Depersonalization Disorder: Symptoms and Treatment Options

People often experience a sensation of detachment from themselves or their surroundings due to severe occupational, financial, or interpersonal stress or due to extreme fatigue. For most people, these feelings are temporary and do not recur.

However, some individuals experience a feeling of detachment from their body, mind, or feelings or feel like they are observing themselves from outside their body. This condition, where a person feels disconnected and detached from themselves or their surroundings, recurrently or occasionally, is called depersonalization disorder (DPDR).

The condition can be triggered by long-term stress, trauma due to childhood abuse or neglect, emotional overwhelm, physical abuse, depression, anxiety, or the use of illegal drugs, especially marijuana, hallucinogens, and ketamine. 

Some individuals with DPDR experience more intense symptoms, such as feeling like they’re watching themselves from outside their body or perceiving things that do not exist. In some cases, both sensations occur simultaneously. 

Such symptoms make it hard for individuals with DPDR to connect with people around them, thus affecting their social lives. It distresses them deeply, and when symptoms are severe, they find it intolerable. They obsess over whether they are psychotic or they have permanent brain damage. It is common for them to have depression and anxiety.

People with depersonalization disorder might also feel like they are living in a dream or that their existence is unreal. These experiences can happen occasionally or repeatedly, depending on the individual. However, the difference between depersonalization disorder and psychotic disorder is that in the former condition, people retain an understanding that their unreal experiences are not, in fact, real. In the latter condition, people are unable to differentiate between what’s real and what’s not.

Continue reading to learn more about the symptoms, causes, and treatment options for depersonalization disorder.

What Is Derealization And Depersonalization?

Derealization is a dissociative experience where a person feels detached from their surroundings. It can make the world, including people and objects, seem unreal or dreamlike. Derealization causes a person to believe that they are present in a dream, or are separated by a veil and living in a different reality, or their surroundings are foggy or blurry. 

Whereas, depersonalization is the dissociative experience of being detached or disconnected from one’s self. People feel dissociated from emotions, actions, thoughts, or sensations of their own. They may feel as if they are observing themselves from outside their body or as if they are someone else entirely.

Both derealization and depersonalization can occur during moments of extreme stress, sleep deprivation, or drug use. These experiences are usually temporary and do not recur often.

For example, a person with derealization may feel that the sound of vehicle horns on the street are deafeningly loud, but they’re actually at a lower decibel. Or they may perceive a change in the appearance of an object, like feeling that an apple or flower in front of them has suddenly disappeared. 

On the other hand, when doing a task, a person with depersonalization feels like someone else is doing it. For example, when they are writing or painting, they feel like someone else is doing the activity.

What Is Depersonalization-Derealization Disorder (DPDR)?

Depersonalization-derealization Disorder (DPDR) is a mental health condition characterized by persistent or recurrent episodes of depersonalization, derealization, or both. Unlike fleeting moments of detachment, these episodes are long-lasting and can interfere with daily life.

Depersonalization disorder is found in around 1-2% of the general population. The onset of symptoms occurs in early or middle childhood. In some populations, it can also start during adolescence or early adulthood. Its onset in adulthood is rare, especially after the age of 40 years.

This disorder is not under the person’s control. It is thought to act as a defense mechanism, where the mind distances itself from reality to cope with distress or trauma. DPDR can occur without any drug use or other mental health conditions, and it is usually triggered by trauma, stress, or drug use.

What Are The Causes of Depersonalization Disorder?

Mental disorders tend to develop in individuals in almost all cases as an impact of an extreme situation, abusive or traumatic, that the individual has undergone. What causes depersonalization disorder or derealization disorder has not been completely identified. However, some of the few events or incidents usually serve as a cause for DPDR:

Traumatic Experiences

Trauma is one of the most common causes of DPDR. People who have experienced severe physical or emotional abuse, especially during childhood, are at higher risk of developing symptoms. Constant neglect, torture, or exposure to threats can lead to dissociation as a defense mechanism to cope with overwhelming emotions.

Loss of a Loved One

The sudden or unexpected death of a family member, friend, or loved one can deeply impact an individual. This emotional shock may trigger episodes of depersonalization or derealization as the mind attempts to process the loss in a detached way to minimize emotional pain.

Life-Threatening Events

Experiencing accidents, natural disasters, or other life-threatening situations can lead to DPDR. These events create immense stress, forcing the brain to dissociate from the immediate reality as a way to protect itself.

Stressful Life Circumstances

Ongoing stress, especially related to finances, relationships, or work, can act as a trigger for DPDR episodes. Chronic stress can lead to an alteration or a “re-wiring” of the brain’s stress system, mostly affecting areas such as the amygdala, prefrontal cortex, and hippocampus. Thus, it makes individuals susceptible to developing dissociative symptoms. It overwhelms the body and mind, leading to feelings of detachment from oneself or the surroundings. 

