Substance/medication-induced disorders. Depersonalization/derealization associated with the physiological effects of substances during acute intoxication or withdrawal is not diagnosed as depersonalization/derealization disorder. The most common precipitating substances are the illicit drugs marijuana, hallucinogens, ketamine, ecstasy, and salvia. In about 15% of all cases of depersonalization/derealization disorder, the symptoms are pre- cipitated by ingestion of such substances. If the symptoms persist for some time in the ab- sence of any further substance or medication use, the diagnosis of depersonalization/ derealization disorder applies. This diagnosis is usually easy to establish since the vast ma- jority of individuals with this presentation become highly phobic and aversive to the trig- gering substance and do not use it again.
Mental disorders due to another medical condition. Features such as onset after age 40 years or the presence of atypical symptoms and course in any individual suggest the possibility of an underlying medical condition. In such cases, it is essential to conduct a thorough medical and neurological evaluation, which may include standard laboratory studies, Viral titers, an electroencephalogram, vestibular testing, visual testing, sleep stud- ies, and/ or brain imaging. When the suspicion of an underlying seizure disorder proves difficult to confirm, an ambulatory electroencephalogram may be indicated; although temporal lobe epilepsy is most commonly implicated, parietal and frontal lobe epilepsy may also be associated.
In a convenience sample of adults recruited for a number of depersonalization research studies, lifetime comorbidities were high for unipolar depressive disorder and for any anxiety disorder, with a significant proportion of the sample having both disorders. Comor- bidity with posttraumatic stress disorder was low. The three most commonly co-occurring personality disorders were avoidant, borderline, and obsessive-compulsive.
300.15 (F44.89)
This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social. occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The other specified dissocia- tive disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific disso- ciative disorder. This is done by recording “other specified dissociative disorder” followed by the specific reason (e.g., “dissociative trance").
Examples of presentations that can be specified using the “other specified" designation include the following: 1. Chronic and recurrent syndromes of mixed dissociative symptoms: This cate- gory includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an in- dividual who reports no dissociative amnesia.
2. Identity disturbance due to proionged and intense coerclve persuasion: Individ- uals who have been subjected to intense coercive persuasion (e.g., brainwashing, thought reform, indoctrination while captive, torture, long-term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in. or conscious questioning of, their identity.
3. Acute dissociative reactions to stressfui events: This category is for acute, tran- sient conditions that typically last less than 1 month, and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness; deper- sonalization; derealization; perceptual disturbances (e.g., time slowing. macropsia); micro-amnesias; transient stupor; and/or alterations in sensory-motor functioning (e.g., analgesia, paralysis).