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The part that makes you question the realness of it is the history of mental illness - atleast illustrated with Bateman's mother being in a ward - and the breakdown at the end. As far as we know, it's only Bateman who is confused by other people to be another person - although people confusing other faces is sort of a big point, especially in Glamorama, as others have stated everyone is the same. IN the book it makes the point many times that everyone is rich, everyone is beautiful, and everyone is fit; and this would seem to be the only reason that Bateman is the way he is externally - to fit in.
A few scenes that are very much a big factor, for me atleast, into whether the murders - either some or all - are real is Paul's apartment being completely spotless and the lone Bateman evading cops and a single shot exploding a cop car. If Batemen did commit the murders then that suggests something so very horrible about society that a real estate broker would cover up so many murders - if not then Paul may really have just gone to England; the murders being real though would drive home the point that Ellis makes throughout the book though. BUt, still, to look at it on the whole you have to ask these questions.
I personally have to say the murders - atleast most of them are real.
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