Understanding and treating depersonalisation disorder

Nick Medford is a psychiatrist attached to the Depersonalisation Research Unit at the Institute of Psychiatry (Section of Cognitive Neuropsychiatry, P.O. Box 68, DeCrespigny Park, London SE5 8AZ, UK. Tel.: 020 7848 0138; fax: 020 7848 5172; e-mail: n.medford{at}iop.kcl.ac.uk). He is a lecturer and research fellow supported by a Wellcome Trust clinical research fellowship. He is currently engaged in research on neurocognitive aspects of depersonalisation disorder. Mauricio Sierra is a psychiatrist from Colombia with a long-standing clinical and research interest in dissociative psychopathology. After gaining a PhD at Cambridge University for research on the phenomenology and neurobiology of depersonalisation, he joined the Depersonalisation Research Unit at the Institute of Psychiatry, where he is currently a lecturer and clinical researcher. Dawn Baker is a chartered psychologist and cognitive–behavioural therapist. She obtained a doctorate in clinical psychology in 2001. Since that time she has worked at the Depersonalisation Research Unit developing a psychological model of depersonalisation disorder as well as treatments and management strategies. Tony David is Professor of Cognitive Neuropsychiatry at the Institute of Psychiatry and honorary consultant at the South London and Maudsley NHS Trust. He has been the head of the Depersonalisation Research Unit since its inception in 1998.

Depersonalisation disorder involves an unpleasant, chronic and disabling alteration in the experience of self and environment. In addition to these classic features of depersonalisation and derealisation, symptoms may also encompass alterations in bodily sensation and a loss of emotional reactivity. Primary depersonalisation disorder is probably more common than previously thought, and here we discuss the diagnosis, assessment and treatment of the condition, with particular reference to our experiences in a specialist depersonalisation clinic. We also consider psychological and biological aspects of the condition. Although there is as yet no recognised treatment for this disorder, various pharmacological interventions, particularly a combination of lamotrigine and a selective serotonin reuptake inhibitor, have shown promise. We discuss these drug treatments, together with psychological approaches, in particular a recent cognitive–behavioural conceptualisation and treatment approach.