Behind the opaque curtain: A 20-year longitudinal study of dissociative and first-rank symptoms in schizophrenia-spectrum psychoses, other psychoses and non-psychotic disorders
Clara Humpston, M. Harrow, C. Rosen
Schizophrenia Research September 1, 2020 DOI: 10.1016/j.schres.2020.07.019 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective longitudinal cohort study Peer reviewed |
|---|---|
| Sample size | 555 |
| Population | Psychiatric patients recruited at index hospitalization with psychotic and non-psychotic diagnoses |
| Duration | Follow-up at approximately 2, 4.5, 7.5, 10, 15, and 20 years after index hospitalization |
| Key findings | Depersonalization and derealization were associated with first-rank symptoms across diagnostic groups, with derealization linked to FRS earlier (2–7.5 years) and depersonalization later (10–20 years). In schizophrenia, depersonalization was more often associated with passivity phenomena and derealization with delusions. The authors argue these phenomena are transdiagnostic and associated with FRS along a continuum, though more closely tied to schizophrenia-spectrum psychoses. |
Abstract
Background: Depersonalization and derealization are currently considered diagnostically distinct from first-rank symptoms (FRS) seen in schizophrenia-spectrum psychoses. Nevertheless, the lived experiences of these symptoms can be very similar phenomenologically.
Aims: To investigate the interrelationships between depersonalization, derealization and FRS in patients with different types of psychotic and non-psychotic diagnoses.
Methods: The Chicago Follow-up Study was a prospective longitudinal research programme designed to study psychopathology and recovery in psychiatric disorders consisting of 555 participants, who were recruited at index hospitalization and studied over six follow-up timepoints at approximately 2, 4.5, 7.5, 10, 15, and 20 years later. The primary clinical indices were depersonalization, derealization and Schneiderian FRS that were measured at index hospitalisation and at each subsequent follow-up.
Results: 62.8% of participants had at least four follow-ups. There were significant differences in the course and chronicity of depersonalization, derealization and first-rank symptoms across the three diagnostic groups. For the whole sample, derealization was significantly associated with FRS at 2-, 4.5- and 7.5-year follow-up timepoints whereas depersonalization was related to FRS from 10-year follow-up to 20-year follow-up. In patients with schizophrenia, overall depersonalization was more often associated with passivity phenomena whereas derealization was more often associated with overall delusions. There was also a significant effect of time on the associations between depersonalization, derealization and FRS across follow-ups.
Conclusions: Depersonalization and derealization should be viewed as transdiagnostic phenomena that are associated with FRS psychopathology along a continuum, although they are more closely associated with schizophrenia-spectrum psychoses.
Citations in the library
Cited by 5
- Can disorders of subjective time inform the differential diagnosis of psychiatric disorders? A transdiagnostic taxonomy of time. Early Intervention in Psychiatry March 1, 2023
- Sensed Presence, Attenuated Psychosis, and Transliminality: At the Threshold of Consciousness. Psychopathology 2023
- A 20-Year Descriptive Phenomenological Study of Depersonalization and Derealization as an Alteration in Sense of Self and Lifeworld. Schizophrenia Bulletin April 10, 2026
- From Body to Brain and Back: Multimodal Evidence for Interoceptive Alterations in Schizophrenia Spectrum Disorders medRxiv Preprint Server January 13, 2026
- Are dissociative psychosis and dissociative schizophrenia reality? World Journal of Psychiatry April 19, 2025
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