reply to post by themightymissm
Pt. II
Diagnosis
Diagnosis is based on the self-reported experiences of the person followed by a clinical assessment by a psychiatrist, social worker, clinical
psychologist or other mental health professional. Psychiatric assessment includes a psychiatric history and some form of mental status examination.
Since some medical and psychiatric conditions mimic the symptoms of DPD, clinicians must differentiate between and rule out the following to establish
a precise diagnosis: temporal lobe epilepsy, panic disorder, acute stress disorder, schizophrenia, migraine, drug use, brain tumour or lesion.[3] No
laboratory test for depersonalization disorder currently exists.[8]
The diagnosis of DPD can be made with the use of the following interviews and scales: The Structured Clinical Interview for DSM-IV Dissociative
Disorders (SCID-D) is widely used, especially in research settings. This interview takes about 30 minutes to 1.5 hours, depending on individual's
experiences.[9]
The Dissociative Experiences Scale (DES) is a simple, quick, self-administered questionnaire that has been widely used to measure dissociative
symptoms.[10] It has been used in hundreds of dissociative studies, and can detect depersonalization and derealization experiences.[11]
The Dissociative Disorders Interview Schedule (DDIS) is a highly structured interview which makes DSM-IV diagnoses of somatization disorder,
borderline personality disorder and major depressive disorder, as well as all the dissociative disorders.[12] It inquires about positive symptoms of
schizophrenia, secondary features of dissociative identity disorder, extrasensory experiences, substance abuse and other items relevant to the
dissociative disorders. The DDIS can usually be administered in 30–45 minutes.[12]
DSM-IV-TR criteria
The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:[8]
1. Persistent or recurrent feelings of being detached from one’s mental processes or body; as if an observer
2. During depersonalization, reality testing is intact
3. Depersonalization causes significant distress, and impairment in social, occupational, or other functioning
4. Depersonalization is not the result of another disorder, substance use, or general medical condition
The DSM-IV-TR specifically recognizes three possible manifestations of depersonalization disorder:
1. Derealization, experiencing the external world as strange or unreal.
2. Macropsia or micropsia, an alteration in the perception of object size or shape.
3. A sense that other people seem unfamiliar or mechanical.
Etiology
This section's factual accuracy is disputed. Please see the relevant discussion on the talk page. (January 2009)
The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. Childhood interpersonal
trauma, emotional abuse in particular, is a significant predictor of a diagnosis.[13] The most common immediate precipitants of the disorder are
severe stress, major depressive disorder and panic, marijuana and hallucinogen ingestion.[14] People who live in highly individualistic cultures may
be more vulnerable to depersonalization, due to threat hypersensitivity and an external locus of control.[15]
One cognitive behavioral conceptualization is that misinterpreting normally transient dissociative symptoms as an indication of severe mental illness
or neurological impairment leads to the development of the chronic disorder. This leads to a vicious cycle of heightened anxiety and symptoms of
depersonalization and derealization.[16]