Depersonalization/Derealization Disorder

What is it?

We’ve all "zoned out" or daydreamed. In other words, had the experience of being awake, but disconnected from what's going on around us. These sensations normally last a few seconds, before we snap back to reality and go about our day. But for some people, this sense of disconnection happens often, intensely and for extended periods of time. This phenomena is called dissociation. It includes two subcategories called depersonalization and derealization. 

Depersonalization/derealization disorder occurs when a person persistently feels disconnected from their surroundings (derealization) or their body (depersonalization). They may describe these sensations as “living in a dream” or “having an out of body experience.” Episodes can last anywhere from a few hours to years on end, and are typically very disturbing for the person experiencing them. 

Depersonalization/derealization disorder is a rare condition that commonly occurs between a person’s teens and early 20s. It is uncommon for children or older adults to experience it. It’s estimated that 2% of the population has depersonalization/derealization disorder, with women and men being affected equally.

What are the symptoms?

Despite being similar in nature, depersonalization and derealization are two different symptoms. Some people with the condition experience both, whereas others only experience one.

Depersonalization occurs when a person feels disconnected to their body. They might describe it as feeling like they’re watching things happen to them, rather than living them. Derealization is when they feel disconnected to their surroundings, which may include the people they care about, their perception of time, their perception of distance, or physical objects. 

Depersonalization symptoms: 

• Feeling as if you’re an outsider observing your own thoughts, feelings or body 
• Feeling out of control of your speech and movements. Some may describe this as feeling “like a robot” 
• Feeling like your body parts are warped in some way (too big, too small) 
• Feeling as if your head is “wrapped in cotton”
• Experiencing a lack of emotional and physical sensations (i.e. being “numb)
• Feeling as if your memories aren’t your own 

Derealization symptoms:

• Feeling disconnected from your physical surroundings 
• Feeling disconnected from the people in your life, as if there is a physical barrier between you and them 
• Feeling as if your surroundings are blurry, colorless, two-dimensional or artificial 
• Feeling as if your surroundings are overly clear or vibrant 
• Having a distorted perception of time (i.e. it’s moving too fast or too slow) 
• Having a distorted perception of distance and size (i.e. objects are closer/farther away than they appear) 

During these episodes, a person is aware that what they’re feeling is not reality. However, that does not make the sensations go away. Some episodes may only last an hour, while others can last for years or decades. In these cases, the depersonalization/derealization symptoms remain present, but may fluctuate in intensity. It is common for people with the condition to develop anxiety and depression spectrum disorders as well, and to become concerned that they are “going crazy.”

What are some common warning signs?

Depersonalization/derealization disorder can look different in different people. Some experience long periods of intense symptoms, while others have more mild episodes. That said, the sensations it causes are almost always frightening and uncomfortable. During an episode, it’s common for a person to appear affected, and have trouble functioning normally at work, school, home and amongst friends. 

If you’re concerned that a loved one has depersonalization/derealization disorder, ask yourself the following questions:  

• Have they mentioned feeling separated from their body? Have they done things like punching or pinching themselves to prove that their limbs are really theirs? 
• Are they avoiding mirrors or pictures of themselves because they do not recognize what who they see? 
• Have they expressed having problems with their vision, such as things seeming fuzzy, overly clear or two-dimensional? 
• Are they overly sensitive to intense sensory experiences, such as being around bright lights or hearing loud music? 
• Are they confused by their own voice and the way it sounds? 
• Do they doubt the memories that they have, or fail to remember important things altogether? 
• Do they seem more confused or foggy than usual? 
• Have they mentioned feeling numb, and like nothing matters?
• Are they having trouble maintaining relationships, or opening up to others? 
• Do they struggle with depression or anxiety, alongside other symptoms? 

These behaviors can’t confirm a diagnosis, but they do hint at one. If you feel comfortable doing so, talk to your loved one about this behavior and why you’re concerned.

What causes Depersonalization/derealization?

The exact causes are unknown. Doctors believe a few factors play a role in its development, including: 

• Genetics: It’s thought that people are more likely to develop the disorder if they have a family history of dissociative conditions 
• Trauma: Like all other dissociative conditions, there’s thought to be a connection between childhood trauma and the development of the disorder. Being in high stress scenarios is also known to trigger episodes.

How is it treated?

Treating depersonalization/derealization normally involves some combination of psychotherapy and medication. Treatment plans tend to be highly individualized based on the severity of the condition. Oftentimes, people seek help for co-occurring conditions, like anxiety and depression, rather than the disorder. It’s common for symptoms to subside on their own overtime. 

Psychotherapy treatment might involved: 

• Individual psychotherapy: One-on-one sessions that help people better understand and manage their symptoms. 
• Cognitive behavioral therapy (CBT): A therapeutic model that challenges negative thinking patterns and behaviors. In CBT, a therapist will help a person establish healthy coping mechanisms for their delusions, hallucinations.
• Hypnotherapy: A form of therapy in which the patient undergoes clinical hypnosis in order to uncover repressed memories, change behaviors, or try and merge their personalities. This is often used alongside individual psychotherapy. 
• Adjunctive therapy: Also called “add on” therapy, these strategies are used alongside a primary treatment method to help boost progress. Common types include art or movement therapy that help people connect with parts of their mind that might have been “shut off” by trauma. 
• Family therapy: A model that teaches family members how to deal with their loved ones condition and empower recovery. 

There are no medications approved specifically for the treatment of depersonalization/derealization. However, people with the condition often struggle with other disorders, such as substance use problems, anxiety and depression. Medications, such as antidepressants or antianxiety drugs, may be used to address those disorders. 

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

How can I help a loved one with Depersonalization/derealization?

It can be hard to know how to react when someone you love isn’t doing well. Do they want to talk about it, or would they prefer to keep their experiences private? Will you push them away by starting the conversation? 

There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. Here are some ways to do so:

• Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 
• Take it easy: During an episode, you should avoid drinking, doing drugs, going to loud or bright places, or being in large crowds. Try and do more calming activities, such as hanging out at someone’s house and drawing or going for a walk somewhere quiet. 
• Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. 
• Use empathy: Depersonalization and derealization can be scary and isolating. Try and refrain from snapping at them when they can’t remember important facts or seem disoriented. Stay calm and remember what they’re going through. Remind them that you’re there for them and that you love them. 
• Be patient: Don’t take it personally if they lash out at you. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care. 

And finally, remember to take care of yourself. Find counseling of your own if you are struggling to cope with their condition.