6.5 Depersonalization/ Derealization Disorder

Question 1

What is depersonalisation/ derealisation disorder?

Answer 1

• Persistent or recurrent feeling of detachment from one’s self (depersonalisation) or one’s environment (derealisation), in the presence of intact reality testing.
• People are very aware of the condition and tend to fear that they are going crazy.
• Frequently associated with anxiety and panic.

Question 2

Describe the epidemiology of derealisation/depersonalisation disorder.

Answer 2

• Twice as common in women compared to men.
• Average age of onset is 15-30yrs old
• Increased incidence of comorbid anxiety and depression.
• Severe stress is a predisposing factor.
• U.S.A. sample prevalence is 20%.
• 50% of college students report depersonalisation.
• Lifetime prevalence in many European countries is 2.8%.

Question 3

Describe two major conceptual models for the development of derealisation and depersonalisation.

Answer 3

1. Cognitive-behavioural model
   
   • Fear is a central component of this response
   • Fear is expressed in 2 major ways:
     
     • Dissociation of affect (not feeling)
     • Alexithymia (identifying and verbalising emotions)
2. Psychodynamic model
   
   • Inability to integrate various aspects of one’s self-experience

Question 4

Describe the pathology of derealisation or depersonalisation disorders.

Answer 4

• Precipitating trauma, in an individual who has various risk factors.
• Risk factors:
  
  • A quintessential response to trauma as one of dissociation
  • Substance abuse
  • Seizures
• Several neurotransmitter systems, (NMDA, opioids, serotonin), brain regions (parietal lobe and right hemisphere) and functional brain circuits (hypo-activation of limbic system) are also associated.

–> A derealisation/depersonalisation response occurs.

Question 5

What are the diagnostic criteria which must be met to diagnose derealisation/depersonalisation?

Answer 5

A. Persistent or recurrent experiences of depersonalisation, derealisation, or both.

One of either:

1. Depersonalisation: unreality, detachments, or being an outside observer.
2. Derealisation: unreality or detachment with respect to surroundings (i.e., individuals are objects and experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

All of:

B. Reality testing is intact in episode.

C. Symptoms cause significant distress and impair social or occupational functioning.

D. Disturbance is not due to substances or general medical conditions.

E. Not due to another psychiatric illness.

Question 6

List other psychiatric differentials for derealisation/depersonalisation disorder?

Answer 6

1. Schizophrenia
2. Panic disorder
3. Acute stress disorder
4. PTSD
5. Other dissociative disorders
6. Personality disorders - borderline and avoidant

Question 7

What is the management of derealisation or depersonalisation disorders?

Answer 7

Often chronic, but may remit without any treatment.

If co-morbid with anxiety or depression can be treated with anxiolytics or SSRI’s.

Question 8

Give an example of a non-pathologic dissociation.

Answer 8

Arriving at a destination in your vehicle without any recollection of the journey there. This is a very ordinary experience and non-pathologic dissociation.