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A 26-year-old graduate student presents with persistent experiences of feeling detached from his own body, as if he is observing himself from outside, and a sense that the world around him appears unreal, 'like being inside a movie or dream.' These experiences have been nearly continuous for 8 months. He reports that during these episodes, he knows he is not actually outside his body and that the world is real, but the feeling persists despite this awareness. He denies hallucinations, delusions, substance use, and has no history of seizure disorder. MRI and EEG are normal.
Explanation
Depersonalization/derealization disorder is characterized by persistent or recurrent experiences of detachment from self (depersonalization) and/or unreality of surroundings (derealization) with critically preserved reality testing. The patient knows the experiences are subjective perceptions, distinguishing this condition from psychotic disorders. Medical causes (temporal lobe epilepsy) and substance effects must be excluded.
Key Takeaway
Depersonalization/derealization disorder requires persistent detachment experiences with intact reality testing. The patient recognizes the experiences as subjective perceptions, distinguishing the condition from psychotic disorders.