Depersonalization / Derealization Disorder
Depersonalization/derealization disorder creates a persistent and pervasive sense of disconnection from self and the world. Inner reality is distorted as sufferers experience the surrounding environment—and even their own thoughts and memories—as something distant and alien. If left unaddressed, depersonalization/derealization disorder can seriously inhibit daily functioning, but with comprehensive treatment sufferers can learn to manage and control their symptoms and resume normal living.
What is Depersonalization / Derealization Disorder?
Depersonalization/derealization disorder is a form of dissociative disorder, a term for mental health conditions that create feelings of psychological, physical, and emotional separation from what is normally perceived to be real.
Depersonalization refers to feelings of separation from the activities and sensations of an individual’s mind and body, while derealization describes a sense of disconnection from the social, natural, or cultural environment, and from other people. Depersonalization/derealization sufferers are plagued by enduring episodes of detachment from self, the world, family, and/or community, and during these periods of confusion their perception shifts into strange and frightening territory.
Symptoms of dissociation can manifest as a side effect of multiple conditions or disorders. But depersonalization/derealization disorder produces these symptoms exclusively and right from the onset of the illness.
This condition can be highly disruptive and can interfere with daily functioning in a variety of ways, and people suffering from full-blown depersonalization/derealization disorder are unlikely to get better without treatment.
This is especially true if co-occurring mental or behavioral health problems are present, as they often are when depersonalization/derealization disorder symptoms are experienced.
Types of Depersonalization/Derealization Disorder
Depersonalization/derealization disorder has only one type, although sufferers may experience depersonalization symptoms only, derealization symptoms only, or an equal mixture of both.
Regardless of which symptoms manifest, or in what order, depersonalization/derealization disorder produces dissociative episodes that can last for hours, days, weeks, or months. Eventually, the condition may become so pervasive that its symptoms are experienced almost continuously, and at that point its capacity to inhibit functioning can be severe.
Depersonalization/Derealization Disorder Facts and Statistics
Up to 50 percent of the general population will experience at least one transitory episode of depersonalization or derealization in their lifetimes. But just two percent will have episodes severe or long-lasting enough to qualify for a depersonalization/derealization disorder diagnosis.
Here are some more interesting statistics about this little-known condition:
- About two-thirds of people who experience a traumatic event will show depersonalization/derealization symptoms.
- One-third of those battling a life-threatening illness will suffer from feelings of depersonalization or derealization during their ordeal.
- Up to 30 percent of veterans who’ve seen action in combat will develop some form or depersonalization/derealization disorder.
- Veterans with major depression are twice as likely as their counterparts to suffer from depersonalization/derealization disorder.
- Two out of three people who suffer a mild head injury will experience feelings consistent with depersonalization or derealization.
- 11 percent of victims who lose consciousness following a serious head injury will suffer from depersonalization/derealization disorder.
- In one study, 43 percent of natural disaster survivors reported feelings of depersonalization or derealization.
- In a study from the 1990s, 79 percent of respondents living highly stressful lives experienced the symptoms of depersonalization and/or derealization.
- Women are twice as likely to suffer from depersonalization/derealization disorder as men.
- Depersonalization/derealization disorder generally develops early in life: the average age of onset is 16, and only five percent of cases start after the age of 25.
- With depersonalization/derealization disorder, earlier age of onset means more intense and debilitating symptoms.
Symptoms and Diagnosis of Depersonalization / Derealization Disorder
Depersonalization/derealization disorder usually develops gradually, and when its symptoms first appear they may be subtle and not particularly alarming. But over time those symptoms may increase in frequency, duration, and intensity, until their adverse effects become obvious and unavoidable.
The characteristic symptoms of depersonalization/derealization disorder are as follows:
- Feelings of disconnection from thoughts, emotions, parts of the body, the whole body, or some combination of all of these
- A loss of connection to normal identity (i.e., the sufferer feels as if their true identity is something different than their name, personal history, memories, etc.)
- Emotional numbness and physical unresponsiveness to the world and in the presence of others
- Distrust of memories, concern that they may be false or inaccurate
- A lack of emotional connection to past experiences
- Distorted perceptions of the body, where limbs may seem enlarged, shrunken, or misshapen
- Feeling as if speech and movement are arbitrary and uncontrollable, despite the illusion of choice
- Feeling alienated or disconnected from the surrounding environment, as if it were a separate existence
- Visual distortions of the environment (objects or people may seem blurry, indistinct, colorless, two-dimensional, or far more distant than they actually are)
- Distortions in the sense of time (recent events seem to have happened long ago, or in another lifetime)
- Familiar people, places, or events seeming somehow new or different, even though no one else notices the changes
- A sense that the individual is living in a dream, movie, or alternate reality
High anxiety and depression aren’t symptoms of depersonalization/derealization disorder, but they frequently accompany its sensations, which helps make states of depersonalization and derealization more powerful and panic-inducing.
