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.
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.
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.
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.
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).
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:
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.
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.
© Copyright 1995-2020 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 04/20/2016