Information for Mental Health Professionals

For most people with symptoms of DPDR, these experiences are extremely frightening. They may fear they have damaged their brain in some way, be experiencing a sudden neurological disorder or ‘going crazy’. It is very important, therefore, to be able to inform them quickly that their symptoms form part of the recognised syndrome of Depersonalisation and/or Derealisation and provide clear and accurate information, as well as reassurance about this condition. 

Clinicians can play a vital role in helping people feel that their symptoms are understood, and that there is hope for recovery. Our resources section provides information which you can give to patients to help them understand their symptoms what may have triggered these, to link with others who have similar symptoms and to see that recovery is possible. You can also direct them to the Unreal website or to our Peer Support service.

To guide your treatment, given there is no NICE guidance, we suggest looking at the BMJ infographic and reading the BMJ article linked below which gives a simple, brief guide to the latest evidence and recommendations for stepped care. This suggests four pathways:

  1. Watchful waiting and monitoring in those with early symptoms of Depersonalisation and/or Derealisation which may naturally recover with information giving

  2. Pharmacological or psychological treatment of associated primary conditions (such as anxiety and depression), if present, with subsequent re-evaluation of DPDR symptoms to see if they have resolved

  3. Treatment of secondary care level associated mental health conditions such as PTSD or Personality disorders, if present, with subsequent re-evaluation of DPDR symptoms to see if they have resolved

  4. Specialist intervention with those who have only DPDR symptoms with no other conditions or where symptoms of DPDR persist after other interventions. This may involve referral to a specialist service if no expertise is available locally.

In terms of psychological interventions, there is published evidence that Cognitive Behavioural Therapy adapted for DPDR can be effective and a new study has replicated these earlier findings. 

Medication can also be helpful in some cases. Early studies into the effectiveness of r-TMS and Mindfulness Based Cognitive Therapy have shown promising results but these treatments need more research and replication. 

For information about the symptoms and lived experience of DPDR:  Look at some of the articles on our resources pages, especially the Guardian article and Victoria Derbyshire excerpt.

For information on the condition, you can find details in the DSM-5 or ICD11.

To listen to more detailed overviews about DPDR and treatments:

Listen to Jane Charlton, Professor Anthony David and Dr Elaine Hunter discussing their article in the BMJ

Resources

KEY PUBLISHED PAPERS AND TEXTS

(AVAILABLE ON REQUEST FROM AUTHORS IF NOT ACCESSIBLE VIA OTHER SOURCES)

Hunter, E.C.M., Baker, D., Lawrence, E.  & David, A.S. (2018) Overcoming Depersonalisation and Feelings of Unreality, Second Edition, Robinson Press, UK

Hunter, E.C.M., Charlton, J & David, A.S. (2017) Depersonalisation and derealisation: assessment and

Management. BMJ ;356:j745 doi: 10.1136/bmj.j745 

Hunter, E.C.M. (2013) Understanding and treating depersonalisation disorder in Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation, Kennerley, H., Kennedy, F & Pearson, D (Eds.) Routledge Press. 

Lee, W.E., Kwok, C.H.T., Hunter, E.C.M., Richards, M. & David, A.S. (2012) Prevalence and childhood antecedents of depersonalization syndrome in a UK birth cohort, Social Psychiatry and Psychiatric Epidemiology, 47 (2), 253-261

Hunter, E. C. M., Baker, D., Phillips, M. L., Sierra, M. & David. A.S. (2005) Cognitive Behaviour Therapy for Depersonalisation Disorder: An Open Study. Behaviour Research and Therapy, 43, 1121-1130. 

Phillips, M.L., Hunter, E., Baker, D., Medford, N., Sierra, M. & David, A.S. (2005) Depersonalisation Disorder. Current Medical Literature - Psychiatry, 16 (1), 1-5. 

Nick Medford, Mauricio Sierra, Dawn Baker & Anthony S. David (2005) Understanding and treating depersonalisation disorder, Advances in Psychiatric Treatment, vol. 11, 92–100

Hunter, E.C.M., Sierra, M. & David, A.S. (2004) The Epidemiology of Depersonalisation and Derealisation: a systematic review.  Social Psychiatry and Epidemiology, 39(1), 9-18.

Hunter, E.C.M., Phillips, M.L., Chalder, T., Sierra, M. &  David, A.S. (2003)  Depersonalisation disorder: A cognitive-behavioural conceptualization. Behaviour Research and Therapy, 41(12), 1451-1467.

Medford, N., Baker, D, Hunter, E.C.M., Sierra, M., Lawrence, E., Phillips, M.L. & David, A.S. (2003) Chronic depersonalisation following illicit drug use: review of forty cases. Addiction, 98, 1731-1736.

Baker, D., Hunter, E.C.M., Lawrence, E., Medford, N., Patel, M., Senior, C., Sierra, M., Lambert, M.V., Phillips, M.L. & David, A.S. (2003) Depersonalisation disorder: clinical features of 204 cases. British Journal of Psychiatry, 182, 428-433