Depersonalization-derealization disorder (DPDR) is a serious condition that can cause debilitating and persistent symptoms. Often, it emerges as a response to trauma, particularly childhood trauma, and causes the individual to feel disconnected from their own thoughts and feelings or the world around them.
- Depersonalization-derealization disorder (DPDR) causes persistent or recurring feelings of detachment from the self and environment.
- DPDR can be serious and chronic and may impair several aspects of life and functioning.
- DPDR can be effectively managed with treatments such as psychotherapy and medications.
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What is depersonalization-derealization disorder (DPDR)?
Depersonalization-derealization disorder (DPDR) is a severe and often debilitating condition that affects emotional well-being and functioning. [1]
Depersonalization is the feeling of detachment from oneself, while derealization is the feeling of detachment from one's environment. Either can occur at varying severities and frequencies, but if both occur persistently or frequently and cause impairments in normal functioning, this is known as DPDR. [1]
Depersonalization and derealization are types of dissociative symptoms that tend to emerge following traumatic events. Mild and transient dissociative symptoms, lasting up to a few hours or days, are very common among the general population. They can be triggered by various causes, including fatigue, jet lag, stress, or drugs. Short-term DPDR symptoms are found to occur in up to three-quarters of the general population. [2][3]
The prevalence of severe and debilitating symptoms, meeting criteria for DPDR, is 1-2% of the population worldwide, with seemingly equal prevalence among men and women. Typically, DPDR emerges in adolescence but may also develop as late as the age of 25. [1]
What does depersonalization-derealization disorder feel like?
People with DPDR may experience the following symptoms: [1][3][4]
- Feeling detached, as though living in a dream
- Feeling empty or like their perception of the world is distorted
- Feeling like behaviors, emotions, or thoughts are not their own, or they are viewing themselves from outside their body
- Struggling to verbalize experience and emotions
- Emotional responses are blunted
- Memories can feel like they are not their own, like they happened to someone else
- Having existential thoughts, questioning their identity
- Feeling numb
- Trouble concentrating
- Perceptual distortions, such as time feels sped up or shapes and colors appear different
- People and places that are known might feel unusual
- They might experience symptoms of other conditions, such as anxiety, depression, or insomnia
- Impaired functioning in social or professional settings
- Being acutely aware of their symptoms and understanding that something is not right, which can cause concerns and a feeling of losing their sanity
Causes, risk factors, and triggers: Why does it happen?
DPDR is currently not well understood or studied within scientific literature, so its causes and risk factors require further research. However, research indicates that dissociative symptoms (including derealization and depersonalization) emerge as a trauma response. [1]
In particular, early interpersonal trauma, such as childhood abuse and neglect, is believed to be a strong factor in the development of dissociative disorders. It is thought that dissociation as a trauma response develops when a child is exposed to extreme stress and cannot process or understand their experiences in the context of themselves and their environment. This causes a splitting in consciousness, as the brain attempts to protect itself from emotional pain. [1][5]
Studies also show that there are neurobiological responses to trauma that further support this, highlighting the need for further research in this area. It is found that people with dissociative PTSD display differences in the activity of certain brain areas, such as the amygdala and frontal lobe, compared to those with other forms of PTSD. It is possible that this neural adaptation occurs in those with DPDR and causes persistent symptoms. [1][3]
Additionally, there may be some genetic factors in the development of the condition, as people with DPDR are found to be more likely to have a family history of anxiety disorders and dissociative disorders. [3]
How is DPDR diagnosed?
Reportedly, it can take 7-12 years to receive a DPDR diagnosis. DPDR is commonly missed or misdiagnosed, as it is not well understood and can present similarly to many other conditions. Individuals can have full clarity and reality testing and be able to respond and interact with no signs of psychosis, which can mean that symptoms are unrecognized during medical interviews. [1]
Additionally, the symptoms are hard to quantify. The condition is related to the individual’s lived experience, thus relying on their personal account and descriptions. This can make diagnosis more challenging, particularly as individuals with the condition often struggle to express their emotions and articulate their symptoms.
