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Depersonalization/Derealization Disorder

Kathryn Patricelli, MA

What is Depersonalization/Derealization Disorder?

This disorder consists of persistent or recurrent experiences of depersonalization, derealization, or both.

Depersonalization involves experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions. You feel like you are separate from your thoughts, feelings or body. You may feel emotionally or physically numb or like things that you are experiencing are not quite real/happening.

In derealization, the person has experiences of unreality or detachment with respect to surroundings, so other people or objects in the environment don't feel real, seem distorted, or like they are in a dream/foggy state.

During these episodes of depersonalization or derealization, the person's reality is still intact - they know who they are and where they are, but things just don't feel/seem quite right.

The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning for a diagnosis to be made. They also can't be occurring because of the effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures), or be explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

How common is Depersonalization/Derealization Disorder?

Occasional occurrences of depersonalization or derealization that occur for hours or even days are fairly common in the general population, and as many as 50% of all adults have experienced one of these states at least once in their life. However, the rate of those that meet the full criteria for a diagnosis of the disorder is approximately 2% of the population.

The disorder typically does not appear before early or middle childhood and most that are diagnosed are between adolescence and approximately 25-30 years of age. The disorder is relatively rare after age 40.

What are the risk factors for Depersonalization/Derealization Disorder?

One of the main risk factors is the temperament of the person - those that try to avoid harm, and have immature defenses, like acting out and not adapting well to stress or difficult situations.

There are also strong associations between trauma in childhood, such as experiencing physical or emotional abuse or neglect, growing up with someone that is seriously ill (physically or mentally), the unexpected death of a parent or close family member, witnessing domestic violence in the home, and other traumatic experiences.

The most common situations occurring right before an episode include "severe stress (interpersonal, financial, occupational), depression, anxiety (particularly panic attacks), and illicit drug use" (DSM-5, 2013).

What other disorders or conditions often occur with Depersonalization/Derealization Disorder?

Those with this disorder are often also diagnosed with depression, anxiety disorders, and personality disorders (avoidant, borderline, and obsessive-compulsive).

How is Depersonalization/Derealization Disorder treated?

The main treatment for this condition is psychotherapy. The therapist will help the person come to terms with what happened and understand the causes of the condition. Stress management techniques will also be taught to help the person handle the situation and to better cope with stressful situations that they face in the future. Once the person has learned coping skills, the therapist may then begin working with the person on the traumatic memories and experiences that came before the condition.

Medication can be also used to treat symptoms such as anxiety, depression or trouble sleeping, but does not cure the overall disorder.