Beyond the mind: Depersonalization and derealization as risk factors for physical health in the German general population

BACKGROUND: Depersonalization and derealization (DP/DR) are dissociative symptoms involving a sense of unreality and detachment from one's self or surroundings. While strongly associated with psychiatric conditions, their relationship to physical health and epistemic trust-shaping how individuals integrate information and particularly fragile in dissociative states-remains underexplored. METHODS: A representative sample of 2318 individuals from the German general population completed standardized self-report instruments assessing DP/DR (DSS), adverse childhood experiences (ICAST-R), epistemic trust (ETMCQ), and physical comorbidities. Group comparisons and stepwise regressions were conducted to explore the associations between DP/DR, ACEs, somatic illness, and epistemic stance. RESULTS: DP/DR symptoms were present in 11.8% and DP/DR was significantly associated with a higher burden of physical illness (OR = 1.96, 95%CI: 1.42-2.71, p < .001), even after controlling for ACEs, psychiatric comorbidity, and sociodemographic variables. Subgroup analyses showed that the presence of DP/DR increased the likelihood of physical illness by 3.5-fold (95% CI: 2.27-5.29, p < .001) in individuals with ACEs and by 2.1-fold (95% CI: 1.24-3.38, p = .005) in those with psychiatric disorders. DP/DR severity was also significantly correlated with lower epistemic trust and higher mistrust and credulity (all p < .001). CONCLUSION: DP/DR symptoms represent an independent risk factor for physical health problems and are strongly associated with disruptions in epistemic trust. These findings highlight the need for trauma-informed approaches that address not only psychological symptoms but also relational and epistemic functioning to improve both mental and physical health outcomes.