Diagnosis of depersonalization disorder

Abstract

Depersonalization Disorder (DPD) is considered both under-researched and underdiagnosed. A variety of reasons have been proposed for the under-diagnosis of DPD, including the high frequency of depersonalization as a symptom and comorbidity of DPD with other disorders. Under-diagnosis of DPD has also been attributed to inadequate diagnostic criteria in the DSM-IV-TR, as it lists only four criteria and only one specifically addresses the phenomenon of depersonalization. Several groups of researchers have proposed more comprehensive and in-depth conceptualizations of DPD. Further, common biases in clinical decision-making, such as an over-reliance on cognitive heuristics and the use of prototypes, can contribute to inaccurate diagnosis and under-diagnosis. A national sample of licensed psychologists was randomly selected and recruited from the membership of the American Psychological Association. The study was conducted on-line and participants were asked to read one of two DPD cases, assign a diagnosis, and rate the representativeness of a series of diagnoses for the case. They were also asked to rate the presence of a list of symptoms, including the DSM-IV-TR and ICD-10 criteria for DPD, and the symptoms and dimensions of DPD and depersonalization from the literature. Half of the participants were asked to assign a diagnosis and then rate symptoms (simulated prototype approach) while the others rated the symptoms before assigning a diagnosis (simulated DSM-IV approach). The study found that clinicians under-diagnosed DPD and that the DSM-IV depersonalization criterion had high sensitivity but not adequate specificity. Results indicated that a simulated DSM-IV approach