Depersonalization/derealization disorder is an altered state of self-awareness and identity that results in a feeling of dissociation, or separation, from oneself, one’s surroundings, or both. Because it is normal to feel this way briefly and occasionally—due to side effects of medication, recreational drugs, or some other physical or mental health condition—depersonalization/derealization disorder is usually diagnosed only if such feelings of detachment frequently recur, cause anguish, and interfere with your quality of life.
People with this disorder will generally start showing signs in early childhood; symptoms rarely occur for the first time in adults over the age of 40. Depersonalization is a sense of experiencing your own behavior, thoughts, and feelings from a dreamlike distance. You may feel emotionally numb, or as if you are not controlling your own words and actions. You may also feel detached from ordinary sensations, such as touch, thirst, hunger, and libido. Derealization is a sense of distance from activities going on in the world outside of yourself. The world may even seem distorted and somewhat unrecognizable, as if objects are the wrong size or color, time is speeding up or slowing down, or sounds are louder or softer than expected.
The feeling of disconnection associated with depersonalization/derealization disorder is more akin to watching events and activities unfold in a movie or on a computer screen, rather than actually participating in what is going on around you. Episodes may last for hours or days at a time and recur for weeks, months, or even years. At all times, you are aware of both your inner thoughts and what is going on around you, so you are conscious of the fact that you feel detached from yourself and your surroundings. These episodes may cause extreme distress and make it difficult for you to function normally at work, in school, or in a social setting. It’s common for people with depersonalization/derealization disorder to fear that they don’t really exist, or that their symptoms are the result of irreversible brain damage.
Depersonalization/Derealization Disorder occurs with equal frequency in both men and women. A history of severe stress, neglect, or physical or emotional abuse can lead to depersonalization/derealization disorder. Any of these conditions can also trigger symptoms. Studies have shown that poor sleep quality is associated with more severe symptoms of dissociation.
Since depersonalizaton/derealization disorder often occurs with (and can be triggered by) other mental health problems, such as anxiety and depression, treatment can be difficult. For treatment to be successful, the therapist must develop an individual plan and ultimately address all symptoms and conditions. A close eye should be kept on whether the patient experiences any suicidal thoughts or impulses. Various psychotherapies can be helpful to those who suffer from the disorder, including cognitive and behavioral techniques, grounding exercises, and psychodynamic therapy. In addition to psychotherapy, antidepressant and anti-anxiety medications are often used to treat depersonalization/derealization disorder. Research indicates a need for more alternative treatments that are based on the case studies and experiences of clinicians who specialize in dissociative disorders.
Poerio GL, Kellett S and Totterdell P. Tracking potentiating states of dissociation: An intensive clinical case study of sleep, daydreaming, and depersonalization/derealization. Frontiers in Psychology. 2016;7:1231. Published online 17 August 2016; doi: 10.3389/fpsyg.2016.01231.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
Last reviewed 10/19/2017