Behavioural and Cognitive Psychotherapy, 1999, 27, 377–381

Cambridge University Press. Printed in the United Kingdom

DEPERSONALIZATION IN A NON-CLINICAL
SAMPLE

Jean Charbonneau

Hopital St-Luc, Montreal, Canada

Kieron O’Connor

Hopital Louis-H Lafontaine, Montreal, Canada

Abstract. Twenty participants self-referred from the general population as experiencing

depersonalization were interviewed to determine the qualities of the experience and
possible pathology. The participants and control group were also administered a bat-
tery of questionnaires measuring different aspects of psychopathology. There were no
consistent diagnostic associations with depersonalization. In the majority of cases, onset
was reported after a traumatic life event, or after sexual abuse or after giving birth.
The most frequent experiences were related to derealization and participants did not
score high on dissociation in general. The most common strategy to alleviate the prob-
lem was concentrating on a task. We distinguish between those clients who viewed the
experience as a loss of or less than normal sensation, which we qualified as negative
symptoms and others who evaluated the experience as an addition to their usual percep-
tions and sensations, which we qualified as positive symptoms.
Keywords: Depersonalization, derealization, coping strategies, psychopathology.

Introduction
Depersonalization as a symptom is distinguished from depersonalization disorder in
both ICD-10 and DSM-IV nosology. Depersonalization symptoms, even if recurrent,
which do not cause serious social or occupational impairment, are not considered to
constitute a depersonalization disorder. DSM-IV diagnostic criteria for depersonaliz-
ation disorder include: persistent or recurrent experiences of feeling detached from and
as if one is an outsider of one’s mental processes or body; feeling like an automaton
or as if in a dream, although reality testing remains intact. In order to meet DSM
criteria, the problem must be severe and persistent enough to cause marked distress.
However, depersonalization as a symptom occurs in a number of psychiatric and
medical disorders including epilepsy, clinical depression and schizophrenia. But, its
presence has also been widely reported in the non-clinical population (Trueman, 1984)
and associated with trauma (Steinberg, 1991). The major indicator of the presence of

Reprint requests and request for an extended report to Kieron O’Connor, Centre de Recherche Fernand-
Seguin, Hopital Louis-H Lafontaine, 7331 rue Hochelaga, Montreal, Quebec, Canada H1N 3V2.

 1999 British Association for Behavioural and Cognitive Psychotherapies

378 J. Charbonneau and K. O’Connor

depersonalization is currently verbal report and diagnostic robustness could be

improved by clarifying the relationship between subjective reports and other clinical
features. Since there is very little research on the qualitative differences in depersonaliz-
ation experiences an essential starting point seems to be to look at the experiences of
those with depersonalization symptoms as a main complaint. There are at present no
fully validated subjective measures of depersonalization, although Riley (1988) has
developed a dissociative experience questionnaire, and Fewtrell (1990) has expert rated
a 54-item questionnaire covering statements representative of the problem and which
distinguishes between depersonalization, derealization and desomatization (Fewtrell &
O’Connor, 1988). The aims of the current study were to examine the clinical character-
istics of people experiencing depersonalization but not reporting to a clinic, and to
describe subjective features of the experience, along with how people interpreted and
coped with the experience.

Method
Participants were recruited by announcements in the local francophone media of Mon-
treal about the nature of our research together with a description of subjective aspects
of the depersonalization experience. All subjects were French speaking Quebeckers.
The inclusion criteria were: depersonalization experience that occurred either continu-
ously or sporadically and experienced at least twice in the last year. Exclusion criteria
were: acute psychotic symptoms, current psychiatric medication, reported use of drugs
in the past year, epilepsy and other cerebral organic disorders. We report here data on
20 consecutive participants who met the above criteria (13 F, 7 M; age range (yrs) 25–
60). All participants attended for interview twice. Total interview time was about 4
hours. On the first occasion, participants received a semi-structured interview based on
the DSM-III-R Schedule administered by an experienced psychiatrist (J.C.). Partici-
pants completed Riley’s (1988) QED and responded to a questionnaire adapted from
Fewtrell’s (1990) list of statements describing the depersonalization experience and were
questioned on accompanying thoughts and sensations. On the second occasion, 17 of
the 20 participants completed a computerized package of standard clinical question-
naires measuring: anxiety level (Spielberger State-Trait Anxiety Inventory [STAI]),
obsessionality (Leyton Obsessional Inventory [LOI] symptom scale), and depression
(Beck Depressive Inventory [BDI]). The questionnaire program also elicited strategies
or behaviours that reduced or augmented the depersonalization experience. The ques-
tionnaires were also administered as part of a wider survey to a control group of 20
participants with no reported psychiatric problems recruited from the general popu-
lation (15 F, 5 M; age range (yrs) 24–50).

