Can derealization or depersonalization cause chest pain or spasms?

Possibly: Derealization can be a symptom of anxiety and anxiety can cause chest pain for some people. If they always occur together, they may be related. However, chest pain can be a vague symptom and should be evaluated by your physician before ruling out that something else is going on such as a heart, lung or rib issue. I hope this is helpful.

Not causation, but..: The reasons that any of these experiences (symptoms) may occur could be the same. Even to say that anxiety can include all of them is still not necessarily getting to the basic cause which is probably different even for the same person at different times. Try to find an experienced psychotherapist to discover what's going on for you. If meds are thought to be useful, they'll refer you to an MD too