My relief came from treating the mental and social problems for which proven treatments exist. This didn't entirely alleviate my depersonalization, but it did cure me of 2D vision, severe dissociation, severe inattentiveness and so forth. Either that or the partial alleviation of symptoms, and worsening of symptoms during triggers, are mere coincidences. There's definitely a relationship between comorbid disorders and depersonalization symptomology, even if the long-time online depersonalization community resents this fact. I'd never say my syndrome is the exact same as yours, but I consider empirically proven methods better than shooting in the dark. It's also true that obsession with the idea of relief can be counterproductive and make suffering worse. At a certain point a person needs to decide if they would calmly accept being short and bald rather than getting surgical hair transplants and leg extension. Even more so in depersonalization, there are no known procedures that can intervene in it so directly.
DDD research project - people needed
Hi everyone!
I am Giovanni Foglia and I have been suffering from Depersonalization/Derealization disorder for the last 12 years.
As you may know, DDD is a seldomly researched condition academically, therefore I decided to take it upon myself to investigate it.
As a student of Psychology at London Metropolitan University I decided to devise a questionnaire for my 3rd year dissertation to administer to individuals suffering from DDD. The aim is to provide a literature review for the existing research on the condition and see if we can discover something new about it.
The questionnaire has 25 questions and will take approximately 5 minutes to be completed.
The more people take it the more statistical evidence we can gather for future research. I will leave the questionnaire online for 1 week, after that I will analyse the results and write an 8-10 pages report. I will publish the completed work sometime in May 2023 for everyone to read. If you know anyone suffering from DDD please forward the link to them. We are all this together.
I will leave the link for the questionnaire below, stay strong!
If you have any questions feel free to get in touch.
DEPERSONALIZATION/DEREALIZATION DISORDER. 25 QUESTIONS FOR A BETTER UNDERSTANDING OF THE CONDITION.
I am Giovanni Foglia and I have been suffering from Depersonalization/Derealization disorder for the last 12 years.
As you may know, DDD is a seldomly researched condition academically, therefore I decided to take it upon myself to investigate it.
As a student of Psychology at London Metropolitan University I decided to devise a questionnaire for my 3rd year dissertation to administer to individuals suffering from DDD. The aim is to provide a literature review for the existing research on the condition and see if we can discover something new about it.
The questionnaire has 25 questions and will take approximately 5 minutes to be completed.
The more people take it the more statistical evidence we can gather for future research. I will leave the questionnaire online for 1 week, after that I will analyse the results and write an 8-10 pages report. I will publish the completed work sometime in May 2023 for everyone to read. If you know anyone suffering from DDD please forward the link to them. We are all this together.
I will leave the link for the questionnaire below, stay strong!
If you have any questions feel free to get in touch.
DEPERSONALIZATION/DEREALIZATION DISORDER. 25 QUESTIONS FOR A BETTER UNDERSTANDING OF THE CONDITION.
21 - 40 of 45 Posts
99 people already completed the survey, thank you everyone!
We may be the most willing to be studied population of all time.99 people already completed the survey, thank you everyone!
i dont wanna offend anyone, but if i was having the opportunity to make any research into dpdr, the first thing to figure out would be the regular outcomes of any dpdr patient.
look, from my knowledge, there is no schizophrenia patient who comes into remission without meds after 25 years (this is just an example for the duration) of illness history. we can also expect from depression patients who got their illness for more than 20+ years that they wont get into remission without any medical intervention. if you know cases please provide me. im very curious.
but if it comes to dpdr, the outcome statistics go mental as fuck. you can find from every digit of duration people who was able to go into remission WITHOUT MEDICAL INTERVENTIONS. this starts from 3 months and goes to 25 years. this fact alone doesnt let me compare this three conditions with each other. and if i go to illnesses like ALS and MS, i wasnt able to find any case where people got into spontaneous remission. i only could find via chat gpt 3 severe cancer cases where people got miraculously into remission. but nothing about ALS or MS.
My point is, the very first logical thought that crosses my mind is, that if a brain stays 25 years long conditioned with dpdr, you can say guaranteed that these people wont get into remission. but, that people indeed can go into remission after such a long duration, just gaves me the idea that there wasnt anything serious in the brain.
i hope you could follow my explanation. english isnt my native
look, from my knowledge, there is no schizophrenia patient who comes into remission without meds after 25 years (this is just an example for the duration) of illness history. we can also expect from depression patients who got their illness for more than 20+ years that they wont get into remission without any medical intervention. if you know cases please provide me. im very curious.
but if it comes to dpdr, the outcome statistics go mental as fuck. you can find from every digit of duration people who was able to go into remission WITHOUT MEDICAL INTERVENTIONS. this starts from 3 months and goes to 25 years. this fact alone doesnt let me compare this three conditions with each other. and if i go to illnesses like ALS and MS, i wasnt able to find any case where people got into spontaneous remission. i only could find via chat gpt 3 severe cancer cases where people got miraculously into remission. but nothing about ALS or MS.
My point is, the very first logical thought that crosses my mind is, that if a brain stays 25 years long conditioned with dpdr, you can say guaranteed that these people wont get into remission. but, that people indeed can go into remission after such a long duration, just gaves me the idea that there wasnt anything serious in the brain.
i hope you could follow my explanation. english isnt my native
Hi! I am not sure I understood all the points you have raised. All the conditions that you mentioned tend to be chronic in nature, including DP/DR.i dont wanna offend anyone, but if i was having the opportunity to make any research into dpdr, the first thing to figure out would be the regular outcomes of any dpdr patient.
look, from my knowledge, there is no schizophrenia patient who comes into remission without meds after 25 years (this is just an example for the duration) of illness history. we can also expect from depression patients who got their illness for more than 20+ years that they wont get into remission without any medical intervention. if you know cases please provide me. im very curious.
but if it comes to dpdr, the outcome statistics go mental as fuck. you can find from every digit of duration people who was able to go into remission WITHOUT MEDICAL INTERVENTIONS. this starts from 3 months and goes to 25 years. this fact alone doesnt let me compare this three conditions with each other. and if i go to illnesses like ALS and MS, i wasnt able to find any case where people got into spontaneous remission. i only could find via chat gpt 3 severe cancer cases where people got miraculously into remission. but nothing about ALS or MS.
