TMS treatment for depersonalisation disorder

Depersonalization/ derealization is a dissociative disorder, defined in the DSM-IV as “persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body.

‘feeling like one is in a dream’

Thus it is the experience of feeling a detachment from their sense of selves and their reality (depersonalization), or their perception of the world (derealization). It is characterised by emotional numbness and a disruption in self-awareness.

Symptoms of DPD can include:

• Feeling as though the world around you is unreal
• Feeling as though you are watching your life in a film
• Feeling disconnected from parts of your body or your emotions
• Seeing objects distorting or changing in appearance

Symptoms of depersonalization disorder are initially episodic but become more frequent and severe over time, with symptoms fluctuating, but never being entirely absent.

Symptoms can affect people on five levels:

1. Emotional
2. Cognitive
3. Physical
4. Behavioural
5. Environmental

Whilst the cause of depersonalization disorder is still not known, there are a number of factors thought to increase the risk of it developing, including:

• Severe trauma
• Severe stress
• Depression or anxiety
• Recreational drug use

Depersonalisation disorder is notoriously difficult to diagnose, as the symptoms can often be mistaken as other conditions. Each sufferer will experience different symptoms, which can often leave you feeling like you're sleepwalking through life.

DPD can co-occur with a range of other mental and physical disorders. However, it is when the symptoms are experienced persistently and recurrently, independently of other mental (schizophrenia, panic disorder) or physical disorders (epilepsy) that it is considered a disorder.

• Onset is usually over the age of 30
• Patients typically exhibit nihilistic delusions
• Perceptual anomalies may be present

People suffering with depersonalization disorder will experience symptoms of depersonalisation, derealisation or both.

Depersonalization: feeling detached from one’s body, feelings, thoughts, sensations. E.g. being unable to recognise oneself in a mirror, or feeling as though it is not them. Patients may feel like an outside observer to their life or feel disconnected for their memories and emotions.

- “A feeling of being fundamentally wrong in your own body”
- “Separate from myself”
- “Like a robot”
- “It feels like my limbs do not belong to me”
- “I do not feel an emotional connection”

Derealization: feeling detached from their surroundings, a sense that things are unreal. Patients may feel as though they are in a dream or a fog, or like there is glass wall between them and the world. Derealization is often experienced in conjunction with blurred vision or perceptual distortions.

- “Everything appears flat or in 2D”
- “My head feels full of cotton wool”
- “Everything is wavy”

Other typical symptoms of derealisation include:

- Difficulty in concentrating
- Loss of emotional reactivity
- Anxiety
- Autoscopy
- Fear of going ‘crazy’
- Emotional numbness

Treating depersonalization disorder is not straightforward, as it is a complex issue. Traditional treatment options are:

• Medication – There are currently no recognised pharmacological treatments for depersonalization disorder. In some cases antidepressants, specifically SSRI’s may relieve some symptoms
• CBT (Cognitive Behaviour Therapy) - This counselling/talking approach with a psychologist or therapist addresses the patterns of thinking that are associated with one’s behaviour and offers a range of techniques and strategies to change these negative thought processes. The therapy involves reducing avoidances, safety behaviours and symptom monitoring. Research for CBT as a treatment for depersonalization has shown some positive, though limited results.

Repetitive Transcranial Magnetic Stimulation – rTMS offers an alternative, medication-free treatment.