Considering Mrs. Spinner’s symptoms, and the diagnostic criteria provided in the Diagnostic and Statistical Manual for Mental Disorders-5 (DSM-S), she meets criteria for depersonalization/derealization disorder.
Depersonalization/derealization disorder is characterized by the presence of persistent or recurrent experiences of depersonalization, derealization, or both (Criterion A). Individuals experiencing depersonalization may have feelings of unreality, detachment, or as if they were being an outside observer of their own thoughts, feelings, sensations, body, or actions (p. ). Similarly, symptoms of derealization may include feelings of unreality or detachment; however, this feelings should be experienced with respect to the individual’s direct surroundings, where objects can be experienced as unreal, dreamlike, foggy, lifeless, or visual distorted (p. ). In the case of Mrs. Spinner, she clearly presents both depersonalization and derealization symptoms. For example, as mentioned in this case, Mrs. Spinner experiences these symptoms as she describes as the feeling of being “floating”, and the inability of “maintaining her balance”, as well as the existence of perceptual alterations such seeing the room “shimmering”. According to criterion B for depersonalization/derealization disorder, reality testing must remain intact during the presence of these dissociative experiences, even when these symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning of the individual (Criterion C). In the case of Mrs. Spinner, though she appears not to have lost the sense of reality, the symptoms are highly distressing as they negatively affect her level of occupational, social, and interpersonal functioning. For instance, the symptoms are described to occur 4 to 5 times a week, accompanied by dizziness and nausea which would leave Mrs. Spinner incapacitated as would had to lie down, being unable to cook or spend time with her family. To add on, and according to the information provided during the patient’s medical and psychological evaluation, there was no evidence of substance use, or the presence of another medical or mental condition. Based on this, Mrs. Spinner meets both, criterion D and E of the diagnostic criteria for depersonalization/ derealization disorder. Criterion D states that the disturbance must not be attributable to the psychological effects of a substance or another medical condition such as seizures, while criterion E refers to the absence of another mental disorder such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder. Having said this, and based on what is stated in criterion D of this dissociative disorder, other possible mental disorders had to be ruled out before determining the final diagnosis. In the case of Mrs. Spinner, she shares some of the criteria for other dissociative and anxiety disorders. For example, Mrs. Spinner meets some of the criteria for dissociative identity disorder (DID), however, and as mentioned in the DSM-5, in order to diagnose depersonalization/derealization disorder the symptoms should not occur in the context of another dissociative disorder such as dissociative identity disorder (p.302). Both, criteria A and B for dissociative identity disorder help differentiate DID from depersonalization/derealization disorder. Criterion A for dissociative identity disorder refers to the disruption of identity characterized by two or more distinct personality states, involving marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory-motor functioning; while criterion B states to how the individual must experience recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting to meet the diagnostic criteria (p. 292). …show more content…
Spinner receives medical treatment to help control the mental health symptoms associated with dissociative disorders. For example, the use of antidepressants and anti-anxiety medications such as fluoxetine, clomipramine and clonazepam.
More specifically, a possible technique that could be effective when treating Mrs. Spinner’s symptoms, would be dialectical behavior therapy (DBT). As described by Corey (2009), by incorporating behavioral and cognitive behavioral techniques, and including a certain form of exposure therapy, the client could learn to tolerate painful emotions without experiencing mechanisms of dissociation. During intervention. Mrs. Spinner should develop new skills that will help her become aware of the present moment without altering reality, and how to let go of attachments that could result in suffering and
Depersonalization/derealization disorder is characterized by the presence of persistent or recurrent experiences of depersonalization, derealization, or both (Criterion A). Individuals experiencing depersonalization may have feelings of unreality, detachment, or as if they were being an outside observer of their own thoughts, feelings, sensations, body, or actions (p. ). Similarly, symptoms of derealization may include feelings of unreality or detachment; however, this feelings should be experienced with respect to the individual’s direct surroundings, where objects can be experienced as unreal, dreamlike, foggy, lifeless, or visual distorted (p. ). In the case of Mrs. Spinner, she clearly presents both depersonalization and derealization symptoms. For example, as mentioned in this case, Mrs. Spinner experiences these symptoms as she describes as the feeling of being “floating”, and the inability of “maintaining her balance”, as well as the existence of perceptual alterations such seeing the room “shimmering”. According to criterion B for depersonalization/derealization disorder, reality testing must remain intact during the presence of these dissociative experiences, even when these symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning of the individual (Criterion C). In the case of Mrs. Spinner, though she appears not to have lost the sense of reality, the symptoms are highly distressing as they negatively affect her level of occupational, social, and interpersonal functioning. For instance, the symptoms are described to occur 4 to 5 times a week, accompanied by dizziness and nausea which would leave Mrs. Spinner incapacitated as would had to lie down, being unable to cook or spend time with her family. To add on, and according to the information provided during the patient’s medical and psychological evaluation, there was no evidence of substance use, or the presence of another medical or mental condition. Based on this, Mrs. Spinner meets both, criterion D and E of the diagnostic criteria for depersonalization/ derealization disorder. Criterion D states that the disturbance must not be attributable to the psychological effects of a substance or another medical condition such as seizures, while criterion E refers to the absence of another mental disorder such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder. Having said this, and based on what is stated in criterion D of this dissociative disorder, other possible mental disorders had to be ruled out before determining the final diagnosis. In the case of Mrs. Spinner, she shares some of the criteria for other dissociative and anxiety disorders. For example, Mrs. Spinner meets some of the criteria for dissociative identity disorder (DID), however, and as mentioned in the DSM-5, in order to diagnose depersonalization/derealization disorder the symptoms should not occur in the context of another dissociative disorder such as dissociative identity disorder (p.302). Both, criteria A and B for dissociative identity disorder help differentiate DID from depersonalization/derealization disorder. Criterion A for dissociative identity disorder refers to the disruption of identity characterized by two or more distinct personality states, involving marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition and/or sensory-motor functioning; while criterion B states to how the individual must experience recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting to meet the diagnostic criteria (p. 292). …show more content…
Spinner receives medical treatment to help control the mental health symptoms associated with dissociative disorders. For example, the use of antidepressants and anti-anxiety medications such as fluoxetine, clomipramine and clonazepam.
More specifically, a possible technique that could be effective when treating Mrs. Spinner’s symptoms, would be dialectical behavior therapy (DBT). As described by Corey (2009), by incorporating behavioral and cognitive behavioral techniques, and including a certain form of exposure therapy, the client could learn to tolerate painful emotions without experiencing mechanisms of dissociation. During intervention. Mrs. Spinner should develop new skills that will help her become aware of the present moment without altering reality, and how to let go of attachments that could result in suffering and