Depersonalization-Derealization Disorder: What To Expect, Symptoms, And Treatment

Content Warning: Please be advised, this article mentions the topic of prescription medication. The information found in the article is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health providers with any questions you may have. In addition, this article mentions trauma-related topics, including abuse and neglect, which could potentially be triggering.

The Basics

Have you ever experienced the feeling of being disconnected from yourself or your surroundings? If so, such unreal experiences may trigger feelings that are overwhelming or even frightening. 

There are times when it is normal to experience the sense of being disconnected or “in a daze.” Fatigue, illness, severe stress, medication side effects, and alcohol (even in small amounts) can cause these feelings. Feelings of disconnectedness can creep in when we feel the need to deny difficult situations, and many have found online therapy can help with feeling disconnected. In some cases, however, symptoms of being detached or disconnected from oneself or one’s surroundings can indicate the presence of a psychological condition known as a dissociative disorder.

Dissociative disorders are mental disorders that cause an affected individual to experience a disconnection from their thoughts, surroundings, memories, actions, and/or identity. Some people report feelings like their head is wrapped in cotton, emotional instability, or having ongoing feelings of being separated from others by a glass wall. Recurring episodes of these symptoms call for seeing a therapist.

The escape from reality that is characteristic of dissociative disorders is involuntary. Dissociative disorders are listed in the manual of mental disorders and recurrent episodes can lead to difficulty functioning in everyday situations and life.

What Causes Dissociative Disorders?

Dissociative disorders usually develop as a person’s way of coping with trauma. Although the symptoms of a dissociative disorder may occur for the first time after childhood, they most often occur in individuals who were exposed as children to long-term abuse or repeated trauma. In the case of trauma, depersonalization symptoms often manifest after severe trauma including severe emotional abuse.

Because personal identity is generally formed during childhood, children find it easier to disconnect from reality. If left untreated, a child who develops a dissociative disorder may continue to use the same coping mechanisms in response to stressful situations during early adulthood or even later.

Types of Dissociative Disorders

According to the American Psychiatric Association, there are three primary categories of dissociative disorders: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder.

Dissociative Identity Disorder

Dissociative identity disorder, once referred to as multiple personality disorder, is generally believed to be the result of abuse, neglect, or other ongoing traumatic experiences that occurred during childhood. An estimated 90 percent of people with dissociative identity disorder are thought to have experienced childhood physical or sexual abuse or lived in conditions of extreme neglect. Severe trauma has a major impact on a child’s brain and as the brain develops through early adulthood and can cause dissociative identity disorder and disrupt other mental processes.

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available. Call 1-800-799-SAFE (7233) or Text "START" to 88788. You can also use the online chat.

Dissociative identity disorder is characterized by the existence of two or more distinct personalities or identities experienced by one individual. Each identity, or alter, has its own characteristic behaviors, preferences, memories, attitudes, and style that are observable by others. A person with dissociative identity disorder may shift from one identity to another when triggered by some sort of stress. The shift is generally sudden and involuntary.

When one has dissociative identity disorder, they may experience difficulty concentrating and gaps in memory. Because of the instability of their behavior, they may experience problems at work or school. They often experience problems with interpersonal relationships and may have a variety of additional symptoms related to mental conditions ranging from mild to severe.

Dissociative Amnesia

Dissociative amnesia refers to the inability to recall information related to past events. Like other types of dissociation, dissociative amnesia is usually caused by feelings that manifest over a stressful or traumatic event. The onset of symptoms can occur suddenly, and they may last from just a few minutes to several months or years. Episodes may occur sporadically throughout an affected person’s life. 

People with dissociative amnesia may experience amnesia that is localized (involving a specific event or period of time), selective (involving specific aspects of personal history or identity), or generalized (involving a complete loss of life history or identity).

Depersonalization-Derealization Disorder

This type of dissociative disorder involves the existence of depersonalization, derealization, or both persistently or repeatedly over time.

According to Cleveland Clinic, depersonalization/derealization disorder can be a sign of another condition such as a seizure disorder, brain disease, or one of several psychiatric disorders.

Depersonalization means feeling detached from one’s own body or disconnected from one’s thoughts, feelings, and experiences. Depersonalization disorder is listed in the statistical manual of mental health disorders as a mental illness.

