I feel so empty without you
SAMHSA’s National Helpline | SAMHSA
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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.
SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders.
This service provides referrals to local treatment facilities, support groups, and community-based organizations.
Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.
The service is open 24/7, 365 days a year.
English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.
In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.
The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs.
In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.
The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.
No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.
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Suggested Resources
What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems.
Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.It's Not Your Fault (NACoA) (PDF | 12 KB)
Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse.
Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.For additional resources, please visit the SAMHSA Store.
Last Updated
Last Updated: 08/30/2022
Alcohol, Tobacco, and Other Drugs
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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).
Alcohol
Data:
- Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
- Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
- In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
- Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.
4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH) - The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
- Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily
Programs/Initiatives:
- STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
- Interagency Coordinating Committee on the Prevention of Underage Drinking
- Talk.
They Hear You. - Underage Drinking: Myths vs. Facts
- Talking with your College-Bound Young Adult About Alcohol
Relevant links:
- National Association of State Alcohol and Drug Abuse Directors
- Department of Transportation Office of Drug & Alcohol Policy & Compliance
- Alcohol Policy Information Systems Database (APIS)
- National Institute on Alcohol Abuse and Alcoholism
Tobacco
Data:
- In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
- Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
- Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses.
The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States - The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes
Electronic cigarette (e-cigarette) use data:
- In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
- Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.
4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH) - Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
- E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals
Resources:
- Tips for Teens: Tobacco
- Tips for Teens: E-cigarettes
- Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
- Synar Amendment Program
Links:
- Truth Initiative
- FDA Center for Tobacco Products
- CDC Office on Smoking and Health
- National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
- National Institute on Drug Abuse: E-Cigarettes
Opioids
Data:
- Among people aged 12 or older in 2021, 3.
3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH) - Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
- According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose
Resources:
- Medications for Substance Use Disorders
- Opioid Overdose Prevention Toolkit
- TIP 63: Medications for Opioid Use Disorder
- Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
- Opioid Use Disorder and Pregnancy
- Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
- The Facts about Buprenorphine for Treatment of Opioid Addiction
- Pregnancy Planning for Women Being Treated for Opioid Use Disorder
- Tips for Teens: Opioids
- Rural Opioid Technical Assistance Grants
- Tribal Opioid Response Grants
- Provider’s Clinical Support System - Medication Assisted Treatment Grant Program
Links:
- National Institute on Drug Abuse: Opioids
- National Institute on Drug Abuse: Heroin
- HHS Prevent Opioid Abuse
- Community Anti-Drug Coalitions of America
- Addiction Technology Transfer Center (ATTC) Network
- Prevention Technology Transfer Center (PTTC) Network
Marijuana
Data:
- In 2021, marijuana was the most commonly used illicit drug, with 18.
7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people). - The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
- Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
- Marijuana can have significant health effects on youth and pregnant women.
Resources:
- Know the Risks of Marijuana
- Marijuana and Pregnancy
- Tips for Teens: Marijuana
Relevant links:
- National Institute on Drug Abuse: Marijuana
- Addiction Technology Transfer Centers on Marijuana
- CDC Marijuana and Public Health
Emerging Trends in Substance Misuse:
- Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year.
Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia. - Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
- Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors.
It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.
Resources:
- Tips for Teens: Methamphetamine
- Tips for Teens: Cocaine
- National Institute on Drug Abuse
More SAMHSA publications on substance use prevention and treatment.
Last Updated
Last Updated: 03/22/2023
I feel superfluous | PSYCHOLOGIES
149,962
Knowing oneself A man among people
“I feel out of place”, “no one is happy with me” - someone who constantly feels rejected, is distrustful of contacts with other people. The slightest inattention on their part makes you feel helpless again and again. “Once having experienced this painful feeling, such a person unconsciously expects that everything will happen again: he will be betrayed, abandoned,” explains existential psychotherapist Svetlana Krivtsova.
Trying to avoid such a development of events, each time he tests the relationship for strength and, as a result, he remains alone again. “Trying to arouse interest in himself, to please him, he gradually becomes dependent on the opinions and assessments of other people,” continues Svetlana Krivtsova, “and his suspiciousness simply exhausts those who are nearby. Relationships become formal, often full of hostility, and eventually end.” To live in constant expectation of a break is to provoke a break.
Child injury
“When I was four, my older brother became seriously ill and my mother sent me to stay with my grandmother for a few months,” says 29-year-old Yaroslav. “I was very worried: it seemed to me that I behaved so badly that my mother had to abandon me.”
The fear of being abandoned first appears in childhood and is usually associated with sudden (often prolonged) separation from parents.
