Search Results for « Depersonalisation/derealisation disorder »

Introduction: Despite depersonalisation-derealisation being the third most commonly reported psychiatric symptom, it remains chronically understudied and poorly understood. Research into depersonalisation-derealisation disorder (DDD) is largely quantitative and remains scarce. This systematic literature review is the first review to synthesise available qualitative research about DDD lived experiences to understand the nature and impact of the disorder’s symptoms. The findings are interpreted in light of the cognitive behavioural model of DDD. Methods: Five electronic databases (APA PsycArticles, APA PsycInfo, CINAHL Ultimate, open dissertations, MEDLINE Ultimate) were searched alongside Google Scholar from their inception until September 2025 using a combination of search terms for depersonalisation, derealisation, lived experiences and qualitative methods. The methodological quality of studies was assessed using the Critical Appraisal Skills Programme Tool for qualitative research and data was analysed using Thomas and Harden’s (2008) approach to thematic synthesis. Results: Twelve studies were identified as eligible for inclusion. Thematic synthesis revealed five themes across participants’ accounts: (i) Struggling to Navigate Distortions in Time and Sensory Perception; (ii) Changes in Identity, Roles and Beliefs; (iii) Navigating Societal Stigma and Altered Relationships; (iv) Negative Affective Responses: Anxiety, Numbness, Suicidality; and (v) Challenges to Daily Functioning. Most studies demonstrated high methodological quality, with only one exception. Discussion: The lived experiences presented in this review provide context to the impact of DDD symptoms on individuals and those around them. It underscores the need for holistic, person-centred interventions that address not only symptom reduction but also broader issues not otherwise captured by standardised measures of DDD symptoms surrounding self-perception, emotional wellbeing, relational difficulties, altered sensory perception and functional recovery. Findings broadly support the cognitive behavioural model of DDD, while also indicating important areas of divergence, thereby extending current theoretical understanding of the condition.

Abstract Depersonalisation (DP) and derealisation (DR) experiences can cause clients and therapists a lot of confusion and anxiety. Therapist confusion has led to the under-recognition of DP and DR symptoms, under-confidence in working therapeutically with this client group and unequal client access to effective cognitive behavioural therapy (CBT) interventions. Client confusion has resulted in missed opportunities to engage in meaningful discussions with therapists about their DP and DR experiences and under-confidence that CBT can be of help. This article seeks to provide clarity for clinicians and clients around key misconceptions we have identified from the authors’ clinical experience of using CBT to treat DP/DR, both when presenting as symptoms in the context of other diagnoses and when presenting as a primary depersonalisation derealisation disorder (DDD). In addressing symptom misconceptions, we want to increase clinicians’ confidence when assessing DP and DR. We hope this will lead to productive discussions with clients and the inclusion of these symptoms in clinical formulations. We draw attention to client misconceptions in the hope that this facilitates better therapeutic dialogues about DP and DR and the potential benefit of CBT. Finally, we address therapist misconceptions about the use of CBT with this population in the hope that we can encourage more CBT therapists to work more proactively, confidently and effectively with DP and DR. Key learning aims (1) To help therapists better recognise depersonalisation (DP) and derealisation (DR) symptoms when in the context of another disorder and when presenting as primary depersonalisation derealisation disorder (DDD). (2) To recognise therapist misconceptions leading to under-confidence in working with clients whose presentation includes symptoms of DP/DR and/or diagnoses of DDD. (3) To understand misconceptions clients might hold about their DP and DR experiences and how these may impact engagement with CBT. (4) To help therapists engage with clients in helpful discussions about the effectiveness of CBT to help with DP and DR, both when experienced in the context of another disorder and when conceptualised as DDD.