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Depersonalisation and derealisation: assessment and management

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j745 (Published 23 March 2017) Cite this as: BMJ 2017;356:j745
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Re: Depersonalisation and derealisation: assessment and management

Good to see an article on depersonalisation and derealisation. As a GP with a special interest in mental health I have had the privilege of meeting many young people with these symptoms during the course of 13 years working in the Icebreak service for ‘emerging personality disorder’ at The Zone in Plymouth.
For me perhaps the most important issue is buried in the article and not in the info-graphic – an understanding that they are often part of a physiological response to adversity fear or trauma. Depersonalisation and derealisation are part of the wider group of experiences known as dissociative symptoms; they are mainly neurophysiological - except when caused by underlying neurological diseases – and represent a break down in the brain’s normal ability to create a coherent representation of the external world and one’s body within it. Sometimes possibly, as suggested by the authors, in a helpful way, and becoming problematic when prolonged or severe.
I have now started focusing discussion about the range of often distressing dissociative symptoms, including fugue state, along with other perceptual problems such as auditory, visual and somatic hallucinations, on a process of education and understanding for the patient. Individual patients are asking questions like, “why am I like this?”, and neurophysiological explanations, ie that the there has been a temporary (or longer term) break down in the brain normal ability to let us experience our body-in-space, often appear to be profoundly reassuring. These, alongside explanations that they are understandable, although distressing, consequences of trauma, relationship problems and genetic inheritance, help individuals understand why they feel as they do in a way that diagnosis with a ‘disorder’ does not.

Competing interests: No competing interests

25 March 2017
Richard Byng
GP and Professor in Primary Care Research
Plymouth University Peninsula Schools of Medicine and Dentistry
N14, ITTC, Tamar Science Park, Plymouth