Phobias What Is Depersonalization/Derealization Disorder (DPDR)? By Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics. Learn about our editorial process Lisa Fritscher Medically reviewed by Medically reviewed by Daniel B. Block, MD on July 10, 2020 twitter linkedin Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Review Board Daniel B. Block, MD Updated on December 04, 2020 Print Aleli Dezmen / Getty Images Table of Contents View All What Is DDD? Symptoms Diagnosis Causes and Risk Factors Types Treatment Coping What Is Depersonalization/Derealization Disorder (DPDR)? Depersonalization/derealization disorder (DPDR), sometimes referred to as depersonalization/derealization syndrome, is a mental health condition that can cause you to experience a persistent or recurring feeling of being outside of your body (depersonalization), a sense that what's happening around you isn't real (derealization), or both. Symptoms Although DPDR 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. It can include: Alexithymia, or an inability to recognize or describe emotionsFeeling physically numb to sensationsFeeling robotic or unable to control speech or movementFeeling unconnected to your body, mind, feelings, or sensationsInability to attach emotions to memories or to "own" your memories as experiences that happened to youThe 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 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.You 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 can periodically get better or worse. Unlike with other psychotic disorders, people with DPDR know that their experiences of detachment aren't real. This can leave them feeling concerned about their mental health. Diagnosis According to the National Alliance on Mental Illness (NAMI), roughly three in four adults have had a dissociative episode in their lives, but only around 2% meet the criteria for DPDR. To diagnose DPDR, a doctor first makes 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. Sometimes imaging and other tests are done to rule out physical issues. Psychological tests, special structured interviews, and questionnaires can also help to diagnose DPDR. Once other potential causes are ruled out, a clinician considers DPDR criteria as outlined in the Diagnostic and Statistic Manual of Mental Health Disorders (DSM-5), including: Persistent or recurrent episodes of depersonalization, derealization, or bothAn understanding by the person that what they're feeling isn't realSignificant distress or impairment of social or occupational functioning caused by symptoms Causes and Risk Factors 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 dissociative occurrence. Severe stress, anxiety, and depression are common triggers for DPDR. A lack of sleep or an overstimulating environment can also make symptoms worse. Anywhere from 25% to 50% of the time, the stress that brings on depersonalization/derealization disorder is relatively minor, or not even obvious. Often, people with DPDR have experienced past trauma in their lives, including: Emotional or physical abuse or neglect in childhoodHaving a loved one die unexpectedlyWitnessing domestic violence Links Between Trauma, PTSD, and Dissociative Disorders Other risk factors for DPDR include: A history of recreational drug use, which can trigger episodes of depersonalization or derealizationAn innate tendency to avoid or deny difficult situations; trouble adapting to difficult situationsDepression or anxiety, especially severe or prolonged depression or anxiety with panic attacksExperiencing or witnessing a traumatic event or abuse as a child or adult Severe stress in any area of life, from relationships to finances to work Types DPDR is one of four types of dissociative disorders. These disorders 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 lifeDissociative fugue: A form of reversible amnesia that involves personality, memories, and personal identityDissociative identity disorder (DID): A condition marked by the presence of two or more distinct personalities within one individual Treatment For some, recovery takes place organically, without formal treatment. Others require targeted, personalized treatments to completely recover from DPDR. Chances of this recovery are best when the underlying stressors that contributed to and triggered the depersonalization and dissociation are successfully dealt with. Psychotherapy The most effective way to deal with DPDR is with psychotherapy. Cognitive behavioral therapy (CBT), for instance, teaches strategies for blocking obsessive thinking about feeling things that aren't real. CBT also teaches distraction techniques, including: Grounding techniques that call on the senses to help you feel more in touch with reality—playing loud music to engage hearing, for instance, or holding an ice cube to feel connected to the sensationPsychodynamic 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 How Cognitive Behavior Therapy Works EMDR While eye movement desensitization and reprocessing (EDMR) therapy was originally designed to treat PTSD, it is often used to treat a variety of mental health conditions, including DPDR. How EMDR Therapy Works Medications There are no medications approved specifically for treating depersonalization/derealization disorder. However, your healthcare professional may prescribe anti-anxiety drugs and antidepressants to help ease or relieve symptoms of the condition. Coping In addition to psychotherapy, there are a few strategies that can help keep you grounded and/or bring you back to reality when you’re experiencing symptoms of DPDR. Pinch the skin on the back of your hand.Use temperature to shift your focus; place something that's really cold or really warm (but 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 as you 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 DPDR, do your best to remain supportive and encourage them to seek treatment, whether through 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. However, once you understand that the symptoms you're experiencing 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. The 9 Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Was this page helpful? Thanks for your feedback! Ever wonder what your personality type means? Sign up to find out more in our Healthy Mind newsletter. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Brewer R, Cook R, Bird G. Alexithymia: A general deficit of interoception. R Soc Open Sci. 2016;3(10):150664. doi:10.1098/rsos.150664 National Alliance on Mental Illness. Dissociative disorders. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013. Merck Manual. Depersonalization/derealization disorder. Updated March 2019. 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 Additional Reading Spiegel D, Loewenstein RJ, Lewis-Fernández R, et al. Dissociative disorders in DSM-5. Depress Anxiety. 2011;28(9):824-52. doi:10.1002/da.20874