Depersonalization-Derealization Disorder: Etiological Mechanism, Diagnosis and Management.

Abstract

This comprehensive review delves into the complexities surrounding Depersonalization-Derealization disorder (DPDR), a dissociative disorder characterized by enduring feelings of detachment from one's self and surroundings. Tracing its historical roots back to 19th-century descriptions and its current classification as a singular disorder, the review meticulously explores the clinical presentation, epidemiology, etiology, diagnosis, and management of DPDR.  Despite many trials and studies conducted the exact cause of this condition is still unknown. The best way to understand its etiology is by taking into account its clinical presentations and linking it to different structural and functional alterations of the brain. Alteration in cortical activity and structure associated with white matter, gray matter, caudate nucleus, amygdala, and other areas like Broadman's areas of cortex are analyzed to be potential mechanisms for etiology. With a concerning rise in its prevalence globally and notable impact on adolescents and young adults, DPDR manifests through a spectrum of symptoms including depersonalization, and derealization, and often accompanies comorbidities such as anxiety and depression. While the precise cause remains elusive, factors such as traumatic experiences, stress, and genetic predispositions have been implicated, with modern neuroimaging studies offering insight into potential structural and functional brain alterations. Managing DPDR necessitates a multifaceted approach integrating psychotherapy, pharmacotherapy, and lifestyle interventions, with cognitive-behavioral therapy (CBT) and pharmacological agents like SSRIs and SNRIs emerging as primary interventions. The importance of early detection and intervention is crucial for improving its prognosis. Unfortunately, DPDR is highly understudied to date. Due to a scarcity of scientific literature about DPDR in recent years, it has become very challenging to get a proper in-depth understanding of this. Therefore, this review serves as an all-in-one source to get information about DPDR ranging from etiology to its management strategies.