“Little children cannot understand the meaning of adults' actions and suffer from loneliness,” explains Svetlana Krivtsova.
“The memory that you didn’t please your parents in some way and therefore turned out to be unnecessary remains for many years.” Those whom their parents really “abandoned” in childhood, without supporting them in a difficult situation, can also feel their abandonment.
“I am learning to talk about my feelings”
Valeriya, 33 years old
“I know well what it means to be unwanted. When my little sister was born, my mother quit her job to take care of it. Maybe my fears appeared then? I always felt that I was not with them. At school, too, no one wanted to be friends with me, and as a teenager, I was absolutely sure that I was unworthy of love. And indeed, no one paid attention to me, I was invisible.
At some point, the feeling of rejection became too painful, but it helped me to see myself from the outside: I turned out to be so closed, gloomy. Now I try to be more sociable, to speak more openly about my feelings, to articulate more clearly what worries me.
Surprisingly, my loved ones now talk about restraint and vulnerability as the best features of my strong character.
Early sacrifices
Sometimes parents force a child very early to take on “adult” responsibilities, to sacrifice their interests in favor of a brother or sister, and the child grows up, confident that no one cares about him. “We feel the most severe pain in those moments when we experience our own worthlessness,” says Svetlana Krivtsova. “If they do this, it means that it is possible with me, it means that I am not worthy of another.” Feeling “worst of all”, building relationships with others is excruciatingly difficult. There are unconscious "filters" through which the growing child "reinterprets" the world in his own way ... and always not in his favor.
The ugly duckling
Some people are always preoccupied with adjusting their behavior to the expectations of others. “The reason is the feeling “I ended up here by chance, I am an ugly duckling among white swans,” explains psychoanalyst Marie-Dominique Linder.
- This painful feeling is especially strong in adolescence. The teenager is trying with all his might to hide his dissimilarity so that his peers do not push him away, do not expel him from his company. Becoming an adult means overcoming this crisis and asserting yourself as a person.
What to do?
Understand the “history” of your feeling
Try to remember when the painful feeling of rejection first arose. What event changed your attitude towards yourself? Once you understand this, you can begin to control your experiences.
Do not dramatize
Try to talk freely about your feelings, write down your story. Humor helps you connect with people. By saying what you feel, you will slightly weaken the power of the image in whose captivity you live.
Open up to people
Don't wait for someone to help you. It takes serious effort to build relationships. Take the first step by trying to see the other person as an ally rather than a potential offender.
Grow up
Accept it as a fact: you are different from others (just like they are from you) and you don't need their approval to be yourself. By refusing to live dependent on the judgmental gaze of others, you can finally grow up.
Advice to a stranger
How to help someone who feels rejected in any situation? In a conversation, focus on his opinion, emphasizing that his point of view is important to you. But at the same time, do not indulge, this will lead to the opposite effect: your interlocutor may feel dependent on you, which will increase his feeling of rejection, because you cannot be with him all the time.
Be sincere in your intentions. The fact is that a person who considers himself useless doubts that he can arouse interest in himself. You can convince him that he is really worthy of attention and love only by sincerely communicating with him.
Text: Tatyana Galesa Photo source: Getty Images
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Fresh films and series about sex: the choice of Psychologies events, anxiety attacks, panic attacks and loss of emotions - these are the symptoms of depersonalization disorder, which is often confused with schizophrenia. Afisha Daily publishes three stories of people with this terrible diagnosis.
Tatiana, 28 years old: “For the first time, I encountered a feeling of unreality of what was happening when I was 22 years old. One day, I just stopped feeling any emotions; my relatives suddenly became strangers, I didn’t want to communicate with anyone, go out anywhere.
I didn’t feel like myself - the personality was erased, and I became a different person: the feeling that there was no more soul, only one shell. This was accompanied by constant anxiety, soul-searching, headaches, and a sense of hopelessness. This is a terrible state when suicide seems to be the only way to stop everything.
I was very frightened and urgently called my mother, because I myself could not even go to the doctor. The neurologist at the hospital said that I was depressed and prescribed a cocktail of antidepressants and neuroleptics. Surprisingly, almost from the first days of taking the pills, I returned to life: the symptoms disappeared, my mood improved, my ability to work increased, I became sociable and open. A month later, I stopped taking these drugs and did not go to the doctor again (although I was warned not to give up the drugs). For four years, I forgot about the problems.
The symptoms returned when a relative offered me a new job. There were rather high requirements for employees - a mandatory driver's license, specialized education in the field of shipping and fluent English.