My point is, the very first logical thought that crosses my mind is, that if a brain stays 25 years long conditioned with dpdr, you can say guaranteed that these people wont get into remission. but, that people indeed can go into remission after such a long duration, just gaves me the idea that there wasnt anything serious in the brain.
i hope you could follow my explanation. english isnt my native
yeah. but the latter seems to have a higher spontaneous recovery rateHi! I am not sure I understood all the points you have raised. All the conditions that you mentioned tend to be chronic in nature, including DP/DR.
I am not aware of any long term studies of patients suffering from DP/DR
Research suggest that 70% of the population will experience DP/DR at some point in their life, but it will be a short episode and that’s it. In that case you wouldn’t get a diagnosis so if it never happens again I wouldn’t say that it went away, becuase you never had it in the first place. While people with a diagnosis tend to experience the symptoms more regularly becuase the brain utilize this brain defends mechanism and is very difficult to unlearn this behaviour. I believe is possible to live with the condition but I am skeptical of those who claim that it just goes away. It would be like saying to a cancer patient that if he/she doesn’t suffer it can’t be cancer. The symptomatology can be irrelevant at times in regards to a diagnosis.
Research suggest that 70% of the population will experience DP/DR at some point in their life, but it will be a short episode and that’s it. In that case you wouldn’t get a diagnosis so if it never happens again I wouldn’t say that it went away, becuase you never had it in the first place. While people with a diagnosis tend to experience the symptoms more regularly becuase the brain utilize this brain defends mechanism and is very difficult to unlearn this behaviour. I believe is possible to live with the condition but I am skeptical of those who claim that it just goes away. It would be like saying to a cancer patient that if he/she doesn’t suffer it can’t be cancer. The symptomatology can be irrelevant at times in regards to a diagnosis.
dont get this.but I am skeptical of those who claim that it just goes away. It would be like saying to a cancer patient that if he/she doesn’t suffer it can’t be cancer.
do you wanna say that people who claim to have gotten into remission after 20 years, just lie?
Schizophrenia is just a diagnosis. There's no direct connection between reality and the words we ascribe to things. People can and do recover from schizophrenia as well as chronic depersonalization. The issue is when people don't accept that they have a condition, such as when schizophrenics refuse treatment because they think the CIA is indeed putting cameras all over their house, or when someone with depersonalization insists with absolute certainty their condition is caused by brain damage despite having no medical evidence.
Just because you and I haven't fully recovered doesn't mean we should go around telling people they won't recover. I don't understand why this community has trouble recognizing that not all of us are the same. We oscillate between bullshit cures and telling people they'll never get better. Something that alleviates my symptoms isn't necessarily going to alleviate yours.
I guess by adding nuance to the "I need to get better right now" people it seems like I'm telling them they won't get better. It's more like I'm trying to tell them quality of life is possible despite having an illness.
Just because you and I haven't fully recovered doesn't mean we should go around telling people they won't recover. I don't understand why this community has trouble recognizing that not all of us are the same. We oscillate between bullshit cures and telling people they'll never get better. Something that alleviates my symptoms isn't necessarily going to alleviate yours.
I guess by adding nuance to the "I need to get better right now" people it seems like I'm telling them they won't get better. It's more like I'm trying to tell them quality of life is possible despite having an illness.
Yes, depressed people have a tendency to become depressed again, and to have subclinical problems that persist despite feeling better. That's one of the reasons diagnoses aren't removed when the patient feels better.Hi! I am not sure I understood all the points you have raised. All the conditions that you mentioned tend to be chronic in nature, including DP/DR.
There is nothing "wrong" in the brain in DPDR-patients as in "irreversibly destroyed". But there seems to be a change in brain chemistry as studies with DPDR-patients reacting to emotional stimuli show.My point is, the very first logical thought that crosses my mind is, that if a brain stays 25 years long conditioned with dpdr, you can say guaranteed that these people wont get into remission. but, that people indeed can go into remission after such a long duration, just gaves me the idea that there wasnt anything serious in the brain.
After all DPDR is a mental disorder and can be cured by either pharmacological or other approaches as well as both together. And people with 20+ years of DPDR don´t just recover without a change in the way their brain works (be it through medication, relaxation techniques, psychotherapy, everyday life or whatever and mostly through a variety of factors). But the very same applies to a person with 20+ years of depression.
A higher rate of remission doesn´t necessarily mean that a chemical imbalance is less pronounced in DPDR than it is in e.g. depression.yeah. but the latter seems to have a higher spontaneous recovery rate
I've only ever heard "chemical imbalance" invoked to develop and sell medications. I'm not against medication but yeah.There is nothing "wrong" in the brain in DPDR-patients as in "irreversibly destroyed". But there seems to be a change in brain chemistry as studies with DPDR-patients reacting to emotional stimuli show.
After all DPDR is a mental disorder and can be cured by either pharmacological or other approaches as well as both together. And people with 20+ years of DPDR don´t just recover without a change in the way their brain works (be it through medication, relaxation techniques, psychotherapy, everyday life or whatever and mostly through a variety of factors). But the very same applies to a person with 20+ years of depression.
A higher rate of remission doesn´t necessarily mean that a chemical imbalance is less pronounced in DPDR than it is in e.g. depression.
