Depersonalization (A Comprehensive Guide)
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This guide will explain depersonalization and derealization, symptoms, treatment, possible causes and risk factors.
What is Depersonalization
Depersonalization is a psychiatric condition that affects behaviour and emotions.
It can be described as an alteration in how a sense of self is perceived or experienced by a person with depersonalization.
The reality of the affected person is temporarily changed or lost.
The person feels as if he is detached from or is an outside observer of his body or mental processes.
It occurs as a sensation one feels when being in a dream.
Condition marked by episodes of feeling detached or disconnected from the thoughts and body of oneself without losing touch with reality is called depersonalization disorder and it belongs to a group of disorders in DSM-5 called Dissociative Disorders.
In the previous version of the Diagnostic Statistical Manual of Mental Disorders, depersonalization and derealization were mentioned separately but in the fifth version of DSM, they are under the category of Depersonalization/derealization disorder.
The feeling of being detached from one’s feelings, thoughts and body are Depersonalization, whereas, feeling of being detached or disconnected from one’s surroundings is called Derealization.
People suffering from these conditions are aware that this experience and perception is not real.
Their reality contact is intact. Other disorders like seizure disorders and brain diseases might trigger the symptoms of Depersonalization and/or derealization.
Depersonalization And Derealization
In order to understand the Depersonalization/derealization disorder, the concept of dissociation must be understood before.
Mental illnesses that involve breakdowns or disruption of those mental functions that typically work smoothly such as awareness or consciousness, memory, perception and/or identity are called Dissociative Disorders.
One of those mental illnesses is Depersonalization Disorder.
This mental health condition is now officially called a depersonalization-derealization disorder.
Diagnosis is only given when the symptoms are severe enough to interfere with the general functioning of a person in his personal life as well as at work.
Women are more likely to be diagnosed with depersonalization or other dissociative disorders than men.
The updated name puts light on two parts of the problem that people with this condition face:
1. Derealization: this affects how a person relates to the things that are in the environment and other people. It makes a person feel as if other people or his surroundings are not real
2. Depersonalization: This condition targets the relatedness of a person with his own thoughts, feelings, and body. Affected person might feel as if he is not real.
When these two conditions are combined, the person becomes distant and disconnected from those around him and the world around him.
It is not unusual for people to feel this way on certain occasions but that feeling is less severe and definitive.
With Depersonalization-derealization disorder, these feelings become severe and last for a long time which hinders their daily life activities.
Symptoms of DDD
Even though the latest version of DSM combines the two conditions together to form a single diagnosis but the disorder contains two distinct sets of symptoms that may or may not apply to one person receiving the diagnosis.
Depersonalization symptoms
These include:
- Person has Feelings that he is an outside observer of his feelings, thoughts, body or parts of his body as if he is floating above himself in the air
- The person feels as if he not in control of his movements of speech. He feels like a robot
- Feeling that the legs, arms or body appear shrunken, distorted or enlarged. The person feels as if cotton is wrapped around his head
- Physical or emotional numbness of the senses or responses to the world around
- Person feels as if the memories have no emotions attached to them and that they might not even be his memories
Derealization symptoms
Derealization symptoms include:
- The person feels as if he is alienated from his surroundings or becomes unfamiliar with the surroundings. For instance, feeling like he is in a dream or a movie
- Feelings that the surroundings are blurry, two-dimensional, distorted, artificial or colourless. Or surroundings might be extremely clear
- A person feels emotionally distant and disconnected from the ones he cares about and might feel like he is separated by a wall of glass
- Experiences distortions of the size, shape, and distance of objects as well as in the perception of time. Recent events might feel like a distant past
These symptoms or states of depersonalization-derealization disorder may linger on for hours or days and in severe cases for months.
Some people might experience these episodes as an ongoing feeling of derealization or depersonalization that sometimes gets better and sometimes gets worse.
Prevalence
As a separate diagnosable disorder, depersonalization/derealization is quite rare, occurring in less than 2% of the population.
However, transient experiences of depersonalization or derealization are normal, occurring almost in about 50% of the population.
Many people with depersonalization/derealization disorder experience the condition at a young age.
The average starting age is 16 years. Lastly, depersonalization/derealization may be symptoms of other psychiatric disorders like dementia and schizophrenia.
Diagnosis
If there are signs of depersonalization disorder, the doctor may begin an investigation by undertaking a complete medical history and physical examination.
Although there are no specific laboratory tests for evaluating the diagnosis of depersonalization and/or derealization disorder, the doctor may use various diagnostic tests such as imaging studies and blood tests to rule out any physical diseases or side effects of medication that might be causing the symptoms.
When the physical examination is done and other medical conditions are ruled out, the person is referred to a psychiatrist or psychologist who or trained in diagnosing and dealing with such conditions.
These mental health professionals conduct thorough interviews and use tools designed specifically for such conditions to assess and diagnose the person and then make effective treatment plans.
Treatment
Many patients with depersonalization-derealization disorder who seek treatment and try to take professional help are worried about their depressive symptoms or anxiety rather than the condition itself.
With time, the symptoms fade away in many cases and treatment is usually only required if the symptoms are severe enough to disturb the daily life of a person or if the disorder is persistent and recurrent.
If the treatment is needed, the goal is to try to resolve the stresses that are associated with the onset of the episode.
The best approach to treatment depends on the severity level of symptoms and the individual as well.
Mostly, talk therapy or psychotherapy is the treatment of choice for depersonalization disorder.
