Session 9 Trauma And Stressor-Related Disorders

Front 1

Reactive Attachment Disorder: Description

Back 1

A disorder in infancy or early childhood characterized by a pattern of markedly disturbed and developmental inappropriate attachment behaviors in which a child rarely turns to preferential attachments figures for comfort, support, nurturance or protection.
Prevalence: Unknown. Less than 10% even in populations of severely neglected children. Conditions usually present in the first several months of life. Clinical features typically manifest between nine months and five years.
Comorbidity: Associated with conditions of neglect. Medical condition associated with neglect (e.g. malnutrition). Depressive symptoms also observed.

Front 2

Reactive Attachment Disorder: Criteria Part A,B,C

Back 2

A. Consistent pattern of inhibited, emotionally withdrawn behavior toward caregivers manifested by both of the following:
1. Child rarely or minimally seeks comfort when distress.
2. Child rarely or minimally responds to comfort when distress.
B. Persistent social and emotional disturbance characterized by at least two of the following:
1. Minimal social and emotional responsiveness to others.
2. Limited positive affect.
3. Episodes of unexplained irritability, sadness or fearfulness that are evident during nonthreatening interactions with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient care as evidence by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having need by adult caregivers.
2. repeated changes by primary caregivers that limit opportunities to form stable relationships.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments.

Front 3

Reactive Attachment Disorder: Criteria Part D,E,F,G

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D. The Care in Criteria C is presumed to be responsible for the disturbed behavior in Criteria A.
E. Criteria are not met for Autism Spectrum Disorder.
F. Disturbance is evident before age five years.
G. Child has developmental age of at least nine months.

Front 4

Disinhibited Social Engagement Disorder: Description

Back 4

DSM p. 268
Sx: Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults, that violates the culture’s social boundaries.
Prevalence: Unknown. Only 20% in populations of children severely neglected and raised in orphanages/institutions.
Comorbidity: Conditions associated with neglect commonly seen, e.g. cognitive delays, language delays etc. ADHD often concurrently diagnosed.

Front 5

Disinhibited Social Engagement Disorder: Criteria A,B,C

Back 5

A. Pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching an interacting with unfamiliar adults
2. Overly familiar verbal/physical behavior (inconsistent with cultural boundaries)
3. Diminished or absent checking back with adult care giver in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. Behaviors in Criterion A are not limited to impulsivity but include socially disinhibited behavior.
C. the child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in form of lack of basic emotional needs by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable relationships.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments

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Disinhibited Social Engagement Disorder: Criteria

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D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
E. The child has a developmental age of at least nine months.

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Adjustment Disorders: Description

Back 7

Sx: Presence of emotional or behavioral symptoms in response to an identifiable stressor where the stressor may be a single or multiple events and single or recurrent in occurrence. May affect others besides the individual.
Prevalence: Common with 5%-20% of individual in outpatient mental health settings with principal diagnosis of Adjustment Disorders.
Comorbidity: Can accompany almost any mental or medical disorder.
Misc. Elements: Can only diagnose Adjustment Disorder in addition to another mental disorder only if the other mental disorder does not better explain the symptoms experienced by the individual.

Front 8

Adjustment Disorders: Criteria A, B,C,D,E

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A. Development of emotional or behavioral symptom in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant as evidence by one or both of the following:
1. Marked stress that is out of proportion to the severity or intensity of the stressor.
2. Significant impairment in functioning.
C. The stress-related disturbance does not meet criteria for another mental disorder nor is an exacerbation of pre-existing disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated the symptoms do not persist for more than six months.

Front 9

Adjustment Disorders Specifiers

Back 9

with depressed mood
with anxiety
with mixed anxiety and depressed mood
with disturbance of conduct
with mixed disturbance of emotions and conduct
unspecified

Front 10

Acute Stress Disorder:

Back 10

Sx: Development of characteristic symptoms lasting three days to one month following exposure to one or more traumatic events.
Prevalence: Varies according to nature of event and its experiential context.
Motor vehicle accidents: 13%-21%
Assault: 19%
Mild traumatic head injury: 14%
Severe burns: 10%
Gender: More prevalent among females.

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Acute Stress Disorder: Diagnostic Criteria A,B,C,D,E

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 A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic events occurred:
C. Duration of the disturbance (symptoms in Criterion B) is three days to one month after trauma exposure.
D. Disturbance causes clinically significant distress and impairments.
E. Disturbance is not attributable to the physiological effects of a substance or belter explained by another mental disorder.

