1) A 21-year-old woman has experienced feelings of depersonalization and derealization since childhood, which are exacerbated during times of stress. She has a history of childhood abuse. 2) She sought psychiatric treatment for increased anxiety, panic attacks, and hallucinations after the death of her alcoholic father from lung cancer. 3) She was diagnosed with depressive symptoms related to grief and treated with SSRIs, which provided partial relief of symptoms except for persistent dissociative experiences.

1. Copyright © 2013
Hernández-Santillán GA1, Martin-Ballesteros E.2
1 Psychiatric Resident Trainer. Hospital. 2Psychiatric Medical Assistant.
Hospital Universitario Príncipe de Asturias. Alcalá de Henares. Spain.
Psychopathology of depersonalization and derealization. What is the
limit between normal and pathological?
Introduction
Depersonalization is a subjective state of unreality in which there is a feeling of strangeness, whether
it is alive from the self or from the external environment. Often involves the symptom of
derealization, a term that denotes a similar sense of unreality with respect to the consciousness of the
external world. These experiences are associated with anxiety and mood disorders, with diseases of
organic origin such as epilepsy or traumatic brain injury; anyway, it causes great distress in the
patient.
Case
21-year-old women, distance-learning psychologist
with a history of parent violence during her early
childhood in the context of her father's alcohol
poisoning, describes experiences of
depersonalization and derealization, of which she is
aware since the age of five years, in situations of
stress or out, for example, when looking in the
mirror or even playing. She consulted to Psychiatry,
seven months after his father died of lung cancer, he
frequently smoked tobacco and cannabis at home,
had been diagnosed a year before his death. The
patient described increased anxiety symptoms, with
panic attacks, hypnopompic and hypnagogic
hallucinations, and increased depersonalization and
derealization phenomena. She denies the use of
psychoactive substances in addition to tobacco and
alcohol, occasionally. Likewise, the depressive
symptomatology was objectified in relation to the
grief for the loss of his father. She received
treatment with SSRIs and two months later, refered
partial remission of symptoms, with persistence of
dissociative symptoms. In addition, she presents
emotional instability, feelings of emptiness, self-
defeating ideas without structured suicide ideation.
In recent months, he has presented avoidant
behaviors and isolation with affectation in his
habitual functioning.
Discussion
Some studies conclude that while in adults
DP symptoms are frequently associated
with mental disorders, in adolescents they
could be considered as a quasi-
physiological phenomenon. Now, in this
case: Are depersonalization and
derealization of a high-risk mental state, or
a prelude to a serious mental ion normal,
part of the anxiety crisis, a illness? In any
event, part of therapy, consists in speaking
precisely of the symptom.
References
-Sims. Sintomas Mentales. Fifth edition. Elsevier 2016.
- Fagioli F, Stanghellini G. Depersonalization: physiological or pathological in adolescents? Compr Psychiatry 2015;59:68-72.