Depersonalisation disorder: a cognitive–behavioural conceptualisation

Hunter, E.C.M.; Phillips, M.L.; Chalder, T.; Sierra, M.; David, A.S.

doi:10.1016/s0005-7967(03)00066-4

Cited by 186Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPersonality Disorders and Psychopathology

Depersonalisation disorder: a cognitive–behavioural conceptualisation

Hunter, E.C.M., Phillips, M.L., Chalder, T., Sierra, M., David, A.S.·2003·Behaviour Research and Therapy

DOI 10.1016/s0005-7967(03)00066-4

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Abstract

Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one's sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals under certain situational conditions to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder, DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We suggest that there is compelling evidence to link DPD with the anxiety disorders, particularly panic. This paper proposes that it is the catastrophic appraisal of the normally transient symptoms of DP/DR that results in the development of a chronic disorder. We suggest that if DP/DR symptoms are misinterpreted as indicative of severe mental illness or brain dysfunction, a vicious cycle of increasing anxiety and consequently increased DP/DR symptoms will result. Moreover, cognitive and behavioural responses to symptoms such as specific avoidances, 'safety behaviours' and cognitive biases serve to maintain the disorder by increasing awareness of the symptoms, heightening the perceived threat and preventing disconfirmation of the catastrophic misinterpretations. A coherent model facilitates the development of potentially effective cognitive and behavioural interventions.

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The cognitive-behavioral model implicates hyperawareness and monitoring of symptoms in the maintenance of DPD.
“Likewise, the cognitive-behavioral model implicates hyperawareness and monitoring of symptoms in the maintenance of DPD (Hunter et al., 2003).”
From Mindfulness and Depersonalization: a Nuanced Relationship (2022) · cites this paper as Hunter et al., 2003
The cognitive model of DPD emphasises the role of anxiety and cognitive processes common to anxiety disorders in the development and maintenance of DPD.
“Additionally, the cognitive model of DPD [20] has emphasised the role of anxiety and cognitive processes common to anxiety disorders, in the development and maintenance of DPD.”
From A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial (2016) · cites this paper as [20]
In the CBT model of DPD, catastrophic appraisals of transient depersonalisation experiences serve to exacerbate and maintain symptoms.
“In the cognitive behavioural therapy (CBT) model of DPD [20], catastrophic appraisals of transient depersonalisation experiences (such as of having damaged one’s brain or of incipient ‘madness’) serve to exacerbate and maintain symptoms.”
From A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial (2016) · cites this paper as [20]

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Authors: Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S.
Affiliations: King's College London (GB)
Corresponding author: Hunter, E.C.M.
ORCID: Hunter, E.C.M.
Phillips, M.L.
Chalder, T.
Sierra, M.
David, A.S.
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2003-12
Volume: 41
Issue: 12
Pages: 1451-1467
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/s0005-7967(03)00066-4
OpenAlex: W2039048442
Cited by: 185
References: 97
Citations by year: 2026: 14 · 2025: 21 · 2024: 16 · 2023: 17 · 2022: 9 · 2021: 9 · 2020: 8 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 9 · 2015: 2 · 2014: 7 · 2013: 7 · 2012: 11
FWCI: 3.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords: depersonalization, derealization, anxiety disorders, panic, safety behavior, cognitive biases, avoidance, cognitive-behavioral model, psychological intervention
MeSH terms: Adult, Anxiety Disorders, Depersonalization, Humans, Male, Models, Psychological, Cognitive Behavioral Therapy

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Depersonalisation disorder: a cognitive–behavioural conceptualisation

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