Katharine Donnelly - Overcoming Depersonalization Disorder: A Mindfulness and Acceptance Guide to Conquering Feelings of Numbness and Unreality

Overcoming Depersonalization Disorder, by Fugen Neziroglu, Katharine Donnelly, and Jose Yaryura-Tobias, is a very welcome addition to the scant book literature on depersonalization disorder. Although the disorder is estimated to afflict up to 2 percent of people over the course of their lifetimes, it remains underdiagnosed and frequently misdiagnosed, leaving its sufferers increasingly frustrated and hopeless as they go from one mental health professional to the next looking for an accurate diagnosis, effective treatment, and hope for the future. Even when the disorder is accurately diagnosed, many clinicians remain at a loss as to how to best treat these patients, since the treatment guidelines for chronic depersonalization continue to be obscure compared to those for many other psychiatric disorders. This new book, happily, offers a wealth of psychological treatment approaches that can ultimately prove helpful to many people afflicted by the disorder.

The book is highly readable, targeting a lay audience as well as clinicians looking for informed help in treating their patients. In the first three chapters, the book introduces all the intricate aspects of the condition, including its symptoms; its course over time; its common antecedents, such as trauma and family dysfunction; and, importantly, its overlap with and its differences from related psychiatric disorders. This book also covers some basic neurobiology in order to give the reader a solid sense of what we know about the biological underpinnings of the disorder.

The bulk of the book is dedicated to a wide variety of psychotherapy approaches that can be used to tackle chronic depersonalization. Its unique contribution is the fact that it draws from both acceptance and commitment therapy and dialectical behavior therapy, and specifically applies both of these models to the treatment of depersonalization. The authors describe in simple and clear ways, illustrated by many examples, how self-focus and obsessional preoccupation with the illness often brings more suffering, while a mental stance based on mindfulness in the moment and on acceptance as a contextual background to the work of change can alleviate pain and suffering. The book describes thoughts, feelings, and avoidance behaviors that stem from the condition and exacerbate it, with an emphasis on enhancing the persons growth potential and commitment to valued aspects of life even in the face of very distressing symptoms.

The authors then introduce basic principles of dialectical behavior therapy as they apply to chronic depersonalization: present-moment mindfulness, distress tolerance, awareness and regulation of emotions, and interpersonal effectiveness. These are supplemented with classic behavioral approaches focusing on exposure and response prevention, targeting not only the symptoms of depersonalization but also its historical precipitants and its most feared outcomes. The book ends with some additional treatment options such as cognitive approaches, general wellness strategies, and an overview of pharmacological treatment options.

This is a comprehensive, up-to-date, highly readable, and user-friendly book. It offers many vignettes and examples, exercises and worksheets, helpful concluding summaries to each chapter, and a question-and-answer section addressing some of the most frequently expressed concerns of people with depersonalization disorder. It is a very welcome addition to a newly emerging field, and one that patients and clinicians alike will find very helpful.

Daphne Simeon, MD author of Feeling Unreal: Depersonalization Disorder and the Loss of Self Associate Professor of Psychiatry Beth Israel Medical Center and Albert Einstein College of Medicine New York