What Is Depersonalization - Derealization Disorder (DPDR)

By Olivia Guy-Evans, published March 07, 2022

Fact checked by Saul Mcleod, PhD

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Depersonalization/derealization disorder is characterized by recurring episodes of depersonalization, derealization, or both.

Depersonalization is a complex symptom which can be defined as ‘a state in which the sense of self and the quality of subjective first-person experience are oddly altered’ (Medford, 2012). It can be described as feeling disconnected from the self or feelings as though you aren’t real.

It can be normal to feel depersonalization from time to time, especially in times of stress, upset, fatigue, or with drug use. Transient episodes of depersonalization have a lifetime prevalence between 26% and 74% of someone experiencing at least one episode. 

Derealization is also a part of the disorder, and this symptom affects how individuals relate to other people and their environment. They may feel as if their surroundings or other people are not real.

Whilst depersonalization is defined as disconnections from the self, derealization is defined as disconnections from external reality. 

Derealization is conceptualized as a sense of “unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings” (APA, 2013, p. 303).

A person who experiences derealization might feel as though he is in a fog or a dream, or that the surrounding world is somehow artificial and unreal. 

For most people who depersonalize, this feeling will usually diffuse once the stressful situation is over, or once the drug has run its course. Often, depersonalization is viewed as the mind’s defense mechanism to help cope with stressful situations. 

Feelings of depersonalization can become pathological when the individual is unable to control when and where these symptoms occur, or when the depersonalization becomes generalized to other situations and circumstances, or when it persists beyond the presence of a stressor.

In this situation, it is possible that the individual may have what was previously known as depersonalization disorder, now known as depersonalization/derealization disorder (DPDR). 

DPDR is classified as one of 3 dissociative disorders, the others being dissociative amnesia and dissociative identity disorder.

Dissociative disorders are mental conditions involving disruptions or breakdowns in awareness, consciousness, and memory. For people with DPDR, the periods of dissociation can last for a relatively short amount of time (minutes or hours), or sometimes much longer (days, weeks, months, or years).

Most people with this disorder develop it when they are young. The average age for the onset of DPDR is 16, with the condition rarely beginning after the age of 40. The prevalence of this disorder is thought to affect around 1-2% of the general population (Hunter et al., 2004). 

Symptoms: How do you know if you have depersonalization?

Individuals who experience depersonalization might believe their thoughts and feelings are not their own; they may feel robotic as though they lack control over their movements and speech; they may experience a distorted sense of time and, in extreme cases, they may sense an “out-of-body” experience in which they see themselves from the vantage point of another person.

Individuals with depersonalization disorder often have difficulty describing their symptoms and may think they are going crazy (APA, 2013).

Feeling disconnected from reality

People who experience depersonalization may feel as if there is a barrier between themselves and the world. They may feel as thought they are living in a dream or that things around them are not real. 

Feeling like you’re not real 

People may feel as if their movements and actions do not feel like their own. They may feel as though they are watching someone else. Sometimes people will report feeling as if they are watching themselves from the outside, as if they are an onlooker. 

Fear of losing one’s mind

Many people may worry that their depersonalization symptoms will become so intense that they could be insane. However, the depersonalization is the brain reacting to what it perceives as danger, although it is not always accurate. 

Visual symptoms

Many people who experience depersonalization report visual symptoms such as tunnel vision, distorted and blurry vision, experiencing floaters in their vision, or the distance and size of objects being altered.

A possible explanation for this is that when anxious, the eyes naturally become more sensitive to picking up movements by dilating the pupils to let more light in.

This can make it feel as if there is too much visual information coming in at once.

Distorted perception of time

Often, people may report that they feel like time goes by too fast, there are gaps of time that are forgotten, they find they jump from one moment to another, recent events feel old, or old events feel recent.

This may be happening because the anxiety is affecting the concentration of individuals, so the passing of time feels different. The racing thoughts that they have could distract them from the time going by. 