Preexisting Mental Health Disorders

Individuals with mental health conditions such as anxiety, depression, panic attacks, or post-traumatic stress disorder (PTSD) are more prone to developing DPDR. These disorders increase emotional vulnerability, making dissociative episodes more likely.

Neurological and Biological Factors

Certain brain areas, like the prefrontal cortex, which controls self-awareness and emotions, can become overactive during episodes. This overactivity can make a person feel detached from themselves or their surroundings. Additionally, low levels of neurotransmitters like serotonin and dopamine can disrupt how the brain processes emotions and reality. Moreover, chronic stress affects the hypothalamic-pituitary-adrenal (HPA) axis, which manages the body’s stress response. When this system is dysregulated, it can make dissociative episodes more likely. 

Parental Psychiatric Issues

Having parents with severe psychiatric conditions or substance abuse problems can significantly increase the risk of DPDR. A lack of emotional stability or proper support during childhood creates a fragile foundation for mental health.

Drug Use

Drug abuse typically does not cause DPDR. However, illicit drug use, particularly substances like cannabis, hallucinogens, and other psychoactive drugs, can worsen or trigger symptoms of DPDR episodes. These substances alter brain chemistry, which triggers or worsens dissociative experiences.

Read More: How to Manage Stress – Understanding the Root Causes

How To Identify Depersonalization Disorder?

The symptoms of depersonalization-derealization disorder (DPDR) can either appear suddenly or develop gradually. Episodes may last for a few hours or days. In some cases, they persist for weeks, months, or even years. Individuals with depersonalization disorder primarily experience detachment from their own body, thoughts, or emotions. 

For example, when performing simple tasks like combing hair or brushing their teeth, a person with DPDR may suddenly feel like they are watching themselves from the outside, disconnected from their own actions. The severity of symptoms varies from person to person. Some may have mild episodes that come and go, whereas others experience severe and constant symptoms lasting years or even decades.

Symptoms of Depersonalization

The symptoms experienced by an individual with depersonalization disorder are as follows:

• A person feels dissociated, disconnected, and detached from their body, mind, thoughts, memories, and behaviors.
• Imagine waking up and looking at one’s own reflection in the mirror, but it feels like they are looking at a stranger. The person feels like they are viewing themselves from outside their body or from a different entity. In other words, they feel like an outside observer of their own life. 
• When a person with DPDR speaks, they feel like the words are coming from someone else’s mouth. They feel like they do not have any control over what they do or say. 
• They may feel physically and emotionally numb.
• Some individuals might experience feelings of non-existent anomalies existing in their bodies.

Symptoms of Derealization

Derealization is an experience of being detached from one’s surroundings or surrounding reality. The commonly encountered symptoms are:

• A feeling that the surroundings are unreal, foggy, or dreamlike.
• Images are perceived as distorted, blurred, or lacking color.
• Sounds and colors appear amplified or muted.
• Feeling emotionally disconnected from people, places, or objects.
• A distorted sense of time, wherein it seems to speed up or slow down.
• Objects appearing smaller, larger, flatter, or oddly shaped.

When the Transition From Depersonalization to Derealization Occurs 

Individuals with depersonalization disorder alone, when left untreated, can move towards derealization. An individual passes through four different stages before they finally reach a point of derealization, which are given below:

• Anomalous Body Experiences: In this stage, the individual experiences a feeling of being disconnected or estranged from their own body. This is sometimes described as a sense of disembodiment.
• Emotional Numbing: Later, they experience a feeling lacking emotional response. This can also be a general numbness to emotions.
• Anomalies or Difficulty In Subjective Recall: In this stage, the individual feels a sense of disruptions in autobiographical memory. This situation makes them feel certain events haven’t happened to that person.
• Derealization: When one reaches this situation, they attain a feeling detached from their surroundings, as if the world and their actual reality are unreal or distant.

In DPDR, during some episodes, patients feel that they are separated from reality by glass walls or veils or the existence of only two dimensions around them. Sounds might appear to be louder than in reality. Feeling objects appearing in distorted shapes, flatter, smaller, or larger than real is a derealization example. They also feel that time is running faster or way too slow than normal.

Read More: Schizophrenia: What It Is, Causes, Symptoms & Treatment

What Techniques Are Used to Diagnose DPDR?

If feelings of depersonalization or derealization persist and disrupt daily life or recur frequently, consult a doctor. If you’ve been feeling disconnected from reality, a doctor might run tests to determine the underlying cause and rule out neurological or pathological bases. A trained mental health specialist would advise you to carry out certain investigations to reach a proper diagnosis:

• Physical examination is carried out to check if the symptoms concern other physical health problems like seizure disorder. They can also be associated with neurological issues, medicines, recreational drugs, or alcohol. 
• Lab tests are carried out to rule out probable medical conditions that could be related to the symptom.
• Investigations such as CT, EEG, and MRI are carried out to rule out structural deformities of the brain that can cause such symptoms.
• A detailed mental health assessment involves discussing the patient’s thoughts, feelings, and behavior patterns. This helps doctors determine if the symptoms match DPDR or another mental health condition.

