Psychiatry Research 93 Ž2000.

153]164

The Cambridge Depersonalisation Scale: a new

instrument for the measurement of depersonalisation

Mauricio Sierra, German E. BerriosU

Department of Psychiatry, Uni¤ ersity of Cambridge, Addenbrooke’s Hospital, P.O. Box 189, Hills Road,
Cambridge CB2 2QQ, UK

Received 26 April 1999; received in revised form 15 December 1999; accepted 29 December 1999

Abstract

Existing self-rating scales to measure depersonalisation either show dubious face validity or fail to address the
phenomenological complexity of depersonalisation. Based on a comprehensive study of the phenomenology of this
condition, a new self-rating depersonalisation questionnaire was constructed. The Cambridge Depersonalisation
Scale is meant to capture the frequency and duration of depersonalisation symptoms over the ‘last 6 months’. It has
been tested on a sample of 35 patients with DSM-IV depersonalisation disorder, 22 with anxiety disorders, and 20
with temporal lobe epilepsy. Scores were compared against clinical diagnoses Žgold standard. and correlated with the
depersonalisation subscale of the Dissociation Experiences Scale ŽDES.. The scale was able to differentiate patients
with DSM-IV depersonalisation disorder from the other groups, and showed specific correlations with the deperson-
alisation subscale of the DES Ž r s 0.80; Ps 0.0007.. The scale also showed high internal consistency and good
reliability ŽCronbach alpha and split-half reliability were 0.89 and 0.92, respectively.. The instrument can, therefore,
be considered as valid and reliable, and can be profitably used in both clinical and neurobiological research. Q 2000
Elsevier Science Ireland Ltd. All rights reserved.

Keywords: Depersonalisation disorder; Anxiety disorder; Temporal lobe epilepsy; Diagnosis; Psychiatric rating scales; Dissociation;
Derealisation; DES

U
Corresponding author. Tel.: q44-1223-336965; fax: q44-1223-336968.
E-mail address: [email protected] ŽG.E. Berrios.

0165-1781r00r$ - see front matter Q 2000 Elsevier Science Ireland Ltd. All rights reserved.
PII: S 0 1 6 5 - 1 7 8 1 Ž 0 0 . 0 0 1 0 0 - 1
154 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

1. Introduction discussed below. of the scale herewith to be re-

ported.
A clinical phenomenon often met with in psy-
chiatric and neurological practice, depersonalisa-
tion has been associated with a variety of neu-
ropsychiatric conditions such as anxiety disorders, 2. Earlier depersonalisation scales
migraine and epilepsy. It can also be a disorder in
its own right, and when so it tends to run a 2.1. Dixon’s scale
chronic course ŽSimeon et al., 1997.. DSM-IV
defines depersonalisation as: ‘an alteration in the A self-administered questionnaire, Dixon’s
perception or experience of the self so that one scale ŽDixon, 1963. addresses depersonalisation
feels detached from, and as if one is an outside as a symptom and includes 12 items selected out
observer of, one’s mental processes or body Že.g. of a larger pool by means of factor analysis.
feeling as if one is in a dream.’; and derealisation Piloted in a sample of normal college students, to
as ‘an alteration in the perception or experience our knowledge it has only been used in a couple
of the external world so that it seems strange or of studies ŽMelges et al., 1970; Mathew et al.,
unreal Že.g. people may seem unfamiliar or me- 1993.. Trueman Ž1984. has questioned its validity.
chanical .’, respectively ŽAmerican Psychiatric As- There are two main problems with Dixon’s
sociation, 1994.. In this article, ‘depersonalisation’ scale. Firstly, it includes clinical features not con-
will be used as a generic term encompassing both sidered as part of the syndrome by the classical
phenomena as there is not conclusive evidence descriptors ŽMayer-Gross, 1935; Ackner, 1954.:
that they are independent. for example: ‘It is as if I am about to receive
The above definitions oversimplify conditions some great revelation or mystical awareness’ ŽItem
that in clinical practice mostly present as complex 12 is in fact redolent of a symptom typical of the
phenomena. Indeed, most researchers endorse the pre-delusional state.. Likewise, other items make
view that depersonalisation constitutes a syn- the Žwrong. assumption that ‘loss of ego boun-
drome which, in addition to ineffable feelings of daries’ is a manifestation of depersonalisation
‘unreality’, also includes emotional numbing, Žitem 7: ‘There is little distinction between ‘‘me’’
heightened self-observation, changes in body ex- and ‘‘not me’’ } There is feeling, but it is not me
perience, distortions in the experiencing of time feeling’..
and space, changes in the feeling of agency, feel- Secondly, there is a problem with item specifi-
ings of having the mind empty of thoughts, cation: for example, some items address opposing
memories andror images, and an inability to fo- or mutually exclusive experiences: ‘My ordinary
cus and sustain attention ŽLewis, 1931; Mayer- feelings of self-awareness seem different: There
Gross, 1935; Saperstein, 1949; Ackner, 1954.. seems to be a greater difference between self and
Elsewhere, we have proposed a model that ren- non-self’ ŽItem 4.; ‘My ordinary feelings of self-
ders the above clinical phenomena amenable to awareness seem different: There seems to be less
neurobiological research Žsee Sierra and Berrios, difference between self and non-self’ ŽItem 6..
1998.. In short, we suggest that the clinical fea- Despite these flaws, a recent study has reported
tures of depersonalisation result from two simul- that Dixon’s scale may differentiate between
taneous mechanisms: an inhibition of emotional patients with depersonalisation disorder and nor-
processing, and a heightened state of alertness mal controls ŽSimeon et al., 1998.. Likewise, its
Ži.e. akin to vigilant attention .. Emotional numb- global score modestly correlated with the deper-
ing and lack of emotional colouring accompany- sonalisation subscale of the Dissociation Experi-
ing perceptual and cognitive processes would re- ences Scale.
sult from the inhibitory process, whereas the so-
called feelings of ‘mind emptiness’, increased per-
ceptual acuity, and feelings of lack of agency 2.2. Jacobs and Bo¤ asso’s depersonalisation scale
would result from the heightened alertness. This
model is one of the sources Žother sources are This scale is constituted by 25 self-rating items,
 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164 155

