340 CHAPTER 8
overlapped with symptoms of possession trance and of other phenomena in the
local culture, such as memory problems or temporarily assuming a new identity.In sum, like dissociative amnesia, dissociative fugue is rare and poorly under-
stood. Although there are clues as to possible factors that contribute to the disorder,
the specifi c roles these factors may play and how they might infl uence each other
are not known.Depersonalization Disorder
Like many people, you may have experienced depersonalization. This does not mean
that you have depersonalization disorder. A persistentfeeling of being detached from
one’s mental processes or body is the key symptom of depersonalization disorder.
Although the primary symptom is depersonalization, people who have this disorder
may also experience derealization.What Is Depersonalization Disorder?
People affl icted with depersonalization disorder may feel “detached from my body”
or “like a robot,” but they do not believe that they are truly detached or actually a
robot. They still recognize reality. (In contrast, people who have a psychotic disorder
may feel and believe such things; see Chapter 12.) In addition, people with deperson-
alization disorder may not react emotionally to events; they may feel that they don’t
control their behavior and are just being swept along by what is happening around
them. Table 8.5 presents the DSM-IV-TR diagnostic criteria; symptoms meet the cri-
teria for the disorder only when they occur independently of anxiety symptoms and
they impair functioning or cause signifi cant distress.
Some researchers point out that symptoms of depersonalization have much
in common with symptoms of certain anxiety disorders (see Chapter 7)—a sense
of being numb or detached, dizziness or faintness, and a tendency to avoid stimuli
associated with increased anxiety (Hunter et al., 2003). Moreover, panic attacks can
include depersonalization and derealization, and people with depersonalization dis-
order often have a comorbid anxiety disorder, which can make accurate diagnosis
diffi cult. Typically, it is the comorbid anxiety symptoms, rather than the dissociative
symptoms themselves, that lead individuals with depersonalization disorder to seek
help. Table 8.6 provides more facts about depersonalization disorder.Understanding Depersonalization Disorder
Researchers are beginning to chart the neurological factors that contribute to
depersonalization disorder. Unfortunately, less is known about possible psychologi-
cal or social factors, perhaps because the disorder is relatively rare. Let’s examine
what is known and how the different types of factors might infl uence one another.Table 8.5 • DSM-IV-TR Diagnostic Criteria for 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 signifi cant 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 [discussed in Chapter 12], Panic Disorder [Chapter 7],
Acute Stress Disorder [Chapter 7], or another Dissociative Disorder [discussed later in this
chapter], 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).
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,
Fourth Edition, (Copyright 2000) American Psychiatric Association.Depersonalization disorder
A dissociative disorder whose primary
symptom is a persistent feeling of being
detached from one’s mental processes or
body, although people who have this disorder
may also experience derealization.