Depersonalization/derealization disorder (DPDR) is one of three recognized dissociative disorders. If you have DPDR or suspect you may, help is available.
When it comes to survival, our minds play an incredible role in helping us navigate even the most difficult of circumstances. But in cases of severe trauma, the coping tools our brains employ to help us survive can sometimes go awry.
This is the case with most dissociative disorders. A person living with these disorders experiences a disconnection from reality, often as a result of trauma.
That said, DPDR can occur for reasons other than trauma, too. These causes may include the effects of psychoactive substances, prolonged sleep or sensory deprivation, and other mental health difficulties, like depression or anxiety
Dissociative conditions can be challenging, but research shows that various treatments can help people manage their symptoms.
DPDR is marked by an altered sense of self or of one’s surroundings, and it can be extremely disorienting, uncomfortable, and even retraumatizing for the person living through it.
The three types of dissociative disorders described by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), include:
While DPDR encompasses both depersonalization and derealization episodes, you only have to experience one or the other in order to meet the criteria for diagnosis.
Depersonalization occurs when you feel disconnected from your own thoughts, self, body, or both. These episodes often involve feeling as though you’re outside your body witnessing the events taking place around you, as opposed to participating in those events yourself.
Derealization is more about feeling disconnected from your surroundings. According to the American Psychiatric Association, this often involves a person feeling as though the world around them isn’t real.
Depersonalization and derealization episodes aren’t entirely uncommon on their own. In fact,
It’s when those episodes become recurrent and chronic that a diagnosis is made, and that only happens in about 2% of cases overall.
Women are impacted by DPDR at twice the rate of men, and most people start experiencing symptoms in childhood, with the average age of onset being 16 years old. Less than one-fifth of people living with DPDR experience their first symptom after the age of 20, and it’s an extremely uncommon diagnosis for individuals over the age of 40.
While both depersonalization and derealization involve dissociation and disconnection, their symptoms vary.
Symptoms of depersonalization include:
- feeling as though you’re no longer in your own body and are instead just a witness of the motions your body is going through
- a loss of memory
- a loss of sensation and feelings
- emotional numbness
- struggling with your sense of self
Meanwhile, symptoms or episodes of derealization include:
- feeling as though you’re moving through a dream
- struggling to recognize and identify your surroundings
- confusion surrounding the passage of time and how long ago certain events took place
- inability to connect with the world around you, almost as if you’re a viewer of, but not a participant in, that world
- a sense that your surroundings are disproportionate or unreal
In both cases, a diagnosis isn’t made until these symptoms occur frequently and severely enough to cause marked distress or impairment in a person’s life.
The use of certain substances can cause episodes of depersonalization and derealization, but in most cases, those episodes are temporary and cease when the substance use ends. Substance use on its own usually does not cause DPDR as a diagnosable condition.
Trauma, on the other hand, has been strongly linked to DPDR — and to dissociative disorders in general. In fact, some researchers have argued that nearly all patients with childhood trauma histories have at least some dissociative symptoms.
When a person experiences severe trauma, especially early in life, DPDR can be the brain’s way of helping them to disconnect from and survive that trauma. It’s a coping strategy the mind embraces to allow the person to separate themselves from what they’re experiencing.
In the moment, this can be a valuable survival tactic. But in the long run, DPDR can also prevent a person from making healthy attachments and interacting with the world around them.
DPDR can also sometimes occur alongside, or as part of, other mental health conditions, including post-traumatic stress disorder (PTSD) and borderline personality disorder. People can also experience DPDR alongside depression and anxiety.
Psychodynamic therapy focuses on resolving conflict from interpersonal relationships and attachment figures (e.g., parents or primary caregivers), while CBT aims to address maladaptive ways of thinking as a means of breaking learned behaviors and poor coping habits in order to learn better coping strategies.
In both cases, a therapist will work with you to address and heal from past traumas and learn how to engage with the people and world around you in a healthier, more active way.
A therapist may also help teach you grounding techniques, which are thought to help those experiencing DPDR episodes reconnect with their bodies and surroundings. These techniques might include intentionally touching and paying attention to the feelings of different water temperatures, or literally standing on the ground and focusing on the sights, smells, and sounds around you.
In some cases, medication may also be prescribed, though it’s important to know there is no one known pharmaceutical treatment for DPDR. Instead, medication may be used to address anxiety and depression that may be occurring alongside DPDR.
Living with DPDR can impact your life in countless ways, from interfering with your personal relationships to making it difficult to hold down a job. But it’s important to know you’re not alone in having these episodes, and there is always help available.
One of the things you can do to help yourself cope is learn grounding techniques that may allow you to reconnect with yourself and the world around you, even as episodes of depersonalization or derealization are beginning.
As mentioned above, grounding techniques are practices that help you focus on what’s happening in the present moment. They can help you to create space from distressing feelings or experiences.
Try stepping outside and focusing on the feeling of the sun hitting your skin. Or, if the weather isn’t quite as pleasant, pay attention to the cold air across your face or the raindrops on your head.
Or sit down if you can and put your hands on the earth around you. Think about how the dirt feels. Close your eyes and breathe in the fresh air. Pay attention to the sounds around you. Are birds chirping? Can you hear a plane overhead?
Breathe deeply as you do this — in through your nose and out through your mouth — allowing yourself to feel the breath enter your body and fill your lungs.
If you’re staying in the house, try touching a table or smelling linens or a scented candle to connect to the present moment.
While grounding may not always work to pull you out of a dissociative episode, it can help you reestablish your connection with your body and the world sooner than you otherwise might have been able to. And finding ways to regain that control may sometimes be all you need to feel like yourself again.
If you’re living with DPDR, you deserve to find healing and a way to move forward with your life in as connected a way as possible. Start by seeking out a therapist who can help, and don’t hesitate to find a new one if you haven’t been able to connect with a therapist you’re already seeing.
It’s also important to remember that you’re not alone. Others have experienced episodes just like you, and they’ve emerged on the other side to talk about it. Shaun O’Connor has written about his own experiences with depersonalization, and you may find his insights helpful.
The National Alliance on Mental Illness (NAMI) also has a piece on healing from DPDR, written by a person who has experienced it for themselves.
Remember: The episodes you’re experiencing are most likely a result of your mind trying to find ways to help you. While it may not feel helpful in the moment, it’s an example of just how powerful your mind can be.
And a mind that powerful is capable of so much, especially healing and moving forward.