nine of which were taken from Dixon’s scale. It capture the clinical aspects of depersonalisation
was also piloted in college students ŽJacobs and in a comprehensive manner. Now that serious
Bovasso, 1992.. Simeon et al. Ž1998. have shown research into depersonalisation disorder is start-
that it can also differentiate patients with deper- ing in earnest, a comprehensive instrument is
sonalisation disorder from normal controls. On required so that future meta-analytical studies
the whole, because it casts a wider net on the may draw, from its repeated application, a valid
phenomenology of depersonalisation, this instru- and stable clinical profile. This will also allow us
ment shows adequate prima facie validity. Still, it to differentiate between depersonalisation dis-
leaves out important cognitive complaints such order and its behavioural phenocopies, as fre-
as: feelings of thought emptiness, changes in the quently found in association with a variety of
subjective experiencing of memory function, in- neuropsychiatric conditions ŽSierra and Berrios,
ability to evoke images, and distortions in the 1998..
experiencing of time, space, etc. In view of the This article presents a new scale which pur-
fact that a new integrative neurobiological model ports to be comprehensive in clinical scope and
of depersonalisation can explain the presence of which was validated on a sample of subjects suf-
cognitive complaints ŽSierra and Berrios, 1998., it fering from depersonalisation disorder Žsee Ap-
would seem that their inclusion should enhance pendix A..
the validity of any scale.

3. Methods
2.3. Dissociati¤ e Experiences Scale
3.1. Subjects
The prevailing view that depersonalisation is a
‘dissociative’ phenomenon is now enshrined in The scale was tried on a sample of 77 subjects:
most dissociation scales of which the Dissociation 35 patients meeting DSM-IV criteria for deperso-
Experiences Scale ŽDES. is the most studied nalisation disorder, 22 with DSM-IV panic dis-
ŽBernstein and Putnam, 1986.. Based on 28 vi- order or generalised anxiety disorder, and 20 with
sual-analogues, the DES is meant to screen se- temporal lobe epilepsy ŽTLE.. The mean age of
vere dissociation and has been shown to be a the sample was 34 years ŽS.D. 10.2; range 18]60.,
valid and reliable instrument Žvan Ijzendoorn and and 50% were females. Patients were examined
Schuengel, 1996.. It seems to include three fac- consecutively in a ‘Depersonalisation and Anxiety
tors: depersonalisation, amnesia and absorption Disorders Clinic’ ŽGEB. and a ‘Seizure Disorder
ŽFisher and Elnitsky, 1990; Ray et al., 1992; Dunn Clinic’ ŽGEB. ŽAddenbrooke’s Hospital, Cam-
et al., 1994.. Recently, Simeon et al. Ž1998. have bridge University..
replicated this factorial solution in patients with
depersonalisation disorder and on this basis have 3.2. De¤ elopment: item source and piloting
concluded that the DES can be used as a screen
for depersonalisation disorder. Earlier applica- A self-rating format was chosen to make
tions of the DES to samples other than deperson- administration easier, reduce interviewer bias, and
alisation disorder found that the ‘depersonalisa- eliminate the need for inter-rater reliability stud-
tion’ factor included six items Žone of which, ies. One of the item sources was an exhaustive
auditory hallucinations, did not seem to have review of the descriptive psychopathology of de-
much face validity.. Simeon et al. Ž1998., on the personalisation ŽSierra and Berrios, 1996, 1997,
other hand, found that when applied to a sample 1998. which includes a statistical analysis of 200
of depersonalisation disorder patients, only five published cases of depersonalisation. Twenty-nine
items loaded in the ‘depersonalisation’ factor. questions map as many of the clinical components
In summary, available depersonalisation ques- of depersonalisation as possible and deal with
tionnaires either lack construct validity or fail to some items in a novel way. An example of the
156 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

