Understanding Depersonalization-Derealization Disorder

There are a variety of reasons why a person might feel temporarily disconnected from themselves or their surroundings, or experience the sensation of being “in a daze”. Fatigue, illness, stress, medication side effects, and alcohol—even in small amounts—can cause these feelings, which may resolve without cause for further concern. In some cases, however, those symptoms may indicate the presence of a psychological condition known as a depersonalization-derealization disorder (DDD).

What Is Depersonalization-Derealization Disorder?

Recurrent episodes of these disorders may lead to difficulties with daily functioning.

Those experiencing depersonalization-derealization disorder may have feelings of detachment from their body or disconnection from their thoughts, feelings, and experiences (depersonalization). Feelings of living “outside of reality” or being disconnected from one’s surroundings (derealization) are also common symptoms. These feelings of disconnection are involuntary and may intensify during times of stress. While anyone may experience these briefly from time to time, those with DDD typically do so frequently and/or to such a great degree that it significantly interferes with their lives.

Symptoms Of DDD

As mentioned, this disorder has two components: depersonalization and derealization. Symptoms of each are distinct, but both must be experienced to fit a DDD diagnosis. 

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 emotional numbness

• Feel a detachment from and a lack of emotion associated with memories, which may cause the individual to question whether those memories are real or their own

Symptoms Of Derealization

Individuals experiencing derealization may:

• Feel like they’re living in a movie

• Feel disconnected from others, especially emotionally

• Perceive their surroundings as blurry or unreal; 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 DDD 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 feelings of anxiety, or a panic attack, their surroundings become foreign to them while the brain tries to process the stress of the situation. 

What Causes This Disorder?

Depersonalization and derealization may be symptoms of a few different mental illnesses, or they may be classified as a disorder (DDD) 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 past trauma. Individuals who experienced or were exposed to neglect or abuse as children—whether physical, sexual, or emotional—are at higher risk of developing either depersonalization-derealization disorder or another mental disorder that includes its symptoms. 

Many mental health professionals believe that because personal identity is generally formed during childhood, children often find it easier to disconnect from reality during times of abuse or extreme 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 stressful situations during early adulthood, or even later.

According to Cleveland Clinic, depersonalization and derealization may also be signs of another condition like a seizure disorder, brain disease, or one of several psychiatric disorders. It may also occur because of the use of or withdrawal from alcohol or drugs. The Merck Manual states that depersonalization/derealization disorder may be triggered later in life by severe stress. Certain environmental factors, sights, smells, sounds, touches, or an event like a natural disaster may also trigger episodes of the disorder. Finally, both depression and anxiety are associated with symptoms of depersonalization and derealization.

How Is DDD Diagnosed?

According to the DSM-5, to be diagnosed with depersonalization-derealization disorder, an individual must experience persistent 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 first to rule out any of these.

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 the disorder. Once a diagnosis is made, the mental health professional will develop and propose a treatment plan.

How Is DDD Treated?

Treatment 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, significant improvements were found in 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 disorder.

Other types of therapy used to treat for depersonalization derealization 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, which involves using a creative outlet such as art, music, or writing to cope with symptoms.

• Clinical hypnosis, which induces a deep state of relaxation to help clients address issues related to their 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 DDD or another mental health condition. 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 contact to reliable transportation to get to appointments, or you simply prefer the convenience of attending therapy from the comfort of home, virtual sessions may be worth considering. 

With an online therapy platform like BetterHelp, for instance, you can get matched with a licensed therapist based on your answers to a brief questionnaire, and you can then meet with them via phone, video call, and/or online chat. For many individuals, this format can be more reachable and comfortable than traditional methods. Read on for a client review of a BetterHelp counselor.

Counselor Reviews

“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.”

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.