Depersonalization-Derealization Disorder
What is Depersonalization-Derealization Disorder (DPDR)?
Depersonalization-Derealization Disorder (DPDR) is a mental health condition characterized by persistent experiences of depersonalization (feeling detached from oneself) and derealization (feeling detached from the external world).
People with this disorder are aware that their experiences are abnormal. They are not losing touch with reality; they simply have an abnormal experience they can identify as abnormal. DPDR can also be a sign of other conditions such as brain diseases, seizure disorders, and psychiatric disorders like dementia and schizophrenia.
What is Depersonalization?
Depersonalization is a detachment from a person’s thoughts, emotions, and/or physical form. It is a dissociative experience characterized by a sense of detachment from oneself, leading to a feeling of observing one’s own thoughts, emotions, or body from an external perspective.
First-hand accounts of depersonalization:
“Have you been in a scenario where you are in some deep emotion – let’s say it’s deep sadness – maybe grief. You’re crying, and then you just kind of stop because you’re thinking about it. You’re contemplating why you’re crying and if you actually care about what’s happening or if you’re just kind of supposed to maybe? If you are just sort of following the general structure of what you’re supposed to do in that moment which at that time is to grieve? Do you actually feel sad – do those feelings – that genuinely are there in your body – belong to you? Who are you and what do you genuinely own over yourself and your own emotions? That’s depersonalization.”. — BD
“Sometimes, the emotions feel like they are coming from somewhere else, even movements, as if someone is moving my hands for me, as if it isn’t my own actions. It isn’t always strong emotions either, sometimes it is basic actions, like my hands scratching an itch on my shoulder that I don’t have or don’t personally feel. These actions and feelings feel like someone else entirely wants them and is even conducting them.
I’ve spent many hours, my arm up in the air above me, my fingers splayed and waggling, but I was fascinated that it didn’t feel like anything. It didn’t feel like I was moving them. It looked and felt like someone else’s hand moving in front of me, mine feeling still at my side, at rest. I’d stare for hours as I do this, somehow simultaneously moving the fingers, and also never willing them to move, myself.” — EJK
What Is Derealization?
Derealization is a dissociative phenomenon characterized by a persistent or recurrent perception of the external world as strange, unreal, or distorted. This experience often leads to a sense of detachment from one’s surroundings, profoundly impacting an individual’s daily life.
First-hand accounts of derealization:
“You know the whole “we’re in a simulation” joke? Yeah… so… that. Derealization feels like you’re the only real thing in existence. Not in a narcissistic way… more in a Truman Show existential terrifying mental health collapse way. Fun stuff.” — BD
“Have you ever had an out of body experience? Have you ever seen them represented in movies and other media? Derealization makes you feel like a ghost, or something surreal among your surroundings. It feels almost like you are floating through a world you know must be real, but you don’t actually feel as if this is everyone else’s reality as well. Everything feels like you might suddenly wake up from being where you are, but you never actually do until you come out of the moment of derealization, and it doesn’t feel like waking up at all. It is sometimes sudden, but most often, it just feels like colour comes back to the world, and things slowly start to feel solid again — as if you share a reality with other people again.” — EJK
“While a person feels detached, they are still aware of reality. They’re aware their experience is not normal, which can lead to more anxiety about the situation, which can make the DPDR worse, starting a feedback loop that can result in a bad panic attack. In short, it’s no fun.” — TEC
Symptoms of DPDR
Feeling Disconnected from Self: Central to depersonalization is the pervasive feeling of being detached from one’s identity, thoughts, and emotions. Individuals may describe themselves as if they are an observer, leading to a profound sense of disconnection.
Emotional Numbness: A common symptom is emotional numbing, where individuals find it challenging to experience or express genuine emotions. This emotional blunting contributes to the overall feeling of detachment from the richness of subjective experiences.
Altered Perception of Body: Depersonalization often involves a distorted perception of one’s body. Individuals may feel that body parts are unreal or don’t belong to them, creating a disconcerting sense of unfamiliarity with one’s physical self.
Cognitive Fog and Confusion: Cognitive symptoms include a sense of mental fog, confusion, and difficulty concentrating. Individuals may struggle to focus on tasks, contributing to a feeling of unreality in their interactions with the world.
Time Distortion: Depersonalization/derealization can lead to a distorted sense of time. Individuals might perceive time as passing unusually slowly or quickly. This distortion can contribute to a sense of disorientation and make it challenging to maintain a coherent sense of the passage of time.
Impaired Concentration: Individuals experiencing depersonalization/derealization may struggle with concentration and focus. The altered perception of reality can make engaging fully in daily tasks or conversations difficult, leading to increased distress and frustration.
Visual Distortions: Visual disturbances are common in derealization particularly, manifesting as changes in perception such as blurriness, heightened brightness, or an exaggerated sense of depth. These disturbances contribute to the overall feeling of unreality.
