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

By: Sarah Fader

Updated June 29, 2020

Medically Reviewed By: Kay Adkins, LPC

Source: pxhere.com

The Basics

If you ever experienced the feeling of being disconnected from yourself or your surroundings?  If so, it may have felt overwhelming or even frightening. 

There are times when it is normal for someone to experience sensations of being disconnected or “in a daze.”  Fatigue, illness, medication side effects and alcohol (even in small amounts) can cause these feelings.  In some cases, however, symptoms of being detached or disconnected from oneself or surrounds 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 between thoughts, surroundings, memories, actions, and/or their identity. The escape from reality that is characteristic of dissociative disorders is involuntary.  Dissociative disorders can lead to difficulty functioning in everyday situations.

What Causes Dissociative Disorders?

Dissociative disorders usually develop as a person’s way of coping with a trauma.  Although people of any age may experience a dissociative disorder, they most often occur in children who have been exposed to long-term abuse or repeated trauma.

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 mechanism in response to other stressful situations later in life. 

Types of Dissociative Disorders

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 typically believed to be the result of extremely traumatic experiences or abuse that occurred during childhood.  An estimated 90 percent of people with dissociative identity disorder are believed to have experienced childhood physical or sexual abuse or lived in conditions of extreme neglect.

Dissociative identity disorder is characterized by the existence of two or more distinct personalities or identities experienced by one individual.  Each identity has its own characteristic behaviors, preferences, memories, attitude and ways that are observable by others.  A person with dissociative identity disorder may shift from one identity another at any time.  The shift is generally sudden and is involuntary.

Difficulty with concentrating, gaps in memory concerning personal information, everyday events or traumatic events once experienced are common.  Because of the instability of behavior, it is not uncommon for people with dissociative identity disorder to experience trouble at work or school.  They often have poor relationship skills and may have a wide range of symptoms that range from minimal to quite significant.

Dissociative Amnesia

Dissociative amnesia causes an inability to recall information related to past events.  Like other types of dissociation, dissociative amnesia is usually related to significantly 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 (cannot remember a specific event or period of time), selective (cannot remember details of events related to a certain time period), or generalized (a complete loss of life history or identity).

Depersonalization/Derealization Disorder

This type of dissociative disorder involves depersonalization, derealization, or both existing in the same person over a long period of time in a recurring pattern.

Depersonalization is defined as feeling as though one is detached from themselves, like a disconnection from their thoughts, feelings, and experiences. The affected person may describe feeling as though they are watching their life as if in a movie, rather than it being a personal experience.

In addition to sensations of constant dreaming and detachment from oneself, a person with depersonalization disorder may experience:

• 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
• Disturbance in self-perception: this can be confusion about one’s own personality or physical state of being
• 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

Derealization disorder causes feelings of not living in reality or being disconnected from one’s surroundings.  People and things that would otherwise seem familiar to an affected person, may be perceived as imaginary.

Symptoms may start in early childhood, but the average age of one’s first experience is 16 years old and may include:

• 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 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 symptoms of depersonalization and derealization may occur in response to other types of mental illness, it may also be attributed to a person’s inability to cope with effectively with problems or stress, trauma from childhood, or the use of alcohol or drugs that effect thought and emotion. 

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

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The key factor in diagnosing depersonalization-derealization disorder is an individual must experience persistent feelings of disconnectedness or dissociation and it must interfere with or significantly affect social or occupational functions that are necessary for daily living. 

Because depersonalization-derealization disorder symptoms may be similar to symptoms associated with medical conditions or side effects of medications or substance use/abuse, it is likely that a thorough physical examination including laboratory and diagnostic tests will be performed to rule out the presence of any such disorder.

Once the presence or absence of physical illness or medication side effects is ruled out, appropriate treatment can be implemented, or a referral for a mental health evaluation and assessment can be provided.  A psychologist, psychiatrist, clinical social worker, or other qualified mental health professional can assess and determine if a diagnosis of depersonalization derealization disorder is appropriate.

Treatment

The treatment for depersonalization derealization disorder typically involves a combination of medication therapy and psychotherapy (talk therapy).  Cognitive behavioral therapy, which is a type of psychotherapy, may be helpful in treating the condition.  Cognitive behavioral therapy involves teaching patients to interpret their symptoms in ways that are not threatening and that promote calm regarding their mental state of mind.  Treatment options may include:

• 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, such as art, music, or writing, to cope with one's disorder.
• Clinical Hypnosis is a more unorthodox treatment method that uses hypnosis to allow a patient to explore their minds, usually in attempt[s] to understand what is causing their disorder to manifest.

Although there is not a medication that has been designated to treat or cure dissociative disorders, there are medication options that may help reduce or manage symptoms of the disorder.  Medications to help reduce stress or anxiety or to help promote healthy sleep patterns may be needed.  It is important to keep in mind that individuals respond to medications differently.  Therefore, any attempt to manage symptoms with the use of medications should be done under the supervision and recommendation of a physician and self-medicating is discouraged. 

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Coping with Depersonalization Derealization Disorder

Dealing with a disorder like depersonalization-derealization disorder can feel overwhelming or frightening.  Although some days may seem difficult, there are ways to cope and learn to manage symptoms.

