Depersonalization-Derealization Disorder

Individuals with depersonalization-derealization disorder (DPDR) may experience a range of symptoms affecting their perception of themselves and their surroundings. The main symptoms can be divided into two categories: depersonalization, referring to detachment from one's own body, thoughts, and feelings, and derealization, defined by disconnection from the environment.

Depersonalization

People experiencing depersonalization may believe they are observing their own thoughts, emotions, and bodily sensations from an outside perspective. Common symptoms of depersonalization an individual with DPDR might experience include:

• Believing they’re an outsider watching their own life unfold
• Sensations of being detached from their body
• Perceiving themselves to be “a robot” with no control over speech or movements
• Believing one’s memories lack emotion or are not their own 
• Emotional or physical numbness of the senses 

Derealization

Derealization creates a sensation of disconnect from the environment. Those affected might have a sense that their environment and the items in it are unreal, foggy, or dreamlike. Below are common symptoms:

• Believing that others are distant or robotic or not real, like you’re living in a movie or dream
• Believing someone you know is unfamiliar or unknown 
• Perceiving surroundings as flat, two-dimensional, or artificial
• Having a distorted perception of time

Depersonalization and derealization can cause significant distress.¹ However, people with DPDR can often remain aware that these experiences are not grounded in reality. This awareness differentiates the condition from psychotic disorders, in which individuals lose touch with reality. DPDR is also different from dissociative identity disorder,² which causes memory loss. 

Additional symptoms that may accompany DPDR include:

• Difficulty concentrating or focusing on tasks
• Emotional numbness or detachment from emotions
• Memory problems, particularly related to the episodes of depersonalization or derealization
• Unrealistic thoughts about the size, shape, and distance of objects

These symptoms can vary in severity and frequency, but they often develop as periodic episodes lasting up to several days or weeks. In addition to symptoms of depersonalization and derealization, the criteria for diagnosis based on the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include:

1. Despite feeling detached from oneself or surroundings, the individual can still distinguish between what's real and what's not. 
2. The symptoms are serious enough to negatively affect critical areas of the person's life, such as social interactions, school performance, or work responsibilities.
3. The dissociative experiences are not a result of taking drugs, prescription medications, or other substances. 
4. Other mental health conditions, like depression or schizophrenia, have been ruled out as the cause of the individual's symptoms.

If you or a loved one are experiencing symptoms of DPDR, seek medical assistance. Treatment options may include therapy, medications, or a combination of both, depending on the individual's overall condition.

The exact cause of DPDR is not entirely understood, but it is believed to be a result of several factors.

One possible cause of DPDR is a history of traumatic experiences, such as emotional, physical, or sexual abuse. These traumas³ may disrupt the brain's processing of information, causing a person to detach from reality to cope with the trauma. In addition to trauma, DPDR may be caused by:

• High levels of stress or anxiety
• Substance use or withdrawal
• A history of other mental health disorders, such as depression or anxiety disorders

Environmental factors and life experiences are thought to play a vital role in the development of DPDR. For example, growing up in an unstable family environment or experiencing significant life changes may be risk factors for derealization or depersonalization. Exposure to ongoing stress, such as living in a chaotic household or working in a high-pressure job, may also increase the risk of developing DPDR.

Another possible cause of DPDR is a genetic predisposition to the condition, which may be more likely to develop in people with a family history of the disorder. Although research on this topic is still in its early stages, some evidence suggests that specific genes may be involved in the development of DPDR.

The causes of DPDR can be complex. Therefore, a mental health professional can assess all potential causes and risk factors when making a diagnosis. Knowing the possible causes could also help guide the appropriate treatment methods.

Depersonalization-derealization disorder can often be treated through a combination of therapy, medication, and self-care strategies. The main goal of treatment is frequently to control symptoms and help individuals regain a sense of connection to their thoughts, feelings, and surroundings.

Medication

There are no specific medications approved to treat depersonalization-derealization disorder. However, some medications may be prescribed to treat underlying symptoms or other mental health conditions that could occur alongside this disorder, such as the following: 

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and other types of antidepressants may alleviate depression or anxiety that could worsen depersonalization-derealization symptoms.
• Anti-anxiety medications: Benzodiazepines and other anxiolytics could be prescribed to temporarily relieve severe anxiety related to depersonalization-derealization disorder. Benzodiazepines should be used with caution, as they can worsen the underlying disassociation. 
• Antipsychotic medications: In some cases, atypical antipsychotics may be prescribed for individuals who experience severe depersonalization-derealization symptoms, acting as mood stabilizers.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. In addition, the above information is not a replacement for medical advice or diagnosis.

