3 - The depersonalization spectrum  pp. 44-62

The depersonalization spectrum

By Mauricio Sierra

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Introduction

Most authors who have written on depersonalization concur on the view that, as a sporadic and fleeting phenomenon, the condition is quite common in both psychiatric and non-clinical populations. For example, in 1964 a panel discussing the clinical relevance of depersonalization concluded that, after depression and anxiety, it was the most frequent symptom seen in psychiatry (Stewart, 1964). Likewise, Paul Schilder (1935), the great German neuropsychiatrist and psychoanalyst, believed depersonalization to be present, at some stage, in ‘almost every neurosis’, and did not hesitate to refer to the condition as ‘one of the nuclear problems of psychology and psychopathology’ (Schilder, 1935).

It has long been known that depersonalization occurs along a spectrum of severity, which ranges from short-lasting episodes (so-called ‘normal depersonalization’) to persistent, severe and disabling forms (abnormal depersonalization). Although depersonalization can frequently accompany other psychiatric conditions (see Chapter 5), in its most chronic and severe form it often follows an independent clinical course. This latter presentation is currently known as ‘depersonalization disorder’ by DSM-IV or as ‘depersonalization-derealization syndrome’ by ICD-10. This chapter is intended to provide an overview of these two extremes of the spectrum.

‘Normal depersonalization’

A number of studies carried out with college students have clearly established that short-lasting episodes of depersonalization are a common occurrence in young people, with a prevalence ranging from 30% to 70% (Dixon, 1963; Roberts, 1960; Sedman, 1966; Myers and Grant, 1972; Trueman, 1984a,b; Elliot et al., 1984; Moyano and Claudon, 2003).

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