Feeling Unreal: A Depersonalization Disorder Update of 117 Cases. [CME]
J Clin Psychiatry 2003;64:990-997
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Despite a surge of interest and
literature on depersonalization disorder in recent years, a large
series of individuals with the disorder has not been described to
date. In this report, we systematically elucidate the
phenomenology, precipitants, antecedents, comorbidity, and
treatment history in such a series.
Method: 117 adult subjects with
depersonalization disorder (DSM-III-R/DSM-IV criteria)
consecutively recruited to a number of depersonalization disorder
research studies were administered structured and semistructured
diagnostic interviews and the Dissociative Experiences Scale.
Data were gathered from 1994 to 2000.
Results: The illness had an approximately 1:1
gender ratio with onset around 16 years of age. The course was
typically chronic and often continuous. Illness characteristics
such as onset, duration, and course were not associated with
symptom severity. Mood, anxiety, and personality disorders were
frequently comorbid, but none predicted depersonalization
severity. The most common immediate precipitants of the disorder
were severe stress, depression, panic, marijuana ingestion, and
hallucinogen ingestion, and none of these predicted symptom
severity. Negative affects, stress, perceived threatening social
interaction, and unfamiliar environments were some of the more
common factors leading to symptom exacerbation. Conversely,
comforting interpersonal interactions, intense emotional or
physical stimulation, and relaxation tended to diminish symptom
intensity. There were no significant gender differences in the
clinical features of the disorder. In this sample,
depersonalization tended to be refractory to various medication
and psychotherapy treatments.
Conclusion: The characteristics of
depersonalization disorder found in this sample, the largest
described to date, are in good accord with previous literature.
The study highlights the need for novel therapeutic approaches to
treat depersonalization disorder. Novel medication classes, as
well as novel psychotherapeutic techniques that build on the
reported symptom fluctuation factors, may prove helpful in the