In addition, a person with depersonalization disorder may experience:

• Feeling as though they are an audience to their thoughts, experiences, and feelings as if someone else is living their life;
• Feeling mechanical, automated, and robotic, sometimes to the point of feeling like they aren't in control of their own actions;
• Disturbance in self-perception (this may be confusion about one’s personality or physical state of being);
• A heightened awareness of what is around them;
• Emotional numbness;
• Detachment from and lack of emotion associated with memories, that may cause them to question whether those memories are real or even their own.

Derealization involves feelings of not living in reality or being disconnected from one’s surroundings. People and things that would otherwise seem familiar may be perceived as imaginary or two-dimensional. A person with derealization disorder may describe feeling as though they are watching their life as if it were in a movie rather than living it directly.

Derealization symptoms may start in early childhood, but the average age of onset is 16 years old. An individual with derealization disorder may experience:

• Feeling like they’re living in a movie;
• Disconnection from others, especially emotionally;
• Perceiving their surroundings as blurry or unreal; alternatively, some people report that they feel like all their senses are heightened and they are extremely aware of where they are;
• An impaired sense of time, such as feeling like recent events, conversations, or experiences happened in the distant past;
• A sense of “going crazy.”

Causes and Risk Factors

Depersonalization and derealization are symptoms of several mental illnesses, which can make it difficult to pinpoint their exact cause. However, there is often a correlation between depersonalization-derealization disorder and trauma. Individuals who have encountered neglect or abuse, be it physical, sexual, or emotional, are at higher risk of developing either depersonalization-derealization disorder itself or a mental disorder that includes its symptoms. The Merck Manual states that depersonalization/derealization disorder may be triggered by severe stress. Environmental factors, sights, smells, sounds, and touches or a natural disaster may also trigger episodes of depersonalization or derealization.

Both depression and anxiety are associated with depersonalization and derealization. In the case of anxiety, derealization is more prevalent. Derealization symptoms occur when the mind is overly stressed and attempts to tune out the rest of the world so an individual can cope. This means that when someone is having feelings of anxiety or a panic attack, their surroundings become foreign to them while their brain tries to deal with the stress of the situation. While this solution may work short term, it can be extremely distressing in the longer term and cause impairment. Repeated panic attacks can manifest as a panic disorder, which is also listed in the diagnostic and statistical manual of mental health disorders.

Finally, depersonalization and derealization may result from the use or withdrawal of alcohol or drugs. 

Presently it is unclear whether genetics may contribute to the development of depersonalization-derealization disorder. However, there is some evidence to support that changes in the chemical structure of the brain and hormonal changes or imbalances may increase a person’s risk of developing the disorder. 

Diagnosis

According to the statistical manual, to be diagnosed with depersonalization-derealization disorder, an individual must experience persistent feelings of disconnectedness or dissociation, and it must interfere with or significantly affect the social or occupational functioning that is necessary for daily living. 

Depersonalization-derealization disorder symptoms can be similar to symptoms associated with medical conditions or the side effects of medications, substance use, or substance withdrawal. Therefore, a thorough physical examination, including laboratory and diagnostic tests, should be performed to rule out the presence of any such state or condition.

Once physical illness or the effects of a medication or substance is ruled out, a diagnosis of depersonalization or derealization can be made by a psychologist, psychiatrist, clinical social worker, or other qualified mental health professional.

Treatment

Treatment for depersonalization-derealization disorder may involve talk therapy, which is also called psychotherapy, and/or medication. Cognitive behavioral therapy, which is a type of psychotherapy, may be helpful in treating the condition. Cognitive behavioral therapy involves teaching clients to challenge negative thoughts and faulty beliefs, resulting in healthier behaviors and symptom reduction. Other types of therapy may include the following:

• Family Therapy helps individuals cope with their disorder while also educating family members about it. This type of therapy is effective because it helps the client feel supported by people in their life who not only understand what they're going through but also have tools to help them.
• Creative Therapy involves using a creative outlet such as art, music, or writing to cope with one's disorder.
• Clinical Hypnosis uses a deep relaxation state to help clients address issues related to their disorder.

Individuals who need education or support about dissociative disorders can contact the National Alliance on Mental Illness (NAMI) which offers support groups and educational programs for people living with the disorder and their loved ones. The NAMI site complies with privacy regarding personally identifiable information about you.

