Journal of Anxiety Disorders 27 (2013) 178–187 Contents lists available at SciVerse ScienceDirect Journal of Anxiety Disorders Depersonalization/derealization during acute social stress in social phobia Juergen Hoyer a,* , David Braeuer a , Stephen Crawcour a , Elisabeth Klumbies b , Clemens Kirschbaum b a Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Germany b Institute of Biopsychology, Technische Universitaet Dresden, Germany a r t i c l e i n f o Article history: Received 8 June 2012 Received in revised form 13 December 2012 Accepted 20 January 2013 Keywords: Depersonalization Derealization Social anxiety disorder Social phobia Post-event processing Trier Social Stress Test (TSST) a b s t r a c t The present study aimed at investigating how frequently and intensely depersonalization/derealization symptoms occur during a stressful performance situation in social phobia patients vs. healthy controls, as well as testing hypotheses about the psychological predictors and consequences of such symptoms. N = 54 patients with social phobia and N = 34 control participants without mental disorders were exam- ined prior to, during, and after a standardized social performance situation (Trier Social Stress Test, TSST). An adapted version of the Cambridge Depersonalization Scale was applied along with measures of social anxiety, depression, personality, participants’ subjective appraisal, safety behaviours, and post-event processing. Depersonalization symptoms were more frequent in social phobia patients (92%) than in controls (52%). Specifically in patients, they were highly positively correlated with safety behaviours and post-event- processing, even after controlling for social anxiety. The role of depersonalization/derealization in the maintenance of social anxiety should be more thor- oughly recognized and explored. © 2013 Elsevier Ltd. All rights reserved. 1. Introduction Social phobia (SP, also defined as social anxiety disorder, SAD) is characterized by persistent fears of one or more social situations in which the person is exposed to others and expects to be scruti- nized. Those affected fear acting in an embarrassing way (American Psychiatric Association, 2000). According to the DSM-IV-TR criteria, such fears are recognized as unreasonable and excessive. Never- theless, exposure to such feared situations may invariably trigger anxiety, with levels possibly escalating to panic attacks. SP is related to clinically significant distress, as well as impairment in social, occupational, or other important areas of functioning (American Psychiatric Association, 2000). Comorbid psychopathology (other anxiety disorders, mood disorders, substance abuse) is common (e.g., Fehm, Beesdo, Jacobi, & Fiedler, 2008). Current psychological models of social phobia emphasize the role of cognitive factors for the development and mainte- nance of the disorder (Clark & Wells, 1995; Hofmann, 2007; Clark, 2001; Rapee & Heimberg, 1997), which include high social * Corresponding author at: Technische Universität Dresden, Klinische Psychologie und Psychotherapie, Hohe Str. 53, D-01187 Dresden, Germany. Tel.: +49 351 46336986; fax: +49 351 46336955. E-mail address: hoyer@psychologie.tu-dresden.de (J. Hoyer). standards, social apprehension, heightened self-focused atten- tion, negative self-perception, high estimated social costs, low perceived emotional control, perceived poor social skills, antic- ipation of social mishaps, avoidance and safety behaviours, and post-event rumination. To the best of our knowledge however, symptoms of depersonalization or derealization have not been explicitly integrated in any of these models although clinical data suggest that these symptoms are associated with social anxiety (e.g., Michal et al., 2005; Simeon, Knutelska, Nelson, & Guralnik, 2003). Depersonalization and derealization are defined as subjective experiences of unreality in one’s sense of self (depersonalization, DP) and the outside world (derealization, DR) (Simeon, 2004). These symptoms, which have been known already in the early psy- chopathology literature (Schilder, 1914) by the term autoscopia, occur in a continuum ranging from transient episodes in healthy individuals under specific conditions to mental and emotional dis- orders including depersonalization disorder (DPD; Hunter, Phillips, Chalder, Sierra, & David, 2003). A maximal expression of DP/DR as observed in DPD may include symptoms such as e.g., emotional numbing, lack of empathy, a sense of isolation, a dream-like state, impaired concentration, “mind numbness” or “racing thoughts,” memory impairments, difficulties in processing new information, dizziness and sensory distortions, or an altered perception of time (American Psychiatric Association, 2000). 0887-6185/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.janxdis.2013.01.002