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Psychotherapy of depersonalization/derealization disorder

Daphne Simeon, MD
Section Editor
David Spiegel, MD
Deputy Editor
Richard Hermann, MD


Depersonalization/derealization disorder (DDD) is characterized by persistent or recurrent depersonalization and/or derealization that causes clinically significant distress. Reality testing remains intact [1].

DDD has a lifetime prevalence in the general population of approximately 2 percent and is associated with significant morbidity, but often goes undetected or misdiagnosed, leading to delays in treatment.

This topic discusses psychotherapy for DDD. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of DDD are discussed separately. Pharmacotherapy for DDD is also discussed separately. (See "Depersonalization/derealization disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Pharmacotherapy of depersonalization/derealization disorder".)


Depersonalization — Depersonalization is a persistent or recurrent feeling of detachment or estrangement from one’s self. An individual experiencing depersonalization may report feeling like an automaton, as if in a dream, or as if watching himself or herself in a movie. Depersonalized individuals may report the sense of being an outside observer of their mental processes or their body. They often report feeling a loss of control over their thoughts, perceptions, and actions. (See "Depersonalization/derealization disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis", section on 'Clinical manifestations'.)

Derealization — Derealization is a subjective sense of detachment or unreality regarding the world around them (eg, other individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted). (See "Depersonalization/derealization disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis", section on 'Clinical manifestations'.)

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Literature review current through: Dec 2017. | This topic last updated: Apr 04, 2017.
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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  2. Simeon D, Abugel J. Feeling Unreal: Depersonalization Disorder and the Loss of the Self, Oxford University Press, New York 2006.
  3. Phillips ML, Medford N, Senior C, et al. Depersonalization disorder: thinking without feeling. Psychiatry Res 2001; 108:145.
  4. Simeon D, Giesbrecht T, Knutelska M, et al. Alexithymia, absorption, and cognitive failures in depersonalization disorder: a comparison to posttraumatic stress disorder and healthy volunteers. J Nerv Ment Dis 2009; 197:492.
  5. Hunter EC, Phillips ML, Chalder T, et al. Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behav Res Ther 2003; 41:1451.
  6. Hunter EC, Baker D, Phillips ML, et al. Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behav Res Ther 2005; 43:1121.
  7. Simeon D, Abugel J. Feeling Unreal: Depersonalization disorder and the loss of self, Oxford University Press, New York 2006.
  8. Lanius RA, Vermetten E, Loewenstein RJ, et al. Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry 2010; 167:640.
  9. Institute of Medicine. Treatment of Posttraumatic Stress Disorder: An assessment of the evidence, The National Academies Press, Washington, DC 2007.
  10. Guralnik O, Simeon D. Depersonalization: Standing in the Spaces Between Recognition and Interpellation. Psychoanal Dialogues 2010; 20:400.
  11. Van Dyck R, Spinhoven P. Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics. Int J Clin Exp Hypn 1997; 45:41.
  12. Spiegel D, Cardeña E. Disintegrated experience: the dissociative disorders revisited. J Abnorm Psychol 1991; 100:366.
  13. Spiegel H. The hypnotic induction profile (HIP): a review of its development. Ann N Y Acad Sci 1977; 296:129.
  14. Spiegel H, Spiegel D. Trance and Treatment: Clinical Uses of Hypnosis, American Psychicatric Publishing, Washington, DC 2004.