I don't know of any statistics about people with DPDR having spontaneous remission after years. But our impression that it's different from other disorders could also be due to the fact that it is not as studied and we have to rely on different sources of information to draw conclusions.
For depression we might rely on scientific studies, and for DPDR we rely for example on the recovery stories section of the forum where we see many self-reported cases. If it's not measured in the same way, it can be normal to obtain different results. I'm just making something up, but it could be because the forum has many more people than you would find in most scientific studies. In the small studies on DPDR I have seen, they didn't observe any spontaneous remission, giving the impression that it doesn't exist, even if it does. And it could be because studies about DPDR are done on a small pool of people who are already chronic, and that they study during a short time frame. And perhaps on forums about depression, you can find many people who report their own remission. But also the incentive to go back on a forum to report about your remission in a dedicated forum section might be different for depression and for DPDR. (I know someone who had spontaneous remission from decades of chronic depression soon after they retired, it's just personal experience, but it happens). Also it could be different kinds of people who go on forums and who are picked to participate in different studies. Then it might also not be so interesting for researchers to do statistics on spontaneous remission because they research what you can do about DPDR and people who don't require them to do anything are not so interesting to them. Or maybe they are, I don't know, I'm just making this up, but I want to say that it's hard to compare different things that are measured so differently.
For depression we might rely on scientific studies, and for DPDR we rely for example on the recovery stories section of the forum where we see many self-reported cases. If it's not measured in the same way, it can be normal to obtain different results. I'm just making something up, but it could be because the forum has many more people than you would find in most scientific studies. In the small studies on DPDR I have seen, they didn't observe any spontaneous remission, giving the impression that it doesn't exist, even if it does. And it could be because studies about DPDR are done on a small pool of people who are already chronic, and that they study during a short time frame. And perhaps on forums about depression, you can find many people who report their own remission. But also the incentive to go back on a forum to report about your remission in a dedicated forum section might be different for depression and for DPDR. (I know someone who had spontaneous remission from decades of chronic depression soon after they retired, it's just personal experience, but it happens). Also it could be different kinds of people who go on forums and who are picked to participate in different studies. Then it might also not be so interesting for researchers to do statistics on spontaneous remission because they research what you can do about DPDR and people who don't require them to do anything are not so interesting to them. Or maybe they are, I don't know, I'm just making this up, but I want to say that it's hard to compare different things that are measured so differently.
I suspect poorly understood things are more likely to appear spontaneous.I don't know of any statistics about people with DPDR having spontaneous remission after years. But our impression that it's different from other disorders could also be due to the fact that it is not as studied and we have to rely on different sources of information to draw conclusions.
For depression we might rely on scientific studies, and for DPDR we rely for example on the recovery stories section of the forum where we see many self-reported cases. If it's not measured in the same way, it can be normal to obtain different results. I'm just making something up, but it could be because the forum has many more people than you would find in most scientific studies. In the small studies on DPDR I have seen, they didn't observe any spontaneous remission, giving the impression that it doesn't exist, even if it does. And it could be because studies about DPDR are done on a small pool of people who are already chronic, and that they study during a short time frame. And perhaps on forums about depression, you can find many people who report their own remission. But also the incentive to go back on a forum to report about your remission in a dedicated forum section might be different for depression and for DPDR. (I know someone who had spontaneous remission from decades of chronic depression soon after they retired, it's just personal experience, but it happens). Also it could be different kinds of people who go on forums and who are picked to participate in different studies. Then it might also not be so interesting for researchers to do statistics on spontaneous remission because they research what you can do about DPDR and people who don't require them to do anything are not so interesting to them. Or maybe they are, I don't know, I'm just making this up, but I want to say that it's hard to compare different things that are measured so differently.
@Peter: Let's face it, TDX: You've wasted the last 10 years of your life visiting this forum (and many others) day after day, spreading negativity and eloquently packaged baseless criticism of Michal and others. You don't even have DPDR, just a mixture of Narcissistic Personality Disorder (or at least tremendous arrogance), low self-esteem (which is why you're quite comfortable in the anonymity of the internet), and a little bit of depression (or rather dysthymia). You also seem to have a massive secondary benefit of illness because, while you don't even have DPDR, you nevertheless seem to really enjoy playing the role of the pessimistic, psychiatric-abandoned hopeless case. You don't feel like you're living in a dream (lucky you!), but (due to your self-loathing) you probably feel some kind of inner detachment from yourself, which you (wrongfully) call "depersonalization", so you can spend time on this forum and have discussions. Not even after 10 years did you realize that there is (of course) no medication that will ever fix your severely pathological personality, cure your hidden fears, give you true self-esteem etc. You are - and there is no doubt about it - mentally (and not biologically or idiopathically) ill. I wish you with all my heart that at some point you will overcome your heavy defense mechanisms and become willing to seek serious psychotherapeutic help. This is the only key; because arrogance, secondary benefit of illness, fear of vulnerabilty and fear of social connectedness cannot be cured by any medication. After having tried so many different things without the slightest success, you should be able to see this, I think.
Now let me say something about the things that you (in really embarrassing unfriendliness) keep accusing Michal of. Correct me if I'm wrong, but I think I can summarize your criticism as follows:
1) Michal withholds pharmacological treatment from DPDR patients by not recommending any pharmacological therapy in his guideline.
2) Michal is just interested in promoting his own psychotherapeutic approach, despite the lack of any evidence and a solid theoretical basis for it.
3) He recommends mindfulness meditation as a treatment, although it has been reported to cause depersonalization disorder.
Here are my replies:
1) This is simply not true. In the guideline as well as in his book, he writes with regard to both opioid antagonists and Lamotrigine that after a thorough cost-benefit analysis, a treatment attempt with these drugs can be made. The studies on Lamotrigine as well as on opioid antagonists have (as you know) yielded conflicting results, so it goes without saying that Michal cannot define treatment with these drugs as the therapy of choice. You make it seem like there is a drug that has been convincingly shown to be particularly helpful in the treatment of DPDR, but that Michal (maliciously) wants to withhold. That is simply not the case.
