominance of the phenomena of depersonalization, Zhurn, a neuropath, and psikhiat., t. 71, century 8, page 1224, 1971, bibliogr.; Mag-r and I would be A. A N. Depersonalization, Yerevan, 1962, bibliogr.; Sechenov I. M. Chosen philosophical and psikhologiches-sky works, page 388, M., 1947; Smulevich A. B. and Vorobyov V. Yu. Depersonalization, Zhurn, neuropath, and psikhiat., t. 73, century 8, page 1242, 1973, bibliogr.; Depersonalisation, hrsg. v. J. E. Meyer, Darmstadt, 1968, Bibliogr.; von Gebsattel Y. E. Zur Frage der Depersonalisation, Nervenarzt, Bd 10, S. 169, 1937; G 1 a t z e 1 J. Zur Differential-typologie juveniler asthenischer Versagens-syndrome, Schweiz. Arch. Neurol. Neurochir. Psychiat., Bd 104, S. 151, 1969; H a-u g K. Depersonalisation und verwandte Erscheinungen, Handb, d. Geisteskr., hrsg. v. O. Bumke, Bd 1, T. 1, S. 134, B., 1939; Tucker G. J., H a r r o w M. a. Quinlan D. Depersonalization, dysphoria and thought disturbance, Amer. J. Psychiat., v. 130, p. 702, 1973.

V. Yu. Vorobyov.

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