What Is Depersonalization/Derealization Disorder (DDD)?

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What Is Depersonalization/Derealization Disorder (DDD)?

Depersonalization/derealization disorder (DDD) is a mental health condition that can cause a person to experience either a persistent or recurring feeling of being outside of their body (depersonalization) or a sense that what's happening around them isn't real (derealization)—or both.

The hallmark of this condition is an involuntary disconnection from reality.

Symptoms

Although depersonalization/derealization disorder is considered a single diagnosis, it has two distinct aspects that may or may not apply to one person.

Depersonalization

Depersonalization refers to feeling detached from yourself as if you're watching your life take place from the sidelines or viewing yourself on a movie screen.

  • Alexithymia, or an inability to recognize or describe emotions
  • Feeling physically numb to sensations
  • Feeling robotic or unable to control speech or movement
  • Feeling unconnected to your body, mind, feelings, or sensations
  • Inability to attach emotions to memories, or even "own" your memories as experiences that happened to you
  • The sense that your body and limbs are distorted (swollen or shrunken)
  • The sense that your head is wrapped in cotton

Derealization

Derealization is a sense of feeling detached from your environment and the objects and other people in it. The world may seem distorted and unreal as if you're observing it through a veil. You may feel as if a glass wall is separating you from people you care about. This aspect of disassociation can also create distortions in vision and other senses.

  • Distance and the size or shape of objects may be distorted, and you also may have a heightened awareness of your surroundings
  • Recent events may seem to have happened in the distant past
  • Surroundings may seem blurry, colorless, two-dimensional, unreal, or larger-than-life or cartoonish

Episodes of depersonalization/derealization disorder can last for hours, days, weeks, or even months. For some, such episodes become chronic, evolving into ongoing feelings of depersonalization or derealization that may periodically get better or worse.

Unlike psychotic disorders, people with DDD know that their experiences of detachment aren't real. Therefore, they may fear that they're going crazy.

Diagnosis 

According to the National Alliance on Mental Illness (NAMI), about half of adults have had a dissociative episode in their lives, but only around 2% of people meet the criteria for DDD.

In order to diagnose depersonalization/derealization disorder, a doctor will first make sure there aren't other reasons for symptoms, such as drug use, a seizure disorder, or other mental health problems like depression, anxiety, post-traumatic stress disorder (PTSD), or borderline personality disorder.

Once other potential causes are ruled out, a clinician will consider criteria outlined in the Diagnostic and Statistic Manual of Mental Health Disorders (DSM-5), including:

  • Persistent or recurrent episodes of depersonalization, derealization, or both
  • An understanding by the person that what they're feeling isn't real
  • Significant distress or impairment of social or occupational functioning caused by symptoms

Sometimes imaging and other tests are done to rule out physical problems. Psychologic tests and special structured interviews and questionnaires can also help to diagnose depersonalization/derealization disorder. 

Causes and Risk Factors

Severe stress, anxiety, and depression are common triggers for depersonalization/derealization disorder. A lack of sleep or an overstimulating environment can make symptoms worse.

Often, people with depersonalization/derealization disorder experienced past trauma in their lives, including:

  • Emotional or physical abuse or neglect in childhood
  • Having a loved one die unexpectedly
  • Witnessing domestic violence

Yet 25% to 50% of the time the stress that brings on depersonalization/derealization disorder is relatively minor, or not even obvious.

Some people are more vulnerable to psychiatric disorders than others. For instance, women are more likely than men to experience depersonalization/derealization or some other type of disassociative occurrence.

Other specific risk factors for depersonalization/derealization disorder include: 

  • A history of using recreational drugs, which can trigger episodes of depersonalization or derealization
  • An innate tendency to avoid or deny difficult situations; problems adapting to difficult situations
  • Depression or anxiety, especially severe or prolonged depression, or anxiety with panic attacks
  • Experiencing or even witnessing a traumatic event or abuse as a child or as an adult 
  • Severe stress in any area of life, from important relationships to finances to work

Types

Depersonalization/derealization disorder is one of four types of dissociative disorders, which are diagnosable conditions in which there's a fragmented sense of identity, memories, and/or consciousness. If left untreated, dissociative disorders can lead to depression and anxiety and are believed to be linked to a history of trauma.

According to the DSM-5, other dissociative conditions include:

  • Dissociative amnesia: A condition that involves the inability to remember important information about your life
  • Dissociative fugue: A form of reversible amnesia that involves personality, memories, and personal identity
  • Dissociative identity disorder: A condition marked by the presence of two or more distinct personalities within one individual

Treatment

With targeted, personalized treatment, some people completely recover from depersonalization/derealization disorder. The chances of recovery are best when the underlying stressors that contributed to and triggered DDD can be successfully dealt with. And for some, recovery takes place organically, without specific treatment.

Psychotherapy

The most effective way to deal with depersonalization/derealization disorder is with psychotherapy. Cognitive behavioral therapy (CBT), for instance, teaches people strategies for blocking obsessive thinking about feeling things that aren't real as well as distraction techniques, including:

  • Grounding techniques that call on the senses to help a person feel more in touch with reality—playing loud music to engage hearing, for instance, or holding an ice cube in order to help a person feel connected to the sensation.
  • Psychodynamic techniques that focus on working through conflicts and negative feelings that people tend to detach from, and moment-to-moment tracking (focusing on what's happening in the moment) along with labeling of dissociation and effect.

EMDR

While eye movement desensitization and reprocessing (EDMR) therapy was originally designed to treat PTSD, it's now often used to treat a variety of mental health conditions, including depersonalization/derealization disorder.

Medications

There are no medications approved specifically for treating depersonalization/derealization disorder. While your healthcare professional may prescribe anti-anxiety drugs and antidepressants to help assuage symptoms of the condition, none of these will directly treat it.

Coping

In addition to psychotherapy, the following strategies can help keep you grounded and/or bring you back to reality when you’re experiencing symptoms of depersonalization/derealization disorder:

  • Pinch the skin on the back of your hand.
  • Use temperature to shift your focus; place something that's really cold or really warm (not too hot) in your hand.
  • Look around the room and count or name the items you see.
  • Keep your eyes moving to stop yourself from zoning out.
  • Slow your breathing—or take long, deep breaths—and pay attention to your inhale and exhale.
  • Practice meditation to develop greater awareness of your internal state.
  • Reach out to a friend or loved one and ask them to keep talking to you.

Supporting a Loved One

If your loved one has depersonalization/derealization disorder, do your best to remain supportive and encourage them to seek treatment, whether psychotherapy, medication, self-help, or a combination of these options.

A Word From Verywell

A diagnosis of depersonalization/derealization disorder can be upsetting and confusing initially, but once you understand that the symptoms you're experiencing (some of which may have you wondering if you're losing your mind) have a recognizable and reasonable cause, you may begin to feel less worried and anxious. It's also important to remind yourself that psychotherapy and perhaps medication can help.

If you or a loved one are struggling with depersonalization/derealization disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
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  2. National Alliance on Mental Illness. Dissociative Disorders.

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.

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  5. Gentile JP, Snyder M, Marie Gillig P. Stress and trauma: Psychotherapy and pharmacotherapy for depersonalization/derealization disorder. Innov Clin Neurosci. 2014;11(7-8):37-41. PMID:25337444

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