Depersonalization and Derealization – Contemporary Findings

Authors: M. Raszka;  J. Praško
Authors‘ workplace: Psychiatrické centrum Praha
Published in: Cesk Slov Neurol N 2008; 71/104(3): 263-270
Category: Review Article


During depersonalization and derealization the individual experiences detachment from his own feelings, identity, body, and his mental processes seem to be unreal, far or automatic. Etiology of depersonalization and derealization is still poorly understood. In this review, a plausible model of frontolimbic disconnection is described. Next, the findings from neuroimaging, neuroendocrinological and psychopharmacological studies of subjects with depersonalization and derealization supporting or contradicting this model are discussed.

Key words:
depersonalization – derealization – functional neuroimaging – autonomic response – frontolimbic disconnection – psychotropic substances



1. Hunter EC, Sierra M, David AS. The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol 2004; 39(1): 9–18.

2. Noyes R jr, Hoenk PR, Kuperman S, Slymen DJ. Depersonalization in accident victims and psychiatric patients. J Nerv Ment Dis 1977; 164(6): 401–407.

3. Lambert MV, Sierra M, Phillips ML, David AS. The spectrum of organic depersonalization: a review plus four new cases. J Neuropsychiatry Clin Neurosci 2002; 14(2): 141–154.

4. Duševní poruchy a poruchy chování. Diagnostická kritéria pro výzkum. In: Mezinárodní klasifikace nemocí – 10. revize. Praha: Psychiatrické centrum 1996.

5. American Psychiatric association. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text revision. Washington DC: American Psychiatric Association 2000.

6. Ross CA. Epidemiology of multiple personality disorder and dissociation. Psychiatric Clin North Am 1991; 14(3): 503–517.

7. Simeon D. Depersonalisation disorder: a contemporary overview. CNS Drugs 2004; 18(6): 343–354.

8. Simeon D, Knutelska M, Nelson D, Guralnik O. Feeling unreal: a depersonalization disorder update of 117 cases. J Clin Psychiatry 2003; 64(9): 990–997.

9. Baker D, Hunter E, Lawrence E, Medford N, Patel M, Senior C et al. Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 2003; 182: 428–433.

10. Cassano GB, Petracca A, Perugi G, Toni C, Tundo A, Roth M. Derealization and panic attacks: a clinical evaluation on 150 patients with panic disorder/agoraphobia. Compr Psychiatry 1989; 30(1): 5–12.

11. Seguí J, Márquez M, García L, Canet J, Salvador-Carulla L, Ortiz M. Depersonalization in panic disorder: a clinical study. Compr Psychiatry 2000; 41(3): 172–178.

12. Lambert MV, Senior C, Fewtrell WD, Phillips ML, David AS. Primary and secondary depersonalisation disorder: a psychometric study. J Affect Disord 2001; 63(1–3): 249–256.

13. Simeon D, Guralnik O, Schmeidler J, Sirof B, Knutelska M. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry 2001; 158(7): 1027–1033.

14. Hunter EC, Phillips ML, Chalder T, Sierra M, David AS. Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behav Res Ther 2003; 41(12): 1451–1467.

15. Hunter ECM, Baker D, Phillips ML, Sierra M, David AS. Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behav Res Ther 2005; 43(9): 1121–1130.

16. Simeon D, Guralnik O, Gross S, Stein DJ, Schmeidler J, Hollander E. The detection and measurement of depersonalization disorder. J Nerv Ment Dis 1998; 186(9): 536–542.

17. Sierra M, Berrios GE. Depersonalization: neurobiological perspectives. Biol Psychiatry 1998; 44(9): 898–908.

18. Mula M, Cassano GB, Pini S. The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal. J Affect Disord 2007; 99(1–3): 91–99.

19. Mathew RJ, Wilson WH, Coleman RE, Turkington TG, Degrado TR. Marijuana intoxication and brain activation in marijuana smokers. Life Sci 1997; 60(23): 2075–2089.

20. Mathew RJ, Wilson WH, Chiu NY, Turkington TG, Degrado TR, Coleman RE. Regional cerebral blood flow and depersonalization after tetrahydrocannabinol administration. Acta Psychiatr Scand 1999; 100(1): 67–75.

21. Simeon D, Guralnik O, Hazlett EA, Spiegel-Cohen J, Hollander E, Buchsbaum MS. Feeling unreal: a PET study of depersonalization disorder. Am J Psychiatry 2000; 157(11): 1782–1788.

22. Phillips ML, Medford N, Senior C, Bullmore ET, Suckling J, Brammer MJ et al. Depersonalization disorder: thinking without feeling. Psychiatry Res 2001; 108(3): 145–160.

23. Lemche E, Surguladze SA, Giampietro VP, Anilkumar A, Brammer MJ, Sierra M et al. Limbic and prefrontal responses to facial emotion expressions in depersonalization. Neuroreport 2007; 18(5): 473–477.

