Important components of the model include: Predisposing factorsĭPD reflects the shift of experiences of depersonalization and derealization from transient to chronic. Similar to other anxiety disorders, they propose that the cycle is maintained by avoidance, safety behaviors and heightened symptom monitoring and self-focused attention. This leads to feelings of anxiety and associated physiological reactions, which may then exacerbate the symptoms of DP/DR. Hunter, Phillips, Chalder, Sierra & David (2003) proposed a cognitive model to account for the maintenance of DPD, which suggests that common, transient symptoms of DP/DR (typically experienced during times of stress or threat) are catastrophically misinterpreted as signs of deteriorating or damaged mental health. Around a third of those with DPD report migraines (31%: Baker et al, 2003). Around a third of those with DPD report Tinnitus (29%: Baker et al, 2003). Heightened self-monitoring and self-observation for DP/DR symptoms are common in DPD. People with DPD often report being afraid to go out alone (59%, Baker et al, 2003) and avoid situations that could lead to increased anxiety or a worsening of their symptoms. Simeon et al (1997) found 50% of patients with DPD had co-morbid social phobia. A high proportion of those with DPD suffer from panic attacks (59%) and will experience worsened DP/DR symptoms during the attacks (40-90%: Hunter et al, 2003). aura, ticks or fidgeting, acute changes in smell or taste, headache and confusion afterwards) (Medford et al, 2005).Ĭo-occurring symptoms of DPD often overlap with experiences of social phobia, panic and health anxiety: In these cases, it is typical for the individual to report circumscribed occurrences of DP/DR symptoms along with cognitive and behavioral changes (e.g. Clinicians should note that episodes of DP/DR can occur as part of the presentation of temporal lobe epilepsy. DPD is classified with the dissociative disorders in DSM5, but hallmark features of dissociation are absent: people with DPD retain insight and dissociative amnesia is absent or very rare (Hunter et al, 2003 Medford et al, 2005). The most widely used clinical tool for assessment is the Cambridge Depersonalisation Scale (Sierra & Berrios, 2000). People with DPD are not delusional, being aware that their symptoms are subjective and not due to changes in the world itself.Īssessment for DPD should be considered for people reporting symptoms in any of the categories described above (Medford et al, 2005). People experiencing DPD have intact reality testing and are acutely aware of the disjunction and the disruption to their sense of self, which may cause them significant distress. They may have recurring thoughts or ruminations on the nature of reality and the self. Individuals might experience impaired concentration, a changed perception of time, an empty mind or racing thoughts, memory impairments, impaired visual imagery, or difficulty processing new information. Individuals may report a dream-like state, a sense of isolation, loss of motivation, lack of empathy, inability to feel the consequences of their behavior, depression and anxiety.
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