Prevalence
It is estimated that between 1-2% of the global population has been diagnosed with DPDR, although the prevalence has been known to be higher in the form of temporary episodes related to traumatic occurrences. DPDR has equal occurrence in both men and women, with a mean age of onset in adolescence; only five percent of cases start in persons above age 25.
What Causes This Disorder to Form?
The formation of DPDR involves a multitude of factors, both psychological and environmental.
Trauma and Stress: A significant precursor to DPDR is exposure to trauma, whether it be a single intense event or prolonged stress. Trauma can overwhelm an individual’s coping mechanisms, leading to dissociative responses, including depersonalization and derealization. According to studies such as those discussed by the National Institute of Mental Health (NIMH), traumatic experiences may increase the risk of DPDR development.
Anxiety and Panic Disorders: Conditions such as anxiety and panic disorders are closely linked to DPDR. Persistent anxiety can contribute to dissociative symptoms, and individuals experiencing panic attacks may develop depersonalization as a defense mechanism.
Substance Use and Medications: Substance use, particularly hallucinogenic drugs, can induce dissociative experiences and trigger DPDR. Additionally, certain medications and their side effects are associated with depersonalization and derealization.
Personality Factors: Certain personality traits, such as high levels of neuroticism or a predisposition to avoidant coping strategies, may contribute to the vulnerability to DPDR.
Neurobiological Factors: Neurobiological factors, including alterations in brain function and neurotransmitter imbalances, are thought to play a role in DPDR. These alterations can include head injury or trauma and seizures.
Understanding the factors contributing to DPDR is crucial for a comprehensive approach to diagnosis and treatment. If you or someone you know is experiencing symptoms of DPDR, seeking professional guidance from mental health experts is recommended. Always consult with qualified healthcare providers for accurate assessments and personalized interventions.
History
Depersonalization was first used as a term by Ludovic Dugas in 1898. It was used to refer to “a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words, a depersonalization.”
Research on DPDR constantly updates and changes as new trends and figures come to light.
Treatment
- Psychotherapy (talk therapy)
- Cognitive-behavioral therapy (CBT)
- Dialectic-behavioral therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Family Therapy
- Creative Therapies
- Meditation and relaxation techniques
- Clinical hypnosis (hypnotherapy)
- Medication (there is no specific medication for DPDR, but treating co-morbid like depression or anxiety can lessen other symptoms that are causing issues that might be contributing to DPDR and might, therefore, help lessen DPDR’s effects on the patient’s daily life.)
Personal Experiences with DPDR
“DID is the meal deal of dissociative disorders – you get a taste of them all. Some members of T-E-C experience intense depersonalization regularly. But, for whatever reason, we don’t have derealization nearly as often.
We’re on both Prozac and Lamictal for other reasons, but we can’t say that they do much for our DPDR symptoms. We get more relief from grounding techniques and meditation. When those fail, taking a long nap sometimes helps. Sometimes nothing works but waiting it out.” — TEC
“I don’t let it bother me. It is sometimes hard to be sure of what is real and what is not when in these states, but I’ve come to terms with the fact that reality is a construct of what our senses can confirm, and what our minds can process. Sometimes, those things just won’t align, and that is okay. I’ve learned that feeling anxious about moments of DPDR can often lead to further instances, and even panic attacks or hallucinations.
Instead, I do my best to address it with assessment of reality techniques, several of which I learned in DBT. Techniques that have me actively question myself and the situation I am in will have me comparing any feelings to the reality around me, allowing me to deconstruct, and reconstruct that reality in a more stable form, grounding myself in what I can confirm, and helping my psyche bypass the parts of the process I simply can’t. Grounding techniques using sensory input can really help, including grounding techniques that involve an outside observer. Sometimes just asking my friend or family member to confirm my surroundings or actions can be enough to put my mind a little more at ease about the unreality I’m feeling, leading to more stability throughout the episode of DPDR.” — EJK
Sources:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm
National Institute of Mental Health (NIMH). (2022). “Feelings of Detachment After Trauma May Signal Worse Mental Health Outcomes.” https://www.nimh.nih.gov/news/science-news/2022/feelings-of-detachment-after-trauma-may-signal-worse-mental-health-outcomes.
PubMed. (2022). “Feelings of Detachment After Trauma: Implications for Mental Health Outcomes.” https://pubmed.ncbi.nlm.nih.gov/35699456/.
PubMed. (2004). “Depersonalization and derealization: assessment and management.” https://pubmed.ncbi.nlm.nih.gov/15022041/.
PubMed Central (PMC). (2020). “Depersonalization-Derealization Disorder: A Contemporary Overview.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132272/.
Suggested Reading
Theravive: Depersonalization or Derealization Disorder DSM-5 300.6(F48.1)
Wikipedia: Depersonalization-derealization disorder