![]() ![]() ![]() However, Meyer (1956), as cited by Sedman (1970), has distinguished schizophrenic ego disturbances from depersonalization on phenomenological grounds that is, on the description by the patient of his own internal experience. In fact, passivity experiences have even been described as a variant of depersonalization. Sometimes there has been considerable confusion over whether depersonalization can be distinguished from the disorders of self-image described in Chapter 12 as occurring in schizophrenia. Many studies have documented the SCID-D's good-to-excellent reliability and validity for detection of depersonalization and its characterization within the full spectrum of dissociative symptoms.įemi Oyebode MBBS, MD, PhD, FRCPsych, in Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology, 2018 Depersonalization: Further Considerations The SCID-D evaluates depersonalization in the context of four additional dissociative symptoms: amnesia, derealization, identity confusion, and identity alteration. The author reviews assessments of depersonalization in adolescents and adults using the Structured Clinical Interview for Dissociative Disorders (SCID-D) (Steinberg, 1994, DSM-5/ICD version). Accurate diagnosis requires assessment of depersonalization within a context of other dissociative symptoms in order to properly characterize an underlying dissociative disorder, or to rule one out. ![]() Depersonalization occurs on a spectrum, from few/transient episodes in individuals with a variety of psychiatric disorders, to recurrent or ongoing episodes experienced in those with posttraumatic and dissociative disorders. Steinberg, in Stress: Concepts, Cognition, Emotion, and Behavior, 2016 Abstractĭepersonalization is often not the presenting complaint, making familiarity with the means for detection and assessment critical to avoiding misdiagnosis and ineffective treatment. What kind of effect does the illness have on the patient's work, family, or financial situation? Is there a feeling of loss of control? Does the patient feel guilt about the illness? Does the patient think that he or she will die? By pondering these questions, you can learn much about patients, and patients will realize that you are interested in them as whole persons, not merely as statistics among the hospital admissions. Inquire specifically as to what the patient thinks is happening. What do the patients think is wrong with them? Do not accept merely the diagnosis. This is discussed further in Chapter 5, Mitigating Racism and Bias in Clinical Medicine.Ī good interviewing session determines what the patients comprehend about their own health problems. Such introspection enhances the self-image of the interviewer and results in the interviewer's being perceived by the patient as a more careful and compassionate human being to whom the patient can turn in a time of crisis. Inexperienced interviewers not only must learn about the patient's problems but also must gain insight into their own feelings, attitudes, and vulnerabilities. This failure to communicate weakens the doctor–patient relationship. They may eventually come to rely on the technical results and reports. They may be irritable and pay inadequate attention to the patient's story. At the same time, clinicians may be pressed for time, overworked, and sometimes unable to cope with everyday pressures. A name tag is placed on the patient's wrist, and he or she becomes “the patient in 9W-310.” This lowers the morale of the patient even more. A patient admitted to the hospital is stripped of clothing and often of dentures, glasses, hearing aids, and other personal belongings. They may be apprehensive because they have a problem that their health care provider considers too serious to be treated on an outpatient basis. Many find themselves in a strange environment, lying naked while clothed people march in and out of the room and touch them, tell them what to do, and so forth. Patients may feel dehumanized on admission to the hospital. Both doctor and patient may feel increasingly neglected, rejected, or abused. Clinicians may order computed tomography scans or sonograms without taking the appropriate time to speak with the patient about the tests. Health care providers may spend more time looking at a computer screen than looking at their patient. In this age of biomedical advancements, a new problem has arisen: a depersonalization of the doctor–patient relationship. Swartz MD, FACP, in Textbook of Physical Diagnosis: History and Examination, 2021 Depersonalization of the Doctor–Patient Relationship ![]()
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