Depersonalization Disorder

Depersonalization disorder, which is also known as depersonalization/derealization disorder, is a mental health condition that causes a sharp and confusing break with reality.

It is officially classified as a dissociative disorder, based on its capacity to produce dissociative states of mind. The altered perceptions of a person with depersonalization/derealization disorder create a bewildering sense of separation between a person’s consciousness and their own minds and bodies (depersonalization), or between their conscious awareness and the outside world (derealization).

Transitory episodes of depersonalization or derealization are experienced by a wide range of people and may represent a natural adaptation to stress, fatigue, or unpleasant memories or sensations. But for those who develop true depersonalization/derealization disorder, their inability to remain grounded in reality can become chronic and uncontrollable. Without treatment, their frequent forays into twilight zones of consciousness will leave them feeling stressed, frightened, and overwhelmed, reducing their ability to function and putting them at the mercy of their troubling symptoms.

Depersonalization/derealization disorder is one of three dissociative disorders recognized by the psychiatric profession. Dissociative states can cause substantial alterations or breaks in consciousness that compromise functioning and produce high levels of stress and anxiety.

Depersonalization, derealization, and other symptoms of dissociation are not familiar to most people, but they are still relatively common in youth and adults:

• In any given year, between one and two percent of the adult population in the United States will have depersonalization/derealization disorder, which represents three-to-four million people.
• While rates of diagnosis are lower, experts estimate that about seven percent of the population will experience symptoms consistent with a dissociative disorder each year.
• Studies reveal that approximately 50 percent of the population will have an episode of depersonalization and/or derealization over the course of their lifetime, although most will develop no psychiatric disorders.
• Even though most diagnoses occur in adulthood, the average age of onset for depersonalization disorder is 16.

Depersonalization and derealization are not separate phenomena. They are alternative versions of the same type dissociative symptom; each changes the relationship between consciousness and reality in a profound and fundamental way.

Depersonalization Symptoms

Episodes of depersonalization are often described as feeling like an out-of-body experience, even though no real shift in the location of consciousness occurs.

Depersonalization manifests as a deep and profound detachment from the mental and physical realities of mind and body. Thoughts and sensations are still there, but they seem distant and disconnected, as if the person is somehow trapped inside the mind of a stranger who is controlling everything they see, hear, feel, and think. Emotions may be muted or non-existent, or they may seem to emerge from nowhere, not really connected to the events of the moment.

A person having a depersonalization episode remains anchored in the body, but their consciousness suddenly exists in a fragmented form. Depersonalization is experienced as a fracturing of personality, awareness, and perception, and it can cause panic if it continues for too long.

Derealization Symptoms

Derealization symptoms leave the viewer’s inner sense of unity intact but play havoc with the viewer’s ability to perceive the outside world as it actually is.

During an episode of derealization, the surrounding environment will suddenly seem strange, unfamiliar, or somehow “wrong.” Physical objects may be distorted, misshapen, or otherwise altered, and it may become difficult to recognize or identify other people. Time may pass at a different rate, odd breaks or discontinuities in the flow of events may be observed, and the five senses (touch, smell, hearing, sight, taste) may become overly sensitive to stimulation.

Diagnosing Depersonalization Disorder

Before depersonalization/derealization disorder can be diagnosed, physicians or mental health professionals must carry out a series of tests and evaluation procedures, to eliminate the possibility that other mental and physical health conditions might be causing symptoms of dissociation.

Assuming these tests come up negative, depersonalization/derealization disorder can be diagnosed if the following three criteria are satisfied:

• The patient reports recurrent episodes of depersonalization, derealization, or both.
• The patient realizes their experiences are imaginary or distorted and does not believe they reflect reality.
• The symptoms experienced are causing significant levels of distress, or impairment of interpersonal functioning and job-related performance.

