Is Depersonalization Disorder Initiated by Illicit Drug Use Any Different? A Survey of 394 Adults

Objective: Previous studies have documented that in a substantial minority of individuals with depersonalization disorder, onset is first triggered by illicit drug ingestion. The goal of this study was to systematically compare a large sample of individuals with drug-initiated (D) versus non–drug-initiated (ND) chronic depersonalization.

Method: We conducted an internet survey of 394 adults endorsing DSM-IV-TR depersonalization and/or derealization symptoms. Sixty-four questions were utilized to inquire about demographic and clinical characteristics, illness course, substance use history, and treatment response. The Cambridge Depersonalization Scale (CDS) was administered. The study was conducted from September 2005 to January 2006.

Results: Compared to the ND group (n = 198), the D group (n = 196) included more male and younger individuals. The 2 most common precipitating drugs were cannabis and hallucinogens, followed by ecstasy. The majority of participants had modest use histories prior to onset and never ingested subsequently. The 2 groups endorsed similar illness course, impairment, suicidality, and limited treatment response. The D group showed significantly greater improvement over time than the ND group (P = .002), although the groups did not differ in reported psychotherapy or pharmacotherapy effectiveness. The groups did not differ in CDS total score or on the 4 subscale scores of unreality of self, perceptual alterations, unreality of surroundings, and temporal disintegration. On the numbing subscale of the CDS, the ND group scored higher (P = .009) only prior to controlling for age and gender.

Conclusion: The study strongly supports a uniform syndrome for chronic depersonalization/derealization regardless of precipitant.

Submitted: May 12, 2008; accepted October 8, 2008.

Online ahead of print: June 16, 2009.

Corresponding author: Daphne Simeon, MD, Family Center for Bipolar Disorder, Fierman Hall, 5-13A, Beth Israel Medical Center, 317 East 17th Street, New York, NY 10003 (

J Clin Psychiatry 2009;70(10):1358-1364