Depersonalization-Derealization Disorder: What It Feels Like (2024)

Depersonalization-derealization disorder (DPDR) is a mental disorder that causes you to feel detached from your body, thoughts, and environment. There are two facets of DPDR known as:

• Depersonalization: The detachment from your own mind and body, making you feel as if you are an "observer" of yourself
• Derealization: The detachment of the external world, causing you to perceive the world around you as unreal, dream-like, distorted, or surreal

DPDR is a type of dissociative disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) issued by the American Psychiatric Association. It affects up to 2% of the general population, mostly as a result of a past traumatic event. Up to half of those with DPDR report being the target of abuse, including child abuse or domestic violence.

This article describes the causes and characteristics of depersonalization-derealization disorder, including how it is diagnosed and treated.

Depersonalization-Derealization Disorder Symptoms

Depersonalization and derealization are symptoms that can be experienced as part ofa dissociative disorder. Depersonalization and derealization are separate experiences. You may experience one of these more profoundly than the other, but they typically occur together in DPDR.

With depersonalization/derealization, there's the sense that you're watching your life in the same way as watching a movie. Some people refer to it as an "out-of-body experience."

Depersonalization means feeling like you are outside of your body or mind. Derealization means feeling like what is around you is not real.

Depersonalization symptoms can include:

• Feeling disconnected from your body, feelings, and mind
• Feeling outside your body and observing your life
• Not being able to describe your emotions
• Feeling numb
• Feeling like a robot
• Feeling like you cannot control what you say or do
• Having memory problems
  

Derealization symptoms can include:

• Feeling disconnected from your environment
• Thinking the world is not real
• Feeling "like a glass wall" separates you from the world
• Having distorted vision, such as seeing blurry, colorless, and unusually small or large objects
  

DPDR symptoms usually last for a few minutes but can persist for hours or days and may recur intermittently for years.

How Depersonalization-Derealization Disorder Is Diagnosed

The average age of onset for DPDR is 16 years with the majority of cases being diagnosed before age 20. According to one study, 72% of those diagnosed with DPDR have another mental health disorder; anxiety and depression are the most common.

According to the DSM-5, to be diagnosed with DPDR, a person must have:

• Constant or recurring episodes of derealization, depersonalization, or both
• Are able to maintain contact with reality during these episodes
• Significant distress or impairment in areas of functioning
  

Before making a diagnosis, a healthcare provider will want to rule out medical conditions like brain trauma, stroke, brain infections (like bacterial meningitis), or neurodegenerative disorders (like Alzheimer's disease and Lewy body dementia) that can cause similar symptoms.

The tests may include:

• Blood tests
• Urine tests
• Brain MRI or CT scan
• Electroencephalogram (EEG)

The healthcare provider will also want to exclude other mental disorders with similar symptoms but different methods of treatment, such as:

• Dissociative identity disorder (DID): A condition, previously known as multiple personality disorder, in which a person experiences two or more distinct personality states or identities
• Dissociative amnesia: A mental disorder in which you have difficulty recalling important information about yourself and your life
• Psychotic disorders: A group of conditions like schizophrenia and schizoaffective disorder in which a person experiences hallucinations, delusions, and a detachment from reality
  

What Causes Depersonalization-Derealization Disorder?

The exact cause of DPDR is unknown, but it is thought to be related to a past trauma that causes a person to be subconsciously detached from themselves and/or the world around them. By "muting" these perceptions, a person can distance themselves from events that trigger memories or sensations of the trauma.

DPDR commonly occurs in people with post-traumatic stress disorder (PTSD) and may be induced by highly stressful situations like:

• War
• Child abuse
• Sexual abuse or rape
• A violent attack (including domestic violence)
• Having a parent with mental illness
• A natural disaster
• A traumatic accident
• The sudden or traumatic death of a loved one

There are other things that can cause or contribute to DPDR, including:

• Taking illicit drugs, such as hallucinogenic drugs
• Sleep deprivation
• Certain types of epilepsy, such as absence seizures
• Other mental disorders, including major depression or panic disorder
• Vestibular disorders that affect your body's orientation in space
• A dysfunctional prefrontal cortex (the part of the brain that helps form emotional responses and sensations)
  

How Is Depersonalization-Derealization Disorder Treated?

It is possible to make a complete recovery from DPDR. Some people do so on their own without treatment. Other people benefit from taking medications or having psychotherapy.

Medications for DPDR

There is no specific medication to treat DPDR, but your provider may prescribe medications to help with your symptoms or related conditions like depression, anxiety, or panic attacks.

Examples of medications that can help someone with DPDR include:

• Antidepressants like Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram)
• Anxiolytic (anti-anxiety) medications like Klonopin (clonazepam) and Diastat (diazepam)
• Anticonvulsants like Lamictal (lamotrigine)
  

Psychotherapy for DPDR

Psychotherapy is a common treatment for depersonalization-derealization disorder. The focus is to eliminate underlying stresses that caused the condition and to help people feel "grounded" in their experiences.

Psychotherapy options include:

• Cognitive behavioral therapy (CBT): A type of talk therapy used to identify and change non-beneficial thought patterns
• Psychodynamic therapy: A kind of talk therapy that focuses on unconscious processes that inform behaviors so that you can change them
• Eye movement desensitization and reprocessing (EMDD): A type of talk therapy in which you move your eyes while processing traumatic memories to remain "in the present"
• Dialectical behavior therapy (DBT): An evidence-based type of talk therapy that helps individuals regulate intense emotions and change maladaptive behaviors.

Coping with Depersonalization-Derealization Disorder

If you are experiencing symptoms of DPDR, there are some strategies that can help you feel more connected to yourself and reality. These include:

• Gently pinching your skin to feel more connected to your body
• Taking slow, deep breaths while focusing on the movement of your chest and diaphragm
• Calling a friend and having them talk to you to help you feel more connected with reality
• Keeping your eyes moving around your surroundings to prevent zoning out
• Practicing meditation to increase your awareness of your experience
• Looking around at your surroundings and counting the objects you see, saying their colors aloud, or naming objects
  

Summary

Depersonalization-derealization disorder (DPDR) is a mental health condition that makes you feel disconnected from your body, thoughts, and environment. Some people experience DPDR after going through trauma, from sleep deprivation, or because they are genetically predisposed to the condition.

Some people with DPDR recover on their own and don't need help but if you have symptoms that you're having trouble managing, medications and psychotherapy can be effective.