Depersonalization/derealization disorder is comprehensively examined, covering its history, diagnosis, and treatment. The book describes the dissociative state of feeling unreal through personal vignettes and explores both psychological and biological perspectives. Treatment options discussed include medications, transcranial magnetic stimulation, and various psychotherapies such as cognitive-behavioral, acceptance, mindfulness, and psychodynamic approaches. Literary and philosophical reflections enrich the understanding, and contemporary societal factors like chronic internet use and virtual reality are explored for their impact on detachment.
Chronic depersonalization/derealization triggered by drugs presents a uniform syndrome indistinguishable from non-drug-triggered cases, except that drug-triggered cases show more improvement over time. An internet survey of 394 adults with chronic depersonalization compared those whose onset was initiated by drugs (196 participants) versus those whose onset was not (198 participants). Cannabis, hallucinogens, and ecstasy were the most common precipitating drugs. Both groups reported similar illness course, impairment, suicidality, and limited treatment response. The drug-initiated group showed significantly greater improvement over time, but the groups did not differ in overall depersonalization severity or in reported effectiveness of psychotherapy or pharmacotherapy.