Depersonalization (Derealization) Disorder - What Is It?

Depersonalization is a type of dissociation in which a person has a sense of detachment from their own self. Depersonalization is often associated with derealization, which is when a person feels disconnected from other people or their surroundings.

The presence of persistent or recurrent experiences of depersonalization, derealization, or both, may reflect the diagnosis of depersonalization/derealization disorder.

Depersonalization vs Derealization

Both depersonalization and derealization are conditions that occur with dissociative disorder. You may experience one of these more profoundly than the other, but most dissociation includes a mix of the two.

While the conditions may cause different sensations, they occur in a similar way.

The average age of onset for both conditions is 16 with the majority of cases being diagnosed before age 20. About 72% of those diagnosed with depersonalization or derealization have another secondary psychiatric diagnosis. Anxiety and depressive spectrum disorders are the most common comorbidity.

Symptoms

With depersonalization, there's the sense that you're watching your life like watching a movie. Some people say depersonalization is like an out-of-body experience.

The symptoms can include:

• Feeling physically numb to sensations in your body
• Feeling like you are unable to control your speech or movement
• Difficulty attaching to your emotions, memories, and physical feelings
• Difficulty relating memories of something that happened to you
• Feeling like your body or limbs are distorted (enlarged or smaller)
• Feeling as though your head is wrapped in cotton
• Difficulty recognizing and describing your emotions

The depersonalization symptoms usually last for a few minutes but can persist for hours or days. They usually occur rarely and may recur intermittently for years.

Causes

The development of dissociative symptoms—like depersonalization—is often a way to cope with trauma. It's a common symptom of post-traumatic stress disorder (PTSD) and often develops in people who are exposed to long-term abuse. Other types of traumatic situations can also cause depersonalization, like a natural disaster or combat.

Anxiety and depression can be comorbidities and are often diagnosed alongside depersonalization.

Risk factors for depersonalization include:

• Emotional or physical abuse during childhood
• History of sexual assault
• Witnessing domestic violence
• The unexpected death of a loved one
• History of drug use
• Anxiety or depression
• Severe stress

The effects of stress and anxiety can trigger a condition known as s Burnout Syndrome (BOS) in which an employee is unable to adapt to a work environment that's caused job disillusionment. Depersonalization is among the symptoms that may develop with BOS. With depersonalization in burnout, a person may engage in negative and unprofessional comments and display a callous attitude toward co-workers, clients, or patients under their care.

Diagnosis

The diagnosis of depersonalization is based on a review of your symptoms and history. Your healthcare provider may also recommend diagnostic tests to rule out other potential causes of your symptoms, such as a head injury, brain lesion, sleep disorder, or seizures.

The diagnosis of depersonalization/derealization disorder is based on the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Typically, a professional who specializes in mental health disorders will complete the assessment.

Criteria include:

• Persistent or recurrent episodes of depersonalization
• An understanding that the feeling isn't real
• Significant distress or impaired social or occupational functioning caused by the symptoms

Treatment

For some people, the symptoms resolve without any interventions or treatments. But sometimes personalized treatments are needed to help with managing the symptoms. Treatment will help to manage triggers and provide strategies to help understand and control symptoms.

Psychotherapy

Psychotherapies, such as cognitive-behavioral therapy, are the most effective treatments for depersonalization disorder.

Psychotherapy techniques can help to:

• Changing persistent thinking about being dissociated from your body
• Engage in tasks to distract from the symptoms of depersonalization
• Use grounding techniques to help you feel more connected to yourself and the world around you, and help you feel more connected with reality
• Provide strategies to cope with negative feelings, internal conflicts, and experiences that trigger dissociation

Medication

There is no specific medication that can cure depersonalization. If you have anxiety or depression, your healthcare provider may recommend medications for the treatment of these conditions. This could also help reduce your symptoms of depersonalization if anxiety and depression are contributing to your symptoms.

Coping

Depersonalization can be highly distressing, so be sure to discuss your symptoms with a healthcare provider so you can get a proper diagnosis and treatment plan.

If you or a loved one is experiencing symptoms of depersonalization, there are some strategies you can use to help you feel more connected to yourself and reality.

These include:

• Gently pinching your skin to feel more connected to your body
• Taking slow, deep breaths while focusing on the movement of your chest and diaphragm
• Calling a friend or family member and have them talk with you to help you feel more connected with other people and reality
• Keeping your eyes moving around your surroundings to prevent zoning out
• Practicing meditation to increase your awareness of your experience
• Looking around at your surroundings and counting the objects you see, saying their colors aloud, or naming the objects

A Word From Verywell

Experiencing the symptoms and being diagnosed with depersonalization can be very confusing and upsetting. Working with a mental health professional can help establish an effective plan to help you manage your experience of depersonalization, and in some cases, the symptoms can be completely resolved.