Self-care

In addition to therapy or medications, self-care strategies may help individuals manage depersonalization-derealization disorder, depending on the severity of symptoms. Some self-care strategies to consider might include:

• Developing a routine: Daily routines may help individuals be more grounded and connected to their environments.
• Regular physical activity: Exercising may promote overall mental well-being. Activities encouraging body awareness, such as yoga, may incite a sense of grounding and calm. 
• Practicing relaxation techniques: Breathing exercises, progressive muscle relaxation, and visualization may help individuals manage stress and anxiety that might cause depersonalization or derealization symptoms.
• Maintaining social connections: Support from friends and family can also be critical in managing this disorder. A strong support network may help individuals with DPDR maintain their treatment progress.

Treating depersonalization-derealization disorder often involves a combination of therapy, medication, and self-care practices. With an effective treatment plan, individuals can learn to manage symptoms while regaining a sense of connection to their thoughts, feelings, and surroundings.

Numerous resources are available to support and guide individuals experiencing DPDR. Online therapy platforms, such as BetterHelp, may be a helpful starting point for those seeking assistance with the condition. In addition, online therapy platforms may offer a convenient way to access therapy from the comfort of one’s home.  

In addition to therapy platforms, mental health organizations may support those with DPDR. For example, the National Alliance of Medical Illness (NAMI) is a reputable organization for information and treatment options for this disorder, among other mental health conditions. In addition, the Initiative for Depersonalization Studies (IDS) is a non-profit organization that aims to increase awareness of DPDR by providing education for the public and sponsorships for support groups or conferences. 

Individuals with DPDR can also connect with others who experience similar challenges through support groups. Networking with peers may allow them to learn about the condition and ways to cope with symptoms. Support groups can also create a sense of belonging to a community made up of individuals who empathize with the experience.

Though living with DPDR may seem overwhelming, help is available. Using the resources mentioned above, combined with a strong support system, individuals may be able to overcome this challenging condition.

Researchers are conducting studies to better understand the causes of DPDR and how to treat it. One study examined parts of the brain and certain pathways tied to stress response involved in DPDR. For example, certain stress response systems like the autonomic functioning and the hypothalamic-pituitary-adrenal (HPA) axis may play a role in the development of the disorder. Ultimately, the review found that brain changes interfere with how individuals perceive their senses and affect more extensive brain networks.

While conventional treatment methods like talk therapy are recommended for DPDR, other treatment methods are being studied. One study assessed how dance and movement therapy may be a potential option for people with DPDR. The researchers used two types of online dance activities: one focused on becoming more aware of the body and the other on strengthening the body’s signals through dance. The results showed that dance exercise tasks may promote mindful engagement with the body.  

Continued research on the treatment for DPDR may improve understanding of the disorder. In addition, more studies can contribute to more accurate diagnoses for those affected.

Depersonalization and derealization have a 26% to 74% occurrence in the general population

Temporary depersonalization and derealization can occur in the general population, with 26% to 74% of lifetime occurences. These symptoms are more common in those who have experienced a traumatic event.¹

¹Social Psychiatry and Psychiatric Epidemiology

Below are more statistics on depersonalization-derealization disorder:

• Individuals with head injuries may experience DPDR. Specifically, of those with mild head trauma, over 60% reported experiencing this syndrome, while 11% of those who were unconscious for a substantial period reported similar symptoms.
• Around 10% to 20% of people with bipolar disorder experience severe dissociative symptoms, even when their mood is stable. These symptoms are more severe in people with bipolar disorder than those who are healthy or have major depression. However, the symptoms are not as severe as in people with trauma-related disorders, like dissociative disorders, complex post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD).
• In a study of 223 people with depersonalization-derealization syndrome (DDS) and 1129 people with depression but no DDS, almost all of the DDS patients wanted specific counseling for their symptoms. In addition, over 70% of these patients expressed interest in receiving treatment through internet-based platforms.