Which diagnosis best fits duration, episodicity, and exclusions?
A
Depersonalisation/derealisation disorder
Persistent or recurrent experiences of depersonalisation (feelings of unreality/detachment from one's mind/body) and/or derealisation (feelings of unreality of surroundings)
Exposure to actual/threatened death, serious injury, or sexual violence (direct, witnessed, learning about close person, or repeated indirect exposure)
AA. Persistent or recurrent experiences of depersonalisation (feelings of unreality/detachment from one's mind/body) and/or derealisation (feelings of unreality of surroundings) B. Reality testing remains intact during experiences C. Clinically significant distress or impairment
BA. Exposure to actual/threatened death, serious injury, or sexual violence (direct, witnessed, learning about close person, or repeated indirect exposure) B. ≥1 intrusion symptom: involuntary memories; nightmares; dissociative reactions (flashbacks); intense psychological distress; marked physiological reactions to trauma cues C. ≥1 persistent avoidance: avoidance of trauma-related internal stimuli or external reminders
Common specifiers
ANo DSM-5-TR specifiers
BWith dissociative symptoms (depersonalisation); With dissociative symptoms (derealisation); With delayed expression
Differential flags
APsychotic disorder (in DDD, reality testing is intact; in psychosis, it is impaired); Panic disorder (depersonalisation can occur during panic; specify if occurs only during attacks); PTSD (dissociation tied to trauma cues; may coexist)