The Biopsychosocial Model of Depersonalisation

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Depersonalisation and derealisation are symptoms of distress that are strikingly under researched despite their prominence in clinical and general populations (Aderibigbe et al, 2001; Ross, Joshi & Currie, 1991). Depersonalisation and derealisation are characterised by strong feelings of detachment from one's body and self (depersonalisation) and from one's environment (derealisation), which can be extremely distressing to individuals (Hunter et al., 2017). These symptoms are common during or following acute stress, for example feeling 'time slowing down' or 'in a dream' after a moment of calamity. Individuals suffering from chronic depersonalisation are experiencing that same phenomena, only instead of fleeting states, they are experiencing it for long periods of time, sometimes weeks, months or years, depending on the individual circumstances. Depersonalisation and derealisation are usually discussed together, however derealisation is simply a feature of depersonalisation, alongside disembodiment feeling, emotional numbing and anomalous subjective recall (Salami, Andreu-Perez and Gillmeister, 2020). For the purpose of this proposal, all features of depersonalisation will be described by the term depersonalisation only. Considered the third most common mental health symptom (Maldonado, 2007; Simeon et al, 1997; Stewart et al, 1964), depersonalisation is experienced transiently and is considered a normal feature of human experience (Hunter, Sierra and David, 2004). Existing on a spectrum of severity, as the symptoms become more intense and regular, they become problematic. This could be likened to the transition from a low mood in response to a sad event, to a consistently low mood indicative of major depression. Similar to depression, depersonalisation is 'invisible', meaning that depersonalised individuals can maintain external appearances (e.g. hold down a job, socialise with friends), yet their internal experience is fraught (e.g. feeling disconnected from the world/their body, inability to put their experiences into words). Depersonalisation holds a lifetime prevalence rate of between 26 and 74%, and between 31 and 66% at the time of a traumatic event. In clinical samples, prevalence rates vary between 30% in war veterans with PTSD and 60% in depression. The highest prevalence is seen in panic disorder, with rates up to 82.6% (Hunter, Sierra and David, 2004). Depersonalisation becomes chronic when symptoms are more frequent and persistent over time, until the experience is "pervasive and unremitting" (Medford et al, 2005). It takes an average of 7-12 years to accurately diagnose chronic depersonalisation (Baker et al, 2003; Michal et al., 2016). As we assess the impact of the Covid-19 pandemic on our population, further depersonalisation research is important, as increased use of digital media during lockdown and subjective distress as a result of lockdown correlate with higher feelings of depersonalisation (Ciaunica et al, 2022). Individual experiences of depersonalisation as a result of the Covid-19 are a common feature of self-help groups.