Depersonalization treatment approach may include the following:
Psychotherapy: Psychotherapy includes a variety of techniques that are helpful in treating mental and emotional distress.
These techniques focus on addressing present and past stresses and the patient’s feelings and thoughts about them that might be leading in the development of depersonalization disorder.
The successful psychotherapies include:
- Cognitive-behavioural therapy that focuses on blocking the obsessive thoughts related to being in an unreal state
- Grounding techniques like focusing on the present by playing loud music or placing ice in the palm of the hand to help the person feel connected to his surroundings
- Behavioural techniques include distraction techniques which will help the person get distracted from his depersonalized or derealized state
- Psychodynamic therapy can be used to address underlying issues and conflicts that are so distressing that causing these dissociative states.
Other treatments include:
1. Family therapy: family of the affected person is educated in this kind of therapy.
They are told about its symptoms and causes and are taught basic techniques to deal when the symptoms surface so that they can help the person when he needs it
2. Medication: dissociative disorders cannot be treated by medicines and they are not generally prescribed to them.
Nevertheless, if a person suffers from anxiety and/or depression because of their condition then the anti-anxiety or antidepressants are given.
Furthermore, to help a person with his disordered thinking about depersonalization, antipsychotics are prescribed
3. Clinical hypnosis: This technique uses intensified relaxation, concentration and attention to achieve a changed state of consciousness or consciousness that allows people to explore feelings, thoughts, and memories that might have been concealed from their conscious thoughts.
4. Art and Music therapy: these therapies help the patient to be open and express his feelings and thoughts in a creative way
Causes
Research is needed to find out about the causes of dissociative disorders as it is not well-understood to date.
Possibly due to environmental and genetic factors, some individuals are more vulnerable to develop and experience these conditions of dissociation.
It has been found that extreme stress or trauma might trigger these episodes.
These symptoms may be connected to trauma experienced in childhood or other situations or experiences causing extreme emotional stress, for instance:
- Being a victim of domestic abuse or witnessing domestic violence
- Being physically abused
- Neglected in childhood or emotionally abused which is the common cause
- Living or have lived with severely mentally ill or impaired parent
- Unexpected death of a really close friend or a family member
- Triggers of the depersonalized episode could be depression, interpersonal stress, use of illicit drugs, occupational stress, anxiety or financial stress.
Risk factors
Risk factors of developing or triggering the disorder include:
- Life stresses like financial, relationship stress or work-related issues
- Use of recreational drugs that causes the episodes of derealization or depersonalization
- Prolonged and/or severe depression
- Anxiety with panic attack
- Severe trauma either in childhood or in adulthood, for instance, witnessing an abuse or experiencing sexual abuse
- Personality traits that make it hard for the person to cope with difficult situations or adapt to them.
Complications
People suffering from such a condition face many difficulties in their daily lives that can be frightening.
The episodes can cause:
- Focused concentration difficulties on tasks
- Memory problems
- Feelings of blacking out completely
- Relationship problems
- Depression or anxiety
- Problems while working or day to day routine tasks
- A sense of hopelessness
Most patients may recover completely from depersonalization disorder.
Sometimes, the symptoms associated with this condition disappear on their own and sometimes, treatment is needed to make the patient independent in coping with the trauma or stress that triggered the episode.
Additional episodes of depersonalization may occur if left untreated.
As a symptom of another condition
Before diagnosing someone with DDD, it is necessary to understand that there are other mental health conditions that cause the experience of depersonalization.
Ruling out other conditions is necessary and can only be done by a trained professional.
The disorders that may lead to dissociation are:
- schizophrenia
- depression
- obsessive-compulsive disorder (OCD)
- epilepsy
- post-traumatic stress disorder (PTSD)
- migraine
- phobic disorder
Conclusion
Depersonalization disorder is a dissociative disorder that is now formally called depersonalization-derealization disorder in DSM-5.
It causes the person to feel as if he is outside of his body or that his surroundings are not real as if in a dream.
However, the affected person is aware that his perceptions are not real.
Causes of such conditions are not well-understood but life stressors and traumatic events can trigger it.
With treatment, it can be resolved and the person can live a normal life.
Frequently Asked Questions
Can depersonalization makes you dizzy?
Yes, depersonalization affects the sense of balance.
It is a disorienting disorder where you might feel like you are walking sideways or hovering over the floor when in actual, you are grounded
Will my depersonalization come back?
Everyone experiences setbacks when they are in recovery.
Your symptoms might come back if the stress is too much to handle but if you notice the slightest of symptoms beforehand, you can start using the techniques you learned in your treatment program and the condition might be controlled.
Do depersonalization lead to schizophrenia?
No, it does not as in schizophrenia there is no contact with reality when in depersonalization, the person is fully aware of his faulty perceptions.
How long does it last?
Episodes of DDD can last for hours, weeks, months and in severe cases, these episodes can turn into ongoing feelings of depersonalization or derealization which may get worse or better with time.
Please feel free to ask any questions you have in the comment section below
References
Recommended Readings
Feeling Unreal: Depersonalization Disorder and the Loss of the Self
Stranger To My Self: Inside Depersonalization: The Hidden Epidemic
Depersonalization: A New Look at a Neglected Syndrome
Overcoming Depersonalization and Feelings of Unreality (Overcoming S) (9781845295547): Anthony S. David, Dawn Baker, Elaine Hunter, Emma Lawrence: Books
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