latter is the allocation of separate items to ‘un- of intensity for each item out of the arithmetic
reality feelings’ associated with all and each of sum of its ratings for frequency and duration
the sensory modalities, proprioception, and pain. Žhence index range: 0]10.. In this way, at least,
This was done on the basis that there is clinical the clinically valid observation is saved that a
evidence that unreality ‘feelings’, as experienced patient experiencing frequent but short-lived de-
in various sensory modalities, can occur indepen- personalisation experiences should be rated as
dent from each other; if so, future research could suffering from an equivalent degree of intensity
use them as potential markers of Žhitherto un- to someone having less frequent but long-lasting
known. new clinical subtypes ŽSierra and Berrios, experiences.
1998.. The scale also makes subtle distinctions The initial version of the scale was piloted in 40
between feelings of mind emptiness, inability to normal subjects, and in 10 patients with anxiety
evoke images, qualitative changes in the subjec- disorders. Comments were also solicited from re-
tive experience of memory, and body image. Like- searchers with experience in scale construction.
wise, instead of including global questions on The information obtained guided the rephrasing
‘emotional numbing’, different categories of emo- of some questions and the modification of the
tional response are defined: loss of affection, loss Likert scales. This explains why the Likert fre-
of pleasure, loss of fear to threatening situations, quency interval is unequal Ži.e. it goes from ‘rarely’
and automatic emotional expression without con- to ‘often’. in favour of higher frequency descrip-
comitant subjective emotion as all these symp- tors. This responded to the need to have more
toms have been differentially reported in deper- scalar choices at the top end of the scale so that
sonalisation ŽSierra and Berrios, 1997, 1998.. pathological depersonalisation experiences could
Questions are also included about deja ´ ` vu, mi- be better captured. In regards to duration, the
cropsia, autoscopy, and out-of-body experiences same situation does not obtain, and hence a sym-
which seem frequent accompaniments of deperso- metrical spread of options is needed. For exam-
nalisation ŽTwemlow et al., 1982; Sno and ple, during the piloting in normal subjects, we
Draaisma, 1993; Dening and Berrios, 1994.. found that some experiences Že.g. unreality .
Given the ineffability of some of the experi- tended to be transient Žseconds, minutes. whilst
ences, a special effort was made to phrase the others Že.g. anhedonia or experiences of mind
question in ways that were both simple and did emptiness. tended to linger on for hours.
not stereotype the experience itself. To avoid halo
responses, positive and negative wordings were 3.3. Data collecting
used Že.g. ‘I have the experience of ...’; ‘I do not
have the experience of ....’.. To diminish ‘social All the subjects of the study were: Ža. examined
undesirability’, the scale instructions state that by one or both of the authors by means of a
any and all the items included might occur in semi-structured interview Žwhich in a general way
normal people. Frequency and duration of the tried to establish whether ‘feelings of unreality’
experience in a period covering the ‘last 6 months’ were present but did not ask any of the specific
were measured by Likert formats as independent questions included in scale. to diagnose the pres-
variables. A global score was calculated by adding ence or absence of DSM-IV depersonalisation
up all item scores. disorder Žthus, clinical diagnosis was used as the
All scales need a score that captures the elusive external ¤ alidator .; and Žb. administered the fol-
clinical concepts of ‘intensity’ or ‘severity’ Žwhich lowing: Cambridge Depersonalisation Scale
cannot help but reflect interactions between the ŽCDS., Zung Anxiety Scale ŽZung, 1971., Disso-
disease and its psychosocial consequences .. It is ciative Experiences Scale ŽBernstein and Putnam,
never easy to find a numerical transformation 1986., Beck’s Depression Inventory ŽBDI. ŽBeck
that does justice to such a qualitative notion. et al., 1961., and the Maudsley Obsessional]
Given that depersonalisation often is intermit- Compulsive Inventory ŽHodgson and Rachman,
tent, there was little option to creating an index 1971.. These instruments were chosen to deal
 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164 157