I was given six months to prepare. The relative paid for all the courses, the university - and then the stress began. I felt that it was covering me, so I arbitrarily returned to the pills. It got a little easier for a while. I tried my last strength not to lose face, to get this job, not to let down the person who believed in me and also spent money. But I got worse and worse, and I failed the job interview. It was a very difficult period.
After that, I began to sit on forums, google articles about mental disorders with similar symptoms. There were thoughts that I had schizophrenia and I was finally going crazy. I started running around psychiatrists, but all of them refuted my suspicions. Depression was re-diagnosed, antidepressants were prescribed - anxiety subsided a little, but emotions and feelings never returned.
Once on some website I saw a description of a diagnosis that exactly matched my symptoms. Then my acquaintance with depersonalization-derealization disorder began.
I went to doctors, but they basically didn't know what it was and how to treat it. Sometimes they simply did not want to listen to me - they immediately prescribed medicines and sent me home. One professor said that I "read on the Internet." I found my salvation in online consultations with a doctor who dealt with dereal: according to his scheme, I started taking antidepressants and antiepileptic drugs.
The reason for my depersonalization is neurosis, which is accompanied by anxiety: under stress, the body defends itself and the brain seems to turn off, isolation from the outside world occurs. This happens to impressionable people who worry about anything, take everything to heart. I am one of those.
My experience is 2.5 years. I know that there may be deterioration, but there is a way out. Now I have reached the stage when a new job is a joy, I feel like myself again, mental abilities, emotions and feelings are the same as before the illness. And, although I'm still on the pills, it's better than suffering again.
I hope someday I can cancel them. It sounds strange, but this illness has changed me for the better. Thanks to her, I truly began to appreciate life and loved ones. Became more patient. I am glad that I can live a normal life again, feel, love, enjoy communication with people and my favorite activities.
Our society is very contemptuous of those in need of psychological help. If they find out that a person has been to a psychiatrist, they immediately label him a psycho and avoid him. Nevertheless, you should not be afraid to seek qualified help, the main thing in this matter is to find a really good doctor. And there are very few of them."
Nikolai, 27 years old: “I have been neurotic since childhood: stuttering, obsessive-compulsive disorder (obsessive thoughts syndrome). In August 2014, I went to a psychiatrist with depression and impaired perception of reality, I was then 25 years old. It all started with rare panic attacks, which were replaced by bouts of severe derealization.
The world turned upside down, and I had to lie down on the floor and close my eyes, this helped to come to my senses. After another such attack, I developed anxiety.
Exactly 6 months I thrashed around looking for and inventing physical illnesses to justify my condition. Admitting to yourself that you are a little "cuckoo" is difficult, and this is how hypochondria appears. The catalyst for hypochondria is still such an unpleasant reality as unskilled medicine. The inertia coming from the USSR still persists - doctors sculpt a diagnosis of VVD (which has long been absent from the world classification of diseases), say that everything is in order, prescribe vitamins and send them home. Therefore, I had to engage in self-diagnosis and be terribly afraid of what was really happening to me. Unfortunately, I made the diagnosis of "depersonalization disorder" myself, once again surfing the Internet. Through acquaintances, I managed to go to a psycho-neurological dispensary. There I was pumped with the same Soviet drugs, put on droppers, there was even a massage and a circular shower.
At discharge, there were no significant results: it became easier to sleep, but the condition remained the same painful.
Finally, miraculously, I managed to get to a good psychiatrist. Properly selected drugs have built a solid foundation for my recovery. Now pharmacology has reached such a level that drugs work reliably with a minimum of side effects and consequences for the body. Of course, they do not eliminate psychological problems, but they provide a runway for climbing to the height where these problems could be eliminated. The antidepressant began to noticeably act somewhere in 3-4 weeks after the start of the reception. The mood improved, strength appeared, life began to bring pleasure. Then slowly: communication with friends began to recover, I began to go out, my libido and the desire to do something woke up. I recovered at work: when getting to the toilet is a huge test, work becomes something unbearable.
Depersonalization is, in the usual sense, the loss of oneself; when you can't understand what kind of person you are.
Recovery after this leads to a rethinking of life attitudes. For example, in the past, I limited myself, tried to conform to the ideas dictated by society. He lived according to the principle “as it should be”, and not “as I want”. During this period, the understanding of one's person is lost: who are you? why are you? who are you supposed to be? You are depersonalizing. At the turning point of frustration, you understand that you need to live for yourself, and not for others, you stop constantly looking for flaws and correcting them in order to become someone. I accepted myself."
