Depersonalization/derealization disorder

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Target exams

Red flags

• Active suicidal ideation, intent or plan — chronic unreality plus comorbid depression often drives despair; same-day risk assessment and safety plan
• First late-onset or atypical DP/DR with focal neurology, seizure clues, fever, progressive confusion — medical/organic work-up before freestanding psychiatric labelling
• Acute substance intoxication (cannabis, ketamine, hallucinogens) with severe panic and unreality — medical stabilisation and safety first
• Presuming schizophrenia from detachment language alone when reality testing and insight are intact — avoid unnecessary long-term antipsychotic burden
• Catastrophic patient conviction of irreversible brain damage driving non-engagement — psychoeducation and CBT framing are urgent, not optional
• Severe functional collapse (unable to leave home, work, or self-care) with untreated panic or major depression — step up care intensity