with views occasionally expressed in the clinical 0.89 and 0.92, respectively, and correlations
literature that depersonalisation may be related between item scores and corrected global scores
to depression ŽLewis, 1934., anxiety ŽRoth, 1959. ranged from 0.3 to 0.86. Lower correlations were
or obsessive-compulsive disorder ŽOCD. ŽHol- obtained for items which, although not part of the
lander and Wong, 1995.. depersonalisation syndrome, can accompany it oc-
´ ` vu Ž0.41.; autoscopy Ž0.41.; mi-
casionally: deja
3.4. Data analysis cropsias 0.56.; feelings of hand or feet enlarge-
Ž
ment Ž0.47.; and not experiencing hunger or other
Data were analysed by means of SPSS Version
bodily needs Ž0.33.. Correlations for all the core
6. Because the distribution of depersonalisation
items of depersonalisationrderealisation experi-
in the population is unknown, non-parametric
ence were ) 0.6 Žmedian s 0.7.. Criterion validity
statistical methods were used. Cronbach alpha
was tested by comparing depersonalisation scores
coefficients and other measures were obtained by
across different clinical groups ŽKruskal]Wallis..
means of the ‘Reliability’ Module of SPSS. Clini-
The highest median CDS global score was ob-
cal diagnosis ŽDSM-IV. and the depersonalisation
tained for depersonalisation disorder Ž113., fol-
sub-scale of the DES Žas per Simeon et al., 1998.
lowed by epilepsy Ž44., and anxiety disorders Ž20.
were used as the external validity criteria; correla-
ŽKruskal]Wallis; x 2 s 26.1; d.f.s 2, Ps 0.00001.
tions between BDI, OCD, and Zung scores, and
Žfor comparison of the three groups across the
scores from the non-depersonalisation subscales
other administered scales, see Table 1.. Across-
of the DES Ži.e. ‘amnesia’ and ‘absorption’, as per
groups comparison showed no demographic dif-
Simeon et al., 1998. were used as a measure of
ferences, and no correlations were found between
discriminant validity. For the purposes of the
demographic variables Žage, sex, schooling. and
analysis, it was predicted that: Ž1. ŽCDS. global
global CDS scores.
scores could differentiate patients with DSM-IV
Table 2 shows the median number of items
‘depersonalisation disorder’ from patients with
endorsed by each group as well as the median
DSM-IV anxiety disorders and TLE; and Ž2.
ŽCDS. global scores would significantly Žand score for endorsed items. As can be seen, patients
with depersonalisation disorder had more fre-
specifically. correlate with the depersonalisation
quent and long-lasting experiences than the other
subscale of the DES Žas per Simeon et al., 1998..
two groups.
Table 3 shows a matrix of correlations for the
4. Results depersonalisation disorder patient subset between
the Cambridge Depersonalisation Scale ŽCDS.
Cronbach alpha and split-half reliability were and the DES, BDI, Zung-Anxiety, and Maudsley

Table 1
Comparison of median scale scores across clinical groups

Scales Depersonalization Anxiety Temporal lobe Kruskal]Wallis

epilepsy ŽBonferroni-
corrected.

Cambridge Depersonalisation 113 20 44 P s 0.0008

Scale
DES 16.2 6.2 12.8 P s 0.0032
DESrdepersonalization 24 4 12 P s 0.0008
DESramnesia 6 0.5 4.5 NS
DESrabsorption 17.6 10.7 18 NS
Beck Depression Inventory 16 9 14 NS
MOC Maudsley Obsessional]Compulsive Inventory 26 13 19 NS
Zung Anxiety Scale 50 47 45 NS
158 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

Table 2
Cambridge Depersonalisation Scale: clinical groups compared by pattern of item endorsement

Clinical group Median no. Median Median Median duration

of items score of items frequency of of items
endorsed endorsed items endorsed endorsed
Žscale 0]10..

