Depersonalization/Derealization Disorder involves persistent experiences of feeling detached from one's thoughts and body (depersonalization) or surroundings seeming unreal (derealization). The most important feature that DISTINGUISHES it from a psychotic disorder is:
- A Onset before age 20
- B No associated anxiety
- C Intact reality testing — patient knows these feelings are not objectively real ✓
- D EEG abnormalities during episodes
Correct answer: C. Intact reality testing — patient knows these feelings are not objectively real
Explanation
The critical distinguishing feature of Depersonalization/Derealization Disorder from psychosis is preserved reality testing — the patient always recognizes that the experience of unreality is subjective and does not reflect objective reality ('I feel like I'm watching myself from outside, but I know I'm really here'). In psychotic disorders, reality testing is impaired and the patient believes the distorted perception is real. SSRIs and lamotrigine are sometimes used but evidence is limited.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.