Dissociative disorders can represent a significant challenge for those affected and for the professionals who accompany these patients in the treatment process. This article aims to provide an overview and informative support for those seeking answers and understanding.
Depersonalization: definition and clinical context
There depersonalization/derealization it is a dissociative disorder characterized by experiences of detachment from oneself (“I see my body as if it were not mine”, “I see the world as if it were unreal”) which can become persistent and disabling.
It affects approximately 1-2% of the general population in a clinically significant form. It is often underdiagnosed and it may take many years for it to be recognized.
Those who suffer from depersonalization can find themselves in situations of disadvantage or discrimination at work, in the social or healthcare sector. Legal protections exist, but their application may depend on various factors such as the severity of the disorder, proven clinical documentation, national legislation, recognition of the disorder as a disability, etc.
In the European Union there are regulations that prohibit discrimination based on disability or mental health conditions. There European Agency for Fundamental Rights found that in most Member States, people with mental health problems are protected by anti-discrimination laws.
In the international context, treaties such as the United Nations Convention on the Rights of Persons with Disabilities (CRPD) provide that people with disabilities (including psychosocial disabilities) do not suffer discrimination and have equal civil and citizenship rights.
Dissociative personality disorders, and in particular the Dissociative Identity Disorder (DID)represent a complex clinical picture characterized by the presence of two or more distinct identities or personality states that alternate in the control of behavior, accompanied by recurrent amnesia, discontinuity of the sense of self and impairment of social, occupational and relational functioning.
According to the DSM-5-TRthe diagnostic criteria include: fragmentation of identity with experiences of possession or multiple self-perception, memory gaps that cannot be explained by normal forgetfulness, symptoms that cause clinically significant distress, exclusion of effects due to substances or general medical conditions.
Right to reasonable accommodations
Anti-discrimination laws often provide that, when a disability or mental condition makes it difficult to carry out certain work activities, the employer must adopt “reasonable measures” to allow the person to work (flexible hours, therapy breaks, suitable working environments, etc.). In the USA, for example, theAmericans with Disabilities Act (ADA) protects these rights.
In Europe and Italy, national legislation often includes similar obligations, although the definition of what is “reasonable” varies greatly.
Privacy, informed consent and protection in the medical relationship
In Italy the Law 219/2017 defines informed consent and advance treatment orders, establishing that no medical treatment can be started or continued without the free and informed consent of the person concerned, except in cases provided for by law. This also includes the psychiatric field.
Anyone suffering from depersonalization therefore has the right to be adequately informed about their condition, possible therapies, risks and alternatives.
Right to mental health and access to treatment
The regulations on the right to mental health provide that those with psychiatric disorders have access to treatment under equitable conditions, and that there is no discrimination in the provision of healthcare services.
Mental health policies should also take into account the specificity of the disorder: correct diagnosis, access to specialists, effective therapies.
Criminal law: capacity to understand and will
In rare cases, depersonalization can be invoked in criminal law when a person claims that at the time of an act he was unable to form full intention or control due to subjective detachment. For example, an English court case is documented in which the defendant describes acting as if he were an external observer to himself, due to severe depersonalization, to challenge the specific intent of the act.
However, jurisprudence tends to treat depersonalization more as a phenomenon of subjective perception/disturbance which does not necessarily invalidate the legal-criminal capacity, unless it is accompanied by serious recognized psychological alterations. This requires solid medical evidence.
The diagnosis requires an accurate clinical evaluation, supported by psychodiagnostic tools (e.g. Dissociative Experiences Scale). The therapeutic intervention is natural multidisciplinary: psychotherapy (especially psychodynamic and trauma-focused orientations such as EMDR or sensorimotor therapy) aims at the integration of the dissociated parts and the re-elaboration of the trauma; the psychiatrist evaluates and manages any comorbidities (depression, anxiety, mood disorders) through the targeted use of psychotropic drugs; psychosocial and educational support interventions promote stabilization, stress management and social reintegration.
Limits and challenges in protection
Despite these potential protections, there are real challenges.
The disorder is not always recognized as disability by national laws, especially if considered “transitory” or moderate. It is often invisible and valid clinical supporting documentation that effectively demonstrates the severity of the person’s mental condition may be missing. There is also the objective difficulty of being able to ask for help due to social stigma and this involves keeping the condition silent so as not to reveal a malaise that could harm various social and personal areas: work, friendships, intimate relationships.
Recommendations for those suffering from depersonalization
The first important condition is to obtain a precise diagnosis from recognized professionals, with written documentation (psychological/psychiatric reports) describing severity, frequency and impact on daily life.
There is also the need to inform yourself about national laws relating to mental health, disability and discrimination, to understand if your situation is protected.
Once you have obtained the certification and the correct legal information, you must proceed with the request for work accommodations when the disorder interferes with functions declared “essential”: breaks, flexible hours, less stressful or adapted working methods, etc.
Conclusion
Depersonalization, while often overlooked, is a real disorder that can have profound impacts on your personal, social and professional life. Legal protections exist, but their effectiveness depends on medical recognition, the national legislative framework, clinical documentation and the awareness of the people involved.