Depersonalisation disorder 21 Ž72%. 5 2 Ž‘Often’. 3 Ž‘Few hours’.

Anxiety disorders 7 Ž24%. 3 1 Ž‘Rarely’. 1 Ž‘Few seconds’.
Temporal lobe epilepsy 11 Ž38%. 3 1 Ž‘Rarely’. 2 Ž‘Few minutes’.

OCD scales. The CDS correlated highly with the Fig. 1 shows a ROC curve of the CDS at
DES and with its depersonalisation subscale Žas different cut-off points. As can be seen, the best
per Simeon et al., 1998.. It did not correlate with compromise between true positive and false nega-
either the other subscales of the DES or the tive rates is at a cut-off of 70, yielding a sensitivity
other three scales. Its correlation with the global of 75.7% and a specificity of 87.2%.
scale of the DES was, in fact, entirely due to the
variance carried by the depersonalisation subscale
of the latter. In the DSM-IV depersonalisation
5. Discussion
disorder group, the correlational selectivity of the
CDS was not matched by the ‘depersonalisation’
subscale of the DES, which correlated with both The scale reported in this article has been
its sister ‘amnesia’ Ž0.67, Ps 0.0001. and ‘absorp- found to be a reliable and valid instrument to
tion’ subscales Ž0.5, Ps 0.002.. measure depersonalisation disorder. Global scores
In the group of non-depersonalisers Žanxiety were able to differentiate patients with deperson-
disorders and TLE., the CDS showed significant alisation disorder from patients with anxiety dis-
correlations ŽBonferroni-corrected. with the fol- orders and patients with TLE. We take the latter
lowing: DES Ž0.75, P s 0.0007.; DESrdeper- as reflecting high validity of our instrument, since
sonalisation Ž0.69, P s 0.0007.; DESramnesia it is well known that patients with anxiety or TLE
Ž0.57, Ps 0.0007.; DESrabsorption Ž0.7, Ps frequently suffer from depersonalisation experi-
0.0007.; and Beck Depression Inventory Ž0.55, ences Žin fact, 50 and 80% of our samples, respec-
Ps 0.001.. tively, reported fleeting depersonalisation-like ex-
periences.. Subjects with DSM-IV depersonalisa-
tion disorder endorsed more items and rated them
Table 3
Correlations for the DSM-IV depersonalisation disorder group
as more frequent and enduring Žhours as opposed
between the Cambridge Depersonalisation Scale and other to seconds or minutes for the other clinical
scales ŽBonferroni-corrected. groups.. Consistent with clinical observation, the
depersonalisation experiences recorded for anxi-
Other scales Cambridge ety disorders and TLE had less phenomenological
Depersonalisation
Scale
richness, and were less frequent and more fleet-
ing. Again in keeping with clinical wisdom, deper-
Dissociative Experiences Scale ŽDES. 0.49 Ž Ps 0.023. sonalisation-like episodes in the TLE group lasted
DES Ždepersonalisation. 0.80 Ž Ps 0.0007. longer.
DES Žamnesia. 0.29 NS
DES Žabsorption. 0.25 NS
In the depersonalisation disorder group, the
Beck Depression Inventory 0.15 NS global score of our scale correlated highly only
Maudsley Obsessional]Compulsive 0.14 NS with the ‘depersonalisation’ subscale of the DES Ž5
Inventory items. and not with the ‘amnesia’ and ‘absorp-
Zung Anxiety Scale 0.03 NS tion’ sub-scales. The DES, on the other hand, did
 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164 159

Fig. 1. ROC curve of the Cambridge Depersonalisation Scale. Numbers on the curve represent different cut-off points. The best
compromise between true positive and false positive rates is at a cut-off of 70, yielding a sensitivity of 75.7% and a specificity of
87.2%.