DPDR is included in the DSM-5, with specific criteria that will inform a clinical diagnosis. The doctor will interview the individual to ascertain the presence of symptoms. For a diagnosis of DPDR, the individual must meet the following criteria: [3][6]
- Ongoing, persistent, or recurrent depersonalization and/or derealization
- Significant emotional distress or impairments in social, professional, personal, or other aspects of life due to symptoms
- Reality testing is not affected by their symptoms
- Symptoms are not attributable to substance use, illness, or other mental health conditions
Dissociative symptoms such as derealization and depersonalization can also occur in the context of various mental health conditions, including obsessive-compulsive disorder (OCD), borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). However, DPDR would not be diagnosed if the symptoms are attributed to one of these conditions. [1][6]
Evidence-based approaches for treatment and recovery
Treatment for DPDR requires a comprehensive and holistic approach, which can involve psychotherapy, medications, and mindfulness. Treatment effectiveness can vary from person to person, and approaches should be tailored to individual needs.
Psychotherapy
Therapeutic interventions, particularly cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR), can be helpful treatments for people with DPDR. These therapies can help people develop positive coping strategies, manage emotional distress, and treat underlying trauma. [3][5]
Medications
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to treat symptoms of DPDR and associated conditions, particularly anxiety and depression-like symptoms. In some cases, antipsychotic or anxiolytic medications can be helpful. [3]
Mindfulness and lifestyle
Managing stress, mental well-being, and physical health can help to improve DPDR symptoms. For example, healthy lifestyle habits such as maintaining balanced nutrition, exercise, and sleep hygiene, alongside stress management techniques such as relaxation exercises, mindfulness, and meditation, can improve mental and physical well-being. [3][7]
Coping with DPDR in daily life
Living with depersonalization-derealization disorder (DPDR) can feel overwhelming, especially when symptoms interfere with everyday activities, relationships, and self-confidence. While recovery can take time, there are practical ways to reduce distress, improve day-to-day functioning, and build resilience. Coping strategies often focus on education, self-care, grounding, and support systems, which can help you feel more in control of your symptoms and less isolated in your experience. [7]
How can I accept and cope with my condition?
To accept and cope with your condition, it may be helpful to: [7]
- Learn more about the condition, its causes, symptoms, and treatments
- Speak with others who have similar symptoms on online forums or at support groups
- Speak with a professional for advice on how to manage symptoms
- Acknowledge symptoms as they arise and learn how not to be afraid of them
- Practice relaxation and mindfulness techniques to improve stress management and feel more present in your body and environment
- Speak with family and friends about your experiences and how they can help support you
How can I snap out of derealization?
It might not always be possible to quickly snap out of derealization. However, using mindfulness techniques, such as breathing exercises or meditation, could be beneficial, helping to bring focus to the present. Grounding exercises that focus on one or more specific senses can also help. For example, ice dives are a commonly used technique to help manage intense emotions and draw focus to the body. [7]
DPDR, addiction, and co-occurring mental health concerns
It is common for people with DPDR to experience co-occurring conditions, which may be caused or worsened by DPDR or may be associated with the underlying causes of the condition. For example, depression and anxiety symptoms are very common among those with this condition and can add to emotional distress. [2][3]
Additionally, substance use issues may occur alongside depersonalization and derealization symptoms. For some, substances are a coping strategy to manage symptoms and distressing thoughts or feelings, although this can worsen the symptoms of the condition. [1]
When and how to get help
People who experience symptoms of DPDR may wish to seek professional advice and support, particularly if these symptoms are having a significant impact on their mental well-being or ability to function. Speaking with a primary care physician can begin the diagnostic process, and they can make a referral to a specialist mental health service for appropriate assessment and treatment.
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