Depersonalization/Derealization Disorder 305
individuals often demonstrate may appear incongruent with the extreme emotional pain
reported by those with the disorder. Impairment is often experienced in both interpersonal
and occupational spheres, largel y due to the hypoemotionality with others, subjective diffi-
culty in focusing and retaining information, and a general sense of disconnectedness from
life. 
Differential Diagnosis
Illness anxiety disorder. Although individuals with depersonalization/derealization dis-
order can present with vague somatic complaints as well as fears of permanent brain dam-
age, the diagnosis of depersonalization/derealization disorder is characterized by the
presence of a constellation of typical depersonalization/derealization symptoms and the ab-
sence of other manifestations  of illness anxiety disorder. 
Major depressive disorder. Feelings of numbness, deadne ss, apathy, and being in a
dream are not uncommon in major depressive  episodes. However, in depersonalization/
derealization disorder, such symptoms are a ssociated with further symptoms of the dis-
order. If the depersonalization/derealization clearly precedes the onset of a major depres-
sive episode or clearly continues after its resolution, the diagnosis of depersonalization/
derealization disorder applies. 
Obsessive-compulsive disorder. Some individuals with depersonalization/dereal-
ization disorder can become obsessively preo ccupied with their subjective experience or
develop rituals checking on the status of their symptoms. However, other symptoms of
obsessive-compulsive disorder  unrelated to depersonali zation/derealization are not
present. 
Other dissociative disorders. In order to diagnose depersonalization/derealization
disorder, the symptoms should not occur in th e context of another dissociative disorder,