assessing patients with depersonalisation and derealisation symptoms

Last reviewed 01/2018

assessing patients with depersonalisation and derealisation symptoms

Depersonalisation (DP) and derealisation (DR) may be a transient occurrence in otherwise healthy people:

  • this is a common occurrence in the general population and is specially seen during periods of stress or fatigue.
  • is mildly distressing to the patient
  • may last from few seconds to few days
  • typical triggers include:
    • fatigue
    • jet lag
    • life threatening incidents
    • heavy alcohol use
    • illicit drug use

DP and DR may be seen concurrent with a range of physical and mental health conditions:

  • is moderately-severely distressing to the patient
  • there may be functional impairment
  • typical triggers include:
    • panic attack
    • aura of migraine or seizure
    • period of prolonged stress
  • comorbidities and risk factors are:
    • neurological conditions e.g. - migraine or temporal lobe epilepsy
    • psychiatric conditions e.g. - depression or schizophrenia
    • anxiety disorder - especially those with panic or obsessive compulsive disorder
    • history of significant childhood abuse
    • post traumatic stress disorder (PTSD)
    • personality disorder - particular borderline personality disorder

DP and DR may suggest of the chronic disorder of depersonalisation/derealisation disorder (DPRD).

  • moderately-severely distressing condition
  • there may be functional impairment
  • onset often seen in adolescent
  • typical triggers
    • acute stress
    • use of illicit drugs - especially after cannabis use
  • comorbidities and risk factors
    • may be none
    • a history of anxiety problems
    • family history of anxiety disorders
    • reported parental emotional abuse, perceived criticism and/or emotional neglect
  • if both anxiety disorder and DPRD are present, monitor both the condition on a monthly basis and id DP and DR does not resolve within a few months, consider a diagnosis of primary DPRD.

Assessing DP and DR symptoms:

  • presence and severity of DP and DR can be assessed by calculating the total score for the following two questions:
    • over the past two weeks, how often have you been bothered by the experience of
      •  your surrounding feeling detached or unreal, as if there was a veil between you and the outside world
      • out of the blue. you fel strange, as if you were not real or as if you were cut off from the world
    • scale -
      • 0 - not at all
      • 1 - several days
      • 2 - more than half the days
      • 3 - nearly every day
    • clinical cut off score is ≥3
    • score above the cut off indicates pathological DPRD symptoms
  • in addition, Cambridge depersonalisation scale can be used assess DP and DR symptoms
  • a score of ≥70 in this 29 item scale is likely to be associated with primary DPRD

Reference: