Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 2, pp 253–261 | Cite as

Prevalence and childhood antecedents of depersonalization syndrome in a UK birth cohort

  • William E. Lee
  • Charlie H. T. Kwok
  • Elaine C. M. Hunter
  • Marcus Richards
  • Anthony S. David
Original Paper

Abstract

Purpose

Depersonalization syndrome is characterised by a sense of unreality about the self [depersonalization (DP)] and/or the outside world [derealization (DR)]. Prevalence estimates vary widely. Little is known about childhood antecedents of the disorder although emotional abuse is thought to play a role.

Methods

Longitudinal data from 3,275 participants of a UK population-based birth cohort (the MRC National Survey of Health and Development) were used to: (1) assess the prevalence of DP syndrome at age 36, measured by the Present State Examination (PSE); and (2) examine the effects of a range of socio-demographic, childhood adversity and emotional responses as potential risk factors for DP.

Results

Thirty three survey members were classified with DP, yielding a prevalence of 0.95% [95% confidence intervals (CI) 0.56–1.34]. There were no associations with socio-economic status, parental death or divorce; self-reported accidents, childhood depression, tendency to daydream or reactions to criticism. However, teacher-estimated childhood anxiety was a strong independent predictor of adult depersonalization, and there were strong cross-sectional relationships between DP and anxiety and depression caseness.

Conclusions

To our knowledge this is the first study assessing nationwide prevalence of the DP syndrome and uses longitudinal data to explore childhood risk factors for adult DP. The prevalence of adult DP was slightly lower than reported by other surveys. The study found that childhood anxiety was the only significant predictor of the adult DP syndrome, supporting the view that depersonalisation disorder forms part of the spectrum of responses to anxiety.

Keywords

Depersonalization Prevalence Population Childhood Anxiety 

Notes

Acknowledgments

A.S.D. acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King’s College London. W.E.L. is funded by a Medical Research Council Training Fellowship.

References

  1. 1.
    Baker D, Hunter E, Lawrence E, Medford N, Patel M, Senior C, Sierra M, Lambert MV, Phillips ML, David AS (2003) Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 182:428–433PubMedCrossRefGoogle Scholar
  2. 2.
    Sierra M, Gomez J, Molina JJ, Luque R, Munoz JF, David AS (2006) Depersonalization in psychiatric patients: a transcultural study. J Nerv Ment Dis 194(5):356–361. doi:10.1097/01.nmd.0000218071.32072.74 PubMedCrossRefGoogle Scholar
  3. 3.
    Hunter EC, Sierra M, David AS (2004) The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol 39(1):9–18. doi:10.1007/s00127-004-0701-4 PubMedCrossRefGoogle Scholar
  4. 4.
    World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, GenevaGoogle Scholar
  5. 5.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV, 4th edn. American Psychiatric Association, Washington D.C.Google Scholar
  6. 6.
    Bebbington P, Hurry J, Tennant C, Sturt E, Wing JK (1981) Epidemiology of mental disorders in Camberwell. Psychol Med 11(3):561–579PubMedCrossRefGoogle Scholar
  7. 7.
    Bebbington PE, Marsden L, Brewin CR (1997) The need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey. Psychol Med 27(4):821–834PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson JG, Cohen P, Kasen S, Brook JS (2006) Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity. J Psychiatr Res 40(2):131–140. doi:10.1016/j.jpsychires.2005.03.003 PubMedCrossRefGoogle Scholar
  9. 9.
    Michal M, Wiltink J, Subic-Wrana C, Zwerenz R, Tuin I, Lichy M, Brahler E, Beutel ME (2009) Prevalence, correlates, and predictors of depersonalization experiences in the German general population. J Nerv Ment Dis 197(7):499–506. doi:10.1097/NMD.0b013e3181aacd94 PubMedCrossRefGoogle Scholar
  10. 10.
    Ross CA (1991) Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am 14(3):503–517PubMedGoogle Scholar
  11. 11.
    Aderibigbe YA, Bloch RM, Walker WR (2001) Prevalence of depersonalization and derealization experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol 36(2):63–69PubMedCrossRefGoogle Scholar
  12. 12.
    Sierra-Siegert M, David AS (2007) Depersonalization and individualism: the effect of culture on symptom profiles in panic disorder. J Nerv Ment Dis 195(12):989–995. doi:10.1097/NMD.0b013e31815c19f7 PubMedCrossRefGoogle Scholar
  13. 13.
    Simeon D, Gross S, Guralnik O, Stein DJ, Schmeidler J, Hollander E (1997) Feeling unreal: 30 cases of DSM-III-R depersonalization disorder. Am J Psychiatry 154(8):1107–1113PubMedGoogle Scholar
  14. 14.
    Lambert MV, Senior C, Fewtrell WD, Phillips ML, David AS (2001) Primary and secondary depersonalisation disorder: a psychometric study. J Affect Disord 63(1–3):249–256 pii:S016503270000197XPubMedCrossRefGoogle Scholar
  15. 15.
    Sierra M, Lopera F, Lambert MV, Phillips ML, David AS (2002) Separating depersonalisation and derealisation: the relevance of the “lesion method”. J Neurol Neurosurg Psychiatry 72(4):530–532PubMedGoogle Scholar
  16. 16.
    Medford N, Baker D, Hunter E, Sierra M, Lawrence E, Phillips ML, David AS (2003) Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases. Addiction 98(12):1731–1736PubMedCrossRefGoogle Scholar
  17. 17.
    McGuire PK, Cope H, Fahy TA (1994) Diversity of psychopathology associated with use of 3, 4-methylenedioxymethamphetamine (‘Ecstasy’). Br J Psychiatry 165(3):391–395PubMedCrossRefGoogle Scholar
  18. 18.
    Mayou R, Bryant B (2001) Outcome in consecutive emergency department attenders following a road traffic accident. Br J Psychiatry 179:528–534PubMedCrossRefGoogle Scholar
  19. 19.
    Noyes R Jr, Kletti R (1977) Depersonilization in response to life-threatening danger. Compr Psychiatry 18(4):375–384PubMedCrossRefGoogle Scholar
  20. 20.
    Chu JA, Dill DL (1990) Dissociative symptoms in relation to childhood physical and sexual abuse. Am J Psychiatry 147(7):887–892PubMedGoogle Scholar
  21. 21.
    Neumann DA, Houskamp BM, Pollock VE, Briere J (1996) The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreat 1(1):6–16. doi:10.1177/1077559596001001002 CrossRefGoogle Scholar
  22. 22.
    Simeon D, Abugel J (2006) Feeling unreal: depersonalization disorder and the loss of the self. OUP, New YorkGoogle Scholar
  23. 23.
    Schilder P (1914) Selbstbewusstsein und Persönlichkeitsbewusstsein. Monographien aus dem Gesamtgebiete der Neurologie und Psychiatrie., Heft 9. BerlinGoogle Scholar
  24. 24.
    Michal M, Beutel ME, Jordan J, Zimmermann M, Wolters S, Heidenreich T (2007) Depersonalization, mindfulness, and childhood trauma. J Nerv Ment Dis 195(8):693–696. doi:10.1097/NMD.0b013e31811f4492 PubMedCrossRefGoogle Scholar
  25. 25.
    Simeon D, Guralnik O, Schmeidler J, Sirof B, Knutelska M (2001) The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry 158(7):1027–1033PubMedCrossRefGoogle Scholar
  26. 26.
    Elliott GC, Rosenberg M, Wagner M (1984) Transient depersonalization in youth. Soc Psychol Q 47(2):115–129PubMedCrossRefGoogle Scholar
  27. 27.
    Salfield DJ (1958) Depersonalization and allied disturbances in childhood. J Ment Sci 104(435):472–476PubMedGoogle Scholar
  28. 28.
    Shimizu M, Sakamoto S (1986) Depersonalization in early adolescence. Jpn J Psychiatry Neurol 40(4):603–608PubMedGoogle Scholar
  29. 29.
