October 6, 2020

Depersonalization Disorder: Definition, Causes, Symptoms, & Treatment

by | Oct 6, 2020 | Dissociative Disorders

Depersonalization Disorder Definition

Depersonalization disorder is a dissociative disorder that refers to the chronic and repeated experiences of detachment from reality. People with this condition often feel like they can observe themselves “outside in.” In other words, they may feel like they see themselves outside of themselves. Many people describe this experience as if they are in a dream or a trance-like state.

Depersonalization does not necessarily indicate a mental disorder. Most people experience this phenomenon at some point in their lives. 

However, it can become a mental health condition if the feelings are chronic, become progressively worse, or interfere with important areas of functioning. Research shows that depersonalization disorder affects about 2% of the population. 

Living With Depersonalization Disorder

Depersonalization causes distortion and disconnection from thoughts, feelings, and perceptions.

It is not psychosis. When someone has a psychotic episode, they lose contact with reality. They cannot distinguish their hallucinations or delusions from the truth.

People with depersonalization disorder do not experience this loss of contact. They can recognize that their perceptions are not real- they know that something is “off.”

The average onset for depersonalization is around 16 years old. That said, people can develop symptoms at any time in their lives. Sometimes, the symptoms may be attributed to other disorders, like schizophrenia, bipolar disorder, or dementia.

If you’re experiencing depersonalization, only a qualified doctor or mental health professional can give you a proper diagnosis. It’s important to reach out if you are struggling with these symptoms. 

Depersonalization Disorder Test

Your health professional will conduct a thorough examination by assessing both your medical and psychiatric history. Currently, there aren’t any specific lab tests that diagnose this condition. However, they may use different diagnostic and psychiatric assessments to make the correct diagnosis. 

Depersonalization Disorder Causes

Like most mental health conditions, there isn’t a single cause for depersonalization disorder. Instead, experts generally agree that various risk factors may increase the likelihood for someone to have this condition. 

History of Severe Trauma

Trauma appears to be one of the most common risk factors associated with depersonalization. Trauma can refer to any life-threatening experience that you undergo or witness. These experiences may include incidents of abuse, threats, natural disasters, or any other event where you feel like your safety is compromised.

Trauma can occur at any time in one’s life, but depersonalization disorder often has roots in early childhood trauma.

Stressful Life Circumstances

Even if some circumstances aren’t inherently traumatic, chronic stress can increase the risk of depersonalization. These circumstances may include financial insecurity, persistent problems in a relationship, work-related issues, and health conditions. These situations can exacerbate emotions related to fear, sadness, anger, and hopelessness- all of which can trigger depersonalization.

Substance Use

Certain drugs like marijuana, ketamine, MDMA, and hallucinogens alter your mood and can distort your ordinary perceptions. When under the influence, you may experience depersonalization episodes. If you struggle with a substance use disorder, these episodes may become more frequent- which can develop into depersonalization disorder.

Depression or Anxiety 

Research demonstrates that many people struggling with depersonalization disorder also experience depression, anxiety, or both. This phenomenon may occur due to shared symptoms of intense emotions, feeling of hopelessness, and disconnect from others.

Depersonalization Disorder Symptoms

Many people find it challenging to communicate their symptoms to others. They might feel afraid of being perceived as crazy. Similarly, they might also worry that they are imagining or exaggerating their own symptoms.

As mentioned, people with depersonalization disorder are aware of their detachment. They know things are distorted or irrational. The common symptoms include:

  • Feeling like an outside observer of thoughts, feelings, or even body parts.
  • The sensation that you are above or next to yourself (watching yourself).
  • Persistent feelings of numbness and overall detachment.
  • Feeling as if certain body parts are distorted or magnified in some way.
  • Inability to trust your memories- feeling like they lack substance or emotion, and that they may not entirely be yours. 
  • Distortions of distance and the relative size of certain objects.
  • Distortions of time- feeling like recent events happened a long time ago and vice versa
  • Distortions in your environmental surroundings- things may seem blurry, colorless, artificial, or one or two-dimensional.
  • Disconnect from your loved ones, as if something is physically keeping you separated.

These symptoms last for at least several hours. Some of them may persist for weeks or months at a time. They can bring on feelings of anxiety, depression, hopelessness, and problems in relationships with loved ones. Because the symptoms may feel so consuming, they may interfere with work and other routines.

Depersonalization symptoms may also coincide with symptoms related to:

  • Increased panic and anxiety
  • Apathy about yourself and others
  • Anhedonia (loss of pleasure in usual hobbies or interests)
  • Feelings of guilt
  • Social anxiety (often due to worries about experiencing depersonalization while in the presence of others)
  • Feelings of worthlessness
  • Paranoid thoughts
  • Disturbing nightmares or flashbacks
  • Intense feelings of sadness and hopelessness
  • Somatic symptoms (headaches, stomach problems, unexplained body aches and pains)
  • Racing thoughts
  • Changes in appetite
  • Sleep issues

Depersonalization Disorder Treatment

There isn’t a single, one-size-fits-all treatment for depersonalization. The best treatment depends on you and your individual circumstances. Ideally, it’s a good idea to seek professional support once symptoms begin interfering with your life. For example, if you’re finding it difficult to focus at work or stay present with your family, it may time to consider reaching out.

