Understanding Depersonalization and Derealization

Understanding Depersonalization

Imagine being stuck inside a small glass box 24 hours a day wherever you go.

Imagine feeling as if you're about to float away or disappear into thin air because you have no human body to tether you to the real world.

Imagine being unable to hold a real conversation because you can't interpret the other person's words or register what they're saying.

Imagine exchanging eye contact with a loved one and seeing nothing but a 2D comic-book image, devoid of emotion or meaning.

Imagine seriously considering whether or not you might have died because you're unable to feel anything – physically or emotionally.

Imagine looking in the mirror and not recognizing the person staring back at you. We feel so separated from both our body and mind that our reflections might as well be different people.

The hypotheticals we gave you are all common descriptions of different people's experiences of depersonalization (often abbreviated to DP). But it is not a condition of delusion as it may initially sound. We understand that our symptoms are part of our condition ('in our minds'). This fact can make depersonalization even harder to cope with.

We know we love our friends and family so why can't we feel it? We know that our unreal sensations are a product of our brains so why can't we just change them? It seems like recovery should be very easy but it's very hard and can take a long time.

Depersonalization is far more common than most people believe. The vast majority of people will experience temporary, insignificant depersonalization at some point in their lives. Clinically significant depersonalization is more common than schizophrenia and at least as prevalent as bipolar disorder and is believed to be the third most common overall mental health problem behind only depression and anxiety.

Clinically significant depersonalization spans a spectrum from mild to severe. Mild depersonalization can disrupt a person's life and ability to function optimally. Severe depersonalization can leave them barely able to function at all. In some severe cases, sufferers are no longer able to work (often, they get fired) and can no longer care for themselves properly. The most extreme forms of depersonalization can render a person disabled (just as in severe cases of schizophrenia).

Depersonalization Symptoms

Depersonalization (DP) is best described as a syndrome, which is a set of symptoms that frequently occur together. Even the best clinical definitions aren't the same as listening to sufferers describe the way these symptoms feel through first-hand experience. 

Some of the most common symptoms of depersonalization as described by sufferers are:

• Feeling as though their body is weightless, ghost-like, or physically non-existent
• Feeling as though their movements are robotic or unnatural or not their own
• Feeling as if their life is on auto-pilot and that they are merely zombies or automatons stumbling through life
• Feeling as if their emotions are non-existent, invalid, or pointless
• Feeling as though their mind is 'blank' and that they have no conscious or natural thoughts
• Feeling as though their body does not belong to them
• Feeling as though they have lost themselves and their identity
• Feeling as if their surroundings are somehow altered and unnatural (e.g. the world appears 2D)
• Feeling as if they're observing their own body from the outside (similar to an out-of-body experience)
• Feeling as though time is distorted (e.g. slow-motion vision or speeding up of time while seemingly doing nothing)
• Feeling as though everything is unreal including their body, mind, thoughts, emotions, and environment
• Experiencing deep existential or nihilistic rumination leads to panic, despair, and suicidal
• Experiencing thick brain fog affecting cognition and memory (one common metaphor is "a head full of cotton wool")

Notice the recurring theme of similes and metaphors in describing the symptoms of depersonalization (which can also be observed in the more illustrative descriptions found at the start of this article). This use of language is no coincidence and reflects the awareness that DP sufferers have of the disconnect between their perception and what they know to be true.

DP is not a delusional state. Sufferers know that their body still has weight and that their surroundings are real but they don't feel that way. The input they receive from their senses and their mind doesn't match up to what they rationally and intuitively know to be objective reality.

DP is a subjective change in how one experiences oneself and the world. There are no words in the English language to adequately and directly describe DP, which is why we often resort to analogies and why the clinical definitions rarely have the necessary descriptive power. DP is something that must be experienced first-hand to be understood and this is a key point for anyone attempting to support a sufferer.

Depersonalization and Derealization

Strictly speaking, depersonalization refers to perceptual distortions and feelings of unreality involving the self (i.e. the body and the mind) and derealization refers to perceptual distortions and feelings of unreality involving everything outside the self (i.e. one's surroundings and environment). Clearly, these are complementary states. Sometimes, sufferers have difficulty separating the two because they are so tightly linked.

Approximately 75% of people with clinically significant DP also experience derealization (often abbreviated to DR). Only around 5% experience DR without DP. Due to their overwhelming concordance, depersonalization and derealization are usually simply brought under the umbrella of ‘depersonalization’.

DP and DR would appear to have very similar causes and mechanisms and this homogeneity was highlighted in the DSM-V where depersonalization disorder was renamed depersonalization-derealization disorder. Both in research and in the depersonalization community, depersonalization is almost universally used to refer to depersonalization and/or derealization.

As in the general case, depersonalization and derealization do not warrant discrimination, which is why we've included DR symptoms in our DP symptoms list above.