Memory loss

Occasionally, those experiencing depersonalization may have issues with their memory. They may forget what they were doing or saying, cannot remember what happened the day previously, or feel as if they are losing their short or long-term memory.

However, this is likely the anxiety that is affecting the memory as anxiety usually affected concentration. This can make it seem like the memories have gone blank and one cannot focus on a task at hand. 

Emotional numbness

This symptom is described as not being able to feel happy, sad, or any emotion. An explanation for why this may happen is because since depersonalization is a defense mechanism which keeps someone safe, it can make them feel distant and cut off.

Pairing this with racing thoughts and finding it difficult to concentrate can make things feel worse.

There is nothing wrong the person’s emotions or the ability to feel them, this is only the temporary effects of anxiety and its symptoms. 

Blank mind

People who depersonalize often find that their mind is empty, their thoughts are gone, or they cannot put a thought together. Having a blank mind is often described as losing one’s inner monologue.

However, you only experience this inner monologue when not consciously thinking about it, so if individuals are constantly trying to see if this is present, they are often interrupting it. 

Existential thoughts

As depersonalization is a bizarre experience, the rational brain is desperately trying to find an explanation as to what is causing this.

Often, people may attribute the bizarre feelings to having significance such as thinking they may be in a coma, dreaming, or in purgatory for instance.

Our brains have a tendency to want big explanations, so it often jumps to the scariest conclusions – this is known as catastrophizing. 

Reality testing

Those who are affected by depersonalization may believe they are experiencing psychosis due to some of the aforementioned symptoms. However, the big distinction with depersonalization disorder is that the individuals have intact reality testing.

This is the objective evaluation of an emotion or thought against real life. So even with the most frightening thoughts, one can always distinguish between thoughts and reality.

The symptoms of depersonalization may be observed in other disorders such as anxiety disorders such as post-traumatic stress disorder (PTSD) and panic disorder, as well as depression and schizophrenia.

Those with DPDR frequently experience cognitive symptoms of increased arousal paired with subjective deficits in attention and concentration, as seen in anxiety disorders. High levels of co-existing anxiety has been found in people with DPDR (Michal et al., 2016). 

Some people with DPDR may experience mild, short-lived symptoms, whilst others have chronic symptoms that may last for fears.

The symptoms may be very distressing to the point where they interfere with their ability to function in daily life, including at work, school or in relationships. 

Diagnosis

Whilst it is normal for most people to have experience some depersonalization episodes, when the symptoms start to become distressing or interfering with daily life, this may be a sign of DPDR. 

Before making a diagnosis of DPDR, the primary care provider may ask whether the individual whether they have experienced regular episodes of depersonalization, derealization, or both.

They will also discuss how distressing the symptoms make them feel. The care provider may also ask whether the individual is aware that what they are feeling is not quite real.

If there is not that awareness, then this may be another condition. If there is the awareness, it is possible that they are experiencing DPDR. 

Often a medical history and physical examination may take place to rule out any other possible causes for the symptoms. The healthcare provider may then refer the individual to a mental health professional.

A psychiatrist, psychologist or psychiatric social worker can discuss in-depth the symptoms being experienced and help diagnose and treat the individual. These providers will talk to the individual to understand their experiences and how they are functioning.

These providers are likely to use the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) to diagnose the condition. 

The DSM-5 criteria states that for depersonalization - derealization disorder to be diagnosed, the following criteria must be met:

1. The presence of persistent or recurrent experience of depersonalization, derealization or both:

• Depersonalization: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions.

• Derealization: experiences of unreality or detachment with respect to surroundings. 

2. During the depersonalization or derealization experiences, reality testing remains intact. 

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

4. The disturbance is not attributable to the physiological effects of a substance or other medical condition. 

5. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder. 

Causes and risk factors

There is not always a clear cause for what causes depersonalization and DPDR. In a lot of the cases, care providers are not able to identify what triggers this disorder in patients.

