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Q6. Depersonalisation Disorder

Depersonalization disorder is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, consciousness, awareness, identity, and/or perception. When one or more of these functions is disrupted, symptoms can result.

Diagnostic Criteria

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, lifeless, or visually distorted).

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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).

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.


In general, approximately one-half of all adults have experienced at least one lifetime episode of depersonalization/derealization. Lifetime prevalence in U.S. and non-U.S. countries is approximately 2% (range of 0.8% to 2.8%). The gender ratio for the disorder is 1:1.

Development and Course

The mean age at onset of depersonalization/derealization disorder is 16 years, although the disorder can start in early or middle childhood; a minority cannot recall ever not having had the symptoms. Onset can range from extremely sudden to gradual. Duration of depersonalization/derealization disorder episodes can vary greatly, from brief (hours or days) to prolonged (weeks, months, or years).
The course of the disorder is often persistent. About one-third of cases involve discrete episodes; another third, continuous symptoms from the start; and still another third, an initially episodic course that eventually becomes continuous.

Risk and Prognostic Factors

Temperamental: harm-avoidant temperament, immature defenses, and both disconnection and overconnection schemata. 
Environmental: clear association with childhood interpersonal traumas in particular, emotional abuse and emotional neglect.

Differential Diagnosis

  • Illness anxiety disorder
  • Major depressive disorder
  • Obsessive-compulsive disorder
  • Other dissociative disorders
  • Anxiety disorders
  • Psychotic disorders
  • Substance/medication-induced disorders
  • Mental disorders due to another medical condition


Lifetime comorbidities are high for unipolar depressive disorder and for any anxiety disorder, with a significant proportion of the sample having both disorders. The three most commonly co-occurring personality disorders were avoidant, borderline, and obsessive-compulsive.

* * *

Depersonalisation disorder involves the presence of persistent or recurrent experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions or with the surroundings. It usually starts in mid-teenage years. Every other adult faces the disorder at some point in time, however the lifetime prevalence is in 2% of the population.


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