The symptoms of depersonalization and derealization are often triggered by stress. Drug and alcohol intoxication, panic attacks, bouts of depression, or fresh trauma can also lead to the onset of such symptoms, which over time can become a reflexive psychological and neurological response to thoughts or experiences that seem threatening in some way.

It is important to recognize that even people without a clinical disorder can experience dissociative symptoms like depersonalization or derealization from time to time. But when such experiences are persistent, recurrent, and predictable, it is a sure sign of an underlying mental health condition.

Some of the known risk factors for depersonalization/derealization disorder include:

• Exposure to extreme child abuse and neglect. When people are severely neglected or subjected to physical, emotional, or sexual abuse during childhood, they may learn to cope with extreme stress and emotional pain by developing the capacity for dissociation. By altering their consciousness, they can shut out the pain—but if this habit is left unchecked, it can lead to a serious dissociative condition down the road.
• Genetics and family history. Inherited traits usually play a role in the development of mental illness, as does the overall family environment.
• Previous history of mental illness and/or substance abuse. Having one form of mental illness is always a risk factor for others, and the likelihood of depersonalization disorder is increased if the previous disorder produced dissociative symptoms (which substance use disorders can sometimes do).
• Stressful lifestyles. In one study, nearly 80 percent of participants who reported frequent exposures to stress had experienced episodes of depersonalization and/or derealization at some time in their lives.
• Being raised by emotionally troubled parents. When parents were abused or otherwise traumatized in childhood, or even later in life, it can affect the way they relate to their children or have an impact on the way they teach their kids to relate to the world.

Dissociative disorders are often accompanied by other mental or behavioral health disorders.

Some conditions that commonly co-occur with depersonalization/derealization disorder include:

• Panic disorder
• PTSD
• Obsessive-compulsive disorder
• Major depression
• Personality disorders, most frequently borderline personality disorder
• Substance use disorders, usually involving the abuse of marijuana or hallucinogens

Shared risk factors may often explain the co-occurrence of such conditions. But most of these disorders are capable of producing dissociative symptoms entirely on their own, which suggests their presence may help initiate the onset of depersonalization disorder in some people.

Treating depersonalization/derealization disorder is challenging, for mental health professionals and patients alike. Outpatient and inpatient treatment programs for dissociative disorders do have a good track record of success, but they require hard work and dedication (on the part of everyone) to produce sustainable results.

During individual therapy sessions, therapists will work closely with patients to help them identify the triggers that provoke their episodes of depersonalization and derealization. They will also encourage an honest examination of any frightening memories or overwhelming emotions that might explain both the onset and the persistence of dissociative symptoms.

Evidence-based practices like cognitive behavioral therapy (CBT) and psychodynamic therapy can help men and women with dissociative symptoms gradually break their dysfunctional patterns of thinking and responding. By probing beneath the surface of their symptoms, they can eventually develop healthier and more constructive ways of reacting to stress, anxiety, and fear.

In addition to individual therapy, family therapy sessions can be beneficial for everyone involved, since much misunderstanding often accompanies the diagnosis of a mental health disorder. The more loved ones know about the symptoms of a dissociative disorder, the more prepared they will be to offer compassion and support, which is essential for men and women seeking to overcome mental health issues.

Medication is not recommended for depersonalization/derealization disorder alone. However, antidepressants and anti-anxiety medications are often administered during rehabilitation, when co-occurring anxiety disorders or depressive disorders have been diagnosed and are causing additional symptoms to manifest.

Holistic healing methods are another effective remedy for depersonalization/derealization disorder. Practices like meditation, yoga, arts and music therapy, Tai Chi, acupuncture, and biofeedback are ideal for stress management, mental discipline, and conscious living, all of which can help promote normal, grounded states of consciousness.

Once their initial recovery program is complete, those who leave mental health facilities following treatment for depersonalization/derealization disorder will have an opportunity to continue receiving therapy in aftercare. As long as patients remain committed to wellness and are willing to follow the advice of their therapists, they stand an excellent chance of staying healthy and remaining symptom-free.