Feeling Unreal: Depersonalization Disorder and the Loss of the Self. By Daphne Simeon & Jeffrey Abugel. Oxford University Press. 2006. 242 pp. £16.99 (hb) ISBN 0195170229

The constellation of symptoms that constitutes depersonalisation is often as perplexing to the therapist as to the sufferer. Interest in it has fluctuated over the years; it was much discussed and studied in the mid-20th century by such luminaries as Mayer-Gross, Schilder, Roth and Shorvon but its intellectual appeal seemed to decline thereafter. Fortunately, interest in the condition has revived in recent years, which has been reflected in the psychiatric literature. This monograph, which aims to review present knowledge of the subject, is therefore timely.

The authors are an unusual combination of a psychiatrist with special expertise in the treatment of depersonalisation (Daphne Simeon), and a medical journalist, (Jeffrey Abugel) who has himself experienced persistent depersonalisation and founded an educational website on the subject (http://www.depersonalization.info). This blend of experience lends authority to their portrayals of sufferers and their symptoms, leaving no doubt of their familiarity with the condition and its often devastating effect.

The authors concentrate on free-standing depersonalisation disorder as defined in DSM–IV. They accept its DSM–IV classification as a dissociative disorder, but acknowledge its dissimilarity from other dissociative symptoms. They trace the history of the condition and review the multifarious theories proposed during the past century, opting for a combination of Mayer-Gross's ‘pre-formed functional response of the brain’ and the psychoanalytic notion of a defence against overwhelming stress, but which has gone awry.

Their review of recent biological studies, including brain imaging and neurochemical observations, concludes that there is still a great deal to unravel. Depersonalisation disorder is notoriously resistant to treatment but promising results are claimed for treatment with either lamotrigine, the combination of a selective serotonin reuptake inhibitor antidepressant and the stimulant modafinil, or opioid antagonists, but there are few controlled trials. The authors favour the use of both pharmaco- and psychotherapy, though the latter is now usually more eclectic and cognitively based than the quasi-mystical psychoanalysis that formerly prevailed.

This book is noteworthy for its paucity of jargon and lucid style, enlivened by the literary quotations with which it is liberally sprinkled. Although the message conveyed is one of promise rather than achievement, it contains much to educate and excite both psychiatrists and interested lay persons. The authors have set a valuable precedent and a high standard for future therapist–sufferer publications.