Understanding depersonalization-derealization disorder (DPDR)

Have you ever experienced an out-of-body moment? It may have felt like you were detached from your body or like the events happening around you weren’t real. These two sensations are known as depersonalization or derealization. And while occasional moments like this are typically nothing to be concerned about, persistent and disruptive episodes of depersonalization or derealization may be a sign of a condition called depersonalization-derealization disorder (sometimes misspelled as depersonalisation-derealisation disorder).

What is depersonalization-derealization disorder?

Depersonalization-derealization disorder is a mental health condition that causes people to feel disconnected from themselves and their surroundings.

To be diagnosed with depersonalization-derealization disorder, a person must:

• Experience persistent or recurrent experiences of depersonalization, derealization, or both

• Be able to maintain contact with reality during these episodes

• Report that episodes have a noticeable impact on their relationships, performance at work and school, or other areas of functioning

Depersonalization-derealization disorder affects approximately 1% to 2% of the general population and is more common in teens, young adults, and people with other mental health conditions.

Symptoms usually begin during childhood or late adolescence, with more than 80% of people first experiencing symptoms before age 20. When left unmanaged, the condition can lead to other mental health concerns, problems at work or school, and reduced quality of life.

Symptoms of depersonalization and derealization

If you’ve ever experienced depersonalization or derealization, you know that it’s tough to describe. Depersonalization can feel like you’re watching yourself play a role in a movie or like you’re an observer of your own life. And with derealization, you may feel so detached from your environment that it’s hard to recognize the size and shape of objects and people around you.

Depersonalization and derealization symptoms and severity vary by person and can persist for hours, days, or even months. Here are some common symptoms of depersonalization and derealization.

Depersonalization symptoms:

• Feeling detached from your own thoughts, feelings, and body

• Feeling emotionally or physically numb

• Feeling unable to control your speech or movement

• Not trusting your memories

Derealization symptoms:

• Feeling like your surroundings are not real

• Confusion about time, like thinking that recent events occurred in the distant past

• Feeling emotionally disconnected from others

• Feeling like the world around you is meaningless or lacks depth

What causes depersonalization and derealization?

Depersonalization-derealization disorder has been linked to adverse childhood experiences, like abuse, neglect, and household violence. In addition to a history of trauma, other risk factors and causes include:

• Substance use (specifically cannabis and ketamine) if you have a history of anxiety disorders or other risk factors

• Mental health conditions, such as anxiety, depression, or post-traumatic stress disorder (PTSD)

• Extreme stress

Common triggers for depersonalization-derealization symptoms include:

• Panic attacks or intense anxiety

• Acute or chronic stress

• Sleep deprivation or significant disruptions to sleep

• Illness, physical exhaustion, or pain

• Unhealthy substance use or withdrawal

• Feeling trapped or emotionally overwhelmed

While risk factors increase vulnerability, triggers are often what initiate or intensify symptoms. Once activated, symptoms may persist if the trigger continues to reinforce the dissociative response.

Is depersonalization/derealization dangerous?

Depersonalization and derealization are not dangerous. They can feel scary or strange but they don’t cause physical harm. These experiences are a protective response. They happen when the nervous system is overwhelmed.

Episodes can last for different lengths of time. Some people experience symptoms for minutes or hours. Others may notice them for weeks or longer. Longer episodes don’t mean the condition is permanent.

In many cases, depersonalization and derealization do go away. Symptoms often improve as anxiety decreases and the nervous system settles. Although these symptoms feel intense, they aren’t a sign of psychosis. People experiencing depersonalization or derealization remain aware of reality.

Treatment and management options

When treating depersonalization-derealization disorder, the goal is to reduce a person’s symptoms and improve their overall quality of life. For many people, this involves a comprehensive approach made up of talk therapy, medication management, and self-care strategies.

1. Talk therapy

Therapy is considered a first-choice treatment for managing depersonalization-derealization disorder. With the support of a trained therapist, you can learn how to reduce your symptoms, develop healthy coping strategies for stressful situations, and improve your overall quality of life. It’s also a chance to better understand your current emotions and how they relate to past trauma.

Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy are considered some of the most effective forms of therapy for depersonalization-derealization disorder.

2. Medication

While there’s no medication specifically for depersonalization-derealization disorder, some medications may reduce distressing symptoms and help people manage co-occurring conditions. If you’re interested in exploring medication as part of your treatment plan, it’s best to discuss the pros and cons with your healthcare provider.

3. Self-care strategies

In addition to talk therapy and medication, there are ways to help manage daily symptoms on your own, like:

• Patient education: Knowledge is power, especially when it comes to managing your mental health. If you’ve been diagnosed with depersonalization-derealization disorder, researching the condition can help you understand your symptoms, learn to identify your triggers, and plan for difficult moments.

• Mindfulness exercises: Meditation, deep breathing exercises, and progressive muscle relaxation can help you manage anxiety and stress during disorienting moments.

• Grounding techniques: These exercises help people focus on the present moment. One example is to scan the room and count as many items as you see. You can also try playing loud music or holding a piece of ice in your hand.

• Lifestyle changes: A balanced diet, sufficient sleep, and regular exercise all contribute to overall well-being. It’s also important to avoid substances that can trigger episodes of depersonalization or derealization.

Clinician’s take

Depersonalization–derealization disorder can feel frightening and isolating, but it’s a reversible stress response — not a permanent state. With the right support, your sense of connection, presence, and ‘self’ can return.

Brandy Chalmers, LPC

Clinical reviewer