Information on the following diseases can be found in the Related Disorders section of this report:

• Panic-Anxiety Syndrome (Panic Disorder)
• Agoraphobia

Depersonalization disorder is characterized by persistent or recurring episodes of the loss of the sense of self (depersonalization). The symptoms of depersonalization disorder are sufficient enough to cause marked distress or impairment in social, occupational, or other important areas of life. The usual sense of one's self or reality is temporarily changed or lost. A feeling of detachment from, or being an outside observer of, one's mental processes or body occurs. The affected individual may feel as if he/she is in a dream. Affected individuals may experience various types of lack of sensory stimulation (sensory anesthesia) and a sensation of not being in complete control of one's actions, including speech. This condition may not occur during the course of another mental disorder or be the effects of a substance or general medical condition.

Depersonalization disorder usually starts during adolescence or early adulthood. The disorder is usually chronic with periods of remission. More severe manifestations may be aggravated by mild anxiety or depression. The disorder usually disappears gradually.

The exact cause of depersonalization disorder is not known. A traumatic event such as military combat, a car accident, or being a victim of a violent crime may trigger an episode of depersonalization disorder. Substance use may cause depersonalization episodes, but not the disorder.

Depersonalization disorder is believed to affect women twice as much as men. The disorder most commonly affects individuals between the ages of 15 and 30. It is rarely seen in those over the age of 40.

The following disorders may be associated with Depersonalization Disorder as secondary characteristics. They are not necessary for a differential diagnosis:

Panic-Anxiety Syndrome (Panic Disorder) is characterized by recurrent attacks of intense fear or discomfort beginning without warning. These attacks typically begin with the sudden onset of intense apprehension, fear, terror, or discomfort without apparent cause. At least four of the following symptoms may occur: shortness of breath (dyspnea) or smothering sensations; dizziness, unsteady feelings, or faintness; choking; palpitations or accelerated heart rate; trembling or shaking; sweating; nausea or abdominal distress; loss of one's sense of self (depersonalization) or feelings of unreality; numbness or tingling sensations (paresthesias); flushes (hot flashes) or chills; chest pain or discomfort; etc. (For more information, choose "Panic-Anxiety Syndrome" as your search term in the Rare Disease Database.)

Agoraphobia is the fear of being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available in the event of a panic attack. As a result of this intense fear, people with Agoraphobia do not leave their home. Common situations that may trigger an agoraphobic attack include being outside the home alone, being in a crowd or standing in line, being on a bridge, or traveling in a bus, train, or car.

Diagnosis
The diagnosis of depersonalization disorder can be suspected after a complete physical examination and laboratory tests have ruled out any substance or geneal medical condition. A complete psychiatric evaluation should also be conducted.

Treatment
Treatment of depersonalization disorder involves psychotherapy. The antidepressant drug desipramine may be beneficial. The drugs dextroamphetamines and amobarbital (Amytal) combined with chlorpromazine (Thorazine) may be beneficial if anxiety is experienced. Other treatment is symptomatic and supportive.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

A study to determine the effects of fluoxetine on patients with depersonalization disorder was recently (2005) completed. This study was sponsored by the National Institute of Mental Health and Mount Sinai School of Medicine. Further information is available on the www.clinicaltrials.gov web site.

COMPREHENSIVE TEXTBOOK OF PSYCHIATRY/V, 5th Ed.: Harold I. Kaplan and Benjamin J. Sadock, Editors; Williams & Wilkins, 1989. Pp. 1038-43.

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS: DSM IV, 4th Ed.: A. Frances et. al., Editors; American Psychiatric Association, 1994. Pp. 488-90.

TREATMENTS OF PSYCHIATRIC DISORDERS, 2nd Ed.: Glen O. Gabbard, M.D., Editor; American Psychiatric Association, 1995. Pp. 1634-53.

DESIPRAMINE: A POSSIBLE TREATMENT FOR DEPERSONALIZATION DISORDER. R. Noyes, Jr. et al.; Canadian Journal Psychiatry (Dec 1987; 32(9)). Pp. 782-84.

DEPERSONALIZATION IN A NONCLINICAL POPULATION. D. Trueman; Journal Psychol (Jan 1984; 116 (1st half)). Pp. 107-12.

DEPERSONALIZATION AND AGORAPHOBIA ASSOCIATED WITH MARIJUANA USE. C. Moran; British Journal Med Psychol (Jun 1986; 59(pt 2)). Pp. 187-96.

FEELINGS UNREAL: 30 CASES OF DSM-III-R DEPERSONALIZATION DISORDER. D. Simeon et al.; Am J Psychiatry (Aug 1997; 154(8)). Pp. 1107-13.

DEPERSONALIZATION DISORDER AND SELF-INJURIOUS BEHAVIOR. D. Simeon et al.; J Clin Psychiatry (1995; 56(suppl 4)). Pp. 36-39.

INTERNET:

eMedicine - Dissociative Disorders : Article by Idan Sharon, MD
www.emedicine.com/med/topic3484.htm

www.mayoclinic.com/health/dissociative-disorders/DS00574