Results
None of the participants were in current psychiatric treatment and did not meet criteria
for current Axis I diagnosis (except depersonalization), but two had a history of panic
with agoraphobia and two had a history of past major depression. On Axis II, five
participants showed evidence of obsessional, three histrionic, two narcissistic and two
avoidant personality. The STAI trait anxiety level of the sample was moderately high
 Depersonalization 379

Table 1. Questionnaire data

Depersonalization Control
group group
[n] (SDnA1 ) [n] (SDnA1 )
Chronicity of depersonalization (yrs) [20] 16.9 (13.7) NyA
Age at onset (yrs) [20] 20.8 (12.4) NyA
QED [19] 14.79 (4.5) NyA
Current age (yrs) [20] 37.8 (10.5) [20] 33.4 (9.2)
Depersonalization items** [20] 30.6 (9.6) [18] 3.83 (3.2)
STAI (trait)* [17] 52.28 (7.5) [18] 35.22 (5.4)
LOI [17] 17.18 (9.3) [18] 16.30 (9.8)
BDI* [17] 12.23 (3.9) [18] 3.47 (3.5)
* Differences between group means significant at pF.01.
** Differences between group means significant at pF.001.

with all participants scoring 40 or above. One person’s current score on the BDI was
in the mildly depressed range according to the Quebec BDI norms. Only two of the
depersonalization sample reported high (QED H20) dissociation scores. A majority of
participants (19) first experienced the problem after negative life events, 15 of these
after sexual trauma, andyor after post-partum. Only three were experiencing severe
enough subjective distress to qualify for DSM-III-RyIV diagnosis of depersonalization
disorder. Three out of the 20 found the depersonalization experience enjoyable. In
the control group, two participants reported depersonalization experiences and were
excluded. Questionnaire data for both depersonalization and control group are pre-
sented in Table 1. The main distinctions between the depersonalization and control
group were in the former’s higher level of depersonalization (t[36]G11.19; pF.001),
trait anxiety (t[33]G7.6; pF.01) and depression (t[33]G6.18; pF.01), but in neither
group did the mean group STAI or BDI scores fall outside the normal range. There
was no significant correlation between depersonalization scores and either level of
depression or trait anxiety within the depersonalization group.
The majority of the depersonalization group responded to derealization and desoma-
tization statements as descriptors of their experience. The most frequently endorsed
statements concerned derealization: ‘‘I am frequently looking on as if not part of
things’’ (95%); ‘‘I feel as if I am floating away from reality’’ (90%); ‘‘nothing seems
absolutely concrete or real’’ (90%); ‘‘I often experience a dream like detachment’’
(85%); ‘‘life seems like a film played in front of me’’ (85%); ‘‘the outside world seems
remote’’ (85%); ‘‘things that I am used to now begin to seem strange’’ (80%). There
were also a number of desomatization items that were frequently endorsed: ‘‘my body
is not in harmony with my being’’ (85%); ‘‘my body does not feel like it belongs’’ (80%);
‘‘my actions and feelings do not come naturally’’ (80%).
The most commonly experienced thoughts and sensations accompanying the deper-
sonalization experience concerned worries of isolation and detachment from others
(60%), feeling vulnerable and embarrassed (45%), worries about feeling and looking
out of control (40%), loss of sense of time and space (50%), loss of coordination (50%)
and difficulty breathing (35%). There was no single thought or sentiment that was
experienced by everyone.
380 J. Charbonneau and K. O’Connor

