Depersonalization/derealization disorder: a case report
Romanian Journal of Psychiatry and Psychotherapy December 31, 2025 DOI: 10.37897/rjpp.2025.4.4 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 24-year-old woman with severe depersonalization/derealization disorder |
| Interventions | Lithium Esketamine Antidepressants Antipsychotics Repetitive transcranial magnetic stimulation |
| Key findings | In this 24-year-old woman with treatment-resistant depersonalization/derealization disorder, lithium produced a marked remission of suicidal thoughts, while adjunctive esketamine did not provide sustained benefit. The authors argue that DPDR is frequently misdiagnosed as a mood or psychotic disorder and propose dysfunctional prefrontal-limbic circuits, possibly as a maladaptive stress response, in its pathogenesis. |
Abstract
We report the case of a 24-year-old woman suffering from severe depersonalization/derealization disorder (DPDR), characterized by profound emotional numbness, feelings of unreality toward herself and her environment, and persistent suicidal ideation. Despite multiple pharmacological interventions – including antidepressants, antipsychotics, and repetitive transcranial magnetic stimulation – her symptoms remained resistant. Initiation of lithium led to a marked remission of suicidal thoughts, while adjunctive esketamine treatment failed to provide sustained benefit. This case illustrates the diagnostic complexity of DPDR, frequently misdiagnosed as mood or psychotic disorders. Neurobiological insights implicate dysfunctional prefrontal-limbic circuits in the pathogenesis of DPDR, possibly as a maladaptive stress response.