Elevated rates of depersonalization in gender dysphoria

by Zinnia Jones — October 20, 2017

Depersonalization is a psychiatric symptom generally described as feelings of unreality, such as a sense that one “has no self”, not genuinely feeling one’s own emotions, feeling like an observer of the world rather than a participant, and a sense that the world is flat, colorless, or lifeless. Experiencing depersonalization is associated with an elevated likelihood of depression, anxiety, suicidality, academic underachievement, poor coping strategies, unemployment, and overall social and occupational impairment. There is evidence that rates of depersonalization are increased among those with gender dysphoria, and that transitioning can reduce depersonalization symptoms for such individuals.

 

Rates of depersonalization disorder in the gender dysphoric population

The prevalence of depersonalization disorder (the clinical syndrome of depersonalization symptoms) among people with gender dysphoria has been found to range from 10.2–14.6%.

• Colizzi, Costa, & Todarello (2015): “A consecutive series of 118 patients was evaluated for gender dysphoria from 2008 to 2012. . . . (82 MtF; 36 Female to Male, FtM)”. Upon evaluation with the Dissociative Disorders Interview Schedule (DDIS), 3.4% of patients had depersonalization disorder and an additional 6.8% had derealization, a type of depersonalization symptom, for a total of 10.2% of gender dysphoric patients with clinical depersonalization.
• Kersting et al. (2003): “The study group comprised 41 transsexuals treated under the terms of the German Transsexuals’ Act between September 1999 and November 2000… The sample consisted of 29 (70.7%) MF-TS and 12 (29.3%) FM-TS aged 19 to 61 years (mean = 34.7; SD = 10.3). . . . Six of the transsexuals (14.6%) recorded a total DES score of more than 20. In all of these cases, the transsexuals also endorsed depersonalization on the SCID-D-R related to feeling disconnected from parts of their body. Recurrent depersonalization of this nature would meet criteria for DSM-IV depersonalization disorder.“

 

Depersonalization disorder in the general population

The general population has been found to experience depersonalization disorder at a base rate ranging from 0.8–3.4%.

• Michal et al. (2016): “Epidemiological surveys suggest that the current prevalence rate of the depersonalization-derealization syndrome is approximately 1% in the general population [5–7].”
• American Psychiatric Association (2013): “symptomatology that meets full criteria for depersonalization/derealization disorder is markedly less common than transient symptoms. Lifetime prevalence in U.S. and non-U.S. countries is approximately 2% (range of 0.8% to 2.8%).”
• Michal et al. (2011): “A nationally representative face-to-face household survey was conducted during the mid of 2009 in Germany. The sample comprised N = 2512 participants. . . . Case level of DP was found for 3.4% of the participants without significant sex and age differences.”

Most narrowly, those with gender dysphoria experience clinical depersonalization at a rate at least 3 times that of the general population (10.2% / 3.4%), and possibly up to 18 times the overall rate (14.6% / 0.8%).

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References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [Excerpt]
• Colizzi, M., Costa, R., & Todarello, O. (2015). Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real? Psychiatry Research, 226(1), 173–180. [Abstract]
• Kersting, A., Reutemann, M., Gast, U., Ohrmann, P., Suslow, T., Michael, N., & Arolt, V. (2003). Dissociative disorders and traumatic childhood experiences in transsexuals. Journal of Nervous and Mental Disease, 191(3), 182–189. [Abstract]
• Michal, M., Adler, J., Wiltink, J. Reiner, I., Tschan, R., Wölfling, K., . . . Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome. BMC Psychiatry, 16, 203. [Full text]
• Michal, M., Glaesmer, H., Zwerenz, R., Knebel, A., Wiltink, J., Brähler, E., & Beutel, M. E. (2011). Base rates for depersonalization according to the 2-item version of the Cambridge Depersonalization Scale (CDS-2) and its associations with depression/anxiety in the general population. Journal of Affective Disorders, 128(1–2), 106–111. [Abstract]