Depersonalization/derealization and its relationship to mood and anxiety disorders in the National Comorbidity Survey-Replication (NCS-R).
Social Psychiatry and Psychiatric Epidemiology July 2026 DOI: 10.1007/s00127-025-02915-2 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Epidemiological survey analysis (secondary analysis of NCS-R data) Peer reviewed |
|---|---|
| Population | National Comorbidity Survey Replication (NCS-R) respondents, a nationally representative sample of U.S. adults |
| Topics | Anxiety |
| Keywords | Anxiety disorders Comorbidity Depersonalization/derealization Dissociation Epidemiology Impairment Mood disorders Prevalence Severity |
| Key findings | Clinically significant depersonalization/derealization was uncommon in mood and anxiety disorders (3.0% of cases; 0.9% one-month national prevalence) and was not uniquely related to any specific disorder or to illness onset, chronicity, or impairment. It was associated with having more comorbid mood and anxiety disorders and with combined mood/anxiety disturbance, which the authors suggest may disrupt the usual sense of self and trigger unreality experiences. |
Abstract
Depersonalization/derealization (dpdr) is known to occur across mood and anxiety disorders (MAD) and has been proposed as a marker of worse illness. However, despite the well-known clinical association, there are no epidemiological data on the relationship between dpdr and MAD. In this NCS-R analysis clinically significant dpdr (DPDR-C) was defined as "sometimes" or "often" past-month endorsement of depersonalization and/or derealization in the absence of other pathological dissociation. Six past-month MAD diagnoses were examined: DSM-IV generalized anxiety disorder, panic disorder, social phobia, major depression, bipolar I, and bipolar II. RESULTS: National DPDR-C one-month prevalence was 0.9%. After excluding all cases with past-month posttraumatic stress disorder or non-dpdr pathological dissociation, 21.2% of DPDR-C cases were accounted for by MAD while 3.0% of MAD cases endorsed DPDR-C, ranging from 0% (generalized anxiety disorder) to 11.8% (comorbid mood and anxiety disorder). DPDR-C was not uniquely related to any MAD disorder, and was not associated with MAD age of onset, chronicity, or impairment. Rather, DPDR-C was significantly associated with number of comorbid MAD disorders and with mood/anxiety comorbidity. At the epidemiologic level DPDR-C was uncommon in MAD but was more likely to occur in the presence of combined mood and anxiety disturbance, which may cause greater disruption to the usual sense of self and thus trigger unreality experiences.
Comparable studies
Other cross-sectional and survey studies on anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. International sample of people who reported having used a psychedelic | 2020 | Cross-sectional survey | n = 985 |
| The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms Internet survey respondents reporting challenging experiences with psilocybin | 2016 | Questionnaire development and validation | |
| Psychedelics and Mental Health: A Population Study Adult population in the United States | 2013 | Cross-sectional survey | n = 130,152 |
| Ecstasy/MDMA attributed problems reported by novice, moderate and heavy recreational users Ecstasy users who participated in a WWW study of recreational drug use | 2002 | Cross-sectional survey | n = 282 |
| 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used in a naturalistic group setting is associated with unintended improvements in depression and anxiety. Adults who used 5-MeO-DMT in a group setting with structured procedures | 2019 | Cross-sectional survey | n = 362 |
Citations in the library
Cites 3
- Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment Journal of Trauma & Dissociation April 15, 2022
- Depersonalization and personality in panic disorder. Comprehensive Psychiatry 2011
- Validity and reliability of the Structured Clinical Interview for Depersonalization-Derealization Spectrum (SCI-DER). Neuropsychiatric Disease and Treatment October 1, 2008