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What you need to know
- Depersonalisation and derealisation symptoms include having a sense of unreality and detachment; patients may describe using phrases such as "it is as if . . . "
Symptoms are often triggered by adverse life events, severe anxiety, or cannabis use
Transient symptoms of less than a couple of weeks' duration are common and need no intervention
Distinguish symptoms of depersonalisation and derealisation that are secondary to another medical or psychiatric diagnosis and treat the underlying problem
Refer those who appear to have persistent symptoms to a psychiatrist for consideration of primary depersonalisation derealisation disorder
Patients who experience depersonalisation and derealisation often have difficulty in describing their symptoms. They experience a sense of unreality and detachment from their sense of themselves (depersonalisation: DP) or their perception of the world (derealisation: DR). In most cases these two symptoms co-occur. This article aims to help clinicians recognise depersonalisation and derealisation (DP DR) symptoms, diagnose the disorder, and discuss current treatment options.
Who experiences depersonalisation and derealisation?
Otherwise healthy people- Transient symptoms of depersonalisation and derealisation are very common in the general population, often during periods of stress or fatigue. One US phone study of more than 1000 people found that nearly a quarter reported a brief episode over the previous one year period. 1
Those with a range of physical and mental health conditions- Such symptoms are also commonly associated with several medical conditions, such as migraine and temporal lobe epilepsy, 2 and with psychiatric conditions, particularly anxiety disorders, such as panic, depression, or in those with complex post-traumatic stress or personality disorders who report a history of childhood abuse or trauma. 3
Those with depersonalisation and derealisation disorder as a primary diagnosis -Less well known is that the symptoms of depersonalisation and derealisation can also occur as a chronic primary mental health disorder called depersonalisation derealisation disorder (DPRD). These symptoms can cause distress and affect quality of life and function. Case series from the UK, 4 Germany, 5 and the US 6 find the primary disorder of DPRD affects men and women roughly equally. Several robust epidemiological surveys indicate prevalence rates over the past month of clinically significant DPRD at around 1% of the general population 3 and at 5%...