2) First, Michal does not have his "own" psychotherapeutic approach. He does mention that he uses experiential psychotherapy approaches (ISTDP by Davanloo, Affect Phobia Therapy by McCullough), but he doesn't "promote" them, and I don't see what he would gain from "promoting" them, because they are not his own anyway. Second, he explicitly states in his book that he usually does not recommend any particular line of therapy (psychodynamic therapy, psychoanalysis, CBT, etc.) to patients. Third, you are right that there are no randomized controlled studies on the effectiveness of psychotherapy in the treatment of DPDR (and Michal even says that explicitly in the guideline). Nevertheless, Michal's 20+ years of experience as a clinician who sees DPDR patients on a daily basis as well as the clinical experience of all the other DPDR experts can, in my view, justifiably be counted as a form of evidence for the effectiveness of psychotherapy treatment. Elaine Hunter, Anthony David, Mauricio Sierra, Daphne Simeon etc. all agree that psychotherapy is the treatment of choice. And by the way, Daphne Simeon (who is, and I think you can agree with me, the world's leading expert on DPDR) completely agrees with Michal's "Affect Phobia Therapy" approach. (Probably Michal was even the first to use it on DPDR patients and Simeon got it from him.) In "Gabbard's Treatments of Psychiatric Disorders" (2014), Simeon writes: "[The] microanalysis of depersonalization symptoms as they wax and wane during psychotherapy sessions can be most effectively utilized with an affect phobia psychodynamic model in mind." And she continues saying that "in our clinical experience, psychodynamic psychotherapy can be very helpful". Although Simeon has not conducted randomized controlled trials on this, given her many years of experience with DPDR patients, I think it's pretty reasonable to trust what she says. Don't you think?
3) Mindfulness meditation is recommended for DPDR patients not only by Michal, but by all DPDR experts, including Simeon, Hunter, David and Sierra. Yes, there are, again, no randomized controlled trials on the effectiveness of mindfulness meditation on DPDR, but there are pretty good theoretical reasons, and Michal explains them in his book (insula activation, getting in touch with your feelings instead of being detached from them etc.). I know that there is indeed at least one small study (Castillo 1990) that describes how meditation appears to have facilitated the emergence of DPDR. But I think it depends a lot on how you practice mindfulness meditation though. One can also meditate in such a way that one separates oneself even more from one's feelings. But that's not what the exercises that Michal recommends are about, so I don't think there's anything to worry about here.
I have the impression that, for whatever reason, you are simply projecting some kind of malevolence into Michal and his work. You should be happy for all DPDR patients (to which you are not one) that there is someone in Germany who knows this disease so well, does research on it and has established a special unit at a university hospital.
Now let me say something about the things that you (in really embarrassing unfriendliness) keep accusing Michal of. Correct me if I'm wrong, but I think I can summarize your criticism as follows:
1) Michal withholds pharmacological treatment from DPDR patients by not recommending any pharmacological therapy in his guideline.
2) Michal is just interested in promoting his own psychotherapeutic approach, despite the lack of any evidence and a solid theoretical basis for it.
3) He recommends mindfulness meditation as a treatment, although it has been reported to cause depersonalization disorder.
Here are my replies:
1) This is simply not true. In the guideline as well as in his book, he writes with regard to both opioid antagonists and Lamotrigine that after a thorough cost-benefit analysis, a treatment attempt with these drugs can be made. The studies on Lamotrigine as well as on opioid antagonists have (as you know) yielded conflicting results, so it goes without saying that Michal cannot define treatment with these drugs as the therapy of choice. You make it seem like there is a drug that has been convincingly shown to be particularly helpful in the treatment of DPDR, but that Michal (maliciously) wants to withhold. That is simply not the case.
2) First, Michal does not have his "own" psychotherapeutic approach. He does mention that he uses experiential psychotherapy approaches (ISTDP by Davanloo, Affect Phobia Therapy by McCullough), but he doesn't "promote" them, and I don't see what he would gain from "promoting" them, because they are not his own anyway. Second, he explicitly states in his book that he usually does not recommend any particular line of therapy (psychodynamic therapy, psychoanalysis, CBT, etc.) to patients. Third, you are right that there are no randomized controlled studies on the effectiveness of psychotherapy in the treatment of DPDR (and Michal even says that explicitly in the guideline). Nevertheless, Michal's 20+ years of experience as a clinician who sees DPDR patients on a daily basis as well as the clinical experience of all the other DPDR experts can, in my view, justifiably be counted as a form of evidence for the effectiveness of psychotherapy treatment. Elaine Hunter, Anthony David, Mauricio Sierra, Daphne Simeon etc. all agree that psychotherapy is the treatment of choice. And by the way, Daphne Simeon (who is, and I think you can agree with me, the world's leading expert on DPDR) completely agrees with Michal's "Affect Phobia Therapy" approach. (Probably Michal was even the first to use it on DPDR patients and Simeon got it from him.) In "Gabbard's Treatments of Psychiatric Disorders" (2014), Simeon writes: "[The] microanalysis of depersonalization symptoms as they wax and wane during psychotherapy sessions can be most effectively utilized with an affect phobia psychodynamic model in mind." And she continues saying that "in our clinical experience, psychodynamic psychotherapy can be very helpful". Although Simeon has not conducted randomized controlled trials on this, given her many years of experience with DPDR patients, I think it's pretty reasonable to trust what she says. Don't you think?
