The essential features of Depersonalization Disorder are persistent or recurrent episodes of depersonalization characterized by a feeling of detachment or estrangement from one’s self (Criterion A). The individual may feel like an automaton or as if he or she is living in a dream or a movie. There may be a sensation of being an outside observer of one’s mental processes, one’s body, or parts of one’s body. Various types of sensory anesthesia, lack of affective response, and a sensation of lacking control of one’s actions, including speech, are often present. The individual with Depersonalization Disorder maintains intact reality testing (e.g., awareness that it is only a feeling and that he or she is not really an automaton) (Criterion B). Depersonalization is a common experience, and this diagnosis should be made only if the symptoms are sufficiently severe to cause marked distress or impairment in functioning (Criterion C). Because depersonalization is a common associated feature of many other mental disorders, a separate diagnosis of Depersonalization Disorder is not made if the experience occurs exclusively during the course of another mental disorder (e.g., Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder). In addition, the disturbance is not due to the direct physiological effects of a substance or a general medical condition (Criterion D).
Associated Features and Disorders
Associated descriptive features and mental disorders. Often individuals with Depersonalization Disorder may have difficulty describing their symptoms and may fear that these experiences signify that they are “crazy.” Derealization may also be present and is experienced as the sense that the external world is strange or unreal. The individual may perceive an uncanny alteration in the size or shape of objects (macropsia or micropsia), and people may seem unfamiliar or mechanical. Other common associated features include anxiety symptoms, depressive symptoms, obsessive rumination, somatic concerns, and a disturbance in one’s sense of time. Hypochondriasis, Major Depressive or Dysthymic Disorder, Anxiety Disorders, Personality Disorders (most commonly Avoidant, Borderline, and Obsessive-Compulsive), and Substance-Related Disorders may also coexist with Depersonalization Disorder. Depersonalization and derealization are very frequent symptoms of Panic Attacks and are more common when anxiety symptoms follow a traumatic stressor, as in Posttraumatic Stress Disorder. A separate diagnosis of Depersonalization Disorder should not be made when the depersonalization and derealization occur exclusively during such attacks.
Associated laboratory findings. Individuals with Depersonalization Disorder may display high hypnotizability and high dissociative capacity as measured by standardized testing.
Specific Culture and Gender Features
Voluntarily induced experiences of depersonalization or derealization form part of meditative and trance practices that are prevalent in many religions and cultures and should not be confused with Depersonalization Disorder. In clinical samples, this disorder is diagnosed at least twice as often in women than in men.
The lifetime prevalence of Depersonalization Disorder in community and clinical settings is unknown. At some time in their lives, approximately half of all adults may have experienced a single brief episode of depersonalization, usually precipitated by severe stress. A transient experience of depersonalization develops in nearly one-third of individuals exposed to life-threatening danger and in close to 40% of patients hospitalized for mental disorders.
Individuals with Depersonalization Disorder usually present for treatment in adolescence or adulthood, although the disorder may have an undetected onset in childhood. The mean age at onset has been reported to be around age 16. Because depersonalization is rarely the presenting complaint, individuals with recurrent depersonalization often present with another symptom such as anxiety, panic, or depression. Duration of episodes of depersonalization can vary from very brief (seconds) to persistent (years). Depersonalization subsequent to life-threatening situations (e.g., military combat, traumatic accidents, being a victim of violent crime) usually develops suddenly on exposure to the trauma, and trauma histories are often associated with this disorder. The course is usually chronic and may wax and wane in intensity but is also sometimes episodic. Most often the exacerbations occur in association with actual or perceived stressful events.
Depersonalization Disorder must be distinguished from symptoms that are due to the physiological consequences of a specific general medical condition (e.g., epilepsy). This determination is based on history, laboratory findings, or physical examination. Depersonalization that is caused by the direct physiological effects of a substance is distinguished from Depersonalization Disorder by the fact that a substance (e.g., a drug of abuse or a medication) is judged to be etiologically related to the depersonalization. Acute Intoxication or Withdrawal from alcohol and a variety of other substances can result in depersonalization. On the other hand, substance use may intensify the symptoms of a preexisting Depersonalization Disorder. Thus, accurate diagnosis of Depersonalization Disorder in individuals with a history of alcohol- or substance-induced depersonalization should include a longitudinal history of Substance Abuse and depersonalization symptoms.
Depersonalization Disorder should not be diagnosed separately when the symptoms occur only during a Panic Attack that is part of Panic Disorder, Social or Specific Phobia, or Posttraumatic or Acute Stress Disorders. In contrast to Schizophrenia, intact reality testing is maintained in Depersonalization Disorder. The feeling of numbness associated with depersonalization may mimic a depression. However, feelings of numbness in individuals with Depersonalization Disorder are associated with other manifestations of depersonalization (e.g., a sense of detachment from one’s self) and occur even when the individual is not depressed.
Diagnostic criteria for 300.6 Depersonalization Disorder
A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream).
B. During the depersonalization experience, reality testing remains intact.
C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).