Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

The patient may claim that the outside world lacks lucidity and emotional color ing and that they feel they are dreaming or dead. Epidemiology Though pathologic depersonalization/derealization is rare (lifetime prevalence is estimated to be between 0.8% and 2%), occasional isolated depersonaliza tion episodes are common and occur in 70% of a given population, with women more likely to experience episodes than men. The mean age of occurrence for the disorder is 16 years and rarely occurs in persons over the age of 40 years. The gender ratio of pathologic depersonalization/derealization is 1:1. Comorbidity Common comorbidities include unipolar depressive disorder and anxiety disorders. Etiology Predisposing factors include anxiety, depression, and severe stress. Depersonal ization/derealization disorder is frequently associated with anxiety disorders, de pressive disorders, and schizophrenia. It may also be caused by a psychological, neurologic, or systemic disease. Stress or trauma may precipitate depersonalization/derealization disorder. Additionally, episodes or extended periods of depersonalization/derealization are associated with an array of substances including alcohol, barbiturates, ben zodiazepines, scopolamine, β -adrenergic antagonists, marijuana, and virtually any phencyclidine (PCP)-like or hallucinogenic substance. Laboratory and psychological tests There are no laboratory tests for depersonalization/derealization disorder. Pathophysiology The pathophysiology of the disorder is not well understood. Diagnosis, signs, and symptoms A number of distinct components comprise the experience of depersonalization, including a sense of (1) bodily changes, (2) duality of self as observer and actor, (3) being cut off from others, and (4) being cut off from one’s own emotions. Pa tients experiencing depersonalization often have great difficulty expressing what they are feeling. Patients who are depersonalized may not adequately convey to the examiner the distress they experience and may try to express their subjective suffering with banal phrases such as “I feel dead,” “Nothing seems real,” or “I’m standing outside of myself.” While complaining bitterly about how this is ruining their life, they may nonetheless appear remarkably undistressed (see Table 16-9 ). TABLE 16-9. Signs and Symptoms of Depersonalization/Derealization Disorder • Persistent feelings of depersonalization or derealization without loss of reality testing • Depersonalization: feeling as though living outside one’s body, disconnected from sensations, emotions, and actions • Derealization: feeling detached from reality, as if in a dream

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