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
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