Depersonalization disorder 自我丧失感

翻译|Bree & Shirly & Renee & Lydia 审校|高淑媛

Depersonalization disorder (DPD) is a mental disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization.

自我感丧失症 (DPD)是一种心理疾病,临床症状为患者持续或经常感觉到人格解体和/或现实解体。

In the DSM-5 it was combined with Derealization Disorder and renamed to Depersonalization/Derealization Disorder.

《精神疾病诊断与统计手册》第5版(DSM-5)将自我感丧失和现实感丧失结合将这种疾病重新命名为自我感丧失/现实感丧失。

In the DSM-5 it remains classified as a dissociative disorder, while in the ICD-10 it is called depersonalization-derealization syndrome and classified as an neurotic disorder.

《精神疾病诊断与统计手册》第5版(DSM-5)将其归为解离性障碍,而国际疾病分类第10版 中将其命名为人格解体-现实解体综合症,并将其归纳为神经质障碍。

Common descriptions of symptoms from sufferers include feeling disconnected from one's physicality or body, feeling detached from one's own thoughts or emotions, feeling as if one is disconnected from the reality of one's self, and a sense of feeling as if one is dreaming or in a dreamlike state.

患者自身描述一般包括感觉和自己的肉体或身体脱离以,感觉和自己的想法和情绪脱离,感觉好像和真实的自我脱离,感觉好像进入了梦境或类似梦境的状态。

In some cases, a person may feel an inability to accept their reflection as their own, or they may even have out-of-body experiences.

在一些情况下,患者似乎找不到自己的影像,或者似乎有离体体验(感觉自己死了,但又活过来的体验)。

The disorder can also be described as suffering from recurrent episodes of surreal experiences, which may in some cases be reminiscent of panic attacks.

这种疾病也可以描述为反复发作的超现实体验,这在大多数情况下会让人想到无端恐慌症。

In addition to these DPD symptoms, the inner turmoil created by the disorder can result in depression,self-harm, low self-esteem, anxiety attacks, panic attacks, extreme phobias (especially of losing their mind), etc. It can also cause a variety of physical symptoms, including chest pain, blurry vision, nausea, and pins and needles.

除了这些DPD症状,由这种疾病所造成的心里混乱可能导致抑郁症,自残、自卑、焦虑、恐慌症,极端的恐惧(更严重的是失去思维能力)等。它还会引起各种各样的身体症状,包括胸痛、视野模糊、恶心、手脚发麻。

Diagnostic criteria for depersonalization disorder includes, among other symptoms, persistent or recurrent feelings of detachment from one's mental or bodily processes.

自我感丧失症的诊断标准除了其他症状外,主要有持续或反复感觉到和自己心理或身体过程脱离。

A diagnosis is made when the dissociation is persistent and interferes with the social and/or occupational functions necessary for everyday living.

当这种脱离持续不断并且影响日常生活中社交和/或工作正常进行就需要诊断治疗。

Providing an accurate description through investigation has however proved challenging due to the subjective nature of depersonalization, sufferers' ambiguous use of language when describing episodes of depersonalization, and because the experiences of depersonalization overlap with those of derealization—a separate disorder.

因为人格解体具有主观特性,患者描述病症用语含糊以及病症和现实感丧失症(一种不同的病症)具有重叠现象,因此通过调查患者准确描述病症很具挑战性。

Depersonalization disorder is thought to be caused largely by severe traumatic lifetime events, including childhood abuse, accidents, natural disasters, war, torture, panic attacks and bad drug experiences.

人们认为自我感丧失症主要由人生中严重创伤事件诱发的,这些事件包括童年受虐、意外事故、自然灾害、战争、酷刑、恐慌和药物不良反应。

It is unclear whether genetics play a role; however, there are many neurochemical and hormonal changes in individuals suffering with depersonalization disorder.

目前尚不清楚病症是否和基因有关,但是患者会有很多影响神经系统的化学物质和激素的变化。

The disorder is typically associated with cognitive disruptions in early perceptual and attentional processes.

这一病症常和早期感知力和注意力形成过程的认知混乱有关。

Although the disorder is an alteration in the subjective experience of reality, it is not related to psychosis, as sufferers maintain the ability to distinguish between their own internal experiences and the objective reality of the outside world.

虽然病症改变了患者对现实世界的主观体验,但这不属于精神错乱,因为患者可以分清自己内心感知和外部世界的客观现实。

During episodic and continuous depersonalization, sufferers are able to distinguish between reality and fantasy, and their grasp on reality remains stable at all times.

在间接发病和连续发病期间,患者始终可以分清现实和幻想世界。而且他们对现实的认知始终保持稳定。

While depersonalization disorder was once considered rare, lifetime experiences with the disorder are common in approximately 1%–2% of the general populace.

尽管曾经认为自我感丧失症发病率很低,但是一生都在遭受此病的折磨是很常见的大约占总人数的 1%–2%。

Chronic depersonalization disorder has a reported prevelence ranging from 0.1 to 1.9%.

慢性自我感丧失症的发病几率为0.1-1.9%。

While these numbers may seem small, depersonalization experiences were frequently reported by a majority of the population to varying degrees of intensity.

尽管发病率很低,但是经常有很多人报告患有不同程度的自我感丧失症。

Whist experiencing brief episodes of depersonalization can be considered fairly common within the general population, in some individuals it may last much longer, progressing into a disorder.

