Depersonalization/Derealization Disorder

Depersonalization/derealization disorder 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.

It's one of four types of dissociative disorders, diagnosable conditions in which there's a fragmented sense of identity, memories, and/or consciousness. The hallmark of these conditions is an involuntary disconnection from reality.

According to the National Alliance on Mental Illness (NAMI), about half of adults have had a disassociative episode in their lives, but only around 2 percent of people meet the criteria for being diagnosed with the disorder. Women are more likely than men to experience depersonalization/ derealization or some other type of disassociative occurrence.

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 and, more important, that psychotherapy and perhaps medication can help, you may begin to feel less worried and anxious.

According to the Diagnostic and Statistic Manual of Mental Health Disorders, 5th Edition (DSM-5), which was published in 2013, the other dissociative conditions are dissociative amnesia, dissociative fugue, and dissociative identity disorder.

Unlike psychotic disorders, people with depersonalization/derealization disorder know that their experiences of detachment aren't real. Therefore, they may fear that they're going crazy. Understandably, dissociative disorders can lead to depression and anxiety. All of these conditions are believed to be linked to a history of trauma.

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

Depersonalization means feeling detached from yourself, as if you're watching your life take place from the sidelines or you're viewing yourself on a movie screen. You may not feel connected to your body, mind, feelings, or sensations. Some people describe feeling robotic or unable to control speech or movement. You may not be able to attach emotions to memories, or even "own" your memories as experiences that happened to you.

Some people who are dealing with depersonalization experience alexithymia—an inability to recognize or describe emotions. There also are potential physical symptoms—the sense that your body and limbs are distorted—swollen or shrunken—or that your head is wrapped in cotton. You may feel physically numb to sensations.

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 also can create distortions in vision and other senses. Your surroundings may seem blurry, colorless, two-dimensional, unreal, or larger-than-life or cartoonish. Distance and the size or shape of objects may be distorted, and you also may have a heightened awareness or your surroundings. Very recent events may seem to have happened in the distant past.

Severe stress, anxiety, and depression are common triggers for depersonalization/derealization disorder. Often, people with depersonalization/derealization disorder experienced past trauma in their lives. They might have suffered emotional or physical abuse or neglect in their childhood, witnessed domestic violence, or had a loved one die unexpectedly. A lack of sleep or an overstimulating environment can make symptoms worse. Yet, according to Merck Manual, 25 percent to 50 percent 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. In the case of depersonalization/derealization disorder, the ​Mayo Clinic lists these specific risk factors: 

• An innate tendency to avoid or deny difficult situations; problems adapting to difficult situations
• 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
• Depression or anxiety, especially severe or prolonged depression, or anxiety with panic attacks
• A history of using recreational drugs, which can trigger episodes of depersonalization or derealization

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.

In order to zero in on a psychiatric diagnosis, a doctor will first make sure there aren't other reasons for symptoms, such as drug abuse, a seizure disorder, or another mental health problems.

Once other potential problems are ruled out, a clinician will consider criteria from the DSM-5. These include:

• Persistent or recurrent episodes of depersonalization, derealization, or both
• An understanding by a 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, especially if symptoms appear after age 40. Psychologic tests and special structured interviews and questionnaires can help to diagnose depersonalization/derealization disorder. 

The most effective way to deal with depersonalization/derealization disorder is with psychotherapy. There are many types of therapy and techniques for treating psychiatric disorders. One that's often used is cognitive-behavioral therapy, which combines strategies for blocking obsessive thinking about feeling things aren't real and distraction techniques. 

Grounding techniques 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 sensation.

Other approaches that are sometimes useful for treating depersonalization/derealization disorder are 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, which "teaches people to recognize and identify their feelings of dissociation," according to Merck Manual.

There are no medications approved specifically for depersonalization/derealization disorder. Doctors sometimes prescribe anti-anxiety drugs and antidepressants to help assuage symptoms of the condition although none of these will directly treat it. 

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