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Acute Stress Disorder: Negative Mood

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persistent inability to experience positive emotions

Front 13

Acute Stress Disorder: Dissociative symptoms

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 An altered sense of the reality of one’s surroundings or oneself.
 Inability to remember an important aspect of the traumatic event(s).

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Acute Stress Disorder: Avoidance Symptoms

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Efforts to avoid distressing memories, thoughts, or feelings closely associated with the traumatic event(s).
Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings closely associated with the traumatic event(s)

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Acute Stress Disorder: arousal symptoms

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 Sleep disturbance.
 .Irritable behavior and angry outbursts.
 Hypervigilance.
 Problems with concentration.
 Exaggerated startle response

Front 16

Post Traumatic Stress Disorder: Description

Back 16

Sx: Development of characteristic symptoms following exposure to one or more traumatic events.
Emotional reactions to Criteria A removed in DSM5.
Prevalence: Using DSM-IV criteria, lifetime prevalence = 8.7% at age 75 years. US 12-month prevalence = 3.5%.
Gender: PTSD more prevalent among females.
Comorbidity: 80% of individuals with PTSD meet criteria for at least one other disorder. Comorbid substance abuse and conduct disorder more common among males than females. Among Iraq/Afghanistan vets with mild TBI = 48%.

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PTSD: Criteria

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A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
NOTE: Exposure through electronic media, television, movies or pictures, unless this exposure is work related.
B. Presence of n (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic events occurred:

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PTSD: B continued Intrusive Symptoms

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1. Recurrent , involuntary and intrusive distressing memories of the traumatic event(s).
NOTE: IN children older than six years, repetitive play may occur in which themes from the trauma are expressed.
2. Recurrent distressing dreams related to the event.
NOTE: In, Children there may be frightening dreams without recognizable content.
3. Dissociative reactions where traumatic event is re-experienced.
NOTE: In, children trauma-specific re-enactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions to internal/external cues of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize aspects of the traumatic event(s).

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PTSD: Criteria C. Persistent avoidance of stimuli associated with the traumatic events beginning after the traumatic evens occurred

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1. Avoidance or efforts to avoid distressing memories, thoughts, or feelings closely associated with the traumatic event(s).
2. Avoidance or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings closely associated with the traumatic event(s).

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PTSD: Criteria D. Negative alterations in cognitions and mood associated with the traumatic events beginning or worsening after traumatic events occurred as evidenced by 2 or more of the following:

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1. Inability to remember an important aspect of the traumatic event(s).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others or the world.
3. Persistent, distorted cognitions about the cause or consequences of the event(s) that lead individual to blame others or self.
4. Persistent negative emotional state.
5. Markedly diminished interest in participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions

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PTSD: Criteria E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following

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1. Irritable behavior and angry outbursts.
2. Reckless or self-destructive behavior.
3. Hyper vigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance.

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PTSD: Criteria F,G,H

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F. Duration of the disturbance (Criteria B, C, D & E) is more than one month after trauma exposure.
G. Disturbance causes clinically significant distress and impairments.
H. Disturbance is not attributable to the physiological effects of a substance or belter explained by another mental disorder.

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Post Traumatic Stress Disorder: Specifiers

Back 23

With dissociative symptoms: PTSD criteria is met. In addition the individual meets criteria for either of the following:
1. Depersonalization:
2. Derealization
Specify if: With delayed expression: If full diagnostic criteria are not met until at least six months after the event (although the onset of symptoms may be immediate).

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PTSD Specifier: Depersonalization

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Persistent or recurrent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body.

Front 25

PTSD Specifier: Derealization

Back 25

Persistent or recurrent experiences of unreality of surroundings.

Front 26

PTSD Child Criteria A,B

Back 26

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the event(s) occurred to a close family member or close friend.
B. Presence of one (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic events occurred:

Front 27

PTSD Child Criteria B. Intrusive Symptoms

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1. Recurrent , involuntary and intrusive distressing memories of the traumatic event(s).
NOTE: IN children older than six years, repetitive play may occur in which themes from the trauma are expressed.
2. Recurrent distressing dreams related to the event.
NOTE: In, Children there may be frightening dreams without recognizable content.
3. Dissociative reactions where traumatic event is re-experienced.
NOTE: In, children trauma-specific re-enactment may occur in play.
4. Intense or prolonged psychological distress or marked physiological reactions to internal/external cues of the traumatic event(s).

