Clinical presentation

clinical presentation

Patients usually present with the core symptoms of unreality and detachment. They may describe their experiences in several different ways e.g. -

• I feel as if I’m living in a dream
• I feel like I don’t (or the world does not) exist anymore
• I feel completely detached from everything or everyone around me
• It’s like I’m just watching life from behind glass/projected onto a screen/in a fog
• I’m robotically going through the motions of being alive but feel dead inside

In addition, patients may complain of the following:

• emotional numbing of positive and negative emotions
• experiences affecting specific parts, or all, of their body
  • e.g. - their reflection, voice, or hands don’t feel like they belong to them and that their actions feel robotic
• blurred vision or perceptual distortions (e.g. - seeing the world in two dimensions)
• obsessive existential thoughts about the meaning of life
• difficulty concentrating or remembering
  • usually not associated with clear-cut objective cognitive deficits such as memory or attention impairments on formal testing

Although patients are aware that their experiences are subjective and do not reflect reality, they might present to a clinician urgently due to the fear that their symptoms may indicate incipient psychosis or brain dysfunction.

Reference:

• (1) Hunter EC, Charlton J, David AS. Depersonalisation and derealisation: assessment and management. BMJ. 2017;356:j745.