- Last edited on March 29, 2021
Depersonalization/Derealization Disorder
Primer
Depersonalization/derealization disorder are persistent or recurrent episodes of depersonalization, derealization, or both. Episodes of depersonalization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, one's whole self or from aspects of the self. The individual often feels completely detached from their own being, and their may be a diminished sense of agency.
Prevalence
The mean age at onset of depersonalization/derealization disorder is 16 years, although the disorder can start in early or middle childhood.
DSM-5 Diagnostic Criteria
Criterion A
The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
- Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
- Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, life less, or visually distorted).
Criterion B
During the depersonalization or derealization experiences, reality testing remains intact.
Criterion C
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion D
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g. - seizures).
Criterion E
The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
Scales
Psychometric Scales for Dissociative Disorders
| Name | Rater | Description | Download |
|---|---|---|---|
| Dissociative Experiences Scale (DES) | Patient | The scale is a 28-item self-report questionnaire measuring dissociation in normal and clinical populations. The mean of all item scores ranges from 0 to 100 and is called the DES score. There are two versions of the DES, there is the original DES, and the second version, the DES-II.[1] See also the DES Taxon Calculator to help differentiate between pathological and normal dissociation. | DES Download |
Pathophysiology
Common causes of the disorder are severe stress (interpersonal, financial, occupational), depression, anxiety (particularly panic attacks), and substance use. Substance such as tetrahydrocannabinol, hallucinogens, ketamine, MDMA, and salvia. Cannabis in particular may precipitate new-onset panic attacks and depersonalization/derealization symptoms simultaneously.
Investigations
Treatment
Differential Diagnosis
- Illness anxiety disorder
- Major depressive disorder
- Obsessive-compulsive disorder
- Other dissociative disorders
- Anxiety disorders (especially panic attacks)
- Psychotic disorders (the presence of intact reality testing versus not having reality testing)
- Substance/medication-induced disorders