Patients With Major Depressive Disorder, Social Phobia More Often Experience Embarrassing Social Interactions

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Depersonalization can be described as feeling disconnected from one’s body, whereas derealization is characterized by feeling disconnected from the world, with environments, objects, and people seeming unreal or unfamiliar.

Although people with major depressive disorder (MDD) or social phobia (SP) experienced more embarrassing social interactions than healthy controls, depersonalization and derealization occurred with similar frequency and duration during interactions across all groups, according to findings published in the Journal of Anxiety Disorders. Depersonalization, described as feeling disconnected from one’s body, and derealization, characterized by feeling disconnected from the world, may be coping strategies for feelings of embarrassment in SP.

The current study used the experience sampling method (ESM) to collect data by having participants record data several times a day with computer-assisted technology (eg, smartphones). In prior studies, retrospective assessments of depersonalization and derealization experiences are less likely to be recalled accurately or clearly, while laboratory settings might create expectations for embarrassing interactions.

The researchers examined depersonalization and derealization frequency and duration between participants with SP (n=47) or MDD (n=118) and controls (n=119), recruited through university clinics, local practitioners, and internet advertisements. Participants used smartphones during the course of 7 days to complete a total of 5 surveys daily at fixed times (every 3 hours). Each survey assessed the number of meaningful social interactions, embarrassing behaviors, and accompanying depersonalization and derealization experiences.

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Patients with either MDD or SP experienced a greater frequency of embarrassment (MDD: odds ratio [OR], 4.78; 95% CI, 2.55-8.96; P <.001 and SP: OR, 6.93; 95% CI, 3.35-14.35; P <.001), as well as depersonalization and derealization, during important social interactions than controls. However, the groups did not differ in terms of duration of derealization or depersonalization. While participants with SP did not differ from controls in the frequency of depersonalization during embarrassing interactions, the frequency of depersonalization was higher in participants with MDD than in controls (OR, 5.88; 95% CI, 1.15-30.05; P =.033). Lastly, there were no differences between any of the groups in the frequency of derealization during embarrassing social interactions.

There were several important limitations to the study, which did not allow for further analysis of depersonalization and derealization outside of embarrassing social interactions or potential triggers beyond embarrassment. These limitations included a failure to account for other factors such as alcohol and drug use, which could possibly increase depersonalization and derealization.

“The results verify that [depersonalization and derealization] symptoms, although aversive in nature, are neither unusual nor specific to only individuals with a psychiatric diagnosis. Furthermore, it shows that feelings of embarrassment proved to be a reliable trigger for [depersonalization and derealization],” the researchers concluded. However, they noted that patients with MDD and SP may have unique psychological processes that relate to embarrassing social interactions.


Čolić J, Bassett TR, Latysheva A, et al. Depersonalization and derealization in embarrassing social interactions: an experience sampling study in social phobia, major depression and controls. J Anxiety Disord. 2020;70:102189.