Many people with this disorder report that they had a history of childhood trauma, particularly emotional abuse and neglect. For someone growing up in a household with a lot of violence or yelling, they may have mentally removed themselves from those situations as a coping mechanism.

Thus, as an adult, they may fall back onto these dissociating tendencies in stressful situations. Or they may find that they dissociate at times when there is no known trigger, but it could link back to their childhood trauma. 

Some people may find that they depersonalize after experiencing trauma or intense stress which did not occur in childhood. This may occur after:

• Witnessing or experience abuse

• An accident 

• Encountering a life-threatening danger

• Natural disasters

• The death of a loved one

• Violence or war

Hunter et al., (2003) proposed that depersonalization disorder is most often triggered by one’s response to situations that provoke anxiety. This symptom overlap and high comorbidity of DPDR with anxiety disorders indicates there may be a link between DPDR and anxiety. 

Some other causes of depersonalization include:

• Certain drugs such as hallucinogens

• Extreme fatigue and sleep deprivation 

• Physical conditions such as seizure disorder

• Living with a parent who has a severe mental illness

• A co-existing mental health condition 

Treatment

In terms of treatment, this depends on the severity of the depersonalization symptoms being experienced and whether DPDR is diagnosed.

During periods of acute stress or some episodes of depersonalization, supportive interventions such as coping skills and strategies may be a good fit. Whereas, during periods of mild to more severe symptoms and a diagnosis of DPDR, other approaches may be required.

There are currently no known medicative treatments for DPDR. Whilst there is no specific medication, antidepressants may be helpful, especially if there is underlying depression or anxiety alongside DPDR.

However, for some people, antidepressants may actually increase depersonalization or derealization symptoms. Trials of a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) with people who had a diagnosis of DPDR, found that this medication may induce some of the symptoms to make the condition worse (Brand et al., 2012).

Otherwise, atypical antipsychotic medications that block both dopamine and serotonin receptors may be of use in treating some cases of DPDR with ‘psychotic features.’  

The most effective treatment for DPDR usually involves a type of therapy, especially psychodynamic or cognitive behavioural therapy (CBT).

Psychodynamic psychotherapy uses self-reflection and self-evaluation achieved through cooperation and interrelationship with a psychiatrist. The expectation is that the patient will explore effective coping strategies and relationship patterns.

The psychiatrist will attempt to reveal the unconscious components of the patient’s maladaptive functioning to tackle the symptoms being experienced. 

For CBT, this is focused on identifying and changing the negative or unhelpful thinking patterns, feelings, and behaviours with the therapist.

Through working with the therapist, the patient can find ways to change to more realistic thinking patterns and learn coping techniques that can be put into practice in times of stress.

Hunter et al., (2005) published a study of patients who received an average of 13 CBT sessions. They found that patients had reductions in their levels of dissociation, and depersonalization, with 29% no longer meeting the diagnostic criteria of DPDR after treatment. 

Aside from psychodynamic therapy and CBT, people may opt for one of the following:

• Dialectical behavior therapy (DBT) – this is a type of CBT which may help individuals with tolerating difficult emotions, including dissociative symptoms. It may also be useful for those who have experienced abuse or trauma. 

• Family therapy – working together, the family of the individual can learn about depersonalization. The group can learn how to recognize signs of when this occurs and offer their support when it does. 

• Creative therapies – art or music therapy can help individuals to explore and express their thoughts and feelings in a safe and creative environment. 

Things you can do right now

When experiencing episodes of depersonalization, there are some techniques that can be used to help make the symptoms more manageable. 

1. Acknowledge your feelings

Often, acknowledging what you are feelings and the emotions being experienced can help to lessen these feelings.

It may be helpful to name the emotion you are experiencing to bring awareness and understanding to what you are feeling. 

2. Breathing exercises

When moments of stress and anxiety arises, the body’s sympathetic nervous system fires up, which can lead to feelings of depersonalization.

Breathing exercises, especially deep breathing, may help reset the nervous system, calming it down. Guided meditation and mindfulness training usually include deep breathing and can also be used to calm the body down. 

