Depersonalization-derealization disorder is a dissociative disorder, or a condition in which a person’s sense of reality is altered — but not to the point of psychosis.

Psychological disorders often affect a person’s perception of reality, but not many mental disorders affect it as directly as depersonalization-derealization disorder. While depression can make reality seem bleaker than it is and schizophrenia causes people to see and hear things that aren’t really there, depersonalization-derealization disorder can cause people to question reality itself.

What Is Depersonalization-Derealization Disorder?

Depersonalization has been attested since the late 19th century, but depersonalization disorder was not added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1968 when the second edition was published. Depersonalization and derealization were both considered to be components of the disorder at that time, but the name of the condition was updated to reflect this in the fifth edition of the manual (DSM-V) in 2013.

Depersonalization-derealization disorder is a dissociative disorder, or a condition in which a person’s sense of reality is altered — but not to the point of psychosis. In other words, a person with a dissociative disorder feels disconnected from their own experiences but does not usually suffer from delusions or hallucinations. In the case of depersonalization and derealization, people either don’t feel like themselves, or they feel like the world around them is unreal.

Symptoms of Depersonalization-Derealization Disorder

As the name of the disorder indicates, there are two sets of symptoms that define depersonalization-derealization disorder: symptoms of depersonalization and symptoms of derealization. Both conditions involve bodily sensations, feelings and thoughts that do not exist. However, in depersonalization, it is the self that feels unreal. Conversely, in derealization, the outside world feels unreal.

Pop culture can be a useful way to illustrate the difference in how people experience each of these clusters of symptoms. For example, someone experiencing depersonalization might say that they feel like an android or replicant being hunted by Deckard in “Blade Runner.” On the other hand, someone experiencing derealization might say that they feel like they are living in a simulated reality, like Neo in “The Matrix.”

Symptoms of Depersonalization

When people experience depersonalization, they are haunted by the otherworldly sensation that their thoughts and feelings are not real. It’s as if they’ve woken up in the wrong body or are robots that have been programmed by someone else. They feel a disconnection from their own experiences. Depersonalization symptoms can include:

  • Feelings of being on a sort of autopilot
  • Experiencing a profound sense of detachment
  • Having blunted or absent emotional responses
  • Feeling separated from sensations as if by a glass wall
  • Seeing body parts as if they are larger or smaller than they are
  • Feelings of disembodiment
  • Being unable to recognize or describe emotions (experiencing alexithymia)

Depersonalization can manifest primarily through thoughts, feelings, or sensations. People experiencing it might feel like they are not making their own decisions, have absent or blunted emotions or notice that their bodily sensations are distorted.

Symptoms of Derealization

When people experience derealization, the world around them seems unfamiliar. Life might feel like a dream from which they have not awakened or like a simulation. After prolonged derealization, they might expect a camera crew to come out from behind the bushes and tell them that everything in their lives had been scripted for a film. Derealization symptoms can include:

  • Seeing objects as larger or smaller than they are
  • Seeing objects as closer or farther away than they are
  • Experiencing visual distortions like blurring or fuzzy textures
  • Experiencing time distortions like fast-forwarding or slow motion
  • Experiencing the world as artificial, flat, overly smooth or colorless
  • Feeling alienated from surroundings, as if they are unfamiliar

In derealization, the cognitive aspect of thinking of life as artificial or unreal appears to be rooted in physical sensations, especially the senses of sight and touch. Research shows that the brains of people with depersonalization-derealization disorder physically process this sensory information differently.

Causes of Depersonalization-Derealization Disorder

Like most dissociative disorders, depersonalization-derealization disorder often stems from trauma. People with this condition frequently have a history of emotional abuse and neglect. They might have grown up in a violent or chaotic home in which one or both parents denied that the abusive events occurred. An authority figure might have questioned or minimized their perceptions or feelings, telling them that they were too sensitive or crazy. In some way, they learned to mistrust or distance themselves from their own experiences.

Symptoms of depersonalization-derealization disorder can also be caused by the following:

  • Chronic use of mind-altering substances like cannabis and hallucinogens
  • Severe anxiety disorders, especially panic disorder
  • Neurological conditions like epilepsy and migraine
  • Organic changes like acquired brain damage

These symptoms can develop into a dissociative disorder if they persist after treatment for depersonalization.

Depersonalization-derealization disorder can have one of two origins. It can develop from coping styles or behaviors learned in highly stressful or traumatizing environments or derive from an alteration of parts of the brain responsible for perception and emotion.

How Is Depersonalization-Derealization Disorder Diagnosed?

Like any mental health condition, depersonalization-derealization disorder is primarily diagnosed through clinical interviews. Using the DSM as a guide, mental health professionals can determine through a series of targeted questions whether a person meets the clinical criteria for a diagnosis.

An important aspect of this process is a differential diagnosis. Symptoms of depersonalization and derealization sometimes indicate a related psychiatric condition. They can arise in other trauma-related disorders like borderline personality disorder or post-traumatic stress disorder (PTSD). It is also possible to experience depersonalization-derealization disorder and another comorbid condition. Targeted questions can illuminate the bigger clinical picture.

Risk Factors for Depersonalization-Derealization

In addition to major causes like repeated trauma in childhood, risk factors for developing depersonalization-derealization disorder include:

  • Being emotionally or physically abused
  • Having an avoidant or detached personality style
  • Using recreational drugs that induce these symptoms
  • Experiencing the sudden, unexpected loss of a loved one
  • Undergoing a period of severe stress at work or at home
  • Suffering from untreated depression, anxiety or PTSD
  • Experiencing cultural trauma, like natural disasters

Stress is a major factor in developing depersonalization and derealization. People who are confronted with circumstances too overwhelming to process emotionally or cognitively often learn to detach or disconnect from their experiences. Severe, untreated stress can lead to these symptoms developing into the disorder.

Depersonalization-Derealization Disorder Statistics

While more than half of the population has at least one experience of depersonalization or derealization, only about 2 percent of people ever meet criteria for depersonalization-derealization disorder. Most of the time, people who develop the disorder do so in adolescence; only 5 percent of people develop the condition after age 25.

Depersonalization-Derealization Treatments

As with most psychiatric conditions, the treatment process for depersonalization-derealization disorder might include:

  • Medication
  • Psychotherapy
  • Behavior modification

While medications are not typically used to treat dissociative disorders, they can treat other conditions that worsen dissociative symptoms like depersonalization and derealization. Medications that can help treat this disorder include antidepressants, anti-anxiety medications, antipsychotic medications and lamotrigine.

There are several types of therapies that work well for depersonalization-derealization disorder. Cognitive behavioral therapy can help people re-frame and question their beliefs, emotions or perceptions. Eye movement desensitization and reprocessing therapy are effective for people with a history of trauma or trauma-based disorders.

Behavioral interventions that help reduce anxiety can also help reduce symptoms of depersonalization and derealization. Specific behavioral approaches that help include aerobic exercise, meditation and other relaxation exercises, dietary changes, creative therapy like art and music therapy, and any other activities that help people explore and connect more deeply with their experiences.

Even if you or someone you care about do not meet the criteria for depersonalization-derealization disorder, its symptoms can and should still be treated. While depersonalization and derealization can actually be successful short-term coping strategies, in the long-term, they often become maladaptive. People may turn to substances to cope, which can lead to addiction over time. Addressing them early can facilitate a healing process in which life’s vivid colors and textures return for people who thought they were gone forever.

To learn more about treatment for drug or alcohol addiction and dissociative disorders, contact a representative at The Recovery Village today.

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Editor – Camille Renzoni
Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more
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Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.