尽管一般人经历短暂的自我感丧失症属于正常现象,但是有些个体发作时间较长逐渐演变成功能障碍。

Contents/目录

• 1 Symptoms/症状

• 2 Assessment/评估

• 3 Diagnosis/诊断

o 3.1 DSM-IV-TR/诊断标准

o 3.2 ICD-10/国际疾病分类第10版

• 4 Causes/病因

o 4.1 Cannabis/大麻

• 5 Prevalence/患病率

o 5.1 Relation to other psychiatric disorders/和其他精神疾病的联系

• 6 Treatment/治疗

o 6.1 Cognitive behavior therapy/认知行为疗法

o 6.2 Iboga total alkaloid/伊博格碱

o 6.3 Medications/药物治疗

o 6.4 Transcranial magnetic stimulation/经颅磁刺激

• 7 History/历史

• 8 Depersonalization and meditation/人格解体和冥想

• 9 Society and culture/社会和文化

Symptoms/症状

The core symptom of depersonalization disorder is the subjective experience of "unreality in one's sense of self",[11] and as such there are no clinical signs.

自我感丧失症的核心症状是患者主观感受到与真实自我脱离的状态,而没有临床迹象。

People who are diagnosed with depersonalization also experience an almost uncontrollable urge to question and think about the nature of reality and existence as well as other deeply philosophical questions.

诊断患有自我感丧失症的人也会经历不可抑制的会质问和思考真实性和存在性以及其他更深奥的哲学问题。

Individuals who experience depersonalization can feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to the same person or identity. Also, a recognition of self breaks down (hence the name).

自我感丧失者感知到身体感觉、感情、情绪和行为不属于同一个人或不同步而觉得脱离了自己的身体,即自我认知解体(这是病症名字的来源)。

Depersonalization can result in very high anxiety levels, which can intensify these perceptions even further.

人格解体会导致患者非常焦虑,这使得自我解体的感觉进一步增强。

Common descriptions: Feeling disconnected from one's physicality; feeling like one is not completely occupying the body; not feeling in control of one's speech or physical movements; and feeling detached from one's own thoughts or emotions; experiencing one's self and life from a distance; a sense of just going through the motions; feeling as though one is in a dream or movie; feeling "weird" being alive; and even out-of-body experiences.

病情一般描述:感觉脱离了自己的身体;感觉自己不能独立支配身体;不能控制自己的言语和身体动作;感觉和自己的思想和情绪脱轨;可以远距离感知自己和生活;仅感知到情绪的变化;感觉好像在做梦或看电影;感觉活着很奇怪;甚至有离体的感觉。

Some patients suffering from depersonalization disorder have also certain visual stimulations such as hallucinations and rapid fluctuations in lighting.

一些患者也会感觉到某些视觉刺激如幻觉和光线的快速波动。

While the exact cause of these hallucinations has not yet been determined, it is generally accepted that patients suffering from them is caused by previous drug usage.

尽管不确定引起幻觉的明确原因,但是普遍认为这和病人之前服用的药物有关。

These hallucinations differ from true hallucinatory phenomena as they are closer to being optical distortions or illusions rather than psychotic breaks.

这些幻觉和真实的幻觉现象不同,因为前者会更接近视觉扭曲或错觉而不是精神崩溃。

Individuals with the disorder commonly describe a feeling as though time is 'passing' them by and they are not in the notion of the present.

患者通常会感觉到好像时间从他们身边经过,但是自己没有活在当下的状态。

These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious.

这些病症会攻击个体自我认同感和自我意识的核心区域,让一个人心神不安或感到焦虑。

Factors that tend to diminish symptoms are comforting interpersonal interactions, intense physical or emotional stimulation, and relaxation.

令人宽慰的人际互动,强烈的身体和情绪刺激以及放松这些因素都可以减缓症状。

Distracting oneself (by engaging in conversation or watching a movie for example) may also provide temporary relief.

分散患者注意力(如通过交流或看电影)也可以暂时性的缓解病症。

Some other factors that are identified as relieving symptom severity are diet and/or exercise; while alcohol and fatigue are listed by others as to cause worsening of symptoms.

其他可以缓解病症的因素包括节食和/或运动;酒精和疲惫会使病情加重。

First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment.

自我感丧失症首次发作会感到比较恐怖,患者会害怕失去控制、与社会脱离以及功能障碍。

The majority of patients suffering from depersonalization disorder misinterpret the symptoms, thinking that they are signs of serious mental illness or brain dysfunction.

大多数患者会错误地认为这些症状是严重的精神疾病或大脑功能障碍。

This commonly leads to an increase of anxiety experienced by the patient, and obsession, which contributes to the worsening of symptoms.

这种错误想法会加重焦虑和增加困惑从而会使病情恶化。

Occasional moments of mild depersonalization are normal; strong, severe, persistent, or recurrent feelings are not.

偶尔轻微的人格解体是正常的,而强烈,严重,持续或反复发作都是不正常的表现。

Assessment 评估

Diagnosis is based on the self-reported experiences of the person followed by a clinical assessment. Psychiatric assessment includes a psychiatric history and some form of mental status examination. Since some medical and psychiatric conditions mimic the symptoms of DPD, clinicians must differentiate between and rule out the following to establish a precise diagnosis: temporal lobe epilepsy, panic disorder,acute stress disorder, schizophrenia, migraine, drug use, brain tumour or lesion. No laboratory test for depersonalization disorder currently exists.

诊断是在结合患者自述及临床评估的基础上做出的。精神评估包括精神病史分析和精神状态检测。有时服用某些药物产生的反应及某些精神病的症状与DPD症状相似,为了做出准确的诊断,医生需要区别排除以下可能:颞叶癫痫,恐慌症,急性应激障碍,精神分裂,偏头痛,药物反应,脑部肿瘤或损伤。目前还没有实验室对自我感丧失症(DPD)进行测试。

The diagnosis of DPD can be made with the use of the following interviews and scales:

DPD的诊断可以通过以下问询和衡量来进行:

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is widely used, especially in research settings. This interview takes about 30 minutes to 1.5 hours, depending on individual's experiences.