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PTSD child criteria C.

Back 28

C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the event(s), must be present beginning or worsening after traumatic event(s) :
Persistent Avoidance of Stimuli
1. Avoidance of or efforts to avoid activities, places or physical reminders of the traumatic event(s).
2. Avoidance of or efforts to avoid people, conversations or interpersonal situations arouse recollections of the traumatic event(s).
Negative Alterations in Cognitions
3. Substantially increased frequency of negative emotional states.
4. Markedly diminished interest in participation in significant activities, including constriction of play.
5. Socially withdrawn behavior.
6. Persistent reduction in expression of positive emotions.

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PTSD child criteria D.

Back 29

D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following:
1. Irritable behavior and angry outbursts.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance.
E. Duration of the disturbance is more than one.
F. Disturbance causes clinically significant distress and impairments.
G. Disturbance is not attributable to the physiological effects of a substance or belter explained by another mental disorder.

Front 30

PTSD child criteria Specifiers

Back 30

With dissociative symptoms: PTSD criteria is met. In addition the individual meets criteria for either od the following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body.
2. Derealization: Persistent or recurrent experiences of unreality of surroundings.
Specify if:
With delayed expression: If full diagnostic criteria are not met until at least six months after the event (although the onset of symptoms may be immediate).

Front 31

PTSD Prevalence

Back 31

1 in 12 adults at some point in their lives (8%)
US Comorbidity Study (Kessler, 1995)
7.8% gen pop with 5.05 men and 10.4% women due to greater incidence of assaultive violence against women
16% of PTSD sufferers also had another disorder
54% of PTSD sufferers also had 3+ disorders

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Points to make about PTSD

Back 32

•Event is persistently re-experienced
•Avoidance of associated stimuli
•Chronic tension or irritability
•Insomnia and inability to tolerate noise
•Impaired concentration and memory
•Depression
•Avoidance of social situations involving excitable stimuli

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Acute stress disorder time period

Back 33

•Symptoms occur within 4 weeks of event
•Symptom duration is between minimum of 3 days and maximum of 4 weeks

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PTSD time period

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•Symptoms occur within 4 weeks of event
•Symptom duration is over 4 weeks
•PTSD delayed expression
•Symptoms occur six months (or more) from event
•Difficult to pin down the originating event
•Symptom onset may be gradual or immediate

Front 35

Somatic Symptom Disorders: General Information

Back 35

New category on DSM5 –
• Common feature: the prominence of somatic symptoms associated with significant distress and impairment.
• These individuals are commonly encountered in primary care medical setting as opposed to mental health clinics.
• Rationale: DSM-IV Somatoform was confusing, overlapping and overly restrictive. DSM5 reduced number of disorders and restrictive criteria.
• “It is not appropriate to give an individual a mental disorder diagnosis solely because a medical cause cannot be demonstrated. Furthermore, the presence of a medical diagnosis does not exclude the possibility of a comorbid mental disorder. . .” (DSM5 p. 309)

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Factors contributing to a somatic symptom disorder diagnosis include:

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– Genetic & biological vulnerability (e.g. increased sensitivity to pain)
– Early traumatic experience (e.g. violence, abuse, etc.)
– Learning (e.g. attention obtained from illness, etc.)
– Somatic Symptom Disorder – 75% of these individual formerly Hypochondriasis Disorder. Balance (25%) under Illness Anxiety Disorder.

Front 37

Somatic Symptom Disorder: Description

Back 37

–(formerly Somatization Disorder)
– Sx: Typically have multiple, current, somatic symptoms that are distressing or result in significant disruption of daily life; often one symptom is present, commonly pain.
Symptoms may or may not be associated with another medical diagnosis. Diagnoses of Somatic Symptom Disorder and a medical condition are not mutually exclusive.
–Prevalence: Unknown. Estimates of somatic symptom disorder in general population are 5%-7%. More restrictive DSM-IV-TR somatization disorder prevalence = <1%.
–Comorbidity: Medical conditions are common. Depressive disorder is common on older adults.

Front 38

Somatic Symptom Disorder: Criteria

Back 38

A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more then six months).

