The copyright to the original version of this article is owned, and was originally published by Counselling Directory.

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Trauma and Depersonalisation​

 

Depersonalisation remains a mystery. Even those who keep up with the ever-expanding psychodiagnostic terminology may be unaware of the term's existence in a therapeutic setting. Nonetheless, it is the third most prevalent mental symptom, trailing only anxiety and depression.

 

Depersonalisation is a subjective state in which one feels alienated from themselves. It is impossible to describe to someone who has not personally experienced it. It might last anywhere from a few seconds to years. It is frequently described as frightening and severely debilitating. Some people believe they are losing their minds, are suffering from psychosis, or have symptoms of a brain tumour.

 

What does depersonalisation feel like?

 

Those suffering from depersonalisation use similes in an attempt to describe their experience. Such usages demonstrates the person's understanding that something appears to be the case despite knowing it is not. This helps to distinguish between depersonalisation and psychosis. Some examples of this are:

 

"It feels like I don't exist."

 

"It feels like I don't have any thoughts or emotions."

 

"It's like  my hands don’t belong to me."

 

"It's like my reflection isn’t of me, but that of a stranger."

 

Depersonalisation Risk Factors

 

Acute depersonalisation is considered to last only a few days, but chronic depersonalisation might last for weeks or even years. Severe stress, sleep deprivation, and acute traumatic events, such as natural disasters, can all lead to acute depersonalisation. Cannabis is a common cause of acute and chronic diseases.

 

Although acute traumatic experiences can produce long-term depersonalisation, chronic depersonalisation is more common in situations of persistent and early interpersonal trauma, including childhood emotional abuse. As a result, such abuse may predispose certain persons to experiencing longer periods of depersonalisation.

 

Predisposing factors are often subtle and insidious forms of emotional abuse. One form of emotional abuse is a caregiver's failure to respect a child's boundaries. Another situation involves the caretaker manipulating the child to raise or regulate their own self-esteem. These caretakers are described as the "helicopter parent" or the "stage mother". This later type encourages the child to appreciate others' viewpoints over their own subjective experience. The child reduces the perceived risk of humiliation, rejection, or hostility by paying close attention to the wishes of others.

 

Dissociation and the Fear of Feeling 

 

Alexithymia, or difficulty recognising, naming, or experiencing emotions, is a common sign of depersonalisation. When asking someone in a detached or depersonalised state how they feel, it is not atypical for them to not be able to identify or articulate this. When speaking about disturbing and unpleasant life experiences, their voice tone and pace may be deadened, monotonous, or limp. Alexithymia is most commonly mobilised to protect people from painful emotions, either deliberately or unconsciously.

 

"Affect phobia” is a strong fear of particular emotions. Certain emotions may be perceived as intolerable or dangerous because they were previously judged inappropriate to express. The expression of a certain emotion may have prompted a parent to withdraw from or behave adversely towards their child. 

 

Anger is viewed as risky when it results in retribution, retreat, or violence. Anger cannot be felt or expressed because the child has intuitively realised that anger is incompatible with achieving basic developmental goals. When some feelings are judged detrimental for legitimate reasons, it is preferable to shut them out since this minimises the possibility that they will be acted upon.

 

During childhood, this has a survival function. Adulthood has the potential to alter one's view of previously dangerous sensations. As a result, shutting off emotions is viewed as dysfunctional or useless protection. The alexithymia and affect fear linked with depersonalisation are significant and serve a function. They hinder the individual from feeling or realising that they are experiencing a certain emotion. Previously, the sensation posed a threat to the individual's survival. Cutting oneself off from emotions is an unconscious activity. It derives from a previous, implicit awareness that expressing such emotions may mean the difference between life and death.

 

Therapy for Depersonalisation

 

Psychodynamic therapy is regarded to be especially beneficial for depersonalisation when alexithymia or affect phobia have developed rigid and pervasive features and defences. Case studies have established the efficacy of an affect phobia-based approach in such circumstances. Treatment should begin with the recognition that alexithymia and affect phobia should be treated and respected for their functions rather than attempted to forcefully eliminate it. 

 

An attuned therapist will observe changes in body language, microexpressions, and tone of voice. Attunement to these oscillations allows the practitioner to recognise when a dissociated emotion was briefly experienced or rejected. In such circumstances, the practitioner and client might collaborate to determine whether emotions were temporarily felt or shut out of consciousness. The more the client acknowledges these times, the more likely it is that previously suppressed emotions will surface. 

 

This helps the client to choose whether experiencing these feelings is now tolerable. For example, if dreaded rage is identified, the client is given the option of expressing it. Taking this risk allows individuals to express and think on their rage. It is possible that the therapist will not retaliate or retreat, but rather discuss and reflect on the incident. 

 

I haven't touched on other unconscious mechanisms that may be used in, or cause, states of depersonalisation. What I've attempted to emphasise is an affect-focused psychodynamic approach that focuses on supporting the depersonalised individual with recognising and familiarising themselves with feelings they had previously ignored or considered intolerable and terrifying. 

 

Furthermore, such an approach helps the individual to learn from experience and be certain that such dreadful sentiments will not kill them or the other. These therapeutic experiences were most likely denied to the depersonalised individual from an early age. It offers a method for treating and resolving alexithymia and affect phobia, both of which can result in recurring bouts of depersonalisation.​