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Possumsurprise t1_ixsdp78 wrote

I’ve always conceptualized dissociation (not in terms of identity as that’s obviously a more severe and post traumatic etiology) as simply parallel to anxiety or panic in my understanding and thus not really ever understood why depersonalization disorder is not more commonly diagnosed especially as concurrent to anxiety disorders or another affective disorder like depression here. Then again there aren’t even diagnostically separate parallel working concepts that handle irritability (unless you want to count the rather narrow relatively speaking IED) and apathy as separate from depression/anxiety or unipolar mania being restored as a diagnosis so I dunno why I would expect anything that makes sense from the current framework and way of defining psychopathological symptom domains.


-flameohotman- t1_ixtftim wrote

It's because the diagnostic guidelines of the DSM and ICD specifically require that for someone to be diagnosed with DPDR, the depersonalization and/or derealization must not caused by another psychiatric disorder, drugs, etc. If the experience of dissociation is comorbid with something else, then it's just a symptom of that other thing (e.g., depression or anxiety). It's probably pretty rare for someone to have a dissociative disorder with no underlying cause.


Possumsurprise t1_ixtnfe2 wrote

I mean, you can argue x causes y for a lot of comorbidities in psychiatry and you may not be wrong. I don't think it limits the utility of the diagnosis. I also have a hunch the poor awareness and understanding of dissociative disorders and dissociation itself really is probably a strong reason it seems like it is only existing as a comorbid type of psychopathology to others like depressive episodes. Someone suffering from chronic dissociation as the main and only substantial issue may just never present to psychiatric care due to the still somewhat vague nature of how dissociation is described and how recent of an entry the word is in casual use. People can piece together more what anxiety or depression are and are more likely to end up in treatment for them because its often routinely screened for, they're not recent entries into common use in the english language so people have more of a name to put to their feelings, and they've been extensively defined over and over due to their prominence.

On the flipside, something like dissociation is probably going unnamed in many suffering from it even to the point of having psychosocial impairment to some degree, and in other cases is probably, due to difficulty in naming and describing it especially amongst middle aged and elderly segments of the population for whom its a pretty foreign concept. I think more bipolar individuals would get a hunch regarding manic episodes if those were, similarly but less so, something the general public knew how to describe. If mania didn't commonly co-occur with depressive episodes as in BD then I would wager most people with some degree of mania would never even present to psychiatrists for diagnosis for this reason, and I think that may be the case with dissociative conditions.


bulbous_plant t1_ixul55t wrote

The DSM does a poor jump regarding DP/DR. It’s severely under diagnosed, and more often just labelled as an additional symptom of anxiety, which, in many ways it is. It’s often the source of anxiety for those with DP/DR, where the fear of the DP/DR experience (“I’m losing my mind”, “my whole life is the matrix”, “what if I’m dead” etc.) generates anxiety, pushing the brain even more into survival mode, leading to more DP/DR. In contrast, those who don’t perceive the experience as threatening tend to find a DP/DR experience diminished quickly. To me, this is the soul reason why 90% of the population will have one transient experience of DP and DR in their life, but only a small fraction develop the chronic type.