Depersonalization/Derealization Disorder

Depersonalization/derealization disorder is characterized by persistent or recurrent experiences of detachment from one’s own self (depersonalization) or the external environment (derealization), accompanied by intact reality testing. Etiology involves stress, trauma, neurobiological dysfunction in corticolimbic circuits, and genetic predisposition. Clinically, patients report feeling as though they are observing themselves from outside the body or that the world is unreal, causing significant distress or functional impairment. Diagnosis requires careful exclusion of psychotic disorders, substance-induced states, and neurological conditions. Management includes psychotherapy, primarily cognitive-behavioral therapy, and pharmacologic interventions targeting comorbid anxiety or depression. Prognosis is variable, with chronic symptoms persisting in some cases, though many experience symptom improvement over time with appropriate treatment.