Depersonalization-derealization: Predicting Factors That Inform Clinical Treatment

Abstract
Purpose
The purpose of this Institutional Review Board approved study was to examine clinical levels of depersonalization-derealization. Complex trauma exposure, shame, anxiety, depression, and emotion regulation difficulties were investigated as predicting variables of clinical depersonalization-derealization (DPDR).

Method
A non-clinical population (N = 655) was examined to determine group differences for clinical DPDR (11%) versus non-clinical levels of DPDR. Three logistic regression analyses were conducted to determine predicting variables that predict clinical DPDR levels. The measurements included Multiscale Dissociation Inventory, Adverse Childhood Experience Questionnaire, Traumatic Events Questionnaire, Internalized Shame Scale, Beck Anxiety Inventory-II, Beck Depression Inventory-II.

Findings
The clinical DPDR group prevalence rate (11%) was much higher than the 2% rate reported in the general population. The significant predictors of clinical DPDR ordered from strongest to weaker predictors included anxiety, emotion regulation difficulties, shame, and cumulative trauma exposure, which classified 89% of the sample. Depression was a non-significant predictor. The three post hoc descriptive logistic regression results to predict clinical DPDR identified specific factors associated with childhood adversity, emotion regulation, and shame. In the first post hoc logistic regression, emotional and physical childhood neglect classified 89% of the sample; this finding highlights the negative effects of neglect even when childhood abuse has been suffered. The second post hoc logistic regression identified two specific aspects of emotion regulation, difficulty mobilizing emotional regulation strategies as well as difficulty accepting negative emotions; these two factors classified 86% of the sample. In the last post hoc logistic regression that examined shame factors, an inferior sense of self was non-significant, but fragile shame-based sense of self and a feeling of being empty classified 86% of the sample.

Conclusion
Clinical levels of DPDR are associated with anxiety, emotion regulation difficulties, shame, and trauma exposure. It is recommended that clinicians who work with patients who struggle with depersonalization-derealization address these factors. Once skills are acquired to manage anxiety, negative emotions, shame, and the effects of cumulative trauma exposure then depersonalization-derealization may become less problematic.

Learning Objectives:

At the conclusion of this session participants will be able to:

• Identify differences between clinical level depersonalization compared to those with no or lower intensity/frequency of depersonalization
• Describe the significant predictors of clinical depersonalization
• Discuss multiple factors associated with difficulties regulating negative emotions
• Describe three aspects inherent in internalized shame
• Identify items included in the adverse childhood experience scale as well as the deleterious psychological effects of childhood neglect