DEPERSONALIZATION-DEREALIZATION DISORDER

DEPERSONALIZATION-DEREALIZATION DISORDER

• A dissociative disorder where severe, frightening, and persistent feelings of unreality dominate life and impair functioning.

• Symptoms:

  • Depersonalization → loss of sense of self (e.g., watching oneself, feeling detached).

  • Derealization → loss of sense of external reality (world seems unreal, distorted).

Case Example: Bonnie

• Dance teacher, late 20s.

• Experienced:

  • Feeling like not controlling her own body.

  • Watching herself from outside.

  • Tunnel vision, panic, shaking.

• Triggered originally after smoking marijuana.

• Recurrence in stressful/demanding situations (e.g., teaching)

Prevalence & Course

• 0.8% – 2.8% of the population (Johnson et al., 2006; Spiegel et al., 2011).

• Equal split between men and women.

• Mean onset age: 16 years.

• Course is often chronic.

• High comorbidity:

  • 73% mood disorders.

  • 64% anxiety disorders.

  • Also overlaps with personality disorders.

Cognitive Findings

• Patients show cognitive deficits despite normal intelligence:

  • Poor attention.

  • Slowed processing of new info.

  • Short-term memory problems.

  • Spatial reasoning difficulties.

• Symptoms correspond to “tunnel vision” & “mind emptiness.”

Biological & Neuropsychological Findings

• Reduced emotional responding (via skin conductance tests).

• Selective inhibition of emotion expression.

• Brain imaging → deficits in:

  • Perception

  • Emotion regulation

Dysregulation in the HPA axis (stress-response system).

Treatment

• Psychological treatments not yet well established.

• Prozac trial → no significant improvement vs placebo.

• Suggests need for more targeted therapies.

Key Takeaways

• DDD = persistent detachment from self or world, leading to major distress.

• Onset typically adolescence, often chronic.

• Strong link with anxiety/mood disorders.

• Involves both cognitive impairments and emotional dysregulation.

• Current treatments are limited and inconclusive.