Symptoms Of Depersonalization-Derealization Disorder

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Psych CentralSubscribeSymptoms of Depersonalization-Derealization Disorder

Medically reviewed by Alex Klein, PsyD — Written by Margarita Tartakovsky, MS — Updated on May 24, 2021

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Many people have felt disconnected from themselves and their surroundings. But if these feelings arise regularly, you might have depersonalization-derealization disorder.

At one time or another, all of us have found ourselves lost in our daydreams, thinking pleasant thoughts about our lives and our futures.

Maybe you’ve gotten lost in a book or become hyper-focused on a fascinating project.

Occasionally, maybe you’ve even felt disconnected from yourself, having an out-of-body experience during a stressful time in your life.

If these feelings are happening more frequently, you may have depersonalization-derealization disorder. Feeling disconnected from reality or yourself are two of the main symptoms of this condition.

What is depersonalization-derealization?

Depersonalization-derealization disorder is classified as a dissociative disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In depersonalization-derealization disorder, people experience one or both of these states:

Depersonalization: feeling detached from your own body, thoughts, or feelings
Derealization: feeling detached from your surroundings

Unlike psychotic disorders, people with depersonalization-derealization disorder know that their experience isn’t reality. People with the condition realize that something is off, which usually causes them to feel distressed.

It’s estimated that depersonalization-derealization disorder affects 1-2% of the population.

Symptoms of depersonalization-derealization

According to the DSM-5, some people with depersonalization-derealization disorder have discrete episodes, while others have continuous symptoms. Or, some individuals may start out experiencing episodes that eventually become continuous symptoms.

People with depersonalization-derealization disorder may have a tough time describing their symptoms. They might also think they’re odd or unusual or fear they have irreversible brain damage, according to the DSM-5.

Understandably, experiencing depersonalization-derealization symptoms can feel unnerving. Some common symptoms include:

Depersonalization symptoms

feeling like you’re completely detached from yourself, even believing that you have no self
feeling detached from parts of yourself such as your thoughts, as in, “My thoughts don’t feel like my own,” or “My head is filled with cotton”
feeling like you’re outside of your body, watching yourself in a movie or from above
having a distorted sense of time – time is either too fast or too slow
feeling mentally, emotionally, or physically numb
feeling like you have no control over your body, including your movements or speech
feeling like you’re a robot

Derealization symptoms

feeling detached from reality
experiencing others or objects as foggy, artificial, cartoonish, or dreamlike
experiencing sounds or voices as muted or heightened
experiencing objects as flat or two-dimensional
seeing objects as distorted in size or distance
feeling like you’re trapped in a glass bell or like there’s a veil between you and the world

Treatment

In some cases, depersonalization-derealization symptoms go away on their own. But for others, symptoms are persistent and can develop into depersonalization-derealization disorder.

Treatment may include psychotherapy, medication, or a combination of both.

Psychotherapy

Research on treatment for depersonalization-derealization disorder is limited. Still, existing research stresses the importance of psychotherapy.

According to this older study, strengthening coping skills is helpful when individuals are experiencing intense or acute symptoms, such as frequent dissociation or severe anxiety or depression.

When symptoms are milder or relatively stable, therapy may help delve into – and over time resolving – why individuals become disconnected from reality or themselves.

Other helpful therapies include:

cognitive behavior therapy (CBT) for changing negative thoughts and unhealthy behavior
dialectical behavior therapy (DBT) for tolerating difficult emotions, reducing self-destructive urges, and improving relationships
eye movement desensitization and reprocessing (EMDR) for reducing distress from traumatic experiences

Grounding techniques that can help you reconnect to reality and yourself may also be addressed in therapy. These in-the-moment strategies may include practicing deep breathing exercises or holding an ice cube.

Overall, a range of approaches may be used, depending on your needs, specific symptoms, and if you have another mental health condition.

Medication

The Food and Drug Administration (FDA) hasn’t approved any medication to treat depersonalization-derealization disorder.

A 2019 review that looked at medication for dissociative disorders found that paroxetine (Paxil) and naloxone (Narcan) may be effective for depersonalization and dissociative symptoms that co-occur with post-traumatic stress disorder (PTSD) and borderline personality disorder.

However, researchers noted that these findings were modest and “should be interpreted with caution” because of limited data.

In some cases, doctors might prescribe medication to reduce accompanying symptoms of anxiety or depression.

If your doctor suggests taking medication, consider asking these questions at your next appointment:

What specific symptoms should this medication reduce or relieve?
When can I expect to experience these improvements? Weeks or months from now?
What are common and less common side effects?
How can I reduce or prevent possible side effects?
When is my follow-up appointment?
How long should I take this medication?
Is it OK to stop abruptly, or will I need to slowly and gradually take a reduced dose to avoid withdrawal syndrome?

When to seek help?

If your symptoms are stressing you out or interfering with an area of your life – like your work or relationships – consider talking with a mental health professional.

It’s common for depersonalization-derealization disorder to co-occur with depression and anxiety disorders. So, it’s important to let your doctor know if you’re also experiencing these symptoms.

Remember that you don’t have to wait until your symptoms worsen or experience a crisis before you consider reaching out to someone for help.

Therapy, if it’s available to you, can be helpful. A therapist can help you:

address specific symptoms or situations that are bothering you
learn to cope with stress
build a healthier lifestyle

What’s next?

Experiencing symptoms of depersonalization or derealization can lead you to feel alone – even if intellectually you know that others also have similar experiences.

Connecting with others to share your story, asking questions about possible treatments, or reminding yourself that you’re not alone can be helpful.

These online communities may be helpful:

Depersonalization community forum
Depersonalization/derealization support group on Facebook
Depersonalization group on Facebook

Understandably, dealing with symptoms of depersonalization or derealization can bring up a range of emotions – from fear and frustration to confusion.

If possible, consider working with a mental health professional and connecting with others. With treatment and support, you can reduce your symptoms of depersonalization or derealization and feel better.

6 sourcescollapsed

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Association.
Büetiger JR, et al. (2020). Trapped in a glass bell jar: Neural correlates of depersonalization and derealization in subjects at clinical high-risk of psychosis and depersonalization – derealization disorder.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516266/
Dissociative disorders. (n.d.).https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders/Overview
Gentile JP, et al. (2014). Stress and trauma: Psychotherapy and pharmacotherapy for depersonalization/derealization disorder.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/
Sierk A, et al. (2018). White matter network alterations in patients with depersonalization/derealization disorder.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158023/
Sutar R, et al. (2019). Pharmacotherapy for dissociative disorders: A systematic review.https://www.sciencedirect.com/science/article/abs/pii/S0165178119311874?via%3Dihub

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Medically reviewed by Alex Klein, PsyD — Written by Margarita Tartakovsky, MS — Updated on May 24, 2021

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