Psychology
Mental Health

Depersonalization-Derealization Disorder: Symptoms, Causes, Treatment, and More

Looking to learn more about the dissociative disorder known as depersonalization-derealization disorder? This article covers symptoms, causes, and more.

By

Attractive Asian woman with mirror on floor
Maddog 229

While most people have experienced some sort of dissociative experience such as a daydream or getting “lost” in a movie or book, those suffering from a dissociative disorder often feel detached from reality for long periods of time. This detachment can lead to further issues, causing a patient to struggle with their memory, emotional control, perception, and identity. Often times, a traumatic experience such as abuse, an accident, or a disaster can trigger a dissociative disorder in order to help a patient tolerate pain or emotions that are difficult to cope with. There are three different kinds of dissociative disorders that range in levels of severity: dissociative identity disorder (DID) is considered the most severe, dissociative amnesia is considered to be slightly less severe, and depersonalization-derealization disorder is considered the least severe.

Depersonalisation-Derealization Disorder

Depersonalization-derealization disorder is a type of dissociative disorder where the patient experiences out-of-body feelings and emotions about being detached from themself, the world around them, or both. When a patient experiences this detachment, they are aware that it’s not real but commonly find themselves doing reality checks to ensure their existence due to the detachment feeling like a dream.

There are two distinct separations occurring within this disorder, one is depersonalization and one is derealization. A depersonalization episode defines the side of this disorder where the patient experiences feeling detached from themself, their emotions, their memories, or can be described as feeling like “an outsider to their lives.” A derealization episode defines the side of this disorder where the patient feels detached from the world around them. Having this kind of dissociation for long periods of time can lead to a patient feeling that their surroundings look blurry or time feels distorted. A patient suffering from the depersonalization–derealization disorder may experience one type of dissociation or both.

Symptoms of Depersonalization-Derealization Disorder

Symptoms of this mental illness normally begin during a patient’s teenage years or early adulthood as the disorder is rare in children or older adults. While it may be common for humans to experience passing moments of dissociation from their surroundings such as daydreams or highway hypnosis, those suffering from a dissociative condition experience dissociative moments for significant periods of time such as hours, days, weeks, or even months.

Depersonalization Disorder Symptoms

Depersonalization symptoms include but are not limited to:

  • Experiencing out-of-body feelings as if the patient is “floating in the air above [themself]”.
  • Feeling like speech and movements are being controlled by someone else.
  • Limbs or head appear distorted or feel misshapen.
  • Losing or feeling cut off from the five senses (sight, taste, hearing, smell, and touch) that allow humans to interact with the world around them.
  • Memories feel like scenes from a movie; the patient remembers them with no emotion and may even feel that the memories aren’t there’s.

Derealization Disorder Symptoms

Derealization symptoms include but are not limited to:

  • Feeling unfamiliar with current surroundings is a common dissociative symptom; as if the patient is living in a dream.
  • Experiencing a disconnect with loved ones.
  • Surroundings may look warped in some way, such as dull, unclear, two-dimensional, super-refined, extremely vibrant. Perception of these surroundings may feel off as well, such as not being able to perceive depth or size.
  • Time may feel mangled as if a recent occurred many years ago or a distant memory happened just yesterday.

Tip: Depersonalization-derealization disorder is not considered a psychotic disorder due to the patient’s ability to remain aware of reality during their moments of detachment. A patient suffering from depersonalization-derealization disorder understand that their feelings while detached do not represent reality. Meanwhile, a patient suffering from a psychotic disorder believes that their detached feelings or episodes portray reality.

DSM-5 Diagnostic Requirements for Depersonalization-Derealization Disorder

According to the DSM-5 diagnostic criteria, a patient diagnosed with depersonalization-derealization disorder exhibit the following symptoms:

  • Symptom 1: Consistent experiences of detachment through depersonalization, derealization, or both.
  • Symptom 2: Awareness is stable during detached moments, meaning that while experiencing a wave of depersonalization, derealization, or both, the patient is able to understand that what they’re feeling is not reality.
  • Symptom 3: Detached moments or symptoms are interrupting the patient’s daily life by impairing professional or social relationships, or limiting a patient’s ability to function.
  • Symptom 4: No physiological factors (substance abuse or medication) or medical conditions (seizures) are triggering the dissociative moments.
  • Symptom 5: Depersonalization-derealization disorder is not acting as a comorbidity to another prominent disorder in the patient such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or another dissociative disorder.