not show this selectivity, and in the same group of ple, in TLE depersonalisation symptoms are likely
patients all three of its sub-scales showed a high to be part of a global and non-specific alteration
correlation with one another. This is likely to in self-consciousness Že.g. so-called ‘dreamy
have resulted from the fact that the novel items states’. whose co-varying features are expected to
of the CDS sharpened its capacity to discriminate. correlate ŽAntoni, 1946.. Likewise, in patients with
Interestingly enough, these results also support anxiety disorders or depression, symptoms of de-
the view that depersonalisation disorder is pheno- personalisation will be secondary to the primary
menologically independent from other dissocia- condition and will correlate with it.
tive and psychopathological conditions. The results herewith reported strongly support
In spite of the apparent heterogeneity of its the view that the CDS is a good instrument for
items, the CDS showed clinical coherence and the differential diagnosis of depersonalisation dis-
stability. This supports its construct validity and order from its many behavioural phenocopies.
shows that depersonalisation disorder is a more Our data Žbecause of the clinical samples utilised.
complex clinical syndrome than recent descrip- do not allow us to state any views on its capacity
tions may suggest. as a screening instrument, although it can be
Not surprisingly, our findings were less specific speculated that the CDS should work well at even
in the groups including patients with anxiety dis- lower cut-off scores.
orders and TLE where the global score of our
scale correlated significantly with the DES global
score, its three subscales, and the Beck Depres- 6. Summary and conclusions
sion Inventory. These findings indirectly support
the validity of the CDS and suggest that fleeting Despite the fact that one century has elapsed
depersonalisation-like experiences, as seen in since the naming and conceptualisation of deper-
anxiety disorders or TLE, might be less distinct sonalisation ŽSierra and Berrios, 1996., little sys-
and specific than the symptoms of the full-blown tematic research has been carried out in relation
condition Ždepersonalisation disorder.. For exam- to its phenomenology and neurobiology. One
160 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

stumbling block has been the absence of valid Frequency Duration

and reliable scales. Available scales are not com- 0 s ne¤ er In general, it lasts:
prehensive from the phenomenological point of 1 s rarely 1 s few seconds
view, and this is a serious shortcoming for we do 2 s often 2 s few minutes
not know yet which clinical features of deperson- 3 s ¤ ery often 3 s few hours
alisation are relevant to the study of its neuro- 4 s all the time 4 s about a day
biology. 5 s more than a day
With this in mind, we constructed a scale com- 6 s more than a week
prehensible enough to map as much as is known
about the classical phenomenology of depersonal- 2. What I see looks ‘flat’ or ‘lifeless’, as if I were
isation disorder. The fact that in a group of looking at a picture.
patients with DSM-IV depersonalisation disorder
the CDS correlated selectively with the four items Frequency Duration
of the depersonalisation sub-scale of the DES 0 s ne¤ er In general, it lasts:
suggests that the inclusion of novel items, ad- 1 s rarely 1 s few seconds
dressing hitherto neglected components of deper- 2 s often 2 s few minutes
sonalisation, does increase the sensitivity and 3 s ¤ ery often 3 s few hours
specificity of the instrument. 4 s all the time 4 s about a day
5 s more than a day
6 s more than a week
Appendix A. Cambridge Depersonalisation Scale 3. Parts of my body feel as if they didn’t belong
to me.
ŽSierra and Berrios, 1996.
Frequency Duration
NAME: } } } } } } } } } } } } 0 s ne¤ er In general, it lasts:
AGE: } } } } } } SEX: MALErFEMALE 1 s rarely 1 s few seconds
Žplease circle as required. 2 s often 2 s few minutes
SCHOOLING: PRIMARYrSECONDARYr 3 s ¤ ery often 3 s few hours
HIGHER ŽE.G. UNIVERSITY. 4 s all the time 4 s about a day
Žplease circle as required. 5 s more than a day
6 s more than a week
PLEASE READ INSTRUCTIONS CARE-
FULLY: 4. I have found myself not being frightened at all
This questionnaire describes strange and ‘funny’ in situations which normally I would find frighten-
experiences that normal people may have in their ing or distressing.
daily life. We are interested in their: Ža. fre-
quency, i.e. how often have you had these experi- Frequency Duration
ences OVER THE LAST SIX MONTHS; and Žb. 0 s ne¤ er In general, it lasts:
their approximate duration. For each question, 1 s rarely 1 s few seconds
please circle the answers that suit you best. If you 2 s often 2 s few minutes
are not sure, give your best guess. 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day
1. Out of the blue, I feel strange, as if I were not 5 s more than a day
real or as if I were cut off from the world. 6 s more than a week
 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164 161

5. My favourite activities are no longer en- 9. When I weep or laugh, I do not seem to feel
joyable. any emotions at all.