Cognitive-Behavioral Therapy (CBT)

CBT is one of the most popular evidence-based treatments. It is used to treat a variety of mental health issues. CBT practitioners believe that thoughts, feelings, and behaviors are all connected. Therefore, by changing your negative or distorted thoughts, you can also change your behaviors and feelings.  

what-does-CBT-stand-for

CBT for depersonalization disorder may include:

  • Identifying the cognitive distortions you experience
  • Examining the evidence behind these distortions 
  • Considering alternative thoughts for your distorted beliefs
  • Practicing relaxation strategies when you feel stressed
  • Doing homework to reinforce skills learned in your sessions

CBT treatment is typically short-term. Therapists and clients collaborate on setting realistic treatment goals. Your therapist will routinely assess your progress to ensure you are getting the most from your care.

Psychodynamic Therapy

Psychodynamic therapy refers to an in-depth therapy that focuses on both past and present relationships. Psychodynamic therapists use this modality to treat a variety of mental health issues, and it’s been proven effective in treating depression, anxiety, and compulsive disorders.

Psychodynamic therapy may include:

  • Free associating about whatever comes to mind (sharing your current thoughts, fears, and experiences without any sense of restriction)
  • Identifying and interpreting dreams 
  • Increasing awareness of unconscious material related to feelings and perceptions
  • Exploring client feelings related to the therapist and therapeutic process
  • Gaining insight into various defense mechanisms used to block pain 

Psychodynamic therapy can be either short-term or long-term. The therapeutic relationship is important in this work- your therapist will encourage you to share any emotions or reactions you experience towards them as they occur in real-time.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an evidence-based treatment designed to reduce the distress associated with traumatic memories. EMDR treatment can help desensitize your emotions surrounding your trauma. This process can improve your overall well-being and may decrease the intensity of your depersonalization symptoms.

EMDR is an eight-phase treatment that starts with thorough history-taking. In this phase, you will identify possible targets (distressing memories or traumatic episodes) to target. Your therapist will ensure that you have appropriate coping skills to manage emotional distress. These skills are important- during this type of treatment, your emotions may feel heightened, and they can seem overwhelming.

During EMDR therapy, you will identify the beliefs you hold about yourself and the related emotions and body sensations you experience. Your therapist will engage in bilateral stimulation (eye movements, taps, and tones) as you recount these details. 

While you may experience an increase in distress after discussing the targeted memory, you should become less sensitive to it over time. The repeated exposure- coupled with using distress tolerance skills- can help you feel more empowered over your past.

Antidepressant Medication (SSRIs)

Because depersonalization and depression often go hand-in-hand, medication can be a crucial component of comprehensive treatment. SSRIs include:

  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro)

SSRIs treat depression symptoms by increasing levels of serotonin. Serotonin is an important hormone associated with emotional well-being, mood regulation, eating, sleeping, and motor skills. 

Although SSRIs all work similarly, they can impact people in different ways. It’s not uncommon to experience mild side effects. You may need to try several different medications before landing on one that works best for you.

Learn more about antidepressants for kids.

Antipsychotic Medication 

Although depersonalization is not a sign of psychosis, antipsychotic medication can still help with reducing anxiety, stabilizing mood, and improving overall affect. Common antipsychotic medications include:

  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Olanzapine (Zyprexa)
  • Aripiprazole (Abilify)

Antipsychotic medications also have side effects to consider. It is important to evaluate the benefits and risks with your healthcare professional.

Self-Help Treatment Strategies

In addition to seeking professional support, it’s also important to develop your own coping skills for managing depersonalization symptoms.

Grounding Techniques

Learning how to ground yourself into the present moment is one of the most effective ways to move from a state of depersonalization. There are several different grounding techniques, and it’s a good idea to know a variety of them.

  • Deep breathing: Take a deep breath with your mouth. Inhale your breath for five counts. Exhale slowly through your mouth for five counts. Repeat several times.
  • Five senses grounding: Activate each of the five senses around you. While either sitting or standing, pause, and reflect on everything you can see, hear, taste, smell, and feel. Scan through each of these sensations until you can name each of them.
  • Feet on the floor: While sitting, plant your feet into the floor, as if you are pushing the ground into the center of the earth. Remind yourself that you are part of this planet and that you are safe and right here.
  • Name five facts: Quickly name five facts that come to mind. These facts can be as simple as the current time, your name, or your address. Recalling facts helps remind you of your present reality.

Building A Positive Support System

When it comes to honoring your mental health, you need people who feel safe, reliable, and encouraging. In trying times, this support can make a profound difference in your emotional well-being. Support is a matter of quality over quantity- even just one or two people can be incredibly influential. Keep in mind the following tips when building your support system:

  • Identify what you want in a friend: We all value universal qualities like trust, loyalty, and kindness, but what else do you need? Someone who can make you laugh? Who can ask you tough questions when you need to be honest with yourself? Who can remind you of all your good qualities when you’re feeling insecure?
  • Find and engage in hobbies: Hobbies offer a great way to meet and interact with like-minded people. Furthermore, hobbies also can improve your mental health and confidence.
  • Strengthen your existing bonds: Take the time to conduct a brief inventory of your current relationships. How can you be a better friend? Do you make an effort to reach out or spend time together? Do you support others when they are having a challenging time? 
  • Consider volunteering: Service work can do wonders for your mental health. After all, it’s gratifying to make the world a better place. Likewise, volunteering provides numerous opportunities for meeting and engaging with other compassionate people. Take the time to get to know them- you might be able to make some meaningful relationships. 

Final Thoughts

Depersonalization disorder can feel frightening, confusing, and lonely for individuals. Moreover, loved ones may not know how to best respond. 

That said, recovery is possible. You can learn how to cope with your symptoms, reduce their intensity and frequency, and establish a sense of meaning and fulfillment. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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