Causes of Depersonalization-Derealization Disorder

There are a wide range of factors that may create chronic depersonalization-derealization episodes or induce a dissociative experience.

Biological Factors:

  • Living with a nervous system that is less reactive to emotions.
  • A common risk factor is suffering from a comorbid mental health condition such as borderline personality disorder, bipolar disorder, schizophrenia, etc.
  • Having a medical condition such as a seizure disorder.

Environmental Factors:

  • In order to help the victim cope, it’s common for this mental disorder to be triggered by past stress or childhood trauma such as:
    • Experiencing or witnessing emotional abuse, verbal abuse, or physical abuse of any kind.
    • Aiding a parent that suffered from a severe mental disorder.
    • Experiencing a major accident of any kind.
    • Working through severe financial stress.
    • Living through a situation that posed a life-threatening danger.
    • Surviving a natural disaster.
    • Mourning the loss of a loved one.
    • Fighting in or living through a war.
  • Experimenting with certain drugs such as hallucinogens or suffering from substance abuse can also cause depersonalization-derealization experiences.
  • Being heavily sleep-deprived can lead to episodes of depersonalization-derealization.

Treatment for Depersonalization-Derealization Disorder

Differential Diagnosis

Prior to receiving treatment for a mental health disorder such as depersonalization-derealization disorder, it’s important to talk with a  doctor or mental health professional to ensure an accurate diagnosis. Due to comorbidities being common with many mental health disorders, it’s possible that a patient may be suffering from one or more disorders simultaneously. The differential diagnosis for depersonalization-derealization disorder includes brain disease, psychiatric disorders such as dementia or schizophrenia, and seizure disorder. Be sure to talk with a medical professional prior to receiving treatment to secure a correct diagnosis and health care plan.

Treatment Options

Based on a patient’s overall health, dissociative triggers, and the derealization or depersonalization severity, a medical professional will comprise a treatment plan. A treatment plan often includes a wide array of options for a patient to choose from and try, such as:

Psychotherapy or “Talk Therapy”:

The goal of psychotherapy is for a patient to regain control over their dissociative episodes so that, over time, they may lessen or go away entirely. This often includes talking through a patient’s past traumas, digging deeper into their dissociative episodes, and learning coping mechanisms that aid a patient in alleviating stress when faced with their triggers. Common types of psychotherapies include but are not limited to:

  • Cognitive-Behavioral Therapy (CBT): This form of therapy focuses on changing patterns of thought or behavior that impairing a patient’s daily life.
  • Dialectic-Behavior Therapy (DBT): This form of therapy is recommended for patients who have suffered from any form of abuse or trauma as it focuses on helping the patient tolerate difficult emotions or stressful situations.
  • Eye Movement Desensitization and Reprocessing (EMDR): This form of therapy is recommended for patients who suffer from PTSD as it helps with reducing nightmares, flashbacks, etc.
  • Family Therapy: This form of therapy focuses on working through a patient’s diagnosis with them and their family to increase awareness for each family member.

Meditation:  Practicing certain relaxation techniques and learning about mindfulness can help a patient to feel more in tune with their thoughts and emotions.

Clinical Hypnosis (Hypnotherapy): Using hypnotherapy to treat a patient, allows a mental health professional to aid the patient in discovering deep thoughts, feelings, or memories that may be at the root of their dissociative disorders.

Medication: While there is no specific medicine to treat a depersonalization-derealization disorder, it’s common for patients to be prescribed an antidepressant or antianxiety medication. Anxiety disorder, severe stress, and/or depression are common comorbidities in patients that suffer from this psychiatric disorder.

Depersonalization-Derealization Tests

Taking a test online may highlight certain symptoms for a patient or help them process their own thoughts, emotions, and dissociative moments. However, while these tests may increase awareness, they online point towards surface-level symptoms. To receive treatment and care for their perceived mental health condition, it’s important for a patient to seek advice from a medical professional.

To take a depersonalization-derealization test online, visit this source or go to this webpage.

Mental Health Resources for Those Who Need Them

Comprehensive List of Hotlines/Call Centers

Find a Therapist in Your Area

Call Centers

Text Hotlines

Sources