Anastasia, 20 years old: “At school, I was often bullied because of my excess weight, no one took me seriously at home, there were constant screams and scandals because of my father’s alcohol addiction. At the age of 15, I decided to try drugs and, not knowing the “correct dosages”, I took too much at one time. After that, my health deteriorated sharply: short-term panic attacks began, heart palpitations, unsteadiness of gait, dizziness appeared.
At first I thought that I had something with my heart or blood vessels; over time, this developed into a fear of a heart attack, stroke, or sudden death. Then there was an examination of the whole body, but nothing concrete was found out: the doctors either did not find anything, or made a diagnosis of "vegetovascular dystonia". One doctor advised me to get tested for cancer.
Over time, the situation progressed. There was a terrible feeling inside, like anxiety: I couldn’t sleep normally, it seemed that I would die any minute. One day I realized that I did not feel my body. There was a feeling of lightness and weightlessness at the same time, and then I began to catch myself thinking that it was as if I were not there. The sensations in my hands became not mine, the reflection in the mirror was not the same. Then I realized that I was in danger not of a heart attack, but of schizophrenia. I completely surrendered to this fear: the physical symptoms disappeared, there was an indescribable horror that now I would lose touch with reality and control over myself.
I began to hide the handle from the balcony so that in a fit of unconsciousness the window would not suddenly jump out. The world as I knew it was shattered. Going out into the street, I understood that there was a big barrier between me and reality. The world behind the glass seemed flat, colorless, dead. I couldn't figure out if this was a dream or reality, or maybe I had died altogether. Time just stopped, it didn't exist, it didn't exist for me. And in the soul there is emptiness, silence and no emotions.
I found out that this is not schizophrenia on a website about dissociative disorder. Thus began a new phase. On VKontakte, I found a group about dereal, where there were hundreds of people like me. For about a week I sat in the community, reading information, personal stories and recommendations, until I fully understood that this was it - depersonalization-derealization disorder.
In the 11th grade, everything got to the point that I was taken from the USE in an ambulance.
When I went to the doctor, he started asking something, and I was silent: I was so tired of this shit that I could not say a word. My parents found out that I have serious mental problems. It seemed to me that my mother did not understand me. I was again taken to the doctors, but we failed to find an intelligent specialist. In Soviet-era hospitals, doctors are not at all familiar with depersonalization: in one of these, I was prescribed 12 dubious pills a day, and glycine was also completely useless for my symptoms. There were doctors who were more interested in my outlook on life than my health.
As a result, I found my psychiatrist, with whom we still keep in touch, through my mother's friend. If we talk about treatment, then you can’t do without antidepressants. They help to return to the previous mode and significantly improve the condition. Now I'm 20, and I'm still on pills: I decided that it's better to feel good with them than to think about suicide every day.
“The basis of the depersonalization-derealization syndrome is an attempt of the psyche to adapt to stress in conditions of its high intensity, for example, during fear or panic.
This syndrome as a separate disorder is included in the international classification of diseases (ICD-10), but often occurs as a secondary syndrome with severe anxiety, depression and other acute conditions. Depersonalization and derealization, although combined into one term due to their similarity and general nature, represent two independent symptoms that can manifest themselves separately from each other. During depersonalization, the patient's own face, figure, smile, speech seem unfamiliar, as if you are watching yourself as an outsider. Derealization, on the other hand, concerns the perception of the environment: place, time, circumstances, etc. Sometimes a feeling of “drunkenness”, “unreality” and “floating picture” is added.
The main cause of DP/DR lies in the activation of opiate receptors - there is an assumption that in this way the human body tries to reduce severe anxiety. Stress can become a reason if it was intense and caused a vegetative crisis (like a panic attack).
Feelings during depersonalization-derealization frighten with their unusualness. It seems to the patient that he has lost control of his own body, and this in itself provokes even more intense fear. It differs from schizophrenia primarily in the absence of symptoms of psychosis (hallucinations, delusions, catatonia, etc.). Also, the DP / DR syndrome can be observed in acute psychotic episodes, but then there must be appropriate mandatory symptoms of a severe mental illness.
Despite its prevalence, this diagnosis is not fully understood in terms of mechanisms and origin, which leads to difficulties in therapy. In the US, the disorder is treated primarily with antidepressants and lamotrigine. In Russia, there are no clear standards and recommendations: in DP/DR, they often look for the “main disorder”, hoping that the syndrome will recede on its own. It is not uncommon for depersonalization or derealization to resolve quickly if it occurs in the context of a panic or other anxiety disorder, but it can take years to treat these disorders in depression and bipolar affective disorder.