针对DSM四型解离性障碍(SCID-D)的结构化临床访谈,被广泛应用,特别是在研究中,根据个人情况不同,可持续30分钟到1个半小时。

The Dissociative Experiences Scale (DES) is a simple, quick, self-administered questionnaire that has been widely used to measure dissociative symptoms. It has been used in hundreds of dissociative studies, and can detect depersonalization and derealization experiences.

另一个用来分析游离性症状的是“游离症状表”(DES),简单,快捷,由病人本人填写,也被广泛采用。已被用到上百个游离症状研究,也可以用来监测自我感和现实感丧失。

The Dissociative Disorders Interview Schedule (DDIS) is a highly structured interview which makes DSM-IV diagnoses of somatization disorder, borderline personality disorder and major depressive disorder, as well as all the dissociative disorders. It inquires about positive symptoms of schizophrenia, secondary features of dissociative identity disorder, extrasensory experiences, substance abuse and other items relevant to the dissociative disorders. The DDIS can usually be administered in 30–45 minutes.

“游离性障碍问询”(DDIS)是一种高度结构化的面谈,可以进行躯体化障碍,边缘型人格障碍,大部分抑郁症和游离障碍的诊断。该询问包括精神分裂阳性症状,游离人格障碍的第二特征,超感体验,药物滥用和其他与游离性障碍有关的内容,时间通常控制在30至45分钟内。

The Cambridge Depersonalization Scale (CDS) is a method for determining the severity of depersonalization disorder patients may suffer from. It has been proven and accepted as a valid tool for the diagnosis of depersonalization disorder in a clinical setting. It was validated through trials with a sample of patients who had been confirmed to be suffering from depersonalization disorder. It is also used in a clinical setting to differentiate minor episodes of depersonalization from suffering from actual symptoms of the disorder. Due to the success of the CDS, a group of Japanese researchers underwent the effort to translate the CDS into the J-CDS or the Japanese Cambridge Depersonalization Scale. Through clinical trials the Japanese research team successfully tested their scale and determined its accuracy. They did discover a limitation that the scale did not allow for the differentiation between past and present episodes of depersonalization. It should also be noted that it may be difficult for the patient to describe the duration of depersonalization episodes and thus the scale lacks some degree of accuracy. The project was conducted in the hope that it would stimulate further scientific investigations into depersonalization disorder.

“剑桥人格解体分析表”(CDS)可以用来诊断病人人格解体障碍的程度,临床应用表明该表是诊断人格解体障碍的有效工具。该表经过了实践检验,曾用于几个人格解体障碍的确诊患者进行实验获得成功。它还可以用于临床来区别人格解体的偶发症状与患该病的真实症状,鉴于该表在实践中的成功应用,,一批日本学者费尽心思将其翻译成日语版的剑桥人格解体分析表(J-CDS)。通过临床实验,日本研究者成功地检验了它的病情划分尺度,确定了该表的精确程度。然而,他们也发现了一个缺点,那就是该表不能反映出过去和现在人格解体症状的区别。同时,让病人描述人格解体的持续时间是有困难的,所以从一定程度上来说,该表缺乏一定的准确性。日本研究者据此希望他们的项目可以促进人格解体障碍方面的后续科学研究。

Diagnosis 诊断

Depersonalization disorder is classified differently in the DSM-IV-TR and in the ICD-10: In the DSM-IV-TR this disorder it is seen as a dissociative disorder; in the ICD-10 as an independent neurotic disorder. Whether depersonalization disorder should be characterized as a dissociative disorder can be discussed; it relies very much upon how dissociative is being described.

人格解体障碍在《精神疾病诊断与统计手册》第四版和国际疾病分类第10版中被归入了不同的类别:《精神疾病诊断与统计手册》第四版认为它属于游离型障碍,国际疾病分类第10版则认为其实一种单独的精神障碍。人格解体障碍是否应当被归为游离型障碍仍有待探讨,因为这很大程度取决于“游离”的定义。

DSM-IV-TR

根据《精神疾病诊断与统计手册》

The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:

该手册在300.6“精神障碍诊断与数据”部分提出了诊断的标准:

1. Longstanding or recurring feelings of being detached from one's mental processes or body, as if one is observing them from the outside or in a dream.

1.有长期或反复出现的游离于身体或精神之外的体验,患者好像从外部或者在梦中远远地旁观着自己。

2. Reality testing is unimpaired during depersonalization

2. 人格解体病发时对现实分辨没有影响。

3. Depersonalization causes significant difficulties or distress at work, or social and other important areas of life functioning.

3. 人格解体给工作,社交和生活其他重要方面带来重大困难。

4. Depersonalization does not only occur while the individual is experiencing another mental disorder, and is not associated with substance use or a medical illness.

4. 与其他精神障碍同时出现,与药物影响或内科疾病无关。

The DSM-IV-TR specifically recognizes three possible additional features of depersonalization disorder:

该手册还特别提出了人格解体障碍的三个可能的特点:

1. Derealization, experiencing the external world as strange or unreal.

1. 现实解体,认为外在世界是陌生或不真实。

2. Macropsia or micropsia, an alteration in the perception of object size or shape.

2. 对物体形状和大小的认识发生改变,出现视物显大症或视物显小症。

3. A sense that other people seem unfamiliar or mechanical.

3. 感到其他人陌生或是机械的。

Dissociation is defined as a "disruption in the usually integrated functions of consciousness, memory, identity and perception, leading to a fragmentation of the coherence, unity and continuity of the sense of self. Depersonalisation is a particular type of dissociation involving a disrupted integration of self-perceptions with the sense of self, so that individuals experiencing depersonalisation are in a subjective state of feeling estranged, detached or disconnected from their own being."