Depersonalization disorder (DPD): Depersonalization-Derealization Disorder (DPDR)

Let's introduce a new term into the mix: depersonalization disorder. Whereas depersonalization is a syndrome that may occur for many, many reasons – including as a symptom of another illness – depersonalization disorder is the ‘pure’ form of depersonalization: it is not a symptom of another condition but a condition in its own right. When a depersonalization sufferer has depersonalization that is disruptive to that person's life and is not obviously caused by a psychological or organic illness or drug use (i.e. DP is the primary problem) then a diagnosis of depersonalization disorder is appropriate.

According to the DSM-V, the criteria for a diagnosis of Depersonalization Disorder (DPD) - now known officially as Depersonalization-Derealization Disorder (DPDR) - are:

• Persistent or recurrent symptoms of depersonalization and/or derealization sufficient to cause distress and/or dysfunction
• Reality testing remains intact (used to exclude a diagnosis of a psychotic disorder or a more severe dissociative disorder)
• The depersonalization is not better explained by a physiological problem, drug use, or another mental health problem including:

▪    Anxiety and panic disorders 

▪    Depressive disorders (Clinical depression, Bipolar Disorder, etc.)

▪    Obsessive-compulsive disorder 

▪    Psychotic disorders 

▪    Substance abuse or withdrawal

▪    A more severe dissociative disorder 

▪    Many others...

The other major collection of diagnostic guidelines, the ICD-10, has almost identical guidelines for depersonalization disorder (as does its successor, the ICD-11).

The depersonalization disorder subgroup contains several very unfortunate people who simply woke up one day with depersonalization and have no idea why. This is called idiopathic depersonalization disorder and is the purest form of depersonalization because it appears to have no underlying cause whatsoever. Cases like this may also be referred to as primary depersonalization disorder to emphasize the fact that DP is the primary problem and seems to have no connection to anything else.

Primary DPD is the hardest form of DP to treat because the sufferer has no idea where it came from. There are reports of people just walking down the street one day and then, bam, all of a sudden, they have long-term DPD. These stories - scarcely believable except for their widespread reportage - prove just how much we still need to figure out about DP.

How to Help Someone with Depersonalization

You can't imagine or understand depersonalization unless you've experienced it first-hand. Like many so-called ‘invisible’ illnesses the best you can do as someone trying to help out a sufferer is to listen to them and trust in what they say. If you've never experienced depersonalization, you may at least be able to empathize with the suffering, desperation, and terrible negative emotions it can create.

If someone you care about suffers from depersonalization, I hope you read this page thoroughly and take the advice to heart. It could make all the difference to your relationship with them. Whether it's a friend, significant other, or family member, the person you know who is suffering through this horrible condition may need your help, love, and support.

It takes real love to stick things through with a depersonalization sufferer - you wouldn't believe how many people have lost long-term partners and spouses to this condition! - but if you come out the other side, you have every right to boast about the strength of your relationship. You're great...

One thing has to be clear at this point: someone with depersonalization may not appear to express love, affection, or concern for you but that does not mean that they don't love you. A lot of people with depersonalization have a hard time experiencing, processing, and expressing their emotions but I can guarantee you that it does not mean they don't care.

Depersonalization is serious

The significance of all mental health conditions is often drastically underestimated by those who have never experienced one. Due to a lack of awareness and understanding, this problem is magnified in depersonalization. You never have to explain depression to those around you. Imagine trying to explain such a strange and abstract condition as depersonalization, which can prove inconceivable to some.

Many sufferers are reluctant to share anything about their condition with anyone for fear of sounding crazy, being disbelieved, or not being taken seriously (this damages their support network and can even stop sufferers from seeking proper help). Unfortunately, even when sufferers do share what they're going through with friends and family members, they are often met with the expected reactions: disbelief and trivialization of their suffering.

Sadly, a number of people have ultimately committed suicide as a direct result of their depersonalization. Most people with moderate or severe depersonalization have at least some level of suicidal thinking on a semi-regular basis. It's possible that the nature of depersonalization - numbing emotions and making everything seem less real - increases the risk of a sufferer acting on their suicidal ideation. Anyone who believes that depersonalization isn't a serious condition is dangerously mistaken.

  Read more: Dissociative Disorders: Types, Symptoms, Causes, Prevention, Treatment

Dealing with Depersonalization and Derealization

Depersonalization and derealization (DPDR) can be a profoundly unsettling and confusing experience. But, know that you're not alone. DPDR is a relatively common condition, and there are effective ways to manage its symptoms and work towards recovery.

Here are some key strategies for dealing with depersonalization and derealization:

Understanding and Acceptance:

• Educate yourself: The more you understand about DPDR, the less frightening it will seem. Read reliable resources, talk to mental health professionals, and connect with other individuals who have experienced it. Knowledge empowers you to manage your symptoms and navigate challenges.

• Validate your experience: Don't doubt or dismiss your feelings. DPDR is real, and it can be incredibly overwhelming. Accepting your experience as valid is the first step towards healing.

