Depersonalization-Derealization Disorder

What does depersonalization-derealization disorder look like?

There are a variety of reasons why a person might feel temporarily disconnected from themselves or their surroundings, or they might experience the sensation of being “in a daze”. Fatigue, illness, stress, depression, medication side effects, and alcohol—even in small amounts—can cause these feelings, which may resolve without a visit to a doctor. Passing feelings aren’t always a cause for concern. In some cases, however, those symptoms may indicate the presence of a psychological condition known as a depersonalization-derealization disorder (DDD), a type of dissociative disorder.

Those experiencing DDD may have a persistent or recurring feeling of detachment from their body or disconnection from their thoughts, mental processes, feelings, and experiences (depersonalization). Feelings of living “outside of reality” or being disconnected from one’s surroundings (derealization) are also common symptoms. These ongoing feelings of disconnection are involuntary and may intensify during times of stress. While anyone may experience these briefly from time to time or during a traumatic event, those with depersonalization-derealization typically do so frequently or to such a great degree that it significantly interferes with their lives. Recurrent episodes of these disorders may lead to stress and difficulties with daily functioning.

Many experts have considered depersonalization-derealization disorder as having two main components: depersonalization and derealization (hence its name.) Each of these components has its own distinct set of symptoms, but both must be experienced to fit a diagnosis for this disorder. 

The symptoms of depersonalization

Individuals experiencing depersonalization may:

• Feel like an audience to their own thoughts, experiences, and feelings, as if someone else is living their life
• Feel mechanical, automated, and robotic, sometimes to the point of feeling like they aren't in control of their own actions
• Have disturbances in self-perception, such as confusion about one’s personality or physical state of being
• Have a heightened awareness of surroundings
• Feel detached, with a sense of emotional or physical numbness
• Find that memories lack emotion or question whether their own memories are real 

The symptoms of realization

People experiencing derealization complications, episodes, or symptoms may:

• Feel like they’re living in a movie or trapped by a glass wall
• Feel disconnected from others, especially emotionally
• Perceive their surroundings as not reality; or, alternatively, feel like all their senses are heightened, like they are extremely aware of where they are
• Have an impaired sense of time

Finally, anxiety is a prevalent symptom of depersonalization-derealization as well. It often occurs when the mind is overly stressed and attempts to detach from the rest of the world as a coping mechanism. This means that when someone is experiencing the negative feelings associated with anxiety or the onset of panic attacks, their surroundings become foreign to them while the brain tries to process the stressful situations. 

What causes it?

While some people fear that depersonalization-derealization is caused by irreversible brain damage, depersonalization and derealization may be symptoms of a few different mental health disorders, or they may be classified as a disorder on their own. This means it can be difficult to pinpoint their exact cause. However, there is often a strong correlation between these symptoms and serious trauma in someone’s early or middle childhood, especially when it involves physical abuse. Individuals who experienced or were exposed to neglect or abuse as children—whether that be physical, sexual, or emotional abuse—are at higher risk of developing either DDD or other mental disorders that include its symptoms. 

Many mental health professionals believe that because personality traits and personal identity are generally formed in childhood and rooted in childhood trauma, children often find it easier to disconnect from reality during difficult situations, severe trauma, or in times of abuse or severe emotional stress as a coping mechanism. If left untreated, a child who develops depersonalization-derealization disorder may continue to use the same coping mechanisms in response to abuse, severe stress, or traumatic situations during early adulthood, or even later.

Depersonalization and derealization may also be signs of other mental health conditions, especially serious depression, anxiety, post-traumatic stress disorder (PTSD), or personality disorders. It may also occur because of drug misuse or withdrawal from chronic alcohol use. An individual might turn to unhealthy coping methods to manage extreme stress from a negative emotional experience, which may make symptoms worse.

Can it be genetic?

In addition, PTSD may also lead to symptoms that are often associated with dissociative disorders, such as feeling emotionally disconnected. The specific subtype of PTSD that can be confused with depersonalization-derealization disorder is referred to as DS-PTSD, in which an individual may experience depersonalization or derealization symptoms. For example, being exposed to life-threatening danger and experiencing serious stress may bring about depersonalization symptoms to help a person cope with significant distress.

How can DDD be diagnosed?

According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), to be diagnosed with depersonalization-derealization disorder, an individual must experience ongoing or serious feelings of disconnectedness or dissociation, and they must interfere with or significantly affect the social or occupational functioning that’s necessary for daily living. 

The symptoms of this disorder can be similar to those associated with certain medical conditions or the side effects of medications, substance use, or substance withdrawal. That’s why a thorough physical examination—including laboratory and diagnostic tests—is usually performed to determine if other conditions are at play or if it’s likely depersonalization-derealization disorder.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

After that, a psychologist may administer a questionnaire and otherwise interview the patient to gather information about their personal history and experience. They’ll likely also consult the DSM-5 to verify that the individual meets the criteria for behaviors that indicate depersonalization or derealization. Once a diagnosis is made, the mental health professional will develop and propose a treatment plan.

How is DDD treated?

The main treatment plan for depersonalization-derealization disorder may involve psychotherapy and/or medication. One of the most popular treatments for the disorder is cognitive behavioral therapy (CBT). 

In one small study, 21 participants with the disorder were treated with CBT. The therapy focused on helping them reinterpret their symptoms in a non-threatening way and reduce avoidance. At both the post-treatment and six-month follow-ups, patients reported significant improvement in the severity of their depersonalization-derealization episodes. In addition, there was a major relationship between significant improvements and standardized measures of dissociation, depression, anxiety, and general functioning at both points. By the end of treatment, 29% of participants no longer met the criteria for depersonalization-derealization disorder.

Other types of therapy used to treat this disorder may include:

• Family therapy, which can help individuals cope with their disorder while also educating their family about it. This type of therapy can be effective because it may help the client feel supported by people in their life once they’re made to understand what they’re going through and are equipped with tools to help.
• Creative therapy involves using a creative outlet such as art, music, or writing to cope with symptoms.
• Clinical hypnosis induces a deep state of relaxation to help clients address issues related to their disorder.

There are also certain techniques that can help with certain symptoms of depersonalization-derealization, like dissociation. One example would be moment-to-moment tracking, which involves identifying when you are having dissociative feelings and choosing to focus on what is actually occurring at that moment. This method can be used in a therapeutic setting to help a person better understand their specific experience with dissociation and this disorder.

Finding a therapist

CBT is one of the most common types of therapy practiced today. That means you’re likely to have a variety of options to choose from when seeking out a provider if you suspect you have depersonalization-derealization or other mental health disorders. First, decide whether you’d like to meet with a mental health professional in person or virtually. While in-person therapy is the traditional treatment model, research now suggests that online therapy can offer similar benefits in most cases. If you’re in an area where locating an in-person provider is difficult, you don’t have reliable transportation to get to appointments, or you simply prefer the convenience of attending talk therapy from the comfort of home, virtual sessions may be worth considering.