人格分解从定义上说,是一种认知,记忆,身份,感知等原本是一个和谐整体的功能的“混乱”,导致对自我的认识破碎,分裂,断续,呈碎片化。人格分解是人格分裂的一种,可能产生自我感知混乱。因此人格分解患者主观感觉到与他们本人疏远,分离。

ICD-10

根据国际疾病分类第10版

In ICD-10, this disorder is called depersonalization-derealization syndrome F48.1. The diagnostic criteria are as follows:

国际疾病分类第10版把该疾病成为人格分解-现实分解综合征F48.1。诊断标准如下:

1. one of the following:

1. 出现以下症状之一:

 depersonalization symptoms, i.e. the individual feels that his or her feelings and/or experiences are detached, distant, etc.

 人格分解症状,例如个体感觉和/或体验到到分离感,距离感等

 derealization symptoms, i.e. objects, people, and/or surroundings seem unreal, distant, artificial, colourless, lifeless, etc.

 现实分解症状,如物体,人,或环境看起来不真实,遥远,虚假,缺乏色彩,死气沉沉等。

2. an acceptance that this is a subjective and spontaneous change, not imposed by outside forces or other people (i.e. insight).

2.认识到这是主观自发的心理变化,而不是由外界或他人强加(也就是说是个人认识)。

The diagnosis should not be given in certain specified conditions, for instance when intoxicated by alcohol or drugs, or together with schizophrenia, mood disorders and anxiety disorders.

在某些特定情况下不宜做出诊断,例如酒精或药物中毒,伴有精神分裂,情绪障碍和焦躁等。

Causes 病因

The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. Childhood interpersonal trauma – emotional abuse in particular – is a significant predictor of a diagnosis. The most common immediate precipitators of the disorder are severe stress; major depressive disorder and panic; and hallucinogen ingestion. People who live in highly individualistic cultures may be more vulnerable to depersonalization, due to threat hypersensitivity and an external locus of control.

尽管一些生理,心理,社会因素被证实与该病有关,但人格分解的具体病因尚不明确。童年时的人际交往创伤—特别是精神虐待—是诊断时需要考虑的一个重要因素。最常见的发病诱因有高度压力,抑郁,恐慌和迷幻剂摄取。生活在个人意识较强环境中的人们,因为对威胁的高度敏感性和外部控制,可能更容易患上人格分解症。

One cognitive behavioral conceptualization is that misinterpreting normally transient dissociative symptoms as an indication of severe mental illness or neurological impairment leads to the development of the chronic disorder. This leads to a vicious cycle of heightened anxiety and symptoms of depersonalization and derealization.

一个认知行为学概念是将短暂的分裂症状错误地解读为严重的精神疾病或神经损伤前兆会导致慢性精神障碍。进而诱发焦虑升级,人格分解,现实分解的恶性循环。

Not much is known about the neurobiology of depersonalization disorder; however, there is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the substrate of emotional experience. A PET scan found functional abnormalities in the visual, auditory, and somatosensory cortex, as well as in areas responsible for an integrated body schema.[27] In an fMRI study of DPD patients, emotionally aversive scenes activated the right ventral prefrontal cortex. Participants demonstrated a reduced neural response in emotion-sensitive regions, as well as an increased response in regions associated with emotional regulation. In a similar test of emotional memory, depersonalization disorder patients did not process emotionally salient material in the same way as did healthy controls. In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing.

人格解体的神经生物原理大部分仍处于空白,然而,一些证据共同指向了前额皮层的病变可能阻碍产生情绪体验的神经回路。一项对人格解体病人的脑部断层扫描发现了患者在视觉,听觉,躯体知觉皮层和负责机体协调的区域出现功能性病变。在对病人的核磁共振检查中,看到令人厌恶的场景会刺激前额皮层的右半部。应试者在情感敏感区的神经反应降低,在情感调节区的神经反应增加。在一项相似的关于情感记忆的测试中,人格分解患者不能像健康人一样处理情感信息。在一项关于皮肤传导对不良刺激反应的测试中,被测试患者对情感信息处理的呈现出选择性阻碍。

Depersonalization disorder may be associated with dysregulation of the hypothalamic-pituitary-adrenal axis, the area of the brain involved in the "fight-or-flight" response. Patients demonstrate abnormalcortisol levels and basal activity. Studies found that patients with DPD could be distinguished from patients with clinical depression and posttraumatic stress disorder.

人格分解障碍或许同丘脑-脑垂体-肾上腺核心的调节异常有关,因为人大脑的这一部分决定了我们面对困难时做出“战斗还是逃跑”的反应。患者皮质醇水平异常,影响基本活动。研究发现DPD患者与临床抑郁患者和创伤后应激障碍患者在症状上有显著不同。

The symptoms are sometimes described by sufferers from neurological organic diseases, such as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), neuroborreliosis (Lyme disease), etc., that directly affect brain tissue.

上述症状有时出现在一些直接影响大脑的神经器质性疾病中,例如肌萎缩性脊髓侧索硬化症,老年痴呆症,多发性硬化(MS),神经型疏螺旋体症 (莱姆病)等等。

It has been thought that depersonalization has been caused by a biological response to dangerous or life-threatening situations which causes heightened senses and emotional neutrality. If this response is applied in real life, non-threatening situations, the result can be shocking to the individual.

