Depersonalisation disorder: a cognitive–behavioural conceptualisation
Section snippets
Depersonalisation disorder: associations with anxiety
Depersonalisation disorder is classified as a dissociative disorder in DSM-IV (American Psychiatric Association, 1994), alongside dissociative amnesia, fugue and identity disorder (DID). The definition of the dissociative disorders is that there is a ‘disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment’ (DSM-IV, p. 477). In this respect, DPD has dissociative features in that sufferers experience a disruption in their previous
A cognitive model of depersonalisation disorder
Transient symptoms of DP/DR are common phenomena in normal populations, as are symptoms of anxiety. Cognitive models of anxiety disorders such as those of panic (Clark, 1986) or health anxiety (Warwick & Salkovskis, 1990) suggest that it is the interpretation of these common symptoms that determines whether they develop into a chronic disorder. More specifically, it is the catastrophic misinterpretation of these symptoms as indicating threat that leads to a vicious cycle of increasing symptoms,
Implications of the model for treatment
The cognitive–behavioural model of DPD described above, based on models of anxiety disorders, provides a framework for the construction of an individual conceptualisation of those factors that are likely to have predisposed and precipitated the presenting problem, and which continue to perpetuate the symptoms. Each of these individual factors should be addressed in therapy, with initial emphasis placed on effecting change on those factors deemed to be maintaining the disorder and later focus on
Conclusions
From the existing literature there appears to be compelling evidence to support an association between DPD and the anxiety disorders. The conceptualisation of DPD within an anxiety disorders framework provides us with an empirically testable model and a rationale for treatment. However, the current lack of empirical research on DPD means that parts of the model proposed in this paper are still very speculative and testing of the model is planned for the near future. It is hoped that further
Acknowledgements
Support for this study came from the Col. W.W. Pilkington Will, Cecil Pilkington and A.P. Pilkington Pilozzo Charitable Trusts.
References (87)
- et al.
Derealization and panic attacks: evaluation on 150 patients with panic disorder/agoraphobia
Comprehensive Psychiatry
(1989) A cognitive model of panic
Behaviour Research and Therapy
(1986)- et al.
The experimental induction of depersonalization and derealization in panic disorder and non-anxious subjects
Behaviour Research and Therapy
(1994) - et al.
Depersonalization in response to life-threatening danger
Comprehensive Psychiatry
(1977) - et al.
Depersonalization disorder: thinking without feeling
Biological Psychiatry
(2000) - et al.
Anxiety, panic, and phobic disorders: an overview
Journal of Psychiatric Research
(1988) - et al.
Depersonalization in panic disorder: a clinical study
Comprehensive Psychiatry
(2000) - et al.
Depersonalization : neurobiological perspectives
Biological Psychiatry
(1998) - et al.
The Cambridge depersonalisation scale: a new instrument for the measurement of depersonalisation
Psychiatry Research
(2000) - et al.
Treatment of depersonalization disorder with clomipramine
Biological Psychiatry
(1998)
The measurement of dissociation in normal and clinical populations : meta-analytic validation of the Dissociative Experiences Scale (DES)
Clinical Psychology Review
Hypochondriasis
Behaviour Research and Therapy
Panic disorder in association with relaxation induced anxiety: an attentional training approach to treatment
Behaviour Therapy
Prevalence of depersonalisation and derealization experiences in a rural population
Social Psychiatry and Psychiatric Epidemiology
Depersonalization. I. Aetiology and phenomenology; II. Clinical syndromes
Journal of Mental Science
Traumatic relationships and serious mental disorders
Chronic depersonalization neurosis au Shorvon—a successful intervention
British Journal of Psychiatry
Depersonalisation disorder: clinical features of 204 cases
British Journal of Psychiatry
Epidemiology of mental disorders in Camberwell
Psychological Medicine
The need for psychiatric treatment in the general population: the Camberwell needs for care survey
Psychological Medicine
Cognitive therapy and the emotional disorders
Cognitive therapy of depression
An inventory for measuring depression
Archives of General Psychiatry
Development, reliability and validity of a dissociation scale
Journal of Nervous and Mental Disease
Use of directive therapy in the treatment of depersonalization neurosis
Psychological Reports
Task concentration training and fear of blushing
Clinical Psychology and Psychotherapy
Depersonalization phenomena in psychiatric patients
British Journal of Psychiatry
Multiple personality disorder and posttraumatic stress disorder: similarities and differences
Measurement of dissociative states with the clinician—administered dissociative states scale (CADSS)
Journal of Traumatic Stress
Depersonalization: psychological and social perspectives
Dissociative symptoms in relation to childhood physical and sexual abuse
American Journal of Psychiatry
A cognitive model of social phobia
Depersonalization phenomena in 214 adult psychiatric in-patients
Psychiatric Quarterly
Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial
American Journal of Psychiatry
Dissociative phenomenology of dissociative identity disorder
Journal of Nervous and Mental Disease
Depersonalization phenomena in a sample population of college students
British Journal of Psychiatry
Relaxation and depersonalisation
British Journal of Psychiatry
Objective assessment of peritraumatic dissociation: psychophysiological indicators
American Journal of Psychiatry
Neurosis and human growth: the struggle towards self-realization
General psychopathology
Cognitive therapy of dissociative symptoms associated with trauma
British Journal of Clinical Psychology
Cited by (119)
Finding neural correlates of depersonalisation/derealisation disorder via explainable CNN-based analysis guided by clinical assessment scores
2024, Artificial Intelligence in MedicineA brief CBT intervention for depersonalisation-derealisation disorder in psychosis: Results from a feasibility randomised controlled trial
2024, Journal of Behavior Therapy and Experimental PsychiatryA cognitive behavioral model for dissociation: Conceptualization, empirical evidence and clinical implications
2023, Journal of Behavioral and Cognitive TherapyDeveloping an understanding of the relationship between anxiety and dissociation in adolescence
2023, Psychiatry Research