A 20-Year Descriptive Phenomenological Study of Depersonalization and Derealization as an Alteration in Sense of Self and Lifeworld.

Depersonalization (DP) and derealization (DR) are alterations in sense of self and lifeworld that often co-occur in psychosis. Over 20 years, the Chicago Longitudinal Study examined these phenomena across psychiatric categories. DP was broadly distributed across diagnoses, while DR showed greater specificity to schizophrenia. Network analyses revealed three foundational constructs in schizophrenia: alteration in sense of self/lifeworld, multisensory experiences, and bodily experiences; bodily and multisensory alterations were foundational in affective-psychosis. Self-disturbance emerged as foundational only in schizophrenia. The findings support reframing DP and DR as points on a continuum of attenuated alterations in sense of self and lifeworld, representing a fundamental self-disturbance in existential feeling.

Study at a glance

Abstract

Depersonalization (DP) and derealization (DR) are phenomena involving alterations in sense of self and lifeworld. These phenomena often co-occur in psychosis, suggesting dimensional psychopathology and complex phenomenological alterations in consciousness, embodiment, and meaning-making. The primary aim of this study was to examine phenomenological associations, dynamics, and diagnostic representations of DP and DR across psychiatric categories over 20 years. The Chicago Longitudinal Study is a prospective study designed to investigate psychopathology, psychosocial determinants, and recovery. Primary clinical indices were DP and DR as measures of alterations in sense of self and lifeworld. DP and DR are transdiagnostic yet more prevalent in schizophrenia. DP was broadly distributed across diagnostic categories and DR showed greater specificity to schizophrenia. Multiple linear regressions of DP and DR revealed specific points of convergence and divergence in positive and negative symptoms. Network analyses revealed three foundational constructs: alteration in sense of self/lifeworld, multisensory, and bodily experiences in schizophrenia, with bodily and multisensory alterations foundational in affective-psychosis. Notably, self-disturbance emerged as a foundational construct in schizophrenia and not affective psychosis. Whereas alteration in bodily and multisensory experiences emerged as foundational constructs that transcend diagnostic categories. Together, our findings support a reframing of DP and DR, as points on a continuum of attenuated alterations in the sense of self (DP) and lifeworld (DR), introducing a more nuanced and dynamic understanding of these phenomena as a fundamental self-disturbance in the "ontological dimension" or "existential feeling" that constitutes an atmosphere of alternative reality in self-disturbance.