The Biopsychosocial Model of Depersonalisation

人格解体和现实解体是痛苦的症状，尽管它们在临床和一般人群中很突出，但研究却明显不足（Aderibigbe等人，2001年；Ross， Joshi和Currie， 1991年）。人格解体和现实感丧失的特征是与身体和自我（人格解体）以及与环境（现实感丧失）的强烈分离感，这对个人来说可能是非常痛苦的（Hunter等人，2017）。这些症状在急性压力期间或之后很常见，例如在灾难发生后感觉“时间变慢了”或“在梦中”。患有慢性人格解体的人也会经历同样的现象，只不过不是短暂的状态，而是长期经历，有时是几周、几个月或几年，这取决于个人情况。人格解体和现实感丧失通常被放在一起讨论，然而，现实感丧失只是人格解体的一个特征，还有分离感、情绪麻木和异常的主观回忆（Salami， Andreu-Perez和Gillmeister， 2020）。为了本建议的目的，人格解体的所有特征将仅用术语人格解体来描述。人格解体被认为是第三大最常见的心理健康症状（Maldonado, 2007； Simeon等人，1997；Stewart等人，1964），是短暂的经历，被认为是人类经历的正常特征（Hunter， Sierra和David， 2004）。存在于严重程度的范围内，随着症状变得更加强烈和有规律，它们变得有问题。这可以比作从对悲伤事件的情绪低落到严重抑郁症的持续情绪低落的转变。与抑郁症类似，人格解体是“看不见的”，这意味着人格解体的人可以保持外表（例如保住一份工作，与朋友交往），但他们的内心体验却令人担忧（例如，感觉与世界/自己的身体脱节，无法将自己的经历用语言表达）。人格解体的终生患病率在26%至74%之间，在创伤性事件时患病率在31%至66%之间。在临床样本中，患有PTSD的退伍军人的患病率在30%和抑郁症的60%之间。在恐慌症中患病率最高，高达82.6% （Hunter， Sierra和David， 2004）。当症状随着时间的推移变得更频繁和持续时，人格解体就会变成慢性的，直到这种经历“普遍和持续”（Medford et al, 2005）。准确诊断慢性人格解体平均需要7-12年（Baker et al., 2003; Michal et al., 2016）。在我们评估Covid-19大流行对我国人口的影响时，进一步的人格解体研究很重要，因为在封锁期间数字媒体的使用增加，以及封锁造成的主观痛苦与更高的人格解体感相关（Ciaunica et al, 2022）。Covid-19导致的个人人格解体经历是自助团体的一个共同特征。

Depersonalisation and derealisation are symptoms of distress that are strikingly under researched despite their prominence in clinical and general populations (Aderibigbe et al, 2001; Ross, Joshi & Currie, 1991). Depersonalisation and derealisation are characterised by strong feelings of detachment from one's body and self (depersonalisation) and from one's environment (derealisation), which can be extremely distressing to individuals (Hunter et al., 2017). These symptoms are common during or following acute stress, for example feeling 'time slowing down' or 'in a dream' after a moment of calamity. Individuals suffering from chronic depersonalisation are experiencing that same phenomena, only instead of fleeting states, they are experiencing it for long periods of time, sometimes weeks, months or years, depending on the individual circumstances. Depersonalisation and derealisation are usually discussed together, however derealisation is simply a feature of depersonalisation, alongside disembodiment feeling, emotional numbing and anomalous subjective recall (Salami, Andreu-Perez and Gillmeister, 2020). For the purpose of this proposal, all features of depersonalisation will be described by the term depersonalisation only. Considered the third most common mental health symptom (Maldonado, 2007; Simeon et al, 1997; Stewart et al, 1964), depersonalisation is experienced transiently and is considered a normal feature of human experience (Hunter, Sierra and David, 2004). Existing on a spectrum of severity, as the symptoms become more intense and regular, they become problematic. This could be likened to the transition from a low mood in response to a sad event, to a consistently low mood indicative of major depression. Similar to depression, depersonalisation is 'invisible', meaning that depersonalised individuals can maintain external appearances (e.g. hold down a job, socialise with friends), yet their internal experience is fraught (e.g. feeling disconnected from the world/their body, inability to put their experiences into words). Depersonalisation holds a lifetime prevalence rate of between 26 and 74%, and between 31 and 66% at the time of a traumatic event. In clinical samples, prevalence rates vary between 30% in war veterans with PTSD and 60% in depression. The highest prevalence is seen in panic disorder, with rates up to 82.6% (Hunter, Sierra and David, 2004). Depersonalisation becomes chronic when symptoms are more frequent and persistent over time, until the experience is "pervasive and unremitting" (Medford et al, 2005). It takes an average of 7-12 years to accurately diagnose chronic depersonalisation (Baker et al, 2003; Michal et al., 2016). As we assess the impact of the Covid-19 pandemic on our population, further depersonalisation research is important, as increased use of digital media during lockdown and subjective distress as a result of lockdown correlate with higher feelings of depersonalisation (Ciaunica et al, 2022). Individual experiences of depersonalisation as a result of the Covid-19 are a common feature of self-help groups.