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Depersonalization Disorder

What is depersonalization/derealization disorder?

Depersonalization/derealization disorder is the feeling of being detached from one’s thoughts, feelings, and body (depersonalization), and/or disconnected from one’s surrounding environment (derealization).

People with this disorder do not lose contact with reality. They realize that their odd perceptions are not real. Depersonalization and/or derealization also might be symptoms of other disorders, including brain diseases and seizure disorders.

Depersonalization/derealization disorder is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, consciousness or awareness, identity and/or perception—mental functions that normally work smoothly.

When one or more of these functions is disrupted, dissociative symptoms can result. These symptoms can interfere with a person’s general functioning, both in their personal life and at work.

What are the symptoms of depersonalization/derealization disorder?

The primary symptom of depersonalization is a distorted perception of feeling disconnected from one’s thoughts, feelings, and body. Derealization is a similar feeling of being disconnected, but from one’s surroundings or environment. Some with this disorder might feel like a robot, or observe themselves from outside their body, or live in a dream world. Some people might fear they are going crazy, or become depressed, anxious, or panicky.

For some people, the symptoms are mild and last for just a short time. For others, however, symptoms can be chronic (ongoing) and last or recur for many years, leading to problems with daily functioning. In some cases chronic depersonalization/derealization can lead to disability.

What causes depersonalization/derealization disorder?

Little is known about the causes of depersonalization/derealization disorder, but biological and environmental factors may both play a role. Some people appear to be more prone to develop dissociative disorders, either because they are neurologically less reactive to emotions, or because they may have certain personality disorders. Many dissociative disorders are triggered by experiencing intense stress or trauma, such as war, abuse, accidents, natural disasters, or violence.

How common is depersonalization/derealization disorder?

Transient depersonalization or derealization experiences are common, estimated to occur in about 50% of the population. However, depersonalization/derealization as a separate diagnosable disorder is quite rare, occurring in less than 2% of the population.

Most people with depersonalization/derealization disorder develop the illness when they are quite young; the average age of onset is 16 years. Finally, depersonalization/derealization can be symptoms of other psychiatric disorders, such as dementia and schizophrenia.

How is depersonalization/derealization disorder diagnosed?

If symptoms are present, an evaluation will be done with a complete medical history and physical examination. Although no laboratory tests diagnose dissociative disorders medically, various diagnostic tests such as blood tests or imaging (X-rays, CT scans, or MRIs) may be used to rule out physical illness or medication side effects.

If no physical illness is found, the person might be referred to a mental health professional, such as a psychiatrist, psychologist, or psychiatric social worker, who is specially trained to diagnose and treat mental illnesses. They will perform a clinical interview to get a full picture of the person’s past experiences and current functioning. Some psychiatrists and psychologists may employ specialized tests (for example, the Dissociative Experiences Scale—DES) or a standard interview such as the Structured Clinical Interview for Dissociation (SCID-D).

How is depersonalization/derealization disorder treated?

Most people who seek treatment for depersonalization/derealization disorder are more concerned about their associated symptoms such as depression or anxiety rather than the dissociative disorder itself. In many cases the symptoms will go away on their own. Treatment is usually only needed (or only sought) when the disorder is lasting or recurrent, or if the symptoms are particularly debilitating or distressing.

The goal of treatment is to address all stressors associated with the onset of the disorder. The best treatment approach depends on the individual, the nature of any identifiable triggers, and the severity of the symptoms. Most likely treatment will include some combination of the following methods:

  • Psychotherapy: Psychotherapy, sometimes called “talk therapy,” is the main treatment for dissociative disorders. This is a broad term that includes several forms of therapy.
  • Cognitive-behavioral therapy: This form of psychotherapy focuses on changing dysfunctional thinking patterns, feelings, and behaviors.
  • Eye movement desensitization and reprocessing (EMDR): This technique was designed to treat people with persistent nightmares, flashbacks, and other symptoms of post-traumatic stress disorder (PTSD).
  • Dialectic-behavior therapy (DBT): This form of psychotherapy was designed for people with severe personality disturbances, which can include dissociative symptoms and often occur after the person has experienced abuse or trauma.
  • Family therapy: This helps to teach the family about the disorder as well as to help family members recognize symptoms of a recurrence.
  • Creative therapies (for example art therapy, music therapy): These therapies allow patients to explore and express their thoughts, feelings, and experiences in a safe and creative environment.
  • Meditation and relaxation techniques: These help people to better tolerate their dissociative symptoms and become more aware of their internal states.
  • Clinical hypnosis: This is a treatment method that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness, allowing people to explore thoughts, feelings, and memories they may have hidden from their conscious minds.
  • Medication: There is no medication to treat dissociative disorders themselves. However, people with dissociative disorders, especially those with associated depression and/or anxiety, may benefit from treatment with antidepressant or anti-anxiety medications.

What is the outlook for people with depersonalization/derealization disorder?

Complete recovery is possible for many patients. The symptoms associated with this disorder often go away on their own or after treatment that helps people deal with the stressors or traumas that triggered the symptoms. However, without treatment to work out the underlying issues, additional episodes of depersonalization/derealization may occur.

Can depersonalization/derealization disorder be prevented?

Although it may not be possible to prevent depersonalization/derealization disorder, it may be helpful to begin treatment as soon as the symptoms are recognized. Generally, quick intervention following a traumatic event or an emotionally distressing experience may reduce the risk of developing dissociative symptoms.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/20/2016...#9791