3) Mindfulness meditation is recommended for DPDR patients not only by Michal, but by all DPDR experts, including Simeon, Hunter, David and Sierra. Yes, there are, again, no randomized controlled trials on the effectiveness of mindfulness meditation on DPDR, but there are pretty good theoretical reasons, and Michal explains them in his book (insula activation, getting in touch with your feelings instead of being detached from them etc.). I know that there is indeed at least one small study (Castillo 1990) that describes how meditation appears to have facilitated the emergence of DPDR. But I think it depends a lot on how you practice mindfulness meditation though. One can also meditate in such a way that one separates oneself even more from one's feelings. But that's not what the exercises that Michal recommends are about, so I don't think there's anything to worry about here.
I have the impression that, for whatever reason, you are simply projecting some kind of malevolence into Michal and his work. You should be happy for all DPDR patients (to which you are not one) that there is someone in Germany who knows this disease so well, does research on it and has established a special unit at a university hospital.
"Detachment from self" is kind of the definition of depersonalization, isn't it? We already talked to Peter about not shitting on people for having hope in things that aren't formal double blind studies. At risk of sounding corny, we need to have hope in ourselves.@Peter: Let's face it, TDX: You've wasted the last 10 years of your life visiting this forum (and many others) day after day, spreading negativity and eloquently packaged baseless criticism of Michal and others. You don't even have DPDR, just a mixture of Narcissistic Personality Disorder (or at least tremendous arrogance), low self-esteem (which is why you're quite comfortable in the anonymity of the internet), and a little bit of depression (or rather dysthymia). You also seem to have a massive secondary benefit of illness because, while you don't even have DPDR, you nevertheless seem to really enjoy playing the role of the pessimistic, psychiatric-abandoned hopeless case. You don't feel like you're living in a dream (lucky you!), but (due to your self-loathing) you probably feel some kind of inner detachment from yourself, which you (wrongfully) call "depersonalization", so you can spend time on this forum and have discussions. Not even after 10 years did you realize that there is (of course) no medication that will ever fix your severely pathological personality, cure your hidden fears, give you true self-esteem etc. You are - and there is no doubt about it - mentally (and not biologically or idiopathically) ill. I wish you with all my heart that at some point you will overcome your heavy defense mechanisms and become willing to seek serious psychotherapeutic help. This is the only key; because arrogance, secondary benefit of illness, fear of vulnerabilty and fear of social connectedness cannot be cured by any medication. After having tried so many different things without the slightest success, you should be able to see this, I think.
Now let me say something about the things that you (in really embarrassing unfriendliness) keep accusing Michal of. Correct me if I'm wrong, but I think I can summarize your criticism as follows:
1) Michal withholds pharmacological treatment from DPDR patients by not recommending any pharmacological therapy in his guideline.
2) Michal is just interested in promoting his own psychotherapeutic approach, despite the lack of any evidence and a solid theoretical basis for it.
3) He recommends mindfulness meditation as a treatment, although it has been reported to cause depersonalization disorder.
Here are my replies:
1) This is simply not true. In the guideline as well as in his book, he writes with regard to both opioid antagonists and Lamotrigine that after a thorough cost-benefit analysis, a treatment attempt with these drugs can be made. The studies on Lamotrigine as well as on opioid antagonists have (as you know) yielded conflicting results, so it goes without saying that Michal cannot define treatment with these drugs as the therapy of choice. You make it seem like there is a drug that has been convincingly shown to be particularly helpful in the treatment of DPDR, but that Michal (maliciously) wants to withhold. That is simply not the case.
2) First, Michal does not have his "own" psychotherapeutic approach. He does mention that he uses experiential psychotherapy approaches (ISTDP by Davanloo, Affect Phobia Therapy by McCullough), but he doesn't "promote" them, and I don't see what he would gain from "promoting" them, because they are not his own anyway. Second, he explicitly states in his book that he usually does not recommend any particular line of therapy (psychodynamic therapy, psychoanalysis, CBT, etc.) to patients. Third, you are right that there are no randomized controlled studies on the effectiveness of psychotherapy in the treatment of DPDR (and Michal even says that explicitly in the guideline). Nevertheless, Michal's 20+ years of experience as a clinician who sees DPDR patients on a daily basis as well as the clinical experience of all the other DPDR experts can, in my view, justifiably be counted as a form of evidence for the effectiveness of psychotherapy treatment. Elaine Hunter, Anthony David, Mauricio Sierra, Daphne Simeon etc. all agree that psychotherapy is the treatment of choice. And by the way, Daphne Simeon (who is, and I think you can agree with me, the world's leading expert on DPDR) completely agrees with Michal's "Affect Phobia Therapy" approach. (Probably Michal was even the first to use it on DPDR patients and Simeon got it from him.) In "Gabbard's Treatments of Psychiatric Disorders" (2014), Simeon writes: "[The] microanalysis of depersonalization symptoms as they wax and wane during psychotherapy sessions can be most effectively utilized with an affect phobia psychodynamic model in mind." And she continues saying that "in our clinical experience, psychodynamic psychotherapy can be very helpful". Although Simeon has not conducted randomized controlled trials on this, given her many years of experience with DPDR patients, I think it's pretty reasonable to trust what she says. Don't you think?
3) Mindfulness meditation is recommended for DPDR patients not only by Michal, but by all DPDR experts, including Simeon, Hunter, David and Sierra. Yes, there are, again, no randomized controlled trials on the effectiveness of mindfulness meditation on DPDR, but there are pretty good theoretical reasons, and Michal explains them in his book (insula activation, getting in touch with your feelings instead of being detached from them etc.). I know that there is indeed at least one small study (Castillo 1990) that describes how meditation appears to have facilitated the emergence of DPDR. But I think it depends a lot on how you practice mindfulness meditation though. One can also meditate in such a way that one separates oneself even more from one's feelings. But that's not what the exercises that Michal recommends are about, so I don't think there's anything to worry about here.
