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Friday, June 28, 2013

Dear Jeannie: Depersonalization Disorder and Survivor's Guilt

Dear Jeannie,

In my sci-fi book, my character endured sensory and sleep deprivation torture for about 5 weeks before being rescued. He hallucinated a malicious version of himself which taunted him. This character had previously died under similar circumstances before being reincarnated. Due to the similar feelings of isolation, helplessness, distortion of senses and reality, as well as the feeling of dying in both situations, do you think it would be realistic for him to develop Depersonalization Disorder as a result of the second event? Also, what other emotional baggage might he develop as a result of this event?

Lively in London

Dear Lively,

Dissociative disorders are a heck of a lot of fun to write, aren't they? Depersonalization disorder might fit the bill for your guy, but let's make sure.

People with this disorder experience episodes during which they feel detached from, outside of, or lacking control of themselves. They know it's only a feeling, not reality.  However, therapists have to rule out certain disorders before considering Depersonalization. One such disorder which you might want to look at is Acute Stress Disorder. Within ASD, the person can have experiences of being outside of their body, numb, and detached. So be sure to check out that link, and if he fits ASD, that would rule out Depersonalization Disorder.

To throw some more research your way, your character's second experience sounds more like Brief Psychotic Disorder to me. Due to his physical and psychological torture, he hallucinated this mean version of himself. Not knowing the full extent of his first experience, just that it is similar to his second, I feel pretty strongly that one of the anxiety disorders (ASD, PTSD) might be a better fit.

What do you think? Feel free to write responses in comment section below.

Dear Jeannie,

A man is responsible for the death of his family in a vehicular accident and because of depression and subsequent job loss, became indigent. What are some ways survivor's guilt would express itself and what is the shortest time frame it would be expected he would recover without intensive professional help?

Wrecked Two Ways in Texas 

Dear Wrecked,

You've already mentioned one of the ways survivor's guilt rears its ugly head: depression, which subsequently led to missing work and eventually losing his job. But in a previous post I did on this subject, I explained that various other reactions would be feasible. Here's an excerpt:
Survivor's guilt used to be it's own diagnosis in the Diagnostic and Statistical Manual until 1994 when it was subsumed under Post Traumatic Stress Disorder. It carried with it many of the same criteria as PTSD does now, including depression, anxiety, sleep disturbances, withdrawal, nightmares, episodes of uncontrollable crying/laughing, and a loss of interest in things that one brought pleasure. (Very similar to PTSD.)
As for recovery time, that is such an individual variable I couldn't hazard a guess. Given his active guilt in that he was driving the car, I would think it could last a fairly long time. Was he really responsible? Driving drunk? Where there any outside influences on what happened for him to lose control of the car? Some individuals never quite get over this, but some might take years. Therapy is the treatment of choice for this condition, so he could receive help in reframing his belief as being the cause of the accident (if indeed he wasn't) so that he can start seeing himself as a victim.

Any other thoughts or questions, shoot them to me below in a comment.

Got Questions?

Post them anonymously below, using monikers like Sleepless in Seattle.
I'll get to them in future Dear Jeannie columns.