有人认为人格分解的成因是对可能引发过高敏感和情感麻木的危险或危及生命的情境作出的生物反应。如果这种这种反应用于真实的,不具威胁性的情况下,对常人来说难以接受的。

Cannabis 大麻

In some cases, the use of cannabis can lead to dissociative states such as depersonalization. and derealization. Sometimes these effects can remain persistent and result in continual depersonalization or derealization disorder. When cannabis is consumed in a high dose during adolescence it increases the risk of acquiring depersonalization disorder, this occurs especially in cases where the individual is predisposed to psychosis or cannabis consumption is proceeded by a panic attack during cannabis intoxication. Cannabis induced depersonalization disorder usually occurs in adolescence and is more common with boys. Overall, the majority of cases of depersonalization disorder induced by cannabis typically begin between the ages of 15 and 19.

有时,大麻的使用可能导致分裂,例如人格分解,现实分解的出现。这种影响有时是持续的,并导致长期的人格分解或现实分解障碍。青少年时期大量吸食大麻会增加患人格分解障碍的危险,特别是那些本身易患精神疾病的青少年,或者吸食大麻后在大麻起效期间感到恐慌,这些情况下更易患病。由于吸食大麻引起的人格分解障碍,其患者通常是青少年男性。总体而言大多数吸食大麻引发的人格分裂大多始于15到19岁之间。

Prevalence 患病率

Men and women are diagnosed in equal numbers with depersonalization disorder. A 1991 study on a sample from Winnipeg, Manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. A 2008 review of several studies estimated the prevalence between 0.8% and 1.9%.This disorder is episodic in about one-third of individuals, with each episode lasting from hours to months at a time. Depersonalization can begin episodically, and later become continuous at constant or varying intensity.

医学诊断出男性和女性患自我感丧失症的人数相等。从1991年一项基于马尼托巴省温尼伯样本的研究估计自我感丧失症的患病率占人口的2.4%。在2008年的一篇文献,综述了几次研究成果,估计患病率间为0.8%和1.9%。约有三分之一的个体偶尔发病,每次发病持续数小时至数月的时间。自我感丧失发病初期持续时间短,之后会以相同的或不同强度发病,病症持续时间变长。

Onset is typically during the teenage years or early 20s, although some report being depersonalized as long as they can remember, and others report a later onset. The onset can be acute or insidious. With acute onset, some individuals remember the exact time and place of their first experience of depersonalization. This may follow a prolonged period of severe stress, a traumatic event, an episode of another mental illness, or drug use. Insidious onset may reach back as far as can be remembered, or it may begin with smaller episodes of lesser severity that become gradually stronger. Patients with drug-induced depersonalization do not appear to be a clinically separate group from those with a non-drug precipitant.

尽管有些人报出的开始发病的时间只是自己能记得的最早时间,有些人报出的发病时间比实际发病时间晚,该病的首次发病时间集中在在青春期或者20岁出头。发病可能是急性或隐性的。如果是急性发病,有些病患会记得他们自我丢失第一次体验的确切时间和地点。这种症可能会发生在长期压力大,遭遇创伤事件,另一精神病发作或使用药物之后。隐性发病远比能记得的发病时间要早,或者开始发病时病症较轻发病时间短,然后强度慢慢增大。临床上,由药物引发的自我感丧失患者和非药物引发的患者没什么不同,不必分在不同的组别。

Relation to other psychiatric disorders

与其他精神疾病的关系

Depersonalization exists as both a primary and secondary phenomenon, although making a clinical distinction appears easy but is not absolute. The most common comorbid disorders are depression and anxiety, although cases of depersonalization disorder without symptoms of either do exist. Comorbid obsessive and compulsive behaviours may exist as attempts to deal with depersonalization, such as checking whether symptoms have changed and avoiding behavioural and cognitive factors that exacerbate symptoms. Researchers at the Institute of Psychiatry in London, England suggest depersonalization disorder be placed with anxiety and mood disorders, as in the ICD-10, instead of with dissociative disorders as in the DSM-IV-TR.

自我感丧失即可以是主要病症也可以是伴发病症,虽然临床区别似乎很容易,但也不是绝对的。最常见的并发病症是抑郁症和焦虑症,尽管有些人格解体症中以上两种并发症都不存在。并发的强迫症和强迫行为可能由于患者企图摆脱人格解体,如检查是否症状已经改变和尽量避免加剧症状的行为和认知因素。英国伦敦精神病学研究所的研究员建议像ICD-10一样,用焦虑和情绪障碍来代替人格解体,而不要像精神疾病诊断与统计手册一样把它称之为解离症。

Treatment 治疗

Primary depersonalization disorder is mostly refractory to current treatments. The disorder lacks effective treatment in part because it has been neglected by the psychiatric community because funding has mainly been allocated to the search for cures of other illnesses, like alcoholism. However, recognizing and diagnosing the condition may in itself have therapeutic benefits, considering many patients express their problems as baffling and unique to them, but are in fact, one: recognized and described by psychiatry, and two: those affected by it are not the only individuals to suffer from the condition. A variety of psychotherapeutic techniques have been used to treat depersonalization disorder, such as cognitive behavioral therapy. Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors, anticonvulsants, and opioid antagonists.

大部分自我感丧失症是目前难以治疗。这种疾病缺乏有效的治疗,部分是因为它已经被精神病学界忽视了,因为资金主要被分配到寻求其他疾病的治疗方法,比如酗酒。然而,认识和诊断条件本身就可能有治疗效果,考虑到许多患者描述自己的问题令人困惑,仅出现在他们自己身上。但实际上却是,1:被精神病学辨认和描述,第二:并非只有患者忍受这些病症的折磨。各种心理治疗技术已被用于治疗自我感丧失,如认知行为疗法。临床药物研究不断探索多种可能的方案,包括选择性五羟色胺再摄取抑制剂,抗惊厥药和阿片拮抗剂。

Cognitive behavior therapy 认知行为疗法

An open study of cognitive behavior therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. A standardized treatment for DPD based on cognitive behavioral principles has recently been published in The Netherlands.

