Depersonalization-Derealization Disorder: What To Expect, Symptoms, And Treatment
By Sarah Fader
Updated December 17, 2018
Reviewer Kay Adkins, LPC
Although there is quite a lot of overlap, there is a difference between depersonalization and derealization. Because of this overlap many medical professionals combine the two.
Depersonalization is defined as feeling as though one is detached from themselves, like a disconnection from their thoughts, feelings, and experiences. Many have described this to feel like dreaming, only their lives are a constant dream. This difficulty in differentiating what is and isn't real is the bulk of what derealization is. However, a common sign of derealization includes the feeling of going crazy, which can be attributed to the loss of one's grip on reality.
When merged, depersonalization-derealization disorder is a combination of the feeling of dreaming, detachment from one's body, and a loss of reality, as well as the consistent feeling of watching oneself live their life.
In addition to sensations of constant dreaming and detachment from oneself, the most common symptoms of depersonalization are as follows:
- Feeling as though you are an audience to your thoughts, experiences, and feelings as if someone else is living your life
- Feeling mechanical, automated, and robotic, sometimes to the point of feeling like you aren't in control of your actions
- Distortion of oneself, whether that be in regard to one's personality or physical state
- Numbness to events and feelings that surround you
- Detachment from memories and lack of emotion associated with memories, sometimes causing one to question whether these memories are real, or even their own
On the other side of the spectrum, derealization is primarily a wavering grip on reality; however, it can also include these symptoms:
- Feeling like you're living in a movie
- Disconnection from others, especially emotionally or in a relationship setting
- Surroundings appear to be blurry or unreal; alternatively, some people report that they feel like all of their senses are heightened, and they are extremely aware of where they are
- Impaired sense of time, such as feeling like recent events, conversations, or experiences happened in the distant past
- Feeling of going crazy
Causes And Risk Factors
Depersonalization and derealization can be possible symptoms for other mental illnesses, which can make it difficult to pinpoint the exact cause of its onset. However, there is often some correlation between depersonalization-derealization disorder and trauma. Individuals who have encountered any neglect or abuse, whether that be physical or emotional, can be at much higher risk of developing either depersonalization-derealization disorder itself or a mental disorder that can lead to the symptoms.
Depression and anxiety can each cause a patient to experience depersonalization and derealization. In the case of anxiety, or panic disorder, derealization is much more prevalent. Derealization occurs when the mind is overly stressed in attempts to tune out the rest of the world so that an individual can cope. This means that when a patient is having a panic or anxiety attack, their surroundings become foreign to them while their brain tries to cope with the stress of the situation. While this may work on a short-term basis, it can cause someone to continue to feel like their surroundings are unreal or that they are in a dream.
While depersonalization and derealization can each manifest from another mental illness, there are other possible causes of onset:
- Tendency to avoid or deny problems, usually deriving from a patient's personality or faulty coping mechanisms
- Trauma, whether that be from childhood abuse or experiencing a traumatic event at any point in one's life (PTSD can also cause depersonalization/derealization)
- Stress from life events or situations, such as financial problems or work-related pressure
- Using drugs can trigger episodes of feeling as though you're living in a dream or an unreal world
Just like any other mental illness, other factors are often ruled out before an individual can be diagnosed with depersonalization-derealization disorder. However, dissimilar to many mental disorders, doctors will often conduct a physical exam before moving on to any mental examination. This is because of the unique symptoms that come along with depersonalization and derealization. Each can be a side effect of certain medications, as well as a symptom of some physical ailment. Of course, there is also the possibility of drug use, which can cause episodes of depersonalization/derealization.
If physical illnesses and medication side effects are ruled out, the patient will be able to move on to meet with a psychologist, psychiatrist, or other mental health care official to determine their disorder or illness. This is usually done through interviewing the patient and using other assessment tools to understand what is happening to the individual and what kind of treatment options are available to them.
A combination of therapy and medication is usually the best course of action when it comes to treating depersonalization-derealization disorder. However, just like all mental illnesses, the treatment plan for an individual can vary according to the patient's unique needs. It's crucial that someone diagnosed with depersonalization-derealization disorder, or another illness that causes these types of episodes, to have a treatment plan that works for them. If treatment isn't tailored to a patient's needs, it could be just as detrimental as not seeking treatment at all. Regarding therapy, here are the most common forms of treatment for those who experience episodes of depersonalization-derealization:
- Psychotherapy is a broad term for different types of therapy involving recognizing psychological conflict and finding solutions for them, whether this be unhealthy coping mechanisms, unconscious issues, or other problems.
- Family Therapy helps the individual cope with their disorder while also educating family members about it. This is effective in that it assures that the patient has people in their life who understand what they're going through, as well as have tools to help their loved one.
- Creative Therapy involves using some creative outlet as a way to cope with one's disorder beneficially and constructively. This can involve a therapist.
- Clinical Hypnosis is a more unorthodox treatment method that uses hypnosis to allow a patient to explore their minds, usually in an attempt[s] to understand what is causing their disorder to manifest.
Most psychiatrists will more than likely prescribe some antidepressant or anti-anxiety medication. However, some are bound to work better than others. Although they may not treat the disorder itself, many medications can aid a patient regarding symptoms like anxiety, depression, and obsessive behaviors. Here are some medications that doctors have found to be more effective when treating depersonalization and derealization:
- Fluoxetine is a serotonin reuptake inhibitor that primarily focuses on decreasing levels of depression, but studies have shown that it has been fairly effective in combatting anxiety as well.
- Clomipramine is classified as a tricyclic antidepressant that has been proven to help patients with depression and obsessive behaviors, as it has also been used to treat obsessive disorders like OCD.
- Lamotrigine is an anticonvulsant that is often used by psychiatrists to treat epilepsy and bipolar disorder. However, studies have shown that it can be a very effective mood stabilizer, which can be extremely helpful for a patient; this success is probably why it's one of two drugs that have been approved by the FDA to treat depersonalization-derealization disorder.
- Naloxone is an antagonist that has been found to treat many symptoms attributed with depersonalization-derealization disorder, even though it's traditionally used for opiate overdose.
- Naltrexone is just like naloxone in that it is usually used for opiate overdose; however, it's been proven to be even more effective.
Coping Alone - How To Ground Yourself
Although seeking treatment is the best course of action, patients with depersonalization-derealization disorder should be readily equipped with coping mechanisms to help bring themselves back to reality when an episode occurs. This is helpful because a therapist or psychiatrist isn't always around to help an individual come back to reality, so these coping mechanisms are important to have and understand. Here are some effective ways to help a patient become more aware of where they are, with the goal of helping them break the cycle of their episode:
- Touch something that can be identified by your senses. Something warm or cold is recommended but touching something that's soft can also be comforting as well as grounding.
- Pinch yourself, just like if you were in a dream. Be careful not to harm yourself, as that's completely counterproductive. Just pinch yourself enough to remind yourself that you are real and the world around you belongs to you.
- Find an object in the room, possibly something comforting and familiar. Describe it as much as possible with everything you know about it - this can help to remind yourself that you know where you are and you are aware of your surroundings.
- Find objects in the room and count them.
- Keep your eyes moving, and your brain stimulated. Otherwise, you may find yourself focused on one thought and start to feel disconnected.
- Try to remember that you aren't going crazy, that this is just a symptom. Disorders and symptoms aren't an ingrained part of you, you are your person, and things will get better with time and coping.