Learn about the disorder.  Learning about any illness or disorder you are experiencing puts the power of change in your hands.  Ask your physician or mental health professional to provide you with information about the disorder.  Search online references or read a book about the disorder.  The more you know, the more control you will have over your own life.

Follow your treatment plan.  Seeking and early treatment and having a plan of care established is so important.  Keep follow up appointments, take medications as prescribed and discuss any concerns with your doctor or care team as soon as possible.

Stay connected.  Having a support group of people to rely on when you are feeling unsure or when symptoms are bothersome can help keep you grounded with reality.  It’s understandable that you may not feel comfortable talking with everyone about your disorder.  However, find a trusted friend or family member and explain to them why it is important to you to have their support.

Additionally, implementing simple techniques to bring your focus back to reality may be effective in relieving some symptoms of depersonalization derealization disorder.

• 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. Not the “leave a huge bruise” kind of pinch.  Just a nudge that is enough to remind you that you and your surroundings are real and not part of your imagination.
• 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 that you are familiar with 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 own person, and things will get better with time and coping.

SOURCES:

https://www.calmclinic.com/anxiety/symptoms/derealization

https://www.newsmax.com/fastfeatures/depersonalizationdisorder-disorderpersonality-depersonalizationsymptoms-disordertreatment/2010/10/15/id/373836/

https://www.webmd.com/mental-health/depersonalization-disorder-mental-health#2

https://www.psychologytoday.com/conditions/depersonalizationderealization-disorder

https://www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/symptoms-causes/syc-20352911

Frequently Asked Questions (FAQs)

What triggers derealization?

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

Do I have depersonalization disorder?

Only a mental health professional can give a definitive diagnosis of depersonalization 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 seems 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 medications, psychotherapy or a combination of both.  A consultation with an experienced mental health professional can be helpful in getting an accurate diagnosis and establishing a treatment plan.

What are the symptoms of depersonalization derealization disorder?

Persistent feelings of feeling unattached or disassociated from oneself or environment, an inability to readily recall events related to a traumatic event, 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. 

How can you fix derealization?

Although there is not a definitive cure that is associated with “fixing” derealization, medications, talk therapy and cognitive behavioral therapy are often effective methods of treatment used to manage the symptoms associated with depersonalization derealization therapy.

Can derealization be permanent?

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

What triggers depersonalization?

Depersonalization usually occurs in response to a traumatic event or long-term exposure to abuse or neglect.  Memories of the event, increased anxiety related to stressful life situations or changes in personal roles may also trigger depersonalization responses.

Why do I keep dissociating?

Dissociating is a coping mechanism that typically occurs in response to a traumatic event and a person’s inability to effectively cope with the trauma or its memory.  If you are experiencing ongoing symptoms of dissociation, it’s important to seek the help of a mental health professional to help address the root cause of the disorder and to help you establish a plan of care to help manage the disorder.

Can derealization be cured?

Although there is no known cure for depersonalization derealization disorder, many people find that treatment for symptoms can be effective in reducing symptoms and may lead to remission of the disorder.

Does anxiety cause depersonalization?

If anxiety is overwhelming and left unmanaged, it can cause symptoms of depersonalization.  While this does not happen in all cases of extreme anxiety, any symptoms of uncontrollable anxiety or depersonalization should be addressed with a mental health professional as soon as possible.

Is derealization a symptom of schizophrenia?

Mental health disorders, such as schizophrenia, may cause symptoms of derealization.  However, not everyone with a diagnosis of schizophrenia is diagnosed with derealization disorder.

Does derealization affect memory?

While derealization may temporarily affect a person’s concentration, it is not typically associated with memory loss or impairment.

How long does depersonalization last?

Depersonalization can last from a few minutes in rare cases to as many as several years in others.  The underlying cause of the disorder may determine how long a person is affected.  For example, someone who experienced trauma or abuse as a child may have symptoms longer than a person who is experiencing symptoms related to the use of drugs or alcohol misuse. 

Does alcohol or nicotine use cause depersonalization?

In some cases, people who use substances such as ketamine, alcohol, nicotine and hallucinogens may experience symptoms of depersonalization.

Can antidepressants cause depersonalization?

Antidepressants may intensify symptoms of depersonalization in some people.  Symptoms often appear worse in individuals who took antidepressants and then, after a period of being off of the medication, began a new regimen of antidepressant therapy.

What does dissociation feel like?

People with dissociative disorder often describe feeling separate from their body, as if they are floating in the air and unable to connect with any sensation that others would normally feel.  Many people report an inability to register the feeling of heat or cold or to recognize when they are hungry or tired. 

When to See a Doctor

If you can identify with any of the following, you should make an appointment with your doctor:

• You experience “beyond ordinary” forgetfulness, such as extensive gaps in memory associated with personal information or skills
• Your symptoms are causing problems or stress in your personal and/or professional life
• Your symptoms are not caused by a medical condition or the use of alcohol or drugs
• You are aware (or others observe) that you exhibit the presence of two or more personalities that relate differently to you and to the world around you.

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

A primary care provider will perform a physical assessment and 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 the necessary treatment to manage symptoms. 

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

Online counseling services, such as BetterHelp, offer access to licensed, experienced doctors, counselors and social workers 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, you are not alone.  There are resources to help you learn to manage symptoms and live without major disruptions in daily life.