9417 - Depersonalization/derealization disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9417 

Definition

A persistent feeling of being detached from one's body. However, the patient realizes that it is only a feeling.

Etiology

It is the third most common psychiatric symptom. The cause is unknown, but it frequently arises in the presence of serious danger, e.g., assaults and serious illness.

Signs & Symptoms

The symptoms are short term, but occur in conjunction with feelings of anxiety, depression, and disturbed sense of time. There may be an alteration in the size or shape of objects (macropsia-larger or micropsia-smaller). Patients fear they are going crazy. Some can block the effect of the disorder, while others have a state of chronic anxiety over it.

Tests

It is necessary to rule out substance abuse, physical problems and other dissociative disorders. Persons who have the disorder are very easy to hypnotize. Interviews and psychological testing are used to determine the presence of the disorder. Diagnostic criteria for the depersonalization disorder include:

  • Persistent or recurrent experiences of feeling detached from one's mental processes or body.

  • Intactness of reality testing during the experience.

  • The depersonalization experience causes significant distress or impaired social, occupational, or some other area of functioning.

  • This depersonalization experience does not occur exclusively during the course of another mental disorder, and is not the physiological effect of a substance or general medical condition.

Treatment

All stresses associated with the onset of the disorder must be addressed. Treatment is necessary only if the disorder persists. If treatment is necessary, then various types of psychotherapy may be helpful. Tranquilizers and antidepressants assist in alleviating the symptoms of some patients.

Residuals

Symptoms can be chronic and persist for years.

Special Considerations

  • If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309(c) Disease subject to presumptive service connection].

  • May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

  • Competency must be addressed in cases where a mental condition is initially evaluated as totally disabling or when the total evaluation is continued in a rating decision. This includes when individual unemployability is awarded or continued on the basis of a single mental health disability, and when assigning or continuing a temporary total evaluation for a mental disorder under 38 CFR 4.29 [38 CFR 3.353 [Determinations of incompetency and competency]].

  • Reference 38 CFR 3.384 for the applicability of the term psychosis.

  • Review 38 CFR 3.354 with regard to determinations of insanit

Notes

  • An incapacitating episode is a period during which bed rest and treatment by a physician are required.

  • Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders. 

  • Review the special provisions outlined in 38 CFR 4.125 through 38 CFR 4.129 for decisions related to mental disorders

  • The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) (see 38 CFR 4.125 for availability information). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in 38 CFR 4.125 through 38 CFR 4.129 and to apply the general rating formula for mental disorders in 38 CFR 4.130.