3. Listen to music

Feelings of depersonalization can become more intense when the brain is focusing on them. using a grounding technique such as listening to music may help you feel less anxious about the experience.

Music has been known to reduce cortisol levels, which is a stress hormone. It may be useful to keep a specific playlist of favourite songs which can be played when experiencing depersonalization symptoms. 

4. Read a book

Reading a book may be another way to help with the anxious thoughts that often occur alongside depersonalization. This may help to focus the mind on something else, interrupting the intrusive thoughts.

Being able to concentrate on the words and being immersed in a story could help ease negative thoughts. 

5. Challenge intrusive thoughts

For some people who experience depersonalization, they may have a lack of intrusive thoughts. However, others, especially if they also have anxiety disorders or PTSD, intrusive thoughts can pose a challenge.

There is a tool called psychological distancing which can be used to help quiet intrusive thoughts.

Psychological distancing means one finds some space between the upsetting thoughts and painful emotions. You may ask yourself what evidence there is that the intrusive thoughts are real.

Finding that there is little to no evidence that these thoughts are real can help provide realistic and rational thought over the intrusive thoughts. 

6. Talk to a trusted friend

Often when experiencing depersonalization, it is tempting to isolate yourself away from others. But at these times, talking to a trusted friend or family member may help.

Sharing these struggles with others can help you feel better. As well as this, others may provide some useful advice or insight which can further help you. 

7. Getting enough sleep

Although this is more of a longer-term method, going to sleep when the body feels tired can help with managing stress and decrease anxiety.

Some people may experience depersonalization due to being fatigued so keeping a regular sleeping schedule can be really beneficial to mental health.

Also, keeping bedtime as relaxing as possible can aid better sleep, such as ensuring that phones or other screens are not used in bed or right before trying to go to sleep.

8. Exercise

Engaging in exercise is often proven to help with managing stress and can be beneficial to mental health. Aerobic exercise in particular could help decrease burnout, which is one of the symptoms of depersonalization.

9. Engaging your senses

If you find yourself in a situation where you feel the symptoms of depersonalization starting to creep up on you, it can be useful to try engaging all your senses.

Being able to engage the senses can help with checking that you are real and can also help in grounding yourself in your body and surroundings.

Engaging the senses can include holding some ice cubes, eating a sour candy, smelling spices, strong coffee, or essential oils. 

Sources

American Psychiatric Association, D. S., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). Washington, DC: American psychiatric association.

Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., & Spiegel, D. (2012). Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. Journal of Trauma & Dissociation, 13(1), 9-31.

Cleveland Clinic. (2020, October 15). Depersonalization/Derealization Disorder. https://my.clevelandclinic.org/health/diseases/9791-depersonalizationderealization-disorder

Depersonalization Manual. (2020, April 6). Depersonalization Symptoms: 10 Most Common (+How To Deal With Them!). YouTube. https://www.youtube.com/watch?v=h7u59TkQTxY&ab_channel=DepersonalizationManual

Fraga, J. (2021, June 27). 10 Ways to Relieve Depersonalization. PsychCentral. https://psychcentral.com/lib/10-simple-ways-to-relieve-depersonalization#things-you-can-do-now

Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: a cognitive–behavioural conceptualisation. Behaviour Research and Therapy, 41(12), 1451-1467.

Hunter, E. C., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour research and therapy, 43(9), 1121-1130.

Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. Social psychiatry and psychiatric epidemiology, 39(1), 9-18.

Medford, N. (2012). Emotion and the unreal self: depersonalization disorder and de-affectualization. Emotion Review, 4(2), 139-144.

Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wölfling, K., Weimert, S., Tuin, I., Subic-Wrana, C., Beutel, M. E. & Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome. BMC psychiatry, 16(1), 1-11.

Raypole, C. (2019, February 1). Understanding Depersonalization and Derealization Disorder. Healthline. https://www.healthline.com/health/depersonalization-disorder