认知行为疗法的开放研究的目的是帮助患者以没有威胁的方式重新诠释他们的症状,从而改善在几个标准化的措施。基于认知行为原则DPD的标准化治疗,最近发表在荷兰。

Iboga total alkaloid Iboga 伊博格总生物碱(抗抑郁药)

Anecdotal reports of DPD sufferers as well as iboga treatment centers, and others have claimed that treatment with iboga total alkaloid has reversed depersonalization in those with DPD who did the treatment. Anecdotal reports occasionally appear of people claiming to find relief from DPD through iboga TA treatment. Given the theorized connection between depersonalization/derealization and the disruption of normal kappa and mu opioid receptor agonization and antagonization, outlined in the book "Inside Depersonalization: The Hidden Epidemic" and the scientifically proven ability of large flood doses of iboga TA to reset the opioid system, which is the mechanism of action in its primary use of treating addiction, it appears clear the effect of iboga TA on opioid receptors to restore their 'factory reset' is responsible for its ability to successfully treat depersonalization and derealization disorder.

DPD患者、抑郁症治疗中心以及其它的传闻断言,抑郁症总生物碱治疗已使那些接受治疗的DPD患者缓解了自我丧失感。经常有人宣称接受伊博格生物总碱治疗使自我感丧失症有所减轻。鉴于人格解体/现实解体和正常κ、μ阿片受体抗体和抗体遭到破坏之间的理论联系已在《人格解体内部:隐性传染病”》一书中列出,且科学证明大剂量伊博格总生物碱有重置阿片系统的功能,该系统的主要作用机制用于治疗上瘾,伊博格生物总碱具有使阿片受体重置出厂功能的功效,这种功效使其能成功治愈自我解体和现实解体。

Medications 药物治疗

In a retrospective report of 117 subjects with DPD, 18 of 35 benzodiazepine subjects reported slight or definite improvement with benzodiazepines and clonazepam in particular. Benzodiazepines are not known to reduce dissociative symptoms; however, they do target the often comorbid anxiety and stress experienced by those with DPD and, thus, lead to global improvement. To date, no clinical trials have studied the effectiveness of benzodiazepines.

一项回顾性报告调查了117名DPD患者,35个苯二氮卓受试者中有18个报告声称在使用西泮和尤其是氯硝西泮之后病情有轻微或一定的改进。苯二氮卓不具有减少游离症状的功效。然而,他们对DPD受试者所产生的并发焦虑和压力会有效果,这样,就使病症得到整体改善。迄今为止,临床试验还未研究苯二氮类的有效性。

A series of small studies have suggested a possible role of selective serotonin reuptake inhibitors in treating primary depersonalization disorder. However, a placebo-controlled trial failed to show benefit with fluoxetine in 54 patients with DPD. SSRI treatment created an overall improvement in participants, but only by reducing anxiety and depression. Clomipramine is a tricyclic antidepressant that is helpful with both depression and obsessional disorders. In a study of four subjects treated with clomipramine, two showed clinically significant improvement of DPD. A combination of an SSRI and a benzodiazepine has been proposed to be useful for DPD patients with anxiety. SSRIs have also been used in combination with lamotrigine, an anticonvulsant.

一系列的小型研究表明,选择性五羟色胺再摄取抑制剂对治疗早期时的自我感丧失症可能有帮助。然而,一项针对54位DPD患者的安慰剂对照试验未能表现出氟西汀是有帮助的。SSRI治疗法能使患者得到整体改善,不仅仅是能通过减少焦虑和抑郁缓解病情。氯米帕明是三环抗抑郁药,对治疗抑郁和强迫症有帮助。在用氯米帕明治疗的4个受试者的研究中,两名DPD患者显现出明显的临床改善。有建议主张把一种SSRI和苯并二氮杂混合制成的药物用于伴有焦虑的DPD患者。SSRIs也已经与拉莫三嗪-一种抗惊厥剂混合使用。

Naloxone, an antagonist used primarily for the treatment of opiate overdose, was used in a pilot study in 14 patients with chronic DPD. Of the 14 patients, three experienced complete remission, and seven had marked improvement of depersonalization symptoms. The study reported only immediate treatment results, which makes the efficacy of continued treatment unknown. Although Naloxone is usually administered intraveneously, it can also be administered intramuscularly, subcutaneously, and intranasally. Given that the latter generally is not practiced, long-term treatment may be difficult.Naltrexone was used in a preliminary study in 14 individuals with DPD. Participants were treated for 6–10 weeks, at a fairly high average dose of 120 milligrams per day. Three individuals were very much improved, another one was much improved, and on average a 30% decrease in depersonalization symptoms was reported. In another study in borderline personality disorder, naltrexone doses of 200 milligrams/day were reported to decrease general dissociative symptoms over a two-week period of treatment.

纳洛酮,主要用于治疗阿片类药物过量的拮抗剂,用于14例慢性DPD患者的试点研究。14例患者中,三例完全缓解,七个人的自我感丧失症得到显著改善。该研究报告只有直接的治疗效果,这使得后期疗效无法知晓。虽然纳洛酮通常施用静脉内,它也可以被施用肌肉内,皮下,和鼻内给药。鉴于通常不采用后者,长期治疗可能会很困难. 在初步研究中14名DPD患者使用了纳洛酮。受试者共治疗6-10周,每一天使用一个相当高的平均剂量-120毫克。三个人有很大的改善,另外也有改善,平均有30%自我感丧失症减少,在另一个关于边缘型人格障碍的研究中,在为期两个星期的治疗中,据称每天会用200毫克纳曲酮的剂量来减少一般分离性症状。

