Dissociative Disorders: Characteristic Symptoms
Dissociative disorders are characterized by depersonalization and derealization (Option B), which represent core disruptions in the integration of memory, identity, and consciousness.
Core Features of Dissociative Disorders
The cardinal feature of dissociation is a disruption in one or more mental functions, with depersonalization and derealization being central phenomena. 1 These symptoms constitute part of a spectrum of dissociative psychopathology that includes:
- Dissociative amnesia - disruption in memory integration 1
- Depersonalization - feeling detached from oneself 1, 2
- Derealization - feeling that the external world is unreal 1, 2
- Identity confusion and identity alterations - disruptions in sense of self 1
Why the Other Options Are Incorrect
Option A (persistent fear of a specific object) describes specific phobia, an anxiety disorder, not a dissociative disorder. 3
Option C (recurrent intrusive images) characterizes post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), not dissociative disorders. 3 While intrusive thoughts occur in PTSD, dissociative symptoms like depersonalization and derealization may represent anxiety or dissociative phenomena rather than true psychotic symptoms. 3
Option D (thoughts dominated by obsessions) defines obsessive-compulsive disorder, which is classified separately in the obsessive-compulsive and related disorders chapter. 3
Clinical Recognition
Depersonalization disorder in DSM-5 now includes derealization symptoms, as the two phenomena frequently co-occur. 2, 4 These experiences involve:
- Feeling detached or estranged from one's own identity 5
- Experiencing the external world as unreal or dreamlike 2
- Disruption in the functional continuity of memory and identity 5
Important Clinical Distinction
Dissociative symptoms can appear in other psychiatric conditions but must be distinguished from the primary dissociative disorders. For example, maltreated children with PTSD may report psychotic-like symptoms that actually represent dissociative phenomena including intrusive thoughts, derealization, or depersonalization rather than true psychosis. 3 The absence of observable formal thought disorder helps distinguish these presentations. 3