Diagnosing Depersonalization/Derealization Disorder
Because other physical and mental health problems can cause symptoms of dissociation (separation from self and/or environment), clinicians must screen for such conditions before making a diagnosis of depersonalization/derealization disorder. The conditions that can produce dissociative symptoms include seizures, substance use disorders, panic disorder, major depression, PTSD, and life-threatening illnesses like cancer.
Assuming the patient’s tests and evaluation comes up clean, they can be officially diagnosed with depersonalization/derealization disorder if and only if:
- They report strong and persistent symptoms of either depersonalization or derealization (or both).
- They know their feelings and sensations are unreal (this is not always the case with other perception-altering mental health conditions, like schizophrenia or manic depression).
- Any co-occurring physical or mental health conditions the patient does have cannot account for their dissociative symptoms.
- As a result of their symptoms, the patient suffers significant distress and impairment of personal, social, and occupational functioning.
Depersonalization/derealization disorder is amenable to treatment, so once it has been diagnosed patients and their families would be wise to follow any recommendations their doctors make.
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Causes and Risk Factors for Depersonalization / Derealization Disorder
Depersonalization/derealization disorder is a type of defense mechanism for people who face stressful situations they might like to escape. It represents the brain’s adjustment to difficult circumstances or experiences, and addressing those causal factors during recovery helps facilitate healing.
Some of the specific risk factors for depersonalization/derealization disorder include:
- Previous transitory incidents of depersonalization or derealization
- History of serious mental illness among an individual’s parents
- Avoidant personality traits (avoidance in the face or stressful or unpleasant circumstances)
- Exposure to severe physical, emotional, or sexual trauma, especially in childhood
- Prolonged and significant life stresses (related to relationships, finances, legal troubles, employment, etc.)
- History of severe depression and anxiety, including panic attacks
- Substance abuse (marijuana, ketamine, and hallucinogens are especially likely to provoke dissociative symptoms)
People who forego treatment after initial episodes of depersonalization or derealization are more likely to develop severe symptoms in the months and years to come.
Anxiety and depression frequently accompany depersonalization and derealization symptoms, and comorbid major depression and anxiety disorders are often diagnosed in people with full-blown depersonalization/derealization disorder.
Panic disorder and PTSD are two anxiety disorders commonly found in those suffering from depersonalization/derealization disorder. The former can exacerbate the intensity of dissociative symptoms, while the latter shares many risk factors with dissociative conditions, including depersonalization/derealization disorder.
In addition to depression and anxiety, people with depersonalization/derealization disorder are often diagnosed with co-occurring substance use disorders.
Many people turn to drugs and alcohol to help them cope with the symptoms of mental illness, and that undoubtedly explains part of the connection between substance abuse and depersonalization/derealization disorder. However, prolonged substance abuse can also trigger depersonalization and derealization in some instances.
Treatment and Prognosis for Depersonalization / Derealization Disorder
Depersonalization and derealization symptoms will only become debilitating if left untreated, even as they begin to escalate in frequency. People who suffer from depersonalization/derealization disorder are unlikely to recover their freedom and peace of mind spontaneously, so for these individuals comprehensive mental health treatment is essential.
Treatment for depersonalization/derealization disorder centers around intensive, multi-dimensional psychotherapy, which is most likely to be effective if administered in a residential mental health facility under the auspices of an inpatient treatment program.
Cognitive-behavioral therapy (CBT) and psychodynamic therapy are frequently recommended for people suffering from depersonalization and derealization symptoms, since both therapies can help patients reorient their thinking and reduce levels of engagement with troubling thoughts and emotions. Individual, group, and family therapy sessions will also address incidents of past trauma that may have predisposed the patient to develop depersonalization/derealization disorder, while any and all symptoms from co-occurring conditions will be addressed as well.
Medications are not used to treat the symptoms of depersonalization/derealization disorder specifically, but they may be prescribed to help patients recover from anxiety disorders or depression if they have been diagnosed. Complementary treatments for depersonalization/derealization disorder include a wide range of holistic healing practices, including meditation, massage therapy, biofeedback, music and arts therapy, yoga, and other techniques that assist with stress management and promoting mindfulness. These therapies are frequently offered during inpatient rehab, and patients will be urged to continue them on their own once they transition into long-term aftercare.
Depersonalization/derealization disorder is a life-altering condition that can become disabling if it is not treated aggressively and rapidly when symptoms start to intensify. But treatment can be extremely effective against it, and those who pursue recovery with dedication and a positive attitude can restore their connection with the world and overcome the worst effects of this troublesome and chaos-inducing condition.