What is Depersonalization / Derealization Disorder?

a lonely woman sitting on a sofa with Depersonalization disorder

Depersonalization / derealization disorder is marked by persistent feelings that nothing is real, that the self is detached from the body, and that you are an outside observer of yourself. People experiencing episodes can feel like they’re not in control, like they’re living in a dream state, and can even experience visual distortions or fog concealing much of what they see. These attacks are normally triggered by stress, panic, or even drug use, but can last anywhere from a few hours to weeks at a time. And, while severe, they chronically affect anywhere from 0.8-2% of the population. Depersonalization disorder is even more common episodically, with an estimated 2-5% of the adult population experiencing an episode at least once.

What is Depersonalization/Derealization Disorder?

In short, depersonalization/derealization disorder is a disorder in which you experience episodes of feeling detached or disconnected from reality or from yourself. Here, specific instances of stress, trauma, panic, drug use, etc., trigger an episode, where the individual then feels either detached from thoughts, feelings, and the body, or disconnected from the world around them (or both).

Here, derealization is the perception that nothing around you is real. With depersonalization, you feel like you aren’t real or that you’re viewing your body as an outsider or as a third party. These can make it difficult to differentiate dreams from reality, to tell if you’re awake or dreaming, and to feel in control of yourself.

Depersonalization Disorder or a Symptom of Another Disorder?

Depersonalization and derealization disorders rarely specifically need treatment because episodes simply go away on their own. However, both often manifest as symptoms of other disorders, including PTSD, heavy depression, schizophrenia, and even sleep deprivation.

For many people, depersonalization or derealization disorders also link to early trauma, such as Adverse Childhood Experiences, child abuse including emotional neglect and domestic violence, and to traumatic incidents such as car accidents. Depersonalization is a coping mechanism that many people use to distance themselves from trauma – with some people experiencing traumatic events as having happened to someone who is not them. Here, they may have the impression they were watching or saw the traumatic event happen, but very rarely connect that that person was “them”. In this case, depersonalization is normally a symptom of PTSD (post-traumatic stress disorder) and can be treated using behavioral therapy, counseling, and other therapy.

Derealization can stem from the same types of traumas, with many people experiencing the disorder following periods of emotional neglect, especially during early childhood. Here, distancing from the self can be a sort of coping mechanism for feeling lonely or unworthy – although derealization can stem from many other triggers, including genetic and epigenetic causes as well. That’s especially true for individuals going through significant depressive episodes, where reality can seem blurred, foggy, or dream-like. Those symptoms qualify as depersonalization, even if the disorder is depression and not specifically “Depersonalization”.

Symptoms of Depersonalization/Derealization

Depersonalization/Derealization always occurs in episodes, with episodes lasting anywhere from an hour or two to several weeks. Symptoms can include:

  • Heightened awareness of surroundings
  • Blurry or foggy vision
  • Things seem unreal, cartoonish, colorless, two-dimensional, extra-dimensional, etc.
  • Distance, size, shape, or color of objects is distorted
  • Feelings of floating or dreaming
  • Inability to recognize or describe emotions
  • Physical numbness to pain or other sensations
  • Feeling not in control and unable to control or steer speech or movement (e.g., feeling like an outsider while your body just ‘does stuff’)
  • Inability to connect memories to yourself/inability to tell dreams from memories
  • Feeling a sense of distortion in the body or limbs
  • Feeling muzzy or cotton headed

Often these work out to feelings of lethargy, someone acting out of touch with reality, or even dazed. To outsiders, you may appear drunk or high or “out of it”.

a sad beautiful woman Getting a Depersonalization Diagnosis

Getting a Depersonalization Diagnosis

Derealization/Depersonalization Disorder is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as a diagnosable dissociative disorder. To be diagnosed, you should meet the following 5 criteria:

  • Persistent or recurrent episodes
  • Episodes do not prevent you from distinguishing reality
  • Symptoms interfere with normal life
  • You are not taking a substance or medication that could be causing the episodes
  • You do not have another psychiatric disorder that could be causing the episodes

Further, you will be checked for medication, substance abuse, recent head trauma, and for neurological disease when getting a diagnosis. For example, individuals with seizures, brain tumors, migraines, Meniere’s disease, or experiencing post-concussion syndrome cannot get a diagnosis until those conditions have been ruled out as a cause. In addition, you should be assessed for panic disorder, PTSD, acute stress syndrome, depression, schizophrenia, and borderline personality disorder, as each can cause disassociation and depersonalization.

How is Depersonalization/Derealization Disorder Treated?

DPDR syndrome is most-often treated with psychotherapy including behavioral therapy. Here, therapies like CBT and EMDR help patients to identify what is real, to block obsessive thinking, and to focus on distraction and grounding techniques. These are primarily intended to disrupt episodes and to make them more livable for the individual.

In many cases, CBT (cognitive behavioral therapy) also helps patients to look into potential causes underlying the disorder. While depersonalization/derealization disorder is not something that can be cured, individuals who have episodes triggered by trauma or stress can come to terms with the original traumas behind the disorder, can learn better coping mechanisms for triggers, and can learn to identify triggers – better preparing them for when an episode does happen.

In addition, treatment often involves grounding techniques, such as using sensation, manual movement, and connection to the real world to try to ground the self in reality.

Depending on your diagnosis, depersonalization/derealization disorder may also result in prescription medication, including SSRIs or other anti-anxiety medication. While uncommon, anti-anxiety medication can reduce the severity and duration of episodes, making it a good fit for persons with long or particularly intrusive episodes.

If you or a loved one is struggling with depersonalization or derealization, there is help. Getting a diagnosis is a good first step, because it can help you to rule out other, potentially more dangerous causes of depersonalization. Once you get a diagnosis, you can move into a mental health treatment program designed to help you cope with specific problems, deal with symptoms in a way that makes sense for you and learn coping strategies.

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