Updated Information on Diagnosis

[David S. Kozin]

OLD DIAGNOSTIC CRITERIA (DSM-IV-TR)

Depersonalization Disorder

A. Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).

B. During the depersonalization experience, reality testing remains intact.

C. The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

UPDATED DIAGNOSTIC CRITERIA FOR DSM-V

Depersonalization/Derealization Disorder

Either (1), (2), or both:

A1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling as though one is in a dream; sense of unreality of self or body; or time moving slowly)

A2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)

B. During the depersonalization or derealization experience, reality testing remains intact

C. The depersonalization or derealization symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The depersonalization or derealization symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., complex partial seizures).

E. The depersonalization or derealization symptoms are not restricted to the symptoms of another mental disorder (e.g.,schizophrenia, panic disorder, acute stress disorder, posttraumatic stress disorder, major depressive disorder, or another dissociative disorder).

Specify if:

a) Depersonalization only

Derealization only

THE RATIONALE FOR THE CHANGES

D and E: Changes allow comorbid diagnoses to be made when warranted.

Reference: Spiegel D et al. (Depression & Anxiety; in preparation)

The group also proposes that depersonalization disorder should retain its classification as a dissociative disorder in its current form. However, it is problematic that chronic derealization is not included in the diagnosis. In the DSM-IV-TR derealization is classified with DDNOS, which is not in line with the ICD which has depersonalization-derealization as a single disorder. There is recent empirical evidence that individuals with prominent derealization alone do not significantly differ from those with depersonalization accompanied with derealization in any respect, including demographics, precipitants, illness characteristics, and comorbidity (Simeon 2009)

Simeon D. 2009. Depersonalization disorder. In: Dell PF, O'Neil JA, editors. Dissociation and dissociative disorders: DSM-V and beyond. New York: Routledge. 2009. p 441-442.