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Somatic Symptom Disorder – Specifiers

Back 39

Specify if:
With predominant pain (previously Pain Disorder): For individuals whose somatic symptoms predominantly involve pain.
Persistent: Characterized by severe symptoms, marked impairment and long duration (more then six months).
Specify current severity:
Mild: Only one of the symptoms in Criteria B is fulfilled.
Moderate: Two or more of the symptoms in Criteria B is fulfilled.
Severe: Two or more of the symptoms in Criteria B is fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

Front 40

Illness Anxiety Disorder: Description

Back 40

(formerly Hypochondriasis)
–DSM p. 315
–Sx: A preoccupation with having or acquiring a serious, undiagnosed illness. Somatic symptoms are absent or mild. Medical testing reveals no evidence of a medical condition.
–Prevalence: Unknown. Based upon DSM III & IV Hypochondriasis diagnosis with one year prevalence rates = 1.3%-10%. Onset estimated at early to middle adulthood.
–Comorbidity: Anxiety disorders (GAD, Panic & OCD) along with depressive disorders. 66% of individuals with Illness Anxiety Disorder estimated to have had at least one other comorbid major mental disorder.
–Misc. elements:
75% of individual formerly diagnoses under Hypochondriasis are now diagnosed under Illness Anxiety Disorder.

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Illness Anxiety Disorder: Criteria

Back 41

A. Preoccupation with having or acquiring a serious illness.
B. Somatic symptoms are not present or if present are only mild in intensity.
C. High level of anxiety about health and the individual is easily alarmed about personal health status.
D. Individual performs excessive level of health related behaviors.
E. Illness preoccupation has been present for at least six months, but the specific feared illness may change over that period.
F. Illness-related preoccupation is not better explained by another mental disorder.

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Illness Anxiety Disorder: Specifiers

Back 42

Care-seeking type: Medical care, including physician visits or undergoing tests and procedures is frequently used.
Care-avoidant type: Medical care is rarely used.

Front 43

Factitious Disorder: Description

Back 43

Munchausen's Syndrome
–Sx: Falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception.
–Prevalence: Unknown. Estimated at 1%. Onset is usually in early adulthood, often after a hospitalization for a medical or mental condition.

Front 44

Factitious Disorder – Diagnostic Criteria

Back 44

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. Individual presents him or herself to others as ill, impaired or injured.
C. The deceptive behavior is evident even in the absence or obvious external rewards.
D. Behavior is not better explained by another mental disorder, such as delusional disorder or other psychotic disorder.

Front 45

Factitious Disorder- Specifier

Back 45

Single episode:
Recurrent episode: two or more events of falsification of illness and/or induction of injury/disease.

Front 46

Factitious Disorder Impose on Another – Diagnostic Criteria

Back 46

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another associated with identified deception.
B. Individual presents another individual (victim) to others as ill, impaired or injured.
C. The deceptive behavior is evident even in the absence or obvious external rewards.
D. Behavior is not better explained by another mental disorder, such as delusional disorder or other psychotic disorder.
NOTE: The perpetrator receives the diagnosis, not the victim.
- Same specifiers

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Dissociative Disorders: Description

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The disintegration of the unity of consciousness characterized by derealization and depersonalization.
Depersonalization: one’s sense of one’s self and one’s own reality is temporarily lost
1. Depersonalization: Persistent or recurrent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body where one’s sense of the reality of the outside world is temporarily lost
2. Derealization: Persistent or recurrent experiences of unreality of surroundings.
NOTE: some spiritual & religious traditions consider this to be a state to be aspired to and attained as part of salvation or enlightenment or transcendence.
Differentiate by degree of impairment to daily functioning

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Dissociative Identity Disorder: Description

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Sx: Presence of two or more distinct personality states or an experience of possession.
Prevalence: 12 month prevalence = 1.6%.
Manifest onset age at almost any age from childhood to adulthood.
Gender: Females = 1.4% and males = 1.6%
Comorbidity: Traumatic experiences usually in early childhood.
Misc. Elements: controversial

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Dissociative Identity Disorder – Diagnostic Criteria

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A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as possession. The disruption in identity involves marked discontinuity in sense of self with related alterations in affect, behavior, consciousness, memory, perception, cognition and/ or sensory-motor functioning. Maybe observed by other and/or self.
B. Recurrent gaps in the recall of everyday events, important personal information and/or traumatic events that are inconsistent with ordinary forgetting.
C. Symptoms cause clinically significant distress and impairments.
D. Disturbance is not a normal part of a broadly accepted cultural or religious practice.
NOTE: In children, symptoms are not better explained by imaginary playmates or other fantasy play.
E. Symptoms are not attributable to the physiological effects of a substance or belter explained by another mental disorder.