    Sierra M, Baker D, Medford N, David AS (2005) Unpacking the depersonalization syndrome: an exploratory factor analysis on the Cambridge Depersonalization Scale. Psychol Med 35(10):1523–1532. doi:10.1017/S0033291705005325 PubMedCrossRefGoogle Scholar
  30. 30.
    Roth M (1960) The phobic anxiety-depersonalization syndrome and some general aetiological problems in psychiatry. J Neuropsychiatr 1:293–306PubMedGoogle Scholar
  31. 31.
    Hunter EC, Phillips ML, Chalder T, Sierra M, David AS (2003) Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behav Res Ther 41(12):1451–1467 pii:S0005796703000664PubMedCrossRefGoogle Scholar
  32. 32.
    Wadsworth M, Kuh D, Richards M, Hardy R (2006) Cohort profile: the 1946 National Birth Cohort (MRC National Survey of Health and Development). Int J Epidemiol 35(1):49–54. doi:10.1093/ije/dyi201 PubMedCrossRefGoogle Scholar
  33. 33.
    CS OP (1971) Office of population censuses and surveys. Classification of occupations 1970. HMSO, LondonGoogle Scholar
  34. 34.
    Department of Education and Science (1972) Burnham further education committee grading courses. HMSO, LondonGoogle Scholar
  35. 35.
    Wing J, Nixon J, von Cranach M, Strauss A (1977) Further developments of the ‘present state examination’ and CATEGO system. Arch Psychiatr Nervenkr 224(2):151–160PubMedGoogle Scholar
  36. 36.
    Wing JK, Cooper JE, Sartorius N (1974) The measurement of classification of psychiatric symptoms. An instruction manual for the PSE and Catego Program. Cambridge University Press, CambridgeGoogle Scholar
  37. 37.
    Wing JK, Sturt E (1978) The PSE-ID-CATEGO system: a supplementary manual. Institute of Psychiatry, London (mimeo)Google Scholar
  38. 38.
    Rodgers B, Mann SA (1986) The reliability and validity of PSE assessments by lay interviewers: a national population survey. Psychol Med 16(3):689–700PubMedCrossRefGoogle Scholar
  39. 39.
    Wing J, Cooper J, Sartorius N (1974) The measurement and classification of psychiatric symptoms. Cambridge University Press, LondonGoogle Scholar
  40. 40.
    World Health Organization (1992) SCAN: schedules for clinical assessment in neuropsychiatry. World Health Organization, GenevaGoogle Scholar
  41. 41.
    Sierra M, Berrios GE (2000) The Cambridge Depersonalization Scale: a new instrument for the measurement of depersonalization. Psychiatry Res 93(2):153–164 pii:S0165178100001001PubMedCrossRefGoogle Scholar
  42. 42.
    Ross CA, Joshi S, Currie R (1991) Dissociative experiences in the general population: a factor analysis. Hosp Community Psychiatry 42(3):297–301PubMedGoogle Scholar
  43. 43.
    Ross CA, Heber S, Norton GR, Anderson D, Anderson G, Barchet P (1989) The dissociative disorders interview schedule: a structured interview. Dissociation 2(3):169–189Google Scholar
  44. 44.
    Bremner JD, Steinberg M, Southwick SM, Johnson DR, Charney DS (1993) Use of the Structured Clinical Interview for DSM-IV dissociative disorders for systematic assessment of dissociative symptoms in posttraumatic stress disorder. Am J Psychiatry 150(7):1011–1014PubMedGoogle Scholar
  45. 45.
    Simeon D, Kozin DS, Segal K, Lerch B (2009) Is depersonalization disorder initiated by illicit drug use any different? A survey of 394 adults. J Clin Psychiatry 70(10):1358–1364. doi:10.4088/JCP.08m04370 PubMedCrossRefGoogle Scholar
  46. 46.
    Simeon D, Knutelska M, Nelson D, Guralnik O (2003) Feeling unreal: a depersonalization disorder update of 117 cases. J Clin Psychiatry 64(9):990–997PubMedCrossRefGoogle Scholar
  47. 47.
    Wadsworth M (1992) Loss and representativeness in a 43 year follow up of a national birth cohort. J Epidemiol Community Health 46:300–304PubMedCrossRefGoogle Scholar
  48. 48.
    Wadsworth ME, Butterworth SL, Hardy RJ, Kuh DJ, Richards M, Langenberg C, Hilder WS, Connor M (2003) The life course prospective design: an example of benefits and problems associated with study longevity. Soc Sci Med 57(11):2193–2205PubMedCrossRefGoogle Scholar
  49. 49.
    Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S (1998) Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. Br Med J 316(7139):1196–1200CrossRefGoogle Scholar
  50. 50.
    Lee WE, Wadsworth ME, Hotopf M (2006) The protective role of trait anxiety: a longitudinal cohort study. Psychol Med 36(3):345–351PubMedCrossRefGoogle Scholar
  51. 51.
    Neeleman J (1998) Predictors of suicide, accidental death and premature natural death in a general-population birth cohort. Lancet 351:9098CrossRefGoogle Scholar
  52. 52.
    Richards M, Abbott R (2009) Childhood mental health and life chances in post-war Britain. http://www.nshd.mrc.ac.uk/pdf/life_chances_report.pdf. Accessed 6th June 2010

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • William E. Lee
    • 1
  • Charlie H. T. Kwok
    • 2
  • Elaine C. M. Hunter
    • 3
  • Marcus Richards
    • 4
  • Anthony S. David
    • 5
  1. 1.King’s College London, Psychological Medicine, Institute of Psychiatry, Weston Education CentreLondonUK
  2. 2.King’s College London, School of Biomedical and Health SciencesLondonUK
  3. 3.Maudsley HospitalLondonUK
  4. 4.MRC Unit for Lifelong Health and AgeingUniversity College LondonLondonUK
  5. 5.King’s College London, Section of Cognitive Neuropsychiatry, Institute of PsychiatryLondonUK

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