Clinical features

Patients with depersonalization disorder often report that they feel like a robot or an outside observer, as if watching themselves from a distance, in a film, or on a stage. There may be a sense of the physical body acting while the mind observes and of not being in full control of one's voice, movements, or behaviour. An emotional numbness or inability to experience feelings and a sensation of being in a dream, fog, or trance are often present as well. Some individuals have even described that they were unable to recognize themselves in a mirror. Accompanying derealization may be experienced as alterations in the quality, colour, shape, distance, or size of objects while other people seem unfamiliar, lifeless, or mechanical. Although unpleasant and distressing, patients are usually aware of the unreality of the changes and retain an intact sensorium and capacity for emotional expression. (1)

Primary depersonalization is considered a rare condition, reflected in the scarcity of systematic investigation into its prevalence, sex ratio, course, treatment response, and aetiology/2) Because of the widespread occurrence of depersonalization, some authors consider it as a non-specific symptom of various psychiatric disorders rather than a separate nosological entity.(3,4) As early as 1935 the variety of identified precipitants caused Mayer Gross to reject psychological theories as being of 'limited value' in explaining the syndrome, suggesting instead that it be regarded as 'an unspecific preformed functional response of the brain'. (5)

Nevertheless, clinical experience, supported by a modest number of individual reports and case series, suggest to some investigators that depersonalization can occur as a primary disorder in its own right.(67) In these patients, comorbid symptoms appear to be secondary in intensity and severity without fulfilling syndromal criteria for another Axis I disorder. If a separate disorder is diagnosed, a clear history may indicate that depersonalization either predated it or occurred persistently and extensively beyond its manifestations. It is on this rather doubtful basis that depersonalization disorder is conceptualized as a discrete syndrome with its own onset, phenomenology, clinical characteristic, course, and treatment response.(2)

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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