A 30-year-old woman experiences episodes of feeling detached from her body and surroundings, as if watching herself from outside. She is fully oriented and has no psychotic features. She describes the experience as unpleasant and alien to her. What defence mechanism underlies the psychodynamic understanding of this presentation?

• A Isolation of affect — separating emotions from thoughts
• B Projection — attributing one's own unacceptable feelings to others
• C Reaction formation — converting anxiety into its opposite
• D Dissociation — segregating mental contents or functions from conscious awareness in response to overwhelming anxiety or trauma ✓

Explanation

Depersonalisation-derealisation disorder is psychodynamically understood through dissociation, a defence mechanism in which aspects of mental experience (identity, memory, consciousness, perception) are segregated from ordinary awareness to manage overwhelming anxiety, often rooted in trauma. The patient experiences ego-dystonic detachment from self (depersonalisation) or environment (derealisation), yet reality testing is intact — distinguishing it from psychosis. Dissociation operates as a continuum from normal (highway hypnosis) to pathological (dissociative identity disorder). Isolation of affect involves separating emotional content from cognition but does not produce the perceptual alienation characteristic of depersonalisation.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.