Frequency Duration Frequency Duration

0 s ne¤ er In general, it lasts: 0 s ne¤ er In general, it lasts:
1 s rarely 1 s few seconds 1 s rarely 1 s few seconds
2 s often 2 s few minutes 2 s often 2 s few minutes
3 s ¤ ery often 3 s few hours 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day 4 s all the time 4 s about a day
5 s more than a day 5 s more than a day
6 s more than a week 6 s more than a week

6. Whilst doing something I have the feeling of 10. I have the feeling of not ha¤ ing any thoughts at
being a ‘detached observer’ of myself. all, so that when I speak it feels as if my words
were being uttered by an ‘automaton’.
Frequency Duration
0 s ne¤ er In general, it lasts: Frequency Duration
1 s rarely 1 s few seconds 0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes 1 s rarely 1 s few seconds
3 s ¤ ery often 3 s few hours 2 s often 2 s few minutes
4 s all the time 4 s about a day 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day
5 s more than a day
5 s more than a day
6 s more than a week
6 s more than a week
7. The flavour of meals no longer gives me a
11. Familiar voices Žincluding my own. sound
feeling of pleasure or distaste.
remote and unreal.
Frequency Duration
Frequency Duration
0 s ne¤ er In general, it lasts:
0 s ne¤ er In general, it lasts:
1 s rarely 1 s few seconds
1 s rarely 1 s few seconds
2 s often 2 s few minutes 2 s often 2 s few minutes
3 s ¤ ery often 3 s few hours 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day 4 s all the time 4 s about a day
5 s more than a day 5 s more than a day
6 s more than a week 6 s more than a week

8. My body feels very light, as if it were floating 12. I have the feeling that my hands or my feet
on air. have become larger or smaller.

q Frequency Duration q Frequency Duration

0 s ne¤ er In general, it lasts: 0 s ne¤ er In general, it lasts:
1 s rarely 1 s few seconds 1 s rarely 1 s few seconds
2 s often 2 s few minutes 2 s often 2 s few minutes
3 s ¤ ery often 3 s few hours 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day 4 s all the time 4 s about a day
5 s more than a day 5 s more than a day
6 s more than a week 6 s more than a week
162 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

13. My surroundings feel detached or unreal, as if 4 s all the time 4 s about a day
there were a veil between me and the outside 5 s more than a day
world. 6 s more than a week

Frequency Duration 17. When in a new situation, it feels as if I have

0 s ne¤ er In general, it lasts: been through it before.
1 s rarely 1 s few seconds
2 s often 2 s few minutes Frequency Duration
3 s ¤ ery often 3 s few hours 0 s ne¤ er In general, it lasts:
4 s all the time 4 s about a day 1 s rarely 1 s few seconds
5 s more than a day 2 s often 2 s few minutes
6 s more than a week 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day
14. It seems as if things that I have recently done 5 s more than a day
had taken place a long time ago. For example, 6 s more than a week
anything which I have done this morning feels as
if it were done weeks ago. 18. Out of the blue, I find myself not feeling any
affection towards my family and close friends.
Frequency Duration
0 s ne¤ er In general, it lasts: Frequency Duration
1 s rarely 1 s few seconds 0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes
1 s rarely 1 s few seconds
3 s ¤ ery often 3 s few hours
2 s often 2 s few minutes
4 s all the time 4 s about a day
3 s ¤ ery often 3 s few hours
5 s more than a day
4 s all the time 4 s about a day
6 s more than a week
5 s more than a day
15. Whilst fully awake I have ‘visions’ in which I 6 s more than a week
can see myself outside, as if I were looking my
image in a mirror. 19. Objects around me seem to look smaller or
further away.
Frequency Duration
0 s ne¤ er In general, it lasts: Frequency Duration
1 s rarely 1 s few seconds 0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes 1 s rarely 1 s few seconds
3 s ¤ ery often 3 s few hours 2 s often 2 s few minutes
4 s all the time 4 s about a day 3 s ¤ ery often 3 s few hours
5 s more than a day 4 s all the time 4 s about a day
6 s more than a week 5 s more than a day
6 s more than a week
16. I feel detached from memories of things that
have happened to me } as if I had not been 20. I cannot feel properly the objects that I touch
involved in them. with my hands for it feels as if it were not me who
were touching it.
Frequency Duration
0 s ne¤ er In general, it lasts: Frequency Duration
1 s rarely 1 s few seconds 0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes 1 s rarely 1 s few seconds
3 s ¤ ery often 3 s few hours 2 s often 2 s few minutes
 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164 163