I have the impression that, for whatever reason, you are simply projecting some kind of malevolence into Michal and his work. You should be happy for all DPDR patients (to which you are not one) that there is someone in Germany who knows this disease so well, does research on it and has established a special unit at a university hospital.
Well, depersonalization is (of course) a form of „detachment from the self“, but not every detachement from the self is worth being called „depersonalization“ in the strict sense. For example, you might feel some inner „distance“ to yourself because you don‘t like certain parts of your personality or body. But that does not imply that you have actual DPDR, namely a persistent feeling of living in a dream and everything being unreal."Detachment from self" is kind of the definition of depersonalization, isn't it? We already talked to Peter about not shitting on people for having hope in things that aren't formal double blind studies. At risk of sounding corny, we need to have hope in ourselves.
And just in case you didn’t know: Peter‘s former user name was TDX, and he was banned from this forum because he gave someone advice on how to commit suicide. It‘s a shame that he‘s still allowed to participate in discussions on this side.
That's the Internet for you. From what I hear there was a lot of vile shit going on here until the site was acquired by VerticleScope and only a few good mods remained. Anyway I don't see what Peter being awful has to do with him having depersonalization or not. Mental illness is actually a flag that someone could exhibit messed up behavior, lack compassion, and lack insight. Of course, normal people are also in fierce competition to see who can be the most dumb and shitty.Well, depersonalization is (of course) a form of „detachment from the self“, but not every detachement from the self is worth being called „depersonalization“ in the strict sense. For example, you might feel some inner „distance“ to yourself because you don‘t like certain parts of your personality or body. But that does not imply that you have actual DPDR, namely a persistent feeling of living in a dream and everything being unreal.
And just in case you didn’t know: Peter‘s former user name was TDX, and he was banned from this forum because he gave someone advice on how to commit suicide. It‘s a shame that he‘s still allowed to participate in discussions on this side.
@NoDevils „Anyway I don't see what Peter being awful has to do with him having depersonalization or not.“
Me neither. I didn‘t say that. 😅
Me neither. I didn‘t say that. 😅
Although I'm obviously not TDX, I will respond to your post nonetheless.Let's face it, TDX:
I joined this forum on Jun 25, 2018 and wrote 197 replies, which would amount to 197/1782 = 0.11 posts per day. Looks like only a tiny fraction of the last 5 years.You've wasted the last 10 years of your life visiting this forum (and many others) day after day, spreading negativity and eloquently packaged baseless criticism of Michal and others.
Can you prove this?You don't even have DPDR
Remote diagnosing is a big no-no in psychology. For example if you were a psychologist and member of the german Society for Psychology you would violate their code of conduct:, just a mixture of Narcissistic Personality Disorder (or at least tremendous arrogance)
"10.4 Auftreten in der Öffentlichkeit
Psychologinnen und Psychologen können in der Öffentlichkeit mündlich und schriftlich, durch die Versendung von Materialien per Post, Fax und E-Mail, über das Internet oder mittels anderer Medien etc. beratend oder kommentierend tätig werden. Sie:
(1) gründen ihre Aussagen und Ratschläge auf zuverlässigem, validem, wissenschaftlich fundiertem Wissen und anerkannter psychologischer Praxis;
(2) begrenzen ihre Aussagen auf sachliche Information, wobei die eigene Person und Praxis nicht werbend hervorgehoben werden;
(3) achten darauf, dass die Persönlichkeitsrechte aller Menschen in der Öffentlichkeit gewahrt bleiben, und enthalten sich diagnostischer Beurteilungen über einzelne Personen ohne deren ausdrückliche Aufforderung."
Moreover Narcissistic Personality Disorder isn't even included in ICD-11, so it was for the most part abolished like half of the other personality disorders.
Most people on the internet are anoymous including yourself. Do all of them have low self-esteem?low self-esteem (which is why you're quite comfortable in the anonymity of the internet)
Actually I scored consistently above 30 on the BDI throughout the years, so that part is a little bit more than a little bit.and a little bit of depression (or rather dysthymia)
Reminds me to chronic fatigue syndrome, where psychosomatics also claimed that people with a disease often worse than death were enjoying benefits from it. I havent't come across sound scientific evidence yet that secondary gain really exists the way it's proponents claim. Especially the effects of severe disease outweight any possible "secondary gain".You also seem to have a massive secondary benefit of illness because, while you don't even have DPDR, you nevertheless seem to really enjoy playing the role of the pessimistic, psychiatric-abandoned hopeless case.
I did not really do much of anything on depersonalization forums or even other mental health forums in the last months or even the previous years. My net acticity probably amounts to just a few minutes per day. But still you claim that I "fake" depersonalization just for being able to take in part on depersonalization forums?You don't feel like you're living in a dream (lucky you!), but (due to your self-loathing) you probably feel some kind of inner detachment from yourself, which you (wrongfully) call "depersonalization", so you can spend time on this forum and have discussions.
I could very well live with all that stuff. I won't confirm to you that I have "hidden fears", lack self-esteem or whatever, but I can say so far that I never ever thought about seeking drug treatment for any of that. The goal of all of my drug trials was to gain relief from my depersonalization.Not even after 10 years did you realize that there is (of course) no medication that will ever fix your severely pathological personality, cure your hidden fears, give you true self-esteem etc.
So my tinnitus, GERD, retinal damage and so on are not biological?You are - and there is no doubt about it - mentally (and not biologically or idiopathically) ill.
Apart from having tried psychotherapy in the past, why should I try psychotherapy, although there is currently no indication that it works for depersonalization disorder?I wish you with all my heart that at some point you will overcome your heavy defense mechanisms and become willing to seek serious psychotherapeutic help.
Even if we take this premise for granted, there would still be the problem that there is no solid evidence that psychotherapy works for those things either. You are massively overstating the limited benefits of psychotherapy.This is the only key; because arrogance, secondary benefit of illness, fear of vulnerabilty and fear of social connectedness cannot be cured by any medication.
