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Am J Psychiatry 1997; 154:1107-1113
Copyright © 1997 by American Psychiatric Association
Feeling unreal: 30 cases of DSM-III-R depersonalization disorder
D Simeon, S Gross, O Guralnik, DJ Stein, J Schmeidler and E Hollander
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
OBJECTIVE: In contrast to the recent surge of interest in other
dissociative disorders, DSM-III-R depersonalization disorder has not been
thoroughly investigated and characterized. The authors systematically
elucidated its phenomenology, comorbidity, traumatic antecedents, and
treatment history. METHOD: Thirty adult subjects (19 women and 11 men) were
consecutively recruited and administered various structured and
semistructured interviews as well as the self-rated Dissociative
Experiences Scale. An age- and sex-matched normal comparison group was also
recruited. RESULTS: The mean age at onset of depersonalization disorder was
16.1 years (SD = 5.2). The illness had a chronic course that was usually
continuous but sometimes episodic. Severe distress and high levels of
interpersonal impairment were characteristic. Unipolar mood and anxiety
disorders were common, but none emerged as specifically related to the
depersonalization. A wide variety of personality disorders was manifested;
avoidant, borderline, and obsessive-compulsive were most common. Although
not highly traumatized, the subjects with depersonalization disorder
reported significantly more childhood trauma than the normal comparison
subjects. Depersonalization had been typically treatment refractory; only
serotonin reuptake inhibitors and, to a lesser extent, benzodiazepines had
been of any therapeutic benefit. CONCLUSIONS: This study supports the
conceptualization of depersonalization disorder as a distinct disorder with
a characteristic course that is independent of mood, anxiety, and
personality symptoms. A subtle relationship may exist between childhood
trauma and depersonalization disorder that merits further investigation.
The disorder appears to be highly treatment refractory, and prospective
treatment trials are warranted.
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