3 s ¤ ery often 3 s few hours 1 s rarely 1 s few seconds

4 s all the time 4 s about a day 2 s often 2 s few minutes
5 s more than a day 3 s ¤ ery often 3 s few hours
6 s more than a week 4 s all the time 4 s about a day
5 s more than a day
21. I do not seem able to picture things in my 6 s more than a week
mind, for example, the face of a close friend or a
familiar place. 25. The smell of things no longer gives me a
feeling of pleasure or dislike.
Frequency Duration
0 s ne¤ er In general, it lasts: Frequency Duration
1 s rarely 1 s few seconds 0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes 1 s rarely 1 s few seconds
3 s ¤ ery often 3 s few hours 2 s often 2 s few minutes
4 s all the time 4 s about a day 3 s ¤ ery often 3 s few hours
5 s more than a day 4 s all the time 4 s about a day
6 s more than a week 5 s more than a day
6 s more than a week
22. When a part of my body hurts, I feel so
detached from the pain that if feels as if it were
‘somebody else’s pain’.
26. I feel so detached from my thoughts that they
seem to have a ‘life’ of their own.
Frequency Duration
0 s ne¤ er In general, it lasts:
Frequency Duration
1 s rarely 1 s few seconds
0 s ne¤ er In general, it lasts:
2 s often 2 s few minutes
3 s ¤ ery often 3 s few hours 1 s rarely 1 s few seconds
4 s all the time 4 s about a day 2 s often 2 s few minutes
5 s more than a day 3 s ¤ ery often 3 s few hours
6 s more than a week 4 s all the time 4 s about a day
5 s more than a day
23. I have the feeling of being outside my body. 6 s more than a week

Frequency Duration 27. I have to touch myself to make sure that I

0 s ne¤ er In general, it lasts: have a body or a real existence.
1 s rarely 1 s few seconds
2 s often 2 s few minutes Frequency Duration
3 s ¤ ery often 3 s few hours 0 s ne¤ er In general, it lasts:
4 s all the time 4 s about a day 1 s rarely 1 s few seconds
5 s more than a day 2 s often 2 s few minutes
6 s more than a week 3 s ¤ ery often 3 s few hours
4 s all the time 4 s about a day
24. When I move it doesn’t feel as if I were in 5 s more than a day
charge of the movements, so that I feel ‘auto- 6 s more than a week
matic’ and mechanical as if I were a ‘robot’.
28. I seem to ha¤ e lost some bodily sensations Že.g.
Frequency Duration of hunger and thirst. so that when I eat or drink,
0 s ne¤ er In general, it lasts: it feels an automatic routine.
164 M. Sierra, G.E. Berrios r Psychiatry Research 93 (2000) 153]164

Frequency Duration trum disorders. Journal of Clinical Psychiatry 56, 3]6.

0 s ne¤ er In general, it lasts: Jacobs, J.R., Bovasso, G.B., 1992. Toward the clarification of
the construct of depersonalization and its association with
1 s rarely 1 s few seconds
affective and cognitive dysfunctions. Journal of Personal
2 s often 2 s few minutes Assessment 59, 352]365.
3 s ¤ ery often 3 s few hours Lewis, A., 1931. The experience of time in mental disorder.
4 s all the time 4 s about a day Proceedings of the Royal Society of Medicine 25, 611]620.
5 s more than a day Lewis, A.J., 1934. Melancholia: clinical survey of depressive
6 s more than a week states. Journal of Mental Science 80, 277]378.
Mathew, R.J., Wilson, W.H., Humphreys, D., Lowe, J.V.,
Weithe, K.E., 1993. Depersonalization after marijuana
29. Previously familiar places look unfamiliar, as
smoking. Biological Psychiatry 33, 431]441.
if I had never seen them before. Mayer-Gross, W., 1935. Depersonalization. British Journal of
Medical Psychology 15, 103]126.
Frequency Duration Melges, F.T., Tinklenber, J.R., Hollister, L.E., Gillespie, H.K.,
0 s ne¤ er In general, it lasts: 1970. Temporal disintegration and depersonalization dur-
1 s rarely 1 s few seconds ing marijuana intoxication. Archives of General Psychiatry
2 s often 2 s few minutes 23, 204]210.
Ray, W.J., June, K., Turaj, K., Lundy, R., 1992. Dissociative
3 s ¤ ery often 3 s few hours
experiences in a college-age population: a factor analytic
4 s all the time 4 s about a day study of two dissociation scales. Personality and Individual
5 s more than a day Differences 13, 417]424.
6 s more than a week Roth, M., 1959. The phobic anxiety]depersonalization syn-
drome. Proceedings of the Royal Society of Medicine 52,
587]595.
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