What Is Depersonalization-Derealization Disorder?
Depersonalization-derealization disorder is an altered state of identity and self-awareness, resulting in a feeling of separation from oneself or one’s surroundings, or both. We call the feeling of separation from oneself as depersonalization. The feeling of separation from one’s surroundings is called derealization.
Such feelings can also occur briefly because of the side effects of medication, drugs, or some illness. We presume this disorder when these symptoms are frequent, cause distress, and interfere with the quality of one’s life.
Around 2% of people have this disorder. Nearly half of adults can have one dissociative episode in their lifetime. Women are more likely than men to experience this disorder. This disorder is more common in people who have had experiences of trauma. The principal treatment for depersonalization-derealization disorder is psychotherapy. But we also use medications.
Symptoms of Depersonalization-Derealization Disorder
Symptoms of depersonalization-derealization disorder usually begin in teenage or early adulthood. Symptoms can be sudden or gradual. The intensity of symptoms varies. Episodes can last hours to months. Episodes may involve only depersonalization, only derealization, or both.
Persistent and repeated episodes of this disorder cause distress and interfere with your functioning at school, work or in other areas of your life. During these episodes, awareness or insight is there that the sense of separation is not real. Worry about “going crazy” can make you preoccupied with checking that you exist and trying to determine what is real.
Anxiety and depression are common. Symptoms can be worsened by stress, new surroundings, and insomnia.
Symptoms of depersonalization include:
- Feeling detached from one’s body, thoughts, feelings, and/or sensations and that you are an outside observer of them — for example, feeling of floating above yourself
- Feeling like a robot or automaton, with no control over what you say or do
- A feeling of emotional or physical numbness of your senses
- Feeling that your body, arms or legs are distorted, shrunken or swollen, or that your head is wrapped in cotton
- A sense that your memories are without emotional content, and even that they may not be your own memories
Symptoms of derealization include:
- Feelings of being detached from or unfamiliar with your surroundings and the objects and other people in it—e.g., feeling as though one is watching events and activities unfold as in a movie or in a dream, rather than participating
- Feeling emotionally disconnected from people near and dear, as if a glass wall was separating you
- Surroundings appear distorted, blurry, colorless, two-dimensional, unreal or larger-than-life or cartoonish, or a heightened awareness of your surroundings
- Distortions in the perception of time, such as very recent events feeling like having happened in the distant past
- Feeling as though time is speeding up or slowing down
- Distortions of distance and the size or shape of objects
- Experiencing sounds as louder or softer than expected
Causes and Risk Factors
The exact cause of depersonalization-derealization disorder is unknown. Symptoms of depersonalization-derealization disorder may be related to childhood trauma or other severe emotional stress and trauma. The stress or trauma can include:
- Emotional abuse or neglect during childhood
- Physical abuse
- Witnessing a traumatic event or abuse, such as domestic violence
- Having had a severely impaired or mentally ill parent
- Severe stress, for example, because of relationships, finances or work-related issues
- The unexpected death of a loved one
- Having anxiety or depression
- Use of illegal or recreational drugs
However, in 25-50% of cases, stresses are relatively minor or one cannot identify.
DSM-5 lists the following diagnostic criteria for depersonalization-derealization disorder:
- The presence of persistent or repeated experiences of depersonalization, derealization, or both:
- Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s body, thoughts, feelings, sensations, or actions (e.g., altered perceptions, sense of speeding up or slowing down of time, emotional and/or physical numbness).
- Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
- During these experiences, reality testing remains intact.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not because of substance abuse, a medication, or another medical condition (e.g., seizures).
- The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
Treatment of Depersonalization-Derealization Disorder
Psychotherapy is the most effective treatment for depersonalization-derealization disorder. There are many types of therapy and techniques:
- Cognitive-behavioral therapy blocks obsessive thinking about feeling that things are not real and helps people get absorbed in certain tasks to distract them from the symptoms.
- Grounding techniques use the five senses to make people feel more connected to themselves and the world. For example, exposure to strong sensations such as loud music or a piece of ice in the hand. These sensations are difficult to ignore. It makes people more aware of the present moment because they feel connected to the sensation.
- Psychodynamic techniques focus on helping people work through conflicts and negative feelings that people tend to detach from.
- Moment-to-moment tracking (focusing on what’s happening at the moment) and labeling of dissociation and affect (the outward expression of emotions and thoughts) teaches people to recognize and identify their feelings of dissociation.
There are no specific medications for depersonalization-derealization disorder. Anti-anxiety drugs and antidepressants help if there is comorbid anxiety or depression.