Depersonalization and derealization are dissociative phenomena characterized by feelings of detachment from oneself and the surrounding world, respectively. While typically transient and triggered by acute stressors, these experiences can become chronic and lead to Depersonalization-Derealization Disorder (DDD), a condition associated with significant morbidity. This manuscript presents a detailed case study of a 43-year-old woman with a longstanding history of recurrent depersonalization and derealization episodes, which began in childhood and worsened over time. Despite multiple psychiatric interventions and pharmacological treatments, her symptoms persisted, culminating in suicidal ideation. The case highlights the challenges of diagnosing and treating DDD, especially in the context of comorbid psychiatric conditions, such as depression, and the difficulty in distinguishing these symptoms from neurological disorders. The patient’s experience underscores the need for a thorough diagnostic approach, including neurological examination and exclusion of conditions like epilepsy and brain lesions. Treatment strategies for DDD remain underdeveloped, with a focus on psychotherapy and medications such as lamotrigine and clomipramine. Despite limited research, a multidisciplinary approach combining pharmacotherapy, psychotherapy, and lifestyle interventions appears most beneficial. This case illustrates the importance of early diagnosis and tailored treatment to manage the persistent and debilitating symptoms of DDD, which often lead to impaired functioning and suicidal tendencies. Further research and clinical trials are crucial to improving treatment outcomes for patients with chronic and refractory depersonalization-derealization symptoms.
Soares et al. (2026) studied this question.