• Normalize your symptoms: DPDR is a common reaction to stress, trauma, or other mental health conditions. Understanding that it's not a sign of weakness or a personal flaw can help reduce shame and self-blame.

Mindfulness and Grounding Techniques:

• Stay present: Focus on the present moment through mindfulness techniques like meditation or deep breathing. Engage your senses and observe your surroundings with curiosity. Grounding exercises, like holding an ice cube or focusing on an object in your hand, can also help anchor you to reality.

• Challenge negative thoughts: DPDR can trigger intrusive thoughts and anxieties. Practice cognitive-behavioral therapy (CBT) techniques to identify and challenge negative thought patterns that exacerbate the symptoms.

• Focus on your body: Gentle physical activity, yoga, or stretching can help reconnect you with your body and its sensations. Engaging in activities you enjoy can also be a grounding experience.

Building a Support System:

• Connect with others: Seek support from loved ones who are understanding and willing to listen without judgment. Joining online or in-person support groups for people with DPDR can provide valuable connections and encouragement.

• Seek professional help: Don't hesitate to seek professional help from a therapist or psychiatrist who specializes in dissociative disorders. Therapy can equip you with coping skills and address the underlying causes of your DPDR.

Additional Tips:

• Maintain a healthy lifestyle: Getting enough sleep, eating nutritious foods, and exercising regularly can improve your overall well-being and make it easier to manage stress and anxiety, which can trigger DPDR symptoms.

• Avoid substance use: Alcohol and drugs can worsen DPDR symptoms and hinder your progress in recovery.

• Keep a journal: Keeping a journal can be a therapeutic way to express thoughts and emotions. Tracking patterns in symptoms may help identify triggers and facilitate discussions with mental health professionals.

• Be patient and kind to yourself: Recovery from DPDR takes time and effort. Be patient with yourself, celebrate your progress, and avoid comparing your journey to others.

Treatment Options for Depersonalization Disorder

• Therapy: Cognitive-behavioral therapy (CBT) is the most effective treatment for DPDR. CBT helps you identify and change negative thought patterns that contribute to your symptoms.

• Eye Movement Desensitization and Reprocessing (EMDR): EMDR can be helpful for individuals with DPDR linked to trauma. This therapy technique helps process and reframe traumatic memories, reducing their impact on your current experience.

• Medications: While medication is not a cure for DPDR, certain medications, such as antidepressants or anti-anxiety medications, can be helpful in managing co-occurring conditions like depression or anxiety, which can exacerbate DPDR symptoms.

Dealing with DPDR can be a daunting task, but by actively engaging in these strategies and seeking support, you can find your way back to stability and connection. Remember, you are not alone in this journey, and there are resources and hope available to help you navigate the fog and find your way back to your reality.

Additional Resources:

• The International Society for Trauma, Stress & Dissociation (ISSTD): https://istss.org/home
• The National Alliance on Mental Illness (NAMI): https://www.nami.org/Home
• The Depersonalization & Derealization Research & Support Network: https://depersonalization.info/

Frequently Asked Questions (FAQs)

Q1. What is the difference between depersonalization and derealization?

A1. Depersonalization refers to the experience of feeling detached from oneself as if observing oneself from the outside. On the other hand, derealization involves a sense of unreality or detachment from the external world. Both depersonalization and derealization can occur simultaneously in individuals with Depersonalization-Derealization Disorder.

Q2. Can Depersonalization-Derealization Disorder be cured?

A2. Depersonalization-Derealization Disorder can be effectively managed and treated with the help of mental health professionals. Treatment approaches may include psychotherapy, medication, and self-help strategies. While it may not be completely cured, many individuals experience significant relief from their symptoms and an improvement in their quality of life.

Q3. How is Depersonalization-Derealization Disorder diagnosed?

A3. Diagnosing Depersonalization-Derealization Disorder involves a comprehensive evaluation by a mental health professional. The clinician will conduct a thorough assessment of the individual's symptoms, medical history, and possible contributing factors. They may also use specific diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make an accurate diagnosis.

Q4. Can stress trigger depersonalization and derealization episodes?

A4. Yes, high levels of stress and anxiety can trigger depersonalization and derealization episodes in individuals with Depersonalization-Derealization Disorder. Individuals experiencing these symptoms need to seek professional help to address the underlying causes and learn effective coping strategies.

Q5. Are there any self-help strategies for managing Depersonalization-Derealization Disorder?

A5. While professional help is essential, there are also self-help strategies that individuals with Depersonalization-Derealization Disorder can incorporate into their daily lives. These may include stress reduction techniques, mindfulness exercises, regular physical activity, maintaining a healthy lifestyle, and seeking support from loved ones or support groups.

Q6. Can medication help with Depersonalization-Derealization Disorder?

A6. Medication can be a helpful component of the treatment plan for Depersonalization-Derealization Disorder. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed to manage associated symptoms of anxiety or depression. It's crucial to consult with a psychiatrist or healthcare professional for appropriate medication recommendations and monitoring.