Regarding the guideline I repeat what I said above:This is simply not true. In the guideline as well as in his book, he writes with regard to both opioid antagonists and Lamotrigine that after a thorough cost-benefit analysis, a treatment attempt with these drugs can be made.
He says that Lamotrigine and Naltrexone should only be used in "single cases". This wording implies that they shouldn't be used in the majority. This has a real effect on sufferers: Both Lamotrigine and Naltrexone aren't approved for depersonalization disorder. You can only get them prescribed off-label for depersonalization disorder, which means health insurance is not obliged to pay for it. However there are certain rules under which health insurance is willing to cover off-label drugs. And one of them is that guidelines recommend them. This is something which can't be said about the depersonalization guideline. Effectively Michal blocked sufferers from getting Lamotrigine and Naltrexone covered by health insurance.
On the 4th edition of his book it says about Lamotrigine:
"Auf Grundlage dieser Studien kann es in sehr seltenen Einzelfällen und nach gründlicher Abwägung der Vor- und Nachteile gerechtfertigt sein, einen Off-Label-Therapieversuch mit Lamotrigin als alleiniger Substanz oder in Kombination mit einem Antidepressivum durchzuführen. Ich selbst verordne Lamotrigin aufgrund der dünnen Datenlage und meiner eigenen Erfahrungen aber nicht mehr. "
Furthermore he says about Naltrexone:
"Naltrexon ist ein Opiatantagonist, der zur unterstützenden Behandlung bei der Rückfallprävention von Patienten mit Opiat- und Alkoholabhängigkeit eingesetzt wird. Vereinzelt berichteten DDS-Patienten nach Einnahme von 100–250 mg Naltrexon/Tag von einer deutlichen Abnahme der DDS-Symptomatik. Dies kann bei alkoholkranken Patienten, bei denen sowieso eine medikamentöse Rückfallprophylaxe mit Naltrexon sinnvoll ist, oder in seltenen Einzelfällen auch bei Patienten ohne eine Alkoholerkrankung und nach gründlicher Abwägung einen Off-Label-Therapieversuch mit Naltrexon rechtfertigen."
So in his opinion Lamotrigine should only be used in "very rare cases" and Naltrexone when there is co-morbid alcoholism or in "rare cases". Does this sound like a recommendation to you?
They aren't really conficting. Apart from the randomized-controlled trial studies showed consistent benefit for Lamotrigine. The randomized-controlled trial does not disprove this as placebo-effect, because there wasn't a placebo-effect in this trial. Most studies for opioid-antagonists also demonstrated beneficial effects.The studies on Lamotrigine as well as on opioid antagonists have (as you know) yielded conflicting results, so it goes without saying that Michal cannot define treatment with these drugs as the therapy of choice.
Even if we assume that these studies are not sufficient to declare Lamotrigine and Naltrexone as "therapy of choice", the question remains why he can make psychotherapy treatment of choice, although it's evidence-base is much lower and for his own treatment approach virtually non-existent? Basically there is just a very questionable non-controlled clinical trial on a cognitive-behavioral therapy with serious flaws based on a model that is illogical and inconsistent with empirical evidence.
Under these preconditions, why does he actively discourage the use of drug treatments, while pushing psychotherapy as the treatment of choice? Shouldn't it be the other way round?
In a book that was recently published Michal says "Die Therapie der Wahl ist Psychotherapie, eine medikamentöse Behandlung existiert derzeit nicht." (which translates to: "The treatment of choice is psychotherapy, a drug treatment currently does not exist").You make it seem like there is a drug that has been convincingly shown to be particularly helpful in the treatment of DPDR, but that Michal (maliciously) wants to withhold. That is simply not the case.
What do you think about him literally stating that drug treatments don't exist?
Still he describes his treatment approach in great detail in his book and it's clear that it's psychodynamic to the core and that he is a big proponent of psychoanalysis. Here is one example:Second, he explicitly states in his book that he usually does not recommend any particular line of therapy (psychodynamic therapy, psychoanalysis, CBT, etc.) to patients.
"Entscheidend ist es, die Depersonalisations-Derealisationsstörung als eine seelische Erkrankung zu akzeptieren. Das heißt anzuerkennen, dass die Beschwerden auch eine Folge der eigenen Lebens- und Beziehungsgeschichte, des eigenen Verhaltens und der eigenen Vorstellungen über sich selbst und andere Menschen sind. Man muss den Mut aufbringen, sich mit den Verhaltensweisen, Vorstellungen und unverarbeiteten Gefühlen zu beschäftigen, die die Entfremdung verursachen (Freud 1914). Man muss sich um ein liebevolles Interesse für die eigene Person, die eigenen Wünsche, Hemmungen und Ängste bemühen. Und man muss den Mut aufbringen, unangemessene Hemmungen, Ängste und falsche Vorstellungen, die die Entfremdung verursachen, als Probleme anzuerkennen, die man letztendlich besser lösen und überwinden kann."
He even refers to Freud, who is discredit by almost all of today's psychology and even by many psychoanalysts.
But still he is making psychotherapy the first-line treatment, although it's evidence is far worse than those for drug treatments.Third, you are right that there are no randomized controlled studies on the effectiveness of psychotherapy in the treatment of DPDR (and Michal even says that explicitly in the guideline).
Expert opinions are very unreliable, the least worthwhile piece of evidence in evidence-based medicine and it's obvious that Michal's bias is extreme.Nevertheless, Michal's 20+ years of experience as a clinician who sees DPDR patients on a daily basis as well as the clinical experience of all the other DPDR experts can, in my view, justifiably be counted as a form of evidence for the effectiveness of psychotherapy treatment.
