Depersonalization/ Derealization Disorder

Prevalence

Transient depersonalization/derealization symptoms lasting hours to days are common in the general population.

The 12-month prevalence of depersonalization/derealization disorder is thought to be markedly less than for transient symptoms, although precise estimates for the disorder are unavailable.

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.

Risk Factors

Temperamental

Individuals with depersonalization/derealization disorder are characterized by harm-avoidant temperament.
Immature defenses such as idealization/devaluation, projection and acting out result in denial of reality and poor adaptation.
Cognitive disconnection schemata reflect defectiveness and emotional inhibition and subsume themes of abuse, neglect, and deprivation.
Overconnection schemata involve impaired autonomy with themes of dependency, vulnerability, and incompetence.

Environmental

There is a clear association between the disorder and childhood interpersonal traumas in a substantial portion of individuals.
In particular, emotional abuse and emotional neglect have been most strongly and consistently associated with the disorder.
Other stressors can include physical abuse; witnessing domestic violence; growing up with a seriously impaired, mentally ill parent; or unexpected death or suicide of a family member or close friend.
Sexual abuse is a much less common antecedent but can be encountered.
The most common proximal precipitants of the disorder are severe stress (interpersonal, financial, occupational), depression, anxiety (particularly panic attacks), and illicit drug use.

Symptoms

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).

During the depersonalization or derealization experiences, reality testing remains intact.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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).
The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or another dissociative disorder.