Depersonalization-Derealization Disorder

What is depersonalization-derealization disorder?

In depersonalization-derealization disorder, you feel detached from yourself (depersonalization) and disconnected from your environment (derealization). While feelings like this may come and go for many people, in people with depersonalization-derealization disorder, they tend to last a long time (persist) or go away and come back (recur).

Depersonalization affects your ability to recognize your thoughts, feelings and body as your own. It might feel like you’re watching yourself play a role in a movie rather than living your life. For example, if you’re grocery shopping, you might feel like you’re watching someone else push your cart, select food from the shelves and go through the check-out line. Or you might not recognize your reflection in the glass doors of the frozen section.

Derealization affects your ability to see your surroundings accurately. Things might not seem real. Or you might feel like you’re looking through a clouded window or in black-and-white rather than full color. Objects might look distorted in shape or size, or you may feel like they change while you look at them.

In depersonalization-derealization disorder, you may experience depersonalization, derealization or both. But you haven’t lost touch with reality. You understand that your perceptions aren’t real, which can be frustrating and cause anxiety.

Psychiatrists classify depersonalization-derealization disorder as a dissociative disorder in the DSM-V. Dissociative identity disorder and dissociative amnesia are also in this category.

How common is depersonalization-derealization disorder?

Most people know what it’s like to be disconnected from time to time. This is called transient depersonalization. But depersonalization-derealization disorder is long-lasting. It generally happens to 1% to 2% of people, though it’s more common in adolescents and young adults.

What are the symptoms of depersonalization-derealization disorder?

People with depersonalization-derealization disorder sometimes find it hard to put their symptoms into words. Others feel like they have words to describe their experience but that people don’t seem to understand them or take them seriously. But the main symptom of depersonalization-derealization disorder is feeling disconnected. You might feel:

• Disconnected from your thoughts, feelings and body (depersonalization).
• Disconnected from your surroundings or environment (derealization).
• Robot-like or that those around you are robotic.
• Emotionally numb.
• Like you’re observing yourself from outside your body.
• Like you’re living in a dream world.
• Sad or anxious.

These symptoms can cause significant distress, as you might start to wonder if there’s something terribly wrong with you. You might focus on the symptoms, think about your symptoms or past events over and over again (rumination) or try to control them. This can increase your feelings of anxiety and worry, which in turn may make your symptoms worse.

What causes depersonalization-derealization disorder?

Healthcare providers don’t know exactly what causes depersonalization-derealization disorder, but it’s often linked to intense stress or trauma, like:

• Physical abuse.
• Domestic violence (witnessing or experiencing it).
• Accidents or natural disasters.
• Life-threatening danger.
• The sudden death of a loved one.
• A parent with severe mental illness.

What are the risk factors?

Some people may be at higher risk for developing a dissociative disorder due to:

• A decreased awareness of emotions.
• Certain personality or other mental health disorders.
• Physical conditions like a seizure disorder.

How is depersonalization-derealization disorder diagnosed?

Your mental healthcare provider will ask a series of questions about your symptoms. They’ll look for other mental health conditions (comorbidities) like:

• Depression.
• Anxiety.
• Obsessive-compulsive disorder (OCD).
• Post-traumatic stress disorder (PTSD).
• Personality disorders.

If you don’t have another diagnosis that more clearly fits, you’re not coming off medication and your experiences aren’t related to mood-altering substances like drugs or alcohol, they may diagnose you with depersonalization-derealization disorder.

What tests will be done to diagnose it?

If your provider suspects depersonalization-derealization disorder, they may ask a series of questions that help identify your symptoms, how often they occur and how much they interfere with your well-being. They may also ask you to complete some assessments on paper or online. Although finding the right words to describe your feelings may be hard, try to be as specific as possible about what life is like for you so that your provider can help you.

How is depersonalization-derealization disorder treated?

Researchers still aren’t sure about the best way to treat depersonalization-derealization disorder. When considering treatment options, your provider will talk with you about your medical history, your symptoms and treatment goals. They may recommend medication and talk therapy (psychotherapy) like cognitive behavioral therapy (CBT) or eye movement desensitization processing (commonly called EMDR).

Medications

Though talk therapy is the best treatment, your mental healthcare provider may recommend a medication (or combination of medications) as part of your treatment, like:

• Selective serotonin reuptake inhibitors (SSRIs).
• Anti-anxiety medications.
• Mood-stabilizing medications.
• Antipsychotic medications.

Side effects

Since mental healthcare providers may use different medications to treat depersonalization-derealization disorder, the side effects vary. But there are some common side effects like:

• Constipation.
• Dizziness.
• Drowsiness.
• Dry mouth.
• Increased appetite.
• Potential interaction with other prescribed medications, recreational drugs or alcohol.
• Urinary retention.
• Weight gain.

How long does depersonalization-derealization disorder last?

Again, there’s not a lot of research about what to expect if you have depersonalization-derealization disorder. Left untreated, depersonalization-derealization disorder can last for years. Sometimes it resolves on its own, but it might negatively impact your relationships or work life. With treatment, people commonly start to see an improvement in their symptoms within a few months.

How do I take care of myself?

If you have lasting symptoms of depersonalization-derealization disorder, your priority should be to seek treatment from a mental healthcare professional. You’ll likely need several visits initially, and then regular follow-ups with a psychologist and occasional follow-ups with a psychiatrist. Your psychiatrist help find the right treatment for your specific situation and ensure that the side effects are manageable. Your psychologist will use talk therapy to teach you skills to cope with your symptoms and gain insight into your symptom triggers.

In the meantime, take your medications as prescribed and try to be gentle with yourself. It’s OK if you can’t find words to accurately describe your experience. And, while it’s natural to worry about your health, try not to dwell on it. Paced breathing that involves a long exhale or meditation can calm your worries.

What can’t I eat or drink?

If you have depersonalization-derealization disorder, it’s a good idea to avoid substance use. Drugs and alcohol can bring about symptoms of depersonalization and derealization. They may also interact with your medications. Be honest with your mental healthcare team about when and how you use substances. They can provide the support you need to help you quit, safely.

When should I see my healthcare provider?

Your providers will set up regular follow-up appointments to monitor your well-being, lingering symptoms and potential side effects of treatment. But there may be times when you have a question or need support and you don’t have an appointment. Don’t hesitate to reach out if your symptoms get worse. If you’re worried that you may hurt yourself or someone else, get help right away. In the United States, you can dial 988 for the Suicide and Crisis Lifeline or 911 for emergency assistance, or go to the closest emergency room.

What questions should I ask my healthcare provider?

It’s important that you feel comfortable asking your healthcare provider questions. But sometimes, people freeze when a provider asks them if they have any questions. It can help to bring a list of questions in with you. You might want to ask:

• How long will it take for me to feel like myself again?
• What side effects should I expect from treatment?
• For how long will I need medication and/or therapy?
• If I have questions or concerns, how would you like me to contact you?
• What should I do if my symptoms get worse? What if it’s after hours or on the weekend?