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When Life Doesn't Feel Real Anymore

What is depersonalization-derealization and ways to take control back.

Key points

  • Derealization-depersonalization is a stress-induced phenomenon, and at least 50% of people have had such an experience.
  • Symptoms of DP/DR include skewed or distorted perceptions of reality involving feelings of detachment or disorientation.
  • Psychotherapy is a primary option for treatment, helping clients understand and process their "unreality" experiences.
  • Ways to help modify the moment of intense stress may include engaging a symbolic activating practice, self-talk, chant, music and journaling.

“This just doesn’t feel real anymore.” Perhaps that statement echoes an experience you have had recently that felt surreal? For many, this experience of “unreality” became more prolific during 2020 with the sudden changes brought forth by the pandemic.

I remember this feeling when standing in a grocery store and finding conspicuously empty shelves due to shortages while also witnessing the frenzy of shoppers nervously loading carts with whatever they could find.

During stressful experiences, a person may feel like their perception of reality has suddenly shifted into something strangely unfamiliar. They may also feel disconnected from their sense of “self.” Life can bring about impactful events that change or alter our reality, such as the sudden and unanticipated loss of a loved one, exposure to intensely frightening situations, or when presented with any stressful discrepant event. Some of my patients have conveyed their reactions to such events as feeling beside themselves, detached, out of their body, or like living in a dream.

Source: Natallia/Adobe Stock Photos', 'Social Issues, licensed for use'.'.
Unreality
Source: Natallia/Adobe Stock Photos', 'Social Issues, licensed for use'.'.

These are all emotional responses to situations that can produce destabilizing effects on one’s self and perception, resulting in the experiences of depersonalization and derealization. Depersonalization and derealization are complex reactions that used to be considered differing disorders until 2013 when the American Psychiatric Association consolidated them as a depersonalization-derealization disorder or DP/DR.

We Count on Stability

All of us depend on a degree of stability to go about our daily lives. For the most part, our experience and sense of self within our environment are typically stable and coherent. A person’s sense of orientation, such as who they are and where they are calibrated through an array of complex cognitive functions like perception.

Source: ' 1STunningART/Adobe Stock Photos', 'licensed for use'.
Perception
Source: ' 1STunningART/Adobe Stock Photos', 'licensed for use'.

Perception allows us to recognize a friend’s face, experience the world through our senses, and more. However, in the presence of extreme stressors, such perceptual processes may be affected harshly, and symptoms may start to surface. Let’s take a look at a few of the symptoms associated with the depersonalization-derealization disorder (Depersonalization-Derealization Disorder, 2017).

Symptoms of Depersonalization

  • Feeling like an outside observer to your experience, remote from body or parts of your body, as if “floating above one’s self.”
  • Feeling as though your body is distorted exaggeratedly.
  • Physical or emotional numbness of senses in response to your environment.

Symptoms of Derealization

  • Unlike depersonalization’s “out of body” experience, derealization may feel more like “alienation” or unfamiliarity to one’s surroundings.
  • Surroundings become distorted, blurry, artificial, or have a "dreamlike" effect.
  • Distortions in time, distance, and sound are common.

According to researchers Schlax et al. (2020), many of the symptoms of DP/DR result from an impairment regarding the capacity to regulate one’s own emotions. Most often, passing feelings of both depersonalization and derealization are common. About 50% of people have had at least one such experience in their lifetime. However, when these feelings persist, it is an excellent time to seek out the assistance of a healthcare professional.

Treatment for DP/DR

Typically, an excellent place to start is with your local physician. Physicians have access to imaging tests such as MRI’s, EEG’s, and basic toxicology tests to rule out anything of a physical nature and will probably recommend seeing a therapist.

Within the field of mental health, psychotherapy is considered one of the primary options in treating DP/DR. Psychotherapy offers clients opportunities to unburden themselves by sharing their experiences and can benefit a person experiencing DP/DR by helping them understand their experiences and make sense of things.

Modifying Intense Feelings

When symptoms from DP/DR begin, you can immediately use some grounding principles to stay rooted, calm, and re-orient yourself.

Source: galitskaya/Adobe Stock Photo, Man doing yoga, licensed for use.
Modify Feeling
Source: galitskaya/Adobe Stock Photo, Man doing yoga, licensed for use.

Here are a few you can try:

Engage a symbolically activating practice–Some creative Cognitive Behavioral Therapy (CBT) may help. Rooted in modifying behaviors, CBT can engage techniques like self-talk and symbolic activities for changing thoughts.

One strategy I use with anxious patients is to invoke a powerful symbolic act with self-talk like washing their hands. Water is grounding, and it is also seen as purifying. While washing hands, we say, "I release the anxiety I feel right now, I am washing it away, letting my senses engage calmness and the gentle sensation of the cleansing water in the here and now."

In such an activity, you create powerful imagery while using self-talk to help guide your way out of intense feelings. Additionally, you are connecting mind and body while modifying the moment.

Try a chant–You may know of the Om chant used by Monks in both Hindu and Buddhist traditions. The practice of the vocal chant can be used to stimulate the vagus nerve. The gliding vowel sound can be felt throughout the body and is a good distraction for the mind and body.

Listen to music–Music can be a suitable grounding mechanism as music has been shown to reduce cortisol levels which affect stress.

Read a book–From a study at the University of Sussex, participants who read for six minutes had displayed lower heart rates and reduced stress. Reading fiction engages our imagination, stimulates our subjective mode of thinking, and involves dynamic imagery.

Journaling–Once you have down-regulated the moment's intensity, find time to journal your experience as another powerful symbolic way to process your feelings.

Education is power, and there are many helpful resources, such as this video by Melissa Shepard on DP/DR. The good news is that DP/DR disorder is often only a transient condition during stressful times, and most people fully recover. With good self-care and treatment, you can stay in control and maintain a better quality of life.

References

1. Maldonado, J.R. (2007). Depersonalization. https://www.sciencedirect.com/topics/medicine-and-dentistry/depersonali…

2. Dewe, H., Watson, D. G., Kessler, K. (2018). The depersonalized brain: New evidence supporting a distinction between depersonalization and derealization from discrete patterns of autonomic suppression observed in a non-clinical sample. Consciousness and Cognition, 63, 29-46. https://www.sciencedirect.com/science/article/pii/S1053810017305536

3. Depersonalization-derealization disorder. (2017). https://www.mayoclinic.org/diseases-conditions/depersonalization-dereal…

4. Sierra, M., Medford, N., Wyatt, G., David, A.S. (2012, May). Depersonalization disorder and anxiety: A special relationship? Psychiatry Research, 197(1-2), 123-127, https://www.sciencedirect.com/science/article/pii/S0165178111008018

5. Brain and Behavior Research Foundation. (2015). Altered Circuits May Cause Out-Of-Body Symptoms in Some People with PTSD. https://www.bbrfoundation.org/content/altered-circuits-may-cause-out-bo…

6. Aderibigbe, R.M. Bloch, W.R. Walker. (2001). Prevalence of depersonalization and derealization experiences in a rural population. Soc. Psychiatry Epidemiol., 36 (2) (2001), pp. 63-69, https://doi.org/10.1007/s001270050291

7. Schlax, J., Wiltink, J., Beutel, M. E., Münzel, Pfeiffer, N., Wild, P., Blettner, M., Kerahrodi, J.G., Michal, M. (2020). Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study. Journal of Affective Disorders, 273, https://www.sciencedirect.com/science/article/pii/S0165032716318961

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