Depersonalization Disorder

Depersonalization disorder, more specifically known as depersonalization/derealization disorder (DDD), is a psychiatric condition in which an individual feels detached from their body and thoughts, as if they were observing themselves from an outside perspective. It is a type of dissociative disorder involving problems with memory, identity, behavior, and sense of self. 

Depersonalization specifically refers to the sense of feeling disconnected from one’s own body. This is in contrast with derealization, which is the sense of being disconnected from the surrounding world and environment. Those with DDD experience feelings of depersonalization, derealization, or both. Notably, individuals are aware that these feelings of detachment are not real, which is what differentiates depersonalization disorder from psychotic disorders. 

While it is common to experience occasional episodes of depersonalization during one’s lifetime (e.g., daydreaming), only 2% of the population have been diagnosed with DDD. Prevalence does not seem to differ depending on gender. The symptoms typically start in early or middle childhood, with 16 years old being the average age of onset. It is rare for the disorder to begin after the age of 25.

While the exact cause of DDD is not well understood, it is thought to be related to a combination of genetic and environmental factors. In some cases, it may be associated with severe residual stress from traumatic events, specifically those that occur during childhood. Examples of traumatic events include emotional or physical abuse and neglect, domestic or intimate partner violence, or the sudden death of a loved one. 

Episodes of depersonalization or derealization can be triggered by personal, financial, or occupational stress, as well as from existing depression or anxiety. The possibility of diagnosis with DDD increases the more often and regularly these episodes happen. 

The symptoms of DDD usually come and go and can increase and decrease in intensity. Depersonalization involves feeling detached from one’s own body, mind, feelings, and sensations. It is often described as feeling robotic, or as if one is watching themself from an outside perspective. Individuals experiencing depersonalization may feel emotionally numb and may be unable to recognize or describe their emotions. In addition, they are often disconnected from their memories and struggle with recall. 

Those who experience derealization may feel like there is a glass wall separating them from their surroundings. They may have the sensation of being in a fog-like state, with the world appearing colorless and lifeless. Sound and time can also seem distorted, so these individuals may perceive noises as louder or quieter than those nearby who hear the same noises. During episodes of derealization, time may feel as though it is passing too quickly or slowly. 

DDD is diagnosed in a clinical setting by first ruling out any other physical causes or psychiatric disorders, including seizures, use of psychoactive substances, panic attacks, major depressive disorder, or other dissociative disorders. Psychological tests and structured interviews, administered by trained clinicians, are often performed. Urine toxicology tests may also be administered to ensure that the symptoms are not due to drug use. Magnetic resonance imaging (MRI) or an electroencephalogram (EEG), a test used to detect electrical activity in the brain, may be performed to rule out other physical causes, like brain tumors. 

Currently, there is no cure for DDD, but there are various treatment options that can help manage the symptoms. Medications, such as antidepressants, can be used to treat related conditions, such as depression or anxiety. 

Coping with DDD can be difficult. Psychotherapy, during which one talks to a psychiatrist, psychologist, or other mental health provider, can help individuals better manage the disorder. Psychotherapy may include psychodynamic psychotherapy and cognitive behavioral therapy, which are both techniques that address the stresses associated with the onset of the disorder. Exploring what may have predisposed the person to develop DDD may help them manage or resolve the symptoms. Cognitive techniques can be used to help block obsessive thinking about the unreal state of being. Grounding techniques, like listening to loud music or holding a piece of ice in one’s hand, stimulate one of the five senses, which can help the individual feel more connected to themself and the world around them. Those with depersonalization disorder may also be urged to use behavioral techniques, such as engaging in certain tasks, to distract themself from the symptoms. 

Depersonalization disorder, formally depersonalization/derealization disorder (DDD), is a psychiatric condition that results in an individual feeling like they are disconnected from their thoughts, emotions, or state of being. Symptoms of depersonalization, or detachment from one's own body, can occur alongside symptoms of derealization, which is detachment from the world. DDD is usually caused by severe stress and trauma, often when experienced during childhood, and can worsen with sudden stress or the use of recreational drugs. To be diagnosed with depersonalization disorder, one must meet the DSM-5 criteria of having recurrent episodes that interfere with everyday life. Treatment generally includes psychotherapy, and medication is sometimes used to treat accompanying symptoms. While there is no definitive cure for DDD, coping mechanisms can be used to manage the symptoms and facilitate daily functioning. Those with symptoms of depersonalization disorder can speak with a clinician to discuss an individualized treatment plan.