How is Depersonalization Disorder Treated?

The main treatment modality used to treat depersonalization-derealization disorder is talk therapy or psychotherapy, with or without internal medication for co-occurring conditions.

Psychotherapy

Psychotherapy, often referred to as talk therapy, is the main treatment option for depersonalization disorder or DPDR. It aims to control or minimize the occurrence of the symptoms and episodes. It uses various techniques, such as cognitive behavioral therapy (CBT), psychodynamic therapy, and eye movement desensitization processing (EMDR). Let’s discuss them in detail: 

Cognitive Techniques

• Cognitive techniques aim to stop obsessive thoughts about detachment or feelings being unreal.
• Therapists help patients challenge and replace irrational beliefs with logical ones. 
• For example, instead of fixating on “I don’t feel real,” they learn to focus on tangible evidence, like their actions or surroundings, to regain a sense of reality.
• Therapists involve the patient in conversations that help them attain a sense of attachment toward reality.

Behavioral Techniques

• Psychotherapy using behavioral techniques involves engaging in tasks or activities to redirect attention away from depersonalization. 
• Patients might be encouraged to create and complete a list of tasks, especially physical tasks, like exercise or journaling. Such activities not only serve as distractions but also help individuals reconnect with their body and environment by focusing on purposeful actions.

Grounding Techniques

• Grounding techniques use the senses of the five sense organs to help patients reconnect with the present moment. 
• For instance, touching a textured object or describing what they see in the room helps them feel rooted or be present. 
• Patients may also be presented with the smell of various objects and asked to recognize it at multiple events. Such processes counter the sense of detachment by reminding them of their connection to their environment.

Psychodynamic Therapy

• Psychodynamic therapy adopts a holistic approach that helps the patient uncover and address emotional triggers, such as unresolved trauma, stress, or conflicts, that lead to depersonalization. 
• Patients explore past experiences, identify negative patterns, and work through suppressed emotions.
• Patients are encouraged to explore their past and unconscious thoughts to regain self-awareness.

Moment-to-Moment Tracking

• Moment-to-moment tracking teaches patients to notice and name their feelings of dissociation in real time. For example, saying, “I feel distant right now” helps them acknowledge their emotions. 
• This kind of awareness method helps them to keep their focus on the present and reduces their tendency to spiral into further detachment.

Medication

Not all patients with DPDR require medication. Patients who have distressing symptoms might experience anxiety or depression and are prescribed antidepressants and anti-anxiety medication to alleviate these symptoms.

Following a proper treatment plan, learning and acknowledging the condition, and connecting with people can help to cope and support the healing process. In case one undergoes an anxiety or panic attack, do not hesitate to seek help from a trained healthcare professional with life-saving skills.

Coping and Healing from Depersonalization Disorder!

Just as how important it is to treat a physical health disorder, so is the importance of treatment and care of mental health issues or psychiatric disorders. Almost every patient diagnosed with depersonalization disorder DPDR has undergone some sort of constant trauma or stress in the past. Along with necessary treatment and medication, these individuals can be provided the best support and help to cope with the situation. Even after complete recovery from depersonalization disorder, avoiding trigger factors and helping them start new can be a great support!

FAQs

1. What does depersonalization feel like? 

Depersonalization is a dissociative experience from one’s self. This means that the individual experiences a feeling of disconnection and detachment from one’s thoughts, memories, behavior, and identity. The person would feel like they exist outside their body and would view themselves with the perspective of being a different person. They feel like they are in a dream-like state.

2. How do you fix depersonalization? 

If one suspects having depersonalization, ensure to consult a doctor to confirm the cause of the condition and reach a diagnosis, if it is DPDR or a symptom related to some other condition. Once diagnosed, psychotherapy methods like cognitive behavioral therapy (CBT) or eye movement desensitization processing EMDR, along with proper medication, can fix depersonalization disorder. A proper coping mechanism, with the support of loved ones, also plays an important role.

3. What are the 4 stages of depersonalization?

Depersonalization has four stages, through which one would reach the stage of derealization. The first stage is anomalous body experiences, in which the individual experiences being disconnected or estranged from their own body. Then comes the stage of emotional numbing, where they experience a lack of emotional response or emotions. The third stage is anomalies in subjective recall, during which they feel a sense of disruptions in autobiographical memory. Finally, in the fourth stage, derealization, they attain an experience of feeling detachment from their surroundings as if everything is unreal.

4. Does DPDR go away? 

Yes. Depersonalization derealization disorders can go away with proper and timely management. The time taken for complete recovery may vary from person to person, depending upon their condition. Although, with adequate psychotherapy sessions, medication, and coping support, one can relieve the condition.