Depersonalization/Derealization Disorder

What is depersonalization/derealization disorder?

Depersonalization disorder, also called derealization disorder, is when you feel:

• Detached from your thoughts, feelings and body (depersonalization).
• Disconnected from your environment (derealization).

People with this condition do not lose touch with reality. They realize their perceptions aren’t real. Depersonalization or derealization disorder can also be signs of other conditions, such as:

• Brain diseases.
• Seizure disorders.
• Psychiatric disorders, such as dementia and schizophrenia.

Is depersonalization disorder the same as dissociative disorder?

Depersonalization/derealization disorder is a type of dissociative condition. Dissociative disorders are mental conditions involving disruptions or breakdowns in:

• Awareness.
• Consciousness.
• Memory.

Is depersonalization disorder a psychotic disorder?

The difference between depersonalization and psychotic disorders is awareness. People with depersonalization disorder know the feelings of detachment are not real. People with psychosis believe their feelings are reality.

Who gets depersonalization disorder?

Most people with this disorder develop it when they are young. The average age for developing depersonalization disorder is 16 years. It rarely begins after age 40.

How common is depersonalization disorder?

It's pretty common to experience depersonalization that comes and goes. You might have a fleeting feeling of being detached from yourself or your environment. It may feel like you’re watching yourself in a movie, and then those feelings go away. Experts call this transient depersonalization. About half of people feel this from time to time. But the actual disorder — where depersonalization is long-lasting and doesn't come and go — happens in less than 2% of the population.

What causes depersonalization disorder?

Researchers don’t know what causes these disorders. In up to half of the cases, healthcare providers cannot identify what triggers the disorder.

Biological and environmental factors may play a role. Some people may be at higher risk for developing a dissociative disorder due to:

• A nervous system that’s less reactive to emotions.
• Certain personality or other mental health disorders.
• Physical conditions, such as a seizure disorder.

Dissociative disorders can also occur after intense stress or trauma, such as:

• A parent with severe mental illness.
• Abuse (witnessing or experiencing it).
• Accidents.
• Life-threatening danger.
• Natural disasters.
• Sudden death of a loved one.
• Violence.
• War.

Other causes include:

• Certain drugs, such as hallucinogens.
• Being very tired.
• Sleep deprivation or sensory stimulation, which may happen in an intensive care unit.

What are the symptoms of depersonalization disorder?

The main symptom of depersonalization/derealization disorder is feeling disconnected. You may feel:

• Disconnected from your thoughts, feelings and body (depersonalization).
• Disconnected from your surroundings or environment (derealization).
• Robot-like.
• As if you’re observing yourself from outside your body.
• As if you’re living in a dream world.
• Depressed, anxious, panicky or like you’re going crazy.

Some people experience mild, short-lived symptoms. Others have chronic (ongoing) symptoms that may last for years. The symptoms may interfere with your ability to function. They may even lead to a disability.

How is depersonalization/derealization disorder diagnosed?

If you have symptoms, your healthcare provider will assess you. You’ll have a medical history and physical exam.

What tests might I have?

No lab tests can diagnose dissociative disorders. But your provider may want to do blood or imaging tests (X-ray, CT scan or MRI). These tests can rule out physical illness or medication side effects.

Your healthcare provider may refer you to a mental health professional. A psychiatrist, psychologist or psychiatric social worker can help diagnose and treat you. These providers talk to you to understand your experiences and how you’re functioning.

Will I need treatment for depersonalization disorder?

Often, people seek treatment because they’re concerned about symptoms such as depression. The depression may be a bigger issue than the disorder. You may need treatment if the:

• Disorder is long-lasting or keeps returning (recurrent).
• Symptoms are debilitating or distressing.

How is depersonalization disorder treated?

The goal of treatment is to address the stressors that trigger the symptoms. Your healthcare provider plans your treatment based on your:

• General health.
• Triggers.
• Symptom severity.

Treatment often includes a combination of:

Psychotherapy: Talk therapy is the main treatment for dissociative disorders. Your provider may opt for one or more of these methods:

• Cognitive-behavioral therapy: CBT focuses on changing thinking patterns, feelings and behaviors that aren’t serving you.
• Dialectic-behavior therapy: DBT may help with severe personality disturbances. It may help you tolerate difficult emotions, including dissociative symptoms. DBT is useful if you’ve experienced abuse or trauma.
• Eye movement desensitization and reprocessing: EMDR can help you cope with post-traumatic stress disorder (PTSD). It can reduce persistent nightmares, flashbacks and other symptoms.
• Family therapy: Working together, your family learns about the disorder. The group learns how to recognize signs of a recurrence.
• Creative therapies: Art or music therapy can help you explore and express your thoughts and feelings in a safe, creative environment.

Other treatments:

• Meditation and relaxation techniques: Mindfulness may help you tolerate symptoms. You can learn to tune in to your thoughts and feelings. It also can help settle your body’s responses.
• Clinical hypnosis (hypnotherapy): This treatment uses intense relaxation, concentration and focused attention. The goal is to achieve an intense state of awareness. A provider can help you explore deep thoughts, feelings and memories. It can help find the root of a problem.
• Medication: There isn’t a medicine for depersonalization disorder. But treating depression or anxiety can help. Your provider may prescribe antidepressant or anti-anxiety medications such as desipramine (Norpramin®).

How can I prevent depersonalization disorder?

It may not be possible to prevent depersonalization/derealization disorder. But it’s helpful to recognize the symptoms so you can get treatment.

If you have experienced a traumatic event, seek help. Quick intervention can reduce the risk of developing a dissociative disorder.

Can depersonalization disorder be cured?

Complete recovery is possible for many people. In some people, the disorder disappears on its own.

Others recover by going to therapy and dealing with the triggers. Therapy helps resolve the underlying issues. Keep going to therapy to prevent the symptoms from coming back.

The disorder may become chronic when it does not respond to treatment. Your provider will discuss the best next steps for you.

What is the outlook for people with depersonalization disorder?

The outlook for people with this disorder is good. The symptoms associated with depersonalization disorder often go away. They may resolve on their own or after treatment to help deal with symptom triggers. Treatment is important so that the symptoms don’t come back.

How can I best take care of myself?

If symptoms interfere with your life, talk to your healthcare provider. The right treatment plan often gets rid of the symptoms, and you can get back to your life. Continue with the treatment to resolve the stressors that trigger your symptoms.

What else should I ask my healthcare provider?

If you have depersonalization disorder symptoms, ask your provider:

• Do I need treatment?
• Will these symptoms go away on their own?
• What’s the best type of therapy for me?
• What techniques can I use to help with the symptoms?
• Do I need medication?
• Can depersonalization disorder be cured?

A note from Cleveland Clinic

Depersonalization/derealization disorder may feel jarring. You may feel detached from yourself or your surroundings. If these feelings happen occasionally and for a short time, you may not need treatment. However, if the symptoms cause stress or interfere with your life, talk to your healthcare provider. Therapy can help you deal with the triggers and prevent the symptoms from returning.