Although there is no medication that specifically treats or cures dissociative disorders, there are medication options that may help reduce or manage symptoms. However, it is important to keep in mind that individuals respond to medications differently, and some medications can have unpleasant side effects. Therefore, any use of medication should occur only under the supervision of a medical professional. 

The American Psychiatric Association notes that many people are successful in the treatment of dissociative identity disorder, and the main treatment for the disorder is talk therapy.

Finally, even without treatment, depersonalization-derealization disorder can resolve once stressors are effectively dealt with.

Seeking Care For Yourself

Additionally, if traumatic flashbacks are present, and are overwhelming or associated with unsafe behavior, it’s important to seek emergency care. 

A primary care provider will perform a physical assessment, gather personal and family history, and may order lab work or other tests to rule out other health conditions. A mental health professional, such as a psychiatrist or psychologist, will perform a mental health evaluation to determine what symptoms are present and will recommend treatment to manage symptoms. 

Mental health care may include individual and/or family therapy, psychosocial support, and the monitoring of any medications that may be prescribed. Some people prefer to develop an in-person relationship with a therapist and/or psychiatrist. Others are more comfortable with an approach that allows them to experience counseling in a more relaxed personal setting. For the latter group, online counseling is a great option.

Online counseling services, such as BetterHelp, offer access to licensed, experienced therapists when and where it is most convenient for you. You can talk on the phone or chat online with professionals who can develop a plan of care tailored to your specific need. The most important thing to remember is that you are not alone. There are resources to help you learn to manage symptoms and live without major disruptions in your daily life.

Cognitive Behavioral Therapy for Depersonalization-Derealization Disorder

In a small study, 21 participants with depersonalization disorder were treated with cognitive behavioral therapy (CBT). The therapy focused on helping participants reinterpret their symptoms in a nonthreatening way and reduce avoidance, safety behavior, and symptom monitoring. At both post-treatment and six-month follow-up, patients reported significant improvement in the severity of their depersonalization-derealization. In addition, significant improvements were found in standardized measures of dissociation, depression, anxiety, and general functioning at both points. Finally, at the end of treatment, 29 percent of participants no longer met the criteria for depersonalization disorder.

The Benefits of Online Therapy

As discussed above, cognitive behavioral therapy can help with depersonalization and derealization. But when you experiencing depersonalization or derealization, attending in-person sessions can be challenging especially if you’re living with prolonged depression. This is where online therapy comes in. You can access BetterHelp’s platform from the comfort and privacy of your own home. In addition, online therapy offers lower pricing than in-person therapy because online therapists don’t have to pay for costs like renting an office. BetterHelp’s licensed therapists have used cognitive behavioral therapy to help people with depersonalization, derealization, and other disorders including anxiety and depression. Read below for some reviews of BetterHelp therapists from people experiencing similar issues.

Counselor Review

Dina is wonderful. She listens, cares, and remembers. She’s helped me deal with anxiety tremendously and I’m so glad we were connected with each other.

Commonly Asked Questions

What triggers derealization?

Derealization is usually an involuntary response to a traumatic event, abuse, or neglect. 

Do I have depersonalization disorder?

Only a mental health professional can give a definitive diagnosis of depersonalization or derealization disorder.  If you are experiencing symptoms similar to those mentioned in this article, such as feeling disconnected from yourself or your environment in a way that is consistent and uncontrollable, it is recommended to schedule an appointment with your primary care provider or a mental health professional for an assessment.

How is Depersonalization-Derealization Disorder treated?

Treatment may include psychotherapy, medication, or a combination of both. A consultation with an experienced mental health professional can help in getting an accurate diagnosis and establishing a treatment plan.

What are the symptoms of depersonalization-derealization disorder?

Persistent feelings of being unattached or disassociated from oneself or one’s environment, an inability to recall events related to a traumatic event and feeling as though you are “outside of yourself” or watching your life as if in a movie are all common symptoms associated with depersonalization-derealization disorder. Other symptoms include negative feelings, significant distress, and physical numbness.

How can you fix derealization?

Although there is not a definitive “fix” or cure for derealization, talk therapy, including cognitive behavioral therapy, and medication may be effective methods to manage its symptoms. In addition, accepting rather than fighting the condition can help it resolve.

Can derealization be permanent?

While not everyone experiences life-long symptoms, some people may experience periods throughout their lives when symptoms of derealization reappear. These periods are often in response to a new or worsening stressor or memory.