Appraisals about the consequences of the depersonalization experience could be gro-

uped under three categories: fears about becoming disconnected and permanently los-
ing touch with reality (50%), fears of losing control of self or actions (30%), worries
about registering stimulus information in order to know what was happening in the
immediate surroundings (30%).
Strategies used to diminish the depersonalization effect also varied across partici-
pants. The following strategies were cited: going into the dark or the shade, restricting
or fixating vision, concentrating on a task, using the imagination, stretching and doing
physical exercise, controlling breathing. The most frequently cited strategy used to
reduce depersonalization was concentrating on a task (53%). The activity most often
cited as likely to worsen depersonalization was doing machine-like tasks (41%). Drink-
ing alcohol and coffee, and keeping still, were also reported to aggravate the sensation
by at least 20% of the sample.
We noted differences in the way the depersonalization was experienced in relation to
the normally experienced self. Some of the sample felt the addition of new experiences
and sensations, some felt the loss of normally felt sensations. We classified these
phenomena as positive symptoms and negative symptoms respectively. The criterion
for positive symptoms was the presence of floating sensations with sensory acuity
enhanced or intensified by the depersonalization experience. Where the person reported
a distancing, a diminution or a masking of normal receptiveness and sensitivity of
either an emotional or sensory kind, the symptoms were classed as negative. For
example, someone feeling superlight or feeling the body had extended or feeling she or
he is seated and watching and speaking elsewhere at the same time, would be experienc-
ing positive symptoms. Conversely, someone reporting that she or he had been deprived
of the usual way of feeling things or had lost spontaneity in relating to people would
be experiencing negative symptoms. This division into negative and positive reports
was not related to whether the experience was enjoyed or not. These differences might
refer to a concentration by the clients themselves on positive and negative symptoms
of the experience. Seven subjects in the present sample reported positive symptoms. All
the other subjects, with the exception of two, who both reported a disoriented clouded
experience not easily identifiable as positive or negative, were classed as experiencing
negative symptoms. This distinction had some clinical relevance in that those in whom
the experience developed after reported sexual trauma focused more on the positive
symptoms than did the rest of the sample (x2(1 df )G4.2, pF.05).

Conclusion
The limitations of our study are the small number of subjects and the way they were
recruited (self-referral after newspaper advertisement) which could account for an over-
representation of anxiety traits in the sense that the sample may have been more aware
and preoccupied by the problem. An important conclusion from our study is that there
do seem to exist non-pathological chronic forms of depersonalization that are not
directly linked to any psychiatric disturbance. Steinberg (1991), in a study comparing
psychiatric patients to normal controls, reported that the chronicity of depersonaliz-
ation indicated a link to dissociative disorders and that such chronic depersonalization
 Depersonalization 381

lacked any associated precipitous events; this was not what we observed in our non-
clinical sample. Clinicians could come across depersonalization symptoms without
important co-morbidity of axis I and axis II disorders related to depersonalization
disorder, such as described by Simeon et al. (1997) in their study of depersonalization
disorders. In this case, it is important for the clinician to specify the quality of the
experience. Derealization seemed, in our study, the most common symptom of deper-
sonalization and this concurs with Simeon et al. (1997). However, our sample seems
less severe than the cases reported by Simeon et al. (1997), the majority of whom
had received multiple psychiatric treatment. Although the DSM distinguishes between
derealization and depersonalization, both experiences are considered dissociative symp-
toms. But whereas dissociation is likely to be present with depersonalization disorders,
non-clinical subjects who experience derealization may not necessarily score high on
dissociative scales.

References
FEWTRELL, D. (1990). Self-statements about depersonalization. Unpublished manuscript. Per-
sonal communication.
FEWTRELL, D., & O’CONNOR, K. P. (1988). Dizziness and depersonalization. Advances in
Behaviour Research and Therapy, 10, 201–218.
RILEY, K. C. (1988). Measurement of dissociation. Journal of Nervous and Mental Disease, 176,
449–450.
SIMEON, D., GROSS, S., GURABRICK, O., STEIN, J., SCHMERLER, J., & HOLLANDER, E. (1997).
Feeling unreal: 30 cases of DSM-III-R depersonalization disorders. American Journal of Psy-
chiatry, 154, 1007–1113.
STEINBERG, M. (1991). The spectrum of depersonalization: Assessment and treatment. Review
of Psychiatry, 10, 223–247.
TRUEMAN, D. (1984). Depersonalization in a non-clinical population. Journal of Psychology,
116, 107–112.