Depersonalization-derealization disorder

Persistent and recurrent episodes of depersonalization or derealization or both cause distress and problems functioning at work or school or in other important areas of your life. During these episodes, you are aware that your sense of detachment is only a feeling and not reality.

The experience and feelings of the disorder can be difficult to describe. Worry about "going crazy" can cause you to become preoccupied with checking that you exist and determining what's actually real.

Symptoms usually begin in the mid- to late teens or early adulthood. Depersonalization-derealization disorder is rare in children and older adults.

Depersonalization symptoms

Symptoms of depersonalization include:

• Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body — for example, as if you were floating in air above yourself
• Feeling like a robot or that you're not in control of your speech or movements
• The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton
• Emotional or physical numbness of your senses or responses to the world around you
• A sense that your memories lack emotion, and that they may or may not be your own memories

Derealization symptoms

Symptoms of derealization include:

• Feelings of being alienated from or unfamiliar with your surroundings — for example, like you're living in a movie or a dream
• Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall
• Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings
• Distortions in perception of time, such as recent events feeling like distant past
• Distortions of distance and the size and shape of objects

Episodes of depersonalization-derealization disorder may last hours, days, weeks or even months at a time. In some people, these episodes turn into ongoing feelings of depersonalization or derealization that may periodically get better or worse.

When to see a doctor

Passing feelings of depersonalization or derealization are common and aren't necessarily a cause for concern. But ongoing or severe feelings of detachment and distortion of your surroundings can be a sign of depersonalization-derealization disorder or another physical or mental health disorder.

See a doctor if you have feelings of depersonalization or derealization that:

• Are disturbing you or are emotionally disruptive
• Don't go away or keep coming back
• Interfere with work, relationships or daily activities

The exact cause of depersonalization-derealization disorder isn't well-understood. Some people may be more vulnerable to experiencing depersonalization and derealization than others, possibly due to genetic and environmental factors. Heightened states of stress and fear may trigger episodes.

Symptoms of depersonalization-derealization disorder may be related to childhood trauma or other experiences or events that cause severe emotional stress or trauma.

Factors that may increase the risk of depersonalization-derealization disorder include:

• Certain personality traits that make you want to avoid or deny difficult situations or make it hard to adapt to difficult situations
• Severe trauma, during childhood or as an adult, such as experiencing or witnessing a traumatic event or abuse
• Severe stress, such as major relationship, financial or work-related issues
• Depression or anxiety, especially severe or prolonged depression, or anxiety with panic attacks
• Using recreational drugs, which can trigger episodes of depersonalization or derealization

Episodes of depersonalization or derealization can be frightening and disabling. They can cause:

• Difficulty focusing on tasks or remembering things
• Interference with work and other routine activities
• Problems in relationships with your family and friends
• Anxiety or depression
• A sense of hopelessness

Your doctor may determine or rule out a diagnosis of depersonalization-derealization disorder based on:

• Physical exam. In some cases, symptoms of depersonalization or derealization may be linked to an underlying physical health problem, medications, recreational drugs or alcohol.
• Lab tests. Some lab tests may help determine whether your symptoms are related to medical or other issues.
• Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns, which can help determine if you have depersonalization-derealization disorder or other mental health disorders.
• DSM-5. Your mental health professional may use the criteria for depersonalization-derealization disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment of depersonalization-derealization disorder is primarily psychotherapy. However, sometimes medications may be added to your treatment plan.

Psychotherapy

Psychotherapy, also called counseling or talk therapy, is the main treatment. The goal is to gain control over the symptoms so that they lessen or go away. Two such psychotherapies include cognitive behavioral therapy and psychodynamic therapy.

Psychotherapy can help you:

• Understand why depersonalization and derealization occur
• Learn techniques that distract from your symptoms and make you feel more connected to your world and feelings
• Learn coping strategies to deal with stressful situations and times of extreme stress
• Address the emotions related to past trauma you've experienced
• Address other mental health conditions such as anxiety or depression

Medications

There are no medications specifically approved to treat depersonalization-derealization disorder. However, medications may be used to treat specific symptoms or to treat depression and anxiety that are often associated with the disorder.

While depersonalization and derealization disorder can feel frightening, realizing that it's treatable may be reassuring. To help you cope with depersonalization-derealization disorder:

• Follow your treatment plan. Psychotherapy may involve practicing certain techniques on a daily basis to help resolve feelings of depersonalization and derealization. Seeking treatment early can improve your chances of successfully using these techniques.
• Learn about the condition. Books and internet resources are available that discuss why depersonalization and derealization occur and how to cope. Ask your mental health professional to suggest educational materials and resources.
• Connect with others. Stay connected with supportive and caring people — family, friends, faith leaders or others.

You're likely to start by first seeing your primary care doctor, but you may be referred to a doctor who specializes in brain and nervous system disorders (neurologist) or a doctor who specializes in diagnosing and treating mental health disorders (psychiatrist).

You may want to take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

Before your appointment, make a list of:

• Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins, herbs and other supplements that you're taking, including dosages
• Questions to ask your doctor

Some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• Do I need any tests to confirm the diagnosis?
• What treatments are available? Which do you recommend?
• Are there alternatives to the primary approach that you're suggesting?
• Do I need to see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What appears to worsen your symptoms?
• Do you have any long-term (chronic) health conditions?
• Do you have any mental health disorders, such as anxiety, depression or post-traumatic stress disorder (PTSD)?
• What medications or herbal supplements do you take?
• Do you drink alcohol or use recreational drugs?