A 2011 study involving lamotrigine demonstrated efficacy in treating depersonalization disorder in a double-blind placebo-controlled trial. In particular, of the 36 lamotrigine-treated patients, 26 were classified as responders by week 12 versus 6 of the 38 in the placebo-treated participants. The most common and problematic adverse effect in the lamotrigine group was rash (potentially important because of the possibility of Stevens–Johnson syndrome). This trial was the first double-blind, placebo-controlled trial to demonstrate efficacy of any drug for DPD. However, it is not clear how robust the study methodology was. Patients did not receive any antidepressant or anticonvulsant drugs for 2 months before the commencement of the study, however the patients were allowed to take up to 4 mg per day of clonazepam for insomnia, and hydroxyzine of 25 mg 3 times per day during 7 days for the treatment of rash. As noted above, clonazepam itself is a potential treatment for depersonalization, and hydroxyzine has been shown to be an effective anxiolytic. Therefore it is unclear whether the benefits in the study are due to the lamotrigine or the clonazepam. The study does not appear to control for the effect of clonazepam or hydroxyzine administration.

2011年的研究,在治疗自我丢失症双盲安慰剂对照试验中,加入拉莫三嗪证实疗效。36位用拉莫三嗪治疗的患者,其中的26位在第12周产生积极反应,而在安慰剂对照组,38人中有6人反响良好。拉莫三嗪组中最常见的和急需解决的的不利影响是皮疹(非常重要因为可能导致Stevens–Johnson 综合症)。这项试验是用来证明药物对DPD功效的第一个双盲,安慰剂对照试验,。不过,目前尚不清楚该研究方法效果是否强劲。患者在研究开始前2个月内没有使用任何抗抑郁药或抗惊厥药物,但是患者们可以每天使用4毫克的高达氯硝西泮用于治疗失眠,在治疗皮疹期间每天可以用25毫克羟嗪 ,每日3次持续7天。如上所述,氯硝西泮本身是自我感丧失的一种潜在的治疗,并且羟嗪已被证明是一种有效的抗焦虑药物。因此,目前还不清楚研究中的药效是由拉莫三嗪或氯硝西泮带来的。该研究目的不在于测试氯硝西泮或羟的效果。

Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). However, clinical trials have not been conducted. Evan Torch calls a combination of an SSRI and Modafinil "the hidden pearl that can really help depersonalization disorder".

已有报道称在某个自我感丧失症亚群的个体(那些注意力有障碍,低唤醒和睡眠过度的个体)中莫达非尼单独使用效果显著。然而,临床试验尚未进行。埃文火炬呼吁将SSRI和莫达非尼一起使用,莫达非尼被称为“可以真正有助于治疗自我感丧失症的潜在珍珠”。

Antipsychotics typically have a paradoxical effect and worsen symptoms of depersonalisation. However evidence suggests that the antipsychotic Aripiprazole could have a therapeutic effect in combating Depersonalization disorder.

抗精神病药通常具有相反的效果会恶化人格解体的症状。然而有证据表明,抗精神病药物阿立哌唑在抗击自我感丧失症中具有治疗作用。

Transcranial magnetic stimulation 经颅磁刺激

A 2011 study has shown positive effects from transcranial magnetic stimulation (TMS) to treat depersonalization disorder. Currently, however, the FDA has not approved TMS to treat depersonalization disorder.

2011年的研究显示,经颅磁刺激(TMS)在治疗自我感丧失症中有积极作用。然而,目前美国食品药品管理局尚未批准用TMS治疗自我感丧失症。

History

历史

The word depersonalization itself was first used by Henri Frédéric Amiel in The Journal Intime. The July 8, 1880 entry reads:

"I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift. Is this madness?"

Depersonalization was first used as a clinical term by Ludovic Dugas in 1898 to refer to "a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization". This description refers to personalization as a psychical synthesis of attribution of states to the self.

自我感丧失这一词本身是由Henri Frédéric Amiel在The Journal Intime中第一次使用。1880年7月8日的记录写道:"我发现自己仿佛穿越坟墓或是从另一世界看待万物。对我来说,一切都很陌生。我自己, 就好像是,不在我的身体里,不是我自己; 我丧失了自我,被分离了,被分割然后漂浮着。这是疯了吗?"而在1898年,Ludovic Dugas是首次将自我感丧失作为临床词汇运用的。它指的是"一种觉得自己的想法和行动逃离自我并且开始变得怪异的感觉或是感知,也就是人格异化 –换句话说,也就是自我感丧失。“这将自我感描述为反应自我状态属性的心理综合状况。

Early theories of the cause of depersonalization focused on sensory impairment. Maurice Krishaber proposed depersonalization was the result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself". One of Carl Wernicke's students suggested all sensations were composed of a sensory component and a related muscular sensation that came from the movement itself and served to guide the sensory apparatus to the stimulus. In depersonalized patients these two components were not synchronized, and the myogenic sensation failed to reach consciousness. The sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words. Pierre Janet approached the theory by pointing out his patients with clear sensory pathology did not complain of symptoms of unreality, and that those who suffered from depersonalization were normal from a sensory viewpoint.