24. Kopeček M, Bareš M, Brunovský M, Horáček J. Chronický syndrom depersonalizace a derealizace v obraze 18FDG PET. Kazuistika. Psychiatrie 2004; 8(4): 322–326.

25. Blanke O, Mohr C. Out-of-body experience, heautoscopy, and autoscopic hallucination of neurological origin Implications for neurocognitive mechanisms of corporeal awareness and self-consciousness. Brain Res Brain Res Rev 2005; 50(1): 184–199.

26. Tart CT. On Being Stoned: A Psychological Study of Marijuana Intoxication. Palo Alto, Calikfornia: Science and Behavior Books 1971.

27. Blanke O, Ortigue S, Landis T, Seeck M. Stimulating illusory own-body perceptions. Nature 2002; 419(6904): 269–270.

28. Tanton BR, David AS, Cleare AJ, Sierra M, Lambert MV, Phillips ML et al. Basal activity of the hypothalamic-pituitary-adrenal axis in patients with depersonalization disorder. Psychiatry Res 2001; 104(1): 85–89.

29. Simeon D, Guralnik O, Knutelska M, Hollander E, Schmeidler J. Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder. Neuropsychopharmacology 2001; 25(5): 793–795.

30. Sierra M, Senior C, Dalton J, McDonough M, Bond A, Phillips ML et al. Autonomic response in depersonalization disorder. Arch Gen Psychiatry 2002; 59(9): 833–838.

31. Yamamotová A, Papežová H. Neurobiologické mechanizmy disociace, bolesti a vnímání vlastního těla. Psychiatrie pro praxi 2002; 5: 213–218.

32. Simeon D, Guralnik O, Schmeidler J, Knutelska M. Fluoxetine therapy in depersonalisation disorder: randomised controlled trial. Br J Psychiatry 2004; 185: 31–36.

33. Ströhle A, Kümpfel T, Sonntag A. Paroxetine for depersonalization associated with multiple sclerosis. Am J Psychiatry 2000; 157(1): 150.

34. Di Michele V, Bolino F. Adjunctive citalopram is effective on hallucinations and depersonalization symptoms: a case report. Eur Psychiatry 2004; 19(3): 185.

35. Black DW, Wojcieszek J. Depersonalization syndrome induced by fluoxetine. Psychosomatics 1991; 32(4): 468–469.

36. Khazaal Y, Zullino DF. Depersonalization-derealization syndrome induced by reboxetine. Swiss Med Wkly 2003; 133(27–28): 398–399.

37. Simeon D, Hollander E, Stein DJ, DeCaria C, Cohen LJ, Saoud JB et al. Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine. Psychiatry Res 1995; 58(2): 161–164.

38. Noyes R jr, Kuperman S, Olson SB. Desipramine: a possible treatment for depersonalization disorder. Can J Psychiatry 1987; 32(9): 782–784.

39. Simeon D, Stein DJ, Hollander E. Treatment of depersonalization disorder with clomipramine. Biol Psychiatry 1998; 44(4): 302–303.

40. Sierra M, Phillips ML, Ivin G, Krystal J, David AS. A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder. J Psychopharmacol 2003; 17(1): 103–105.

41. Sierra M, Medford N, Baker D, Lawrence E, Patel M, Phillips ML et al. Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases. Clin Neuropharmacol 2006; 29(5): 253–258.

42. Bob P, Susta M, Pavlat J, Hynek K, Raboch J. Depression, traumatic dissociation and epileptic-like phenomena. Neuro Endocrinol Lett 2005; 26(4): 321–325.

43. Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Böhme R, Schmahl CG. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry 1999; 60(9): 598–603.

44. Nuller YL, Morozova MG, Kushnir ON, Hamper N. Effect of naloxone therapy on depersonalization: a pilot study. J Psychopharmacol 2001; 15(2): 93–95.

45. Walsh SL, Strain EC, Abreu ME, Bigelow GE. Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans. Psychopharmacology (Berl) 2001; 157(2): 151–162.

46. Baker D, Hunter E, Sierra M, Lawrence E, Phillips ML, David AS. Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases. Addiction 2003; 98(12): 1731–1736.

47. Mathew RJ, Wilson WH, Humphreys D, Lowe JV, Weithe KE. Depersonalization after marijuana smoking. Biol Psychiatry 1993; 33(6): 431–441.

48. Vollenweider FX, Vontobel P, Hell D, Leenders KL. 5-HT modulation of dopamine release in basal ganglia in psilocybin-induced psychosis in man--a PET study with [11C]raclopride. Neuropsychopharmacology 1999; 20(5): 424–433.

49. Wittmann M, Carter O, Hasler F, Cahn BR, Grimberg U, Spring P et al. Effects of psilocybin on time perception and temporal control of behaviour in humans. J Psychopharmacol 2007; 21(1): 50–64.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2008 Issue 3

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account