Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Dissociative Disorders

Diagnostic criteria for the disorder include the experience of depersonaliza tion or derealization while maintaining reality testing. The disturbance must also cause clinically significant distress, not attributable to substance or another med ical condition, and not better explained by another mental disorder. Differential diagnosis Depersonalization as a symptom can occur in many syndromes, both psychiatric and medical. Mood disorders, anxiety disorders, schizophrenia, DID, substance use, adverse effects of medication, brain tumors or injury, and seizure disorders (eg, temporal lobe epilepsy) must be ruled out. Depersonalization disorder de scribes the condition in which depersonalization is predominant and is differen tiated from psychotic disorders in that reality testing is intact (see Table 16-10 ).

TABLE 16-10. Causes of Depersonalization Neurologic disorders

Epilepsy Migraine Brain tumors Cerebrovascular disease Cerebral trauma Encephalitis General paresis Dementia of the Alzheimer type Huntington disease Spinocerebellar degeneration Toxic and metabolic disorders Hypoglycemia Hypoparathyroidism Carbon monoxide poisoning Mescaline intoxication Botulism

Dissociative Disorders

Hyperventilation Hypothyroidism Idiopathic mental disorders Schizophrenia Depressive disorders Manic episodes Conversion disorder Anxiety disorders Obsessive-compulsive disorder Personality disorders Phobic-anxiety depersonalization syndrome In normal persons Exhaustion Boredom; sensory deprivation Emotional shock In hemi-depersonalization Lateralized (usually right parietal) focal brain lesion

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Adapted with permission of Elsevier Science &Technology Journals from Cummings JL. Dissociative states, depersonalization, multiple personality, episodic memory lapses. In: Cummings JL, ed. Clinical Neuropsychiatry . Grune & Stratton; 1985:123; permission conveyed through Copyright Clearance Center, Inc.