Depersonalization/Derealization Disorder

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 physical and mental health conditions—depersonalization/derealization disorder is usually diagnosed only if such feelings of detachment frequently recur, cause anguish, and interfere with an individual's quality of life.

Symptoms

Depersonalization is a sense of experiencing one's own behavior, thoughts, and feelings from a dreamlike distance. According to DSM-5, symptoms include:

  • Feeling emotionally numb, or as if the person is not controlling his or her words and actions
  • Feeling detached from ordinary sensations, such as touch, thirst, hunger, and libido

Derealization is a sense of distance from activities going on in the world, or feeling that one's surroundings are distorted or somewhat unrecognizable. This may include:

  • Feeling as if objects are the wrong size or color
  • Feeling as though time is speeding up or slowing down
  • Experiencing sounds as louder or softer than expected
  • Feeling as though one is watching events and activities unfold in a movie or on a computer screen, rather than actually participating

In order to qualify for a diagnosis of depersonalization/derealization disorder, these episodes must cause clinically significant distress and/or make it difficult for the person to function normally at work, in school, or in a social setting. They must also not be attributable to another psychological condition such as schizophrenia. Individuals with depersonalization/derealization disorder will generally start showing signs in early childhood; symptoms rarely occur for the first time in adults over the age of 40, and only 5 percent occur in adults over the age of 25.

Episodes of depersonalization and/or derealization may last for hours or days at a time and recur for weeks, months, or even years. At all times, the individual is typically aware of both their inner thoughts and what is going on around them; as a result, they are conscious of the fact that they feel detached from their body and/or their surroundings. 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.

Causes

A history of severe stress, neglect, or physical or emotional abuse can lead to depersonalization/derealization disorder. Acute moments of stress, anxiety, or trauma may also trigger symptoms in individuals without a history of such factors. Studies have shown that poor sleep quality is associated with more severe symptoms of dissociation. Depersonalization/derealization disorder occurs with equal frequency in both men and women.

Treatment

Since depersonalization/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.