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

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. 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. 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). 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. • Depersonalization and derealization (DP/DR) symptoms are present in ~11.8% of the German population. • DP/DR is significantly associated with higher risk of physical illness. • Increased risk for obesity, hypertension, heart attack, and stroke was observed. • Combined with ACEs DP/DR triples the likelihood of somatic illness. • Impaired epistemic trust may be a mechanism for these associations.