早期研究自我感丧失的病因的理论集中在感官机能受损。Maurice Krishaber提出自我感受丧失是由身体中多种感觉通道的病理性改变引起的,这种病理改变导致了“自我陌生感”的经历,病人描述的“感觉他再也不是自己了”。Carl Wernicke的一个学生建议说所有的感官都是由感觉组件和肌肉知觉组成,肌肉知觉则来自肌肉本身的运动并且能引导感觉器官应对刺激。而自我感丧失的病人这两个组件是不同步且肌源性的知觉不能被意识感知。这一理论受到了其他研究者的质疑,他们认为对病人的抱怨的理解过于字面化了,而且有些描述还运用了比喻的手法---尝试去面描述很难清晰明了的表达出来的经历。对于这一理论,Pierre Janet 持赞同观点,他指出感觉系统患病者并没有报告他们有感觉不现实的症状,而那些被诊断为自我感丧失的病人却拥有着正常的感觉系统。

Psychodynamic theory formed the basis for the conceptualization of dissociation as a defense mechanism. Within this framework, depersonalization is understood as a defense against a variety of negative feelings, conflicts, or experiences. Sigmund Freud himself experienced fleeting derealization when visiting the Acropolis in person; having read about it for years and knowing it existed, seeing the real thing was overwhelming and proved difficult for him to perceive it as real. Freudian theory is the basis for the description of depersonalization as a dissociative reaction, placed within the category of psychoneurotic disorders, in the first two editions of the Diagnostic and Statistical Manual of Mental Disorders.

心理动力学理论为把解离看作一种防御机制这种观点提供了基础。在这一理论框架中,自我丧失感觉的产生被理解成对多重负面情绪,冲突或是经历的一种防御。Sigmund Freud他自己就曾在自己参观古城堡的时候经历了短暂的现实感丧失;因为已经了解到这个症状很多年并且知道了它的存在,大部分情况下看到的是真实物体但是要把这些物体当成真的却很困难。弗洛伊德的理论是将自我感丧失描述为解离反应的基础,在精神疾病诊断与统计手册的最初两版中被收录进了精神神经性疾病的分类中。

Arguments have been brought forth by researchers that despite the fact that depersonalization and derealization are both impairments to one’s ability to distinguish reality and thus they fall into the same disorder and are merely two facets of it. Depersonalization also differs from delusion in the sense that the patient is able to differentiate between reality and the symptoms they may experience. The ability to sense that something is unreal it maintained when experiencing symptoms of the disorder. The problem with properly defining depersonalization also lies within the understanding of what reality actually is. In order to comprehend the nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again.

研究者们指出尽管自我感丧失和现实感丧失都是一个人辨别现实的能力受到了损害,因此他们被归为了同一种障碍,只是所属的方面不同。自我感丧失同样与妄想在某种程度上有所不同,自我感丧失的病人可以区别自己的正在经历的病症与现实的情况不同,在经历障碍症状的时候,他们有感觉某件事物不真实的能力。恰当定义自我感丧失的困难同样表现在如何理解现实到底是什么。为了理解现实的本质,我们必须把所有的主观经验合并起来,因此会再度面临如何得到客观定义的问题。

Depersonalization and meditation

自我感丧失与冥想

The outcome of one study on meditation and depersonalization concluded the following

一个关于冥想与自我感丧失的研究结果如下:

 Meditation can sometimes lead to the experience of depersonalization.

 冥想有时会使冥想者经历自我感丧失。

 The meditator's understanding and meaning regarding the experience of depersonalization will greatly determine whether anxiety is present as part of the experience.

 冥想者对自我感丧失的理解与认识会很大程度上决定自我感丧失时是否会感到焦虑。

 A meditator who interprets depersonalization with catastrophic interpretations will likely experience significant panic/anxiety.

 一个将自我感丧失理解为灾难性的冥想者很有可能遭受到极大的痛苦/焦虑情绪。

 The meditator's social or occupational functioning as a result of depersonalization need not have significant anxiety or impairment.

 自我感丧失不一定会导致冥想者的社会、职业功能令人担忧或受到损害。

 The meditator's depersonalized state can become a permanent mode of functioning.

 冥想者的自我感丧失可成为一个长期的运作模式。

 People who wish to reduce Depersonalization Disorder may be treated by changing the meanings associated with depersonalization in the mind of the patient, thereby reducing anxiety and functional impairment.

 希望减轻由自我感丧失症的患者可以通过改变自己赋予的与自我感丧失相关联的意义进行治疗,从而减轻焦虑情绪,减弱功能损害。

Society and culture

社会文化

Depersonalization disorder has appeared in a variety of media. The director of the autobiographical documentary Tarnation, Jonathan Caouette, suffers from depersonalization disorder. The screenwriter for the 2007 film Numb suffers from depersonalization disorder, as does the film's protagonist played by Matthew Perry. Norwegian painter Edvard Munch's famous masterpiece The Scream may have been inspired by depersonalization disorder. In Glen Hirshberg's novel The Snowman's Children, main female plot characters throughout the book suffer from a condition that is revealed to be depersonalization disorder. Suzanne Segal had an episode in her 20s that was diagnosed by several psychologists as depersonalization disorder, though Segal herself interpreted it through the lens of Buddhism as a spiritual experience. The song "Is Happiness Just A Word?" by Hip-Hop artist and rapper Vinnie Paz describes his struggle with Depersonalization disorder.

自我感丧失症已经在许多媒体中出现了。自传纪录片《诅咒》(英文:Tarnation)的导演 Jonathan Caouette就患有自我感丧失症。2007年上映的电影《麻木》(英文: Numb)的编剧就像片中由Matthew Perry出演的主角一样也患有自我感丧失症,。挪威画家Edvard Munch的著作《呐喊》(英文:The Scream)就有可能是受到了自我感丧失症的启发所画。在Glen Hirshberg所著的小说《雪人的孩子》(英文: The Snowman's Children)中,女主人公在整篇作品中遭受的症状也被认定为自我感丧失症。 Suzanne Segal在她20多岁的那段经历中被数名心理学家诊断为自我感丧失症,虽然她自己解释说从佛教的uddhism的角度来看,这是一种精神历程。由嘻哈艺术家,说唱歌手Vinnie Paz创作的歌曲《幸福只是一个词吗?》(英文: "Is Happiness Just A Word?")也描述了自己与自我感丧失症抗争的经历。

以上英文来源于:维基百科

中文由有道词典翻译提供

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