Clinicians agreeing about a certain treatment approach is the weakest possible evidence and has often been proven wrong, especially when the level of bias is so high. Example: In chronic fatigue syndrome, a much higher number of clinicians pushed a psychotherapeutic treatment approach, which not only did not work, but made people worse, in many cases permanently and in some cases even led to suicide.Elaine Hunter, Anthony David, Mauricio Sierra, Daphne Simeon etc. all agree that psychotherapy is the treatment of choice.
She isn't that good in my opinion and far behind Sierra. In my opinion we must look at the arguments and they are not really convincing.And by the way, Daphne Simeon (who is, and I think you can agree with me, the world's leading expert on DPDR)
Which is basically your whole argument for Affect Phobia Therapy, although there is not only zero evidence that it works, but there is also no empirical evidence that affect phobia causes depersonalization or people with depersonalization even have affect phobia. I would even go as far as to say, that there isn't even sound evidence that "affect phobia" exists the way it's proponents claim.completely agrees with Michal's "Affect Phobia Therapy" approach.
Basically your whole argument reduces to argumentum ad verecundiam, which is not convincing and clearly much lower evidence for psychotherapy than the clinical trials for Lamotrigine and Naltrexone.Although Simeon has not conducted randomized controlled trials on this, given her many years of experience with DPDR patients, I think it's pretty reasonable to trust what she says. Don't you think?
Mindfulness was featured in one or two of their studies, but I can't remember anyone else other than Michal consistently pushing mindfulness meditation as a treatment for depersonalization disorder. So far Mindfulness meditation is just a Michal-thing.Mindfulness meditation is recommended for DPDR patients not only by Michal, but by all DPDR experts, including Simeon, Hunter, David and Sierra.
I have some counter-arguments:Yes, there are, again, no randomized controlled trials on the effectiveness of mindfulness meditation on DPDR, but there are pretty good theoretical reasons, and Michal explains them in his book (insula activation, getting in touch with your feelings instead of being detached from them etc.).
- He claims that mindfulness was the "antithesis of depersonalization", but he doesn't really say what this "antithesis" is (lack of something is not necessaily the antithesis of something) and his study showing a negative association is clouded by shared item-content between depersonalization and mindfulness questionnaires.
- Michal doesn't mention in his book that there are also studies, where mindfulness meditation induced brain activity consistent with depersonalization, like increased activation of prefrontal areas or the temporoparietal junction.
- There is no plausible reason why attending to bodily perceptions should return emotions or reduce depersonalization. While it is generally belived that recognizing bodily arousal is necessary for emotional experience, Michal showed in one of his own studies that the interoceptive sensitivity of patients with depersonalization disorder is normal. Mindfulness meditation doesn't seem to improve interoceptive sensitivity anyway.
- His argument that mindfulness meditation might work by reducing self-observation seems questionable, given that there is no evidence that self-observation causes or maintains depersonalization disorder and mindfulness meditation is self-observation by itself.
This study features transcendental meditation, which is much more dangerous than mindfulness meditation.I know that there is indeed at least one small study (Castillo 1990) that describes how meditation appears to have facilitated the emergence of DPDR. But I think it depends a lot on how you practice mindfulness meditation though.
So the blame is put on the patient, by claming without any evidence that he practiced meditation in a wrong way?One can also meditate in such a way that one separates oneself even more from one's feelings. But that's not what the exercises that Michal recommends are about, so I don't think there's anything to worry about here.
I have read a lot of accounts on what is going on in his so-called "special unit". There are some positive experiences, but many of the reports are quite shocking, especially regarding Michal's conduct. Importantly it appears to be very rare that people improve in this clinic.I have the impression that, for whatever reason, you are simply projecting some kind of malevolence into Michal and his work. You should be happy for all DPDR patients (to which you are not one) that there is someone in Germany who knows this disease so well, does research on it and has established a special unit at a university hospital.
Do you have evidence for this?And just in case you didn’t know: Peter‘s former user name was TDX, and he was banned from this forum because he gave someone advice on how to commit suicide.
You don't like my (or TDX's) opinion, so you want to cancel me or him or whatever. It's also quite evident from your post that you have a lot of resentment for TDX.It‘s a shame that he‘s still allowed to participate in discussions on this side.
It even went so far that you chased TDX down some obscure Podcast site and smeared him in the comments:
Depersonalisation - Wer bin ich? | TALK - der Podcast | NRWision
I can't really see what he might have done to you to justify such a reaction, which seems a bit overblown, especially with all those insults disguised as psychiatric diagnoses.
Old forum users are gross. If TDX really were some "canceled enemy of the forum" Peter would be banned on account of how many people think he's TDX, plus Peter's constant tongue in cheek references to him. I hope you guys know how rightfully repulsed a normal person would be by this nonsense.
About psychoanalysts, hypnosis, meditation and so on, I never had an experience with a psychoanalyst that wasn't creepy and don't expect I ever will. The only type of therapist I can tolerate are those who speak to patients like equal human beings and don't recommend any voodoo. Such therapy doesn't cure depersonalization but it can help with cooccurring depression and anxiety. That's just my opinion, of course, based on personal experience and no epic small studies. Psychoanalysis seems a lot like religion in that it's important to our freedom that it's allowed to be practiced but it probably shouldn't be recommended to anyone, especially not to desperate people.
About psychoanalysts, hypnosis, meditation and so on, I never had an experience with a psychoanalyst that wasn't creepy and don't expect I ever will. The only type of therapist I can tolerate are those who speak to patients like equal human beings and don't recommend any voodoo. Such therapy doesn't cure depersonalization but it can help with cooccurring depression and anxiety. That's just my opinion, of course, based on personal experience and no epic small studies. Psychoanalysis seems a lot like religion in that it's important to our freedom that it's allowed to be practiced but it probably shouldn't be recommended to anyone, especially not to desperate people.
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