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Dissociative Identity Disorder formerly

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Multiple Personality Disorder
Dramatic Dissociative disorder in which a patient manifests two or more distinct identities or personality states that alternate in some way in taking control of behavior.
Usually there is “lost time” during personality alternation.

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Dissociative Identity Disorder: Host identity

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most frequent, real name, often not the original personality and may not be the best-adjusted of the personalities.

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Dissociative Identity Disorder: Alternates Identity

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differs in striking ways from host (gender, age, fashion, sexual orientation/attitude, affect and sometimes language, etc)

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Dissociative Identity Disorder: Roles

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Child, Protector, Persecutor, Opposite Sex and Victim.

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DID: Alters are not real people only _____________

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aspects

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Dissociative Identity Disorder: Onset Prevalence

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–Starts in childhood; diagnosis in 20’s -30’s
–3-9times more likely in females than males
–DSM criteria tightened and distinguished from Schizophrenia

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Dissociative Identity Disorder: Development and Treatment Outcomes

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Development:
Sociocognitive – person learns to adopt and enact the roles
Post-traumatic theory – child is overwhelmed by trauma and creates alters to manage stress and trauma
Real or fake recovered memories: BOTH
Poorly skilled therapist role vs highly skilled
Abuse role: NOT 100%
Treatment Outcomes
Primary techniques is hypnosis
Most be prolonged; years
Positive correlation of severity to length of treatment.
Only Dissociative Disorders: 54% of patients achieve personality integration.

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Dissociative Amnesia Disorder Description

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Sx: An inability to recall important autobiographical information that 1) should be successfully stored in memory and 2) ordinarily would be readily remembered.
Prevalence: 12 month prevalence = 1.8%
Gender: Males =-m 1.0% Females=2.6%
Comorbidity: Little known. Hollywood loves it!! IN recovery from amnesia, victim may experience symptoms of: dysphoria, grief, rage, shame, guilt, and general psychological conflict and turmoil. PTSD not uncommon in later life.

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Dissociative Amnesia Disorder: Types of Amnesia

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Localized amnesia
Selective amnesia
Generalized amnesia
Continuous amnesia
Dissociative amnesia

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Localized amnesia

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specific time period

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Selective amnesia

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some portion of a specific time period

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Generalized amnesia

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entire life history, rare, may or may not lose skills or world knowledge.

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Continuous amnesia

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nothing from certain time point to present

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Dissociative Amnesia Disorder Criteria

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A. An inability to recall autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
B. symptoms cause clinically significant distress and impairments.
C. Disturbance is not attributable to the physiological effects of a substance or not better explained by another mental or medical disorder.
D. Disturbance is not better explained by Dissociative Identity Disorder, PTSD, Acute Stress Disorder, Somatic Symptom Disorder or major or mild neurocognitive disorder.
CODING NOTE:
Dissociative amnesia without dissociative fugue: 300.12 (F44.0).
Dissociative amnesia with dissociative fugue: 300.13 (F44.1).1

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Dissociative Amnesia Disorder: Fugue

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apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.2

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Dissociative amnesia is usually limited to:

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failure to recall info not caused by general med condition (i.e. Psychogenic Amnesia)

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Dissociative Fugue

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Essential feature is (Crit A) sudden unexpected travel away from one’s home with inability to recall one’s past and often (Crit B) with the assumption of a new identity

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Depersonalization/Derealization Disorder: Description

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Sx: Persistent or recurrent episodes of depersonalization, derealization or both. Episodes of depersonalization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, one’s whole self or from aspects of the self.
Prevalence: Lifetime prevalence = 2% (range 0.8% - 2.8%).
Gender: 1:1
Comorbidity: High for unipolar comorbidity and any anxiety disorder.
Misc Elements: diagnostic cautionary statement1

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–Depersonalization/Derealization Disorder – Diagnostic Criteria

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A. Presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from and as if one were an outside observer of one’s mental processes or body.
2. Derealization: Persistent or recurrent experiences of unreality of surroundings.
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress and impairments.
D. Disturbance is not attributable to the physiological effects of a substance or not better explained by another medical condition.
E. Disturbance is not better explained by another mental disorder.