Patients with vestibular disease have an increased rate of reporting symptoms of depersonalisation/derealisation (DD) and similar symptoms can be provoked in healthy subjects during caloric vestibular stimulation.To assess the relationship between DD symptoms in patients with peripheral vestibular disease and their ability to update orientation in the environment.Sixty healthy subjects and 50 patients with peripheral vestibular disease completed a DD questionnaire (Cox and Swinson, 2002) and a General Health Questionnaire (GHQ)-12 (Goldberg and Williams, 1988). This was followed by a test of updating spatial orientation in which subjects were exposed to 10 manually driven whole body rotations of 45 degrees, 90 degrees or 135 degrees in a square room, which contained distinctive features on the walls, in such a way that the features and corners subtended 45 degrees with respect to the subject. After each rotation subjects reported which wall or corner they were facing. Estimation error was calculated by subtracting the reported rotation from the actual rotation.DD scores were significantly higher in vestibular patients than in healthy subjects (p