Depersonalisation in BPD — MRCPsych Paper B MCQ

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ModeratePersonality DisordersDepersonalisation in BPDMRCPsych Paper B

During an intense argument, a woman with borderline personality disorder suddenly feels that her body and thoughts do not belong to her and that she is watching herself from outside. In a mirror, her face feels unfamiliar, although she knows that the reflection is hers. She recalls the episode fully, and the surrounding room does not seem unreal. Which dissociative phenomenon is she experiencing?

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Correct answer: D — Depersonalisation

The correct answer is **A, depersonalisation**. This is a dissociative alteration in the experience of the self, producing detachment from one's body, thoughts or actions. Feeling as though one is observing oneself from outside and experiencing one's reflection as unfamiliar, while retaining intellectual recognition that it is one's own reflection, are characteristic features. Derealisation instead involves the external environment seeming unreal or dreamlike; the room remains normal here. Dissociative amnesia requires significant memory gaps, and dissociative fugue involves apparently purposeful travel or wandering associated with amnesia or identity disturbance. A visual hallucination is a perception without an external stimulus; here an actual reflection is present and reality testing remains intact.

Reference: Royal College of Psychiatrists, RCPsych Insight, “When reality feels unreal”, Spring 2025, https://www.rcpsych.ac.uk/docs/default-source/members/rcpsych-insight-magazine/rcpsych-insight-31---spring-2025.pdf?sfvrsn=51613ec2_3