Depersonalization Disorder – DSM IV Definition

Depersonalization Disorder is codified 300.6 in DSM IV.

Diagnostic Criteria

According to DSM IV, the following criteria must be met in order for the individual to be diagnosed for depersonalization disorder:

Criterion A: there is persistent feeling of detachment or estrangement from one’s self, as if one is an outside observer of one’s body and / or one’s mental processes. There is a feeling of being in a dream. Various types of sensory anesthesia, lack of affective response, and a sensation of not being in control of one’s actions, including one’s speech, are often present.

Criterion B: there is awareness that the feeling of detachment is but a feeling; the connect with reality is intact.

Criterion C: the persistent feeling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion D: the experience is not due to direct physiological effects of a substance or a general medical condition. Also, the experience must not occur exclusively during the course of any other mental disorder, such as schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder.

The individual afflicted with the disorder has difficulty describing their symptoms. They fear that the experiences are symptomatic somehow of their being labeled “crazy”. There is a sense of “derealization”, and the external world appears unreal and fuzzy. People around the individual may appear to be unfamiliar or mechanical. Familiar objects too appear to be distorted out of shape and size. Such individuals are also highly susceptible to hypnotizability. The disorder is diagnosed at least twice in females than in males. It is estimated that about half of all adults may experience at least a single episode of depersonalization precipitated by severe stress, at some point of time in their lives. In some cultures, experiences of depersonalization and derealization are induced voluntarily, by choice. Such cases are not considered to be part of the ambit of the depersonalization disorder.

Associated Features and Disorders

The individual suffering from depersonalization disorder also may experience hypochondriasis, major depressive or dysthymic disorder, anxiety disorders, personality disorders and / or substance-related disorders. During panic attacks, especially when a truamatic stressor triggers anxiety symptoms, the symptoms of depersonalization and derealization have been found to concurrently occur too. In such case, a separate diagnosis of depersonalization disorder may not be made.

Course

The disorder is usually presented for treatment in adolescence or adulthood, though the onset may have taken place in childhood and remained undetected. The main age at onset is reported to be 16. However, the individual usually presents with some other symptoms, such as anxiety, panic, or depression.

An episode of depersonalization may last anywhere from a few seconds to several years. The course is usually chronic and may wax and wane in intensity. It is also episodic sometimes.