Depersonalization-derealization disorder, also known as depersonalization disorder, is a dissociative disorder that was once only vaguely understood. Advances in understanding and treating trauma-related disorders have led to improved insight into depersonalization and other dissociative disorders, which are now known to be trauma-related disorders like post-traumatic stress disorder and borderline personality disorder. Researchers have also discovered that these conditions can be treated with some of the same interventions. Depersonalization disorder treatment typically involves using one or more therapeutic interventions to address different aspects of the disorder. Individual therapy is the primary depersonalization treatment, though medications are sometimes used in conjunction with therapy to treat the disorder. While derealization is considered to be a distinct aspect of this condition, derealization treatment is incorporated fully into interventions for depersonalization.
There is no depersonalization cure, but treatment can reduce distressing symptoms and even lead to full remission of the disorder. It’s important for people experiencing depersonalization or derealization to talk to a professional about their symptoms so they can begin treatment and start feeling like themselves again.
Medications for Depersonalization-Derealization Disorder
Selective Serotonin Reuptake Inhibitors (SSRIs)
Most people with dissociative disorders have co-occurring conditions, and depression is one of the most common. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are frequently prescribed to treat comorbid depression. Popular SSRIs for dissociative disorders include:
These SSRIs can treat several symptoms specific to depersonalization-derealization disorder. The sense of detachment that accompanies depersonalization is often closely linked with flat affect and blunted emotion, all of which can be improved with SSRIs. Antidepressants can also stabilize mood and reduce the intrusive symptoms that trigger dissociative symptoms. Research shows that a combination of an SSRI and lamotrigine, a mood stabilizer, is an effective treatment for dissociative disorders, especially depersonalization-derealization disorder. The same SSRIs that are used as antidepressants can also be used to treat anxiety, which is another commonly co-occurring condition with depersonalization-derealization disorder. They are often the best medical option for treating dissociative disorders with comorbid anxiety. Benzodiazepines, on the other hand, may exacerbate dissociation in depersonalization disorder.
One of the defining features of dissociative disorders like depersonalization is that they are not psychotic disorders. People who experience them maintain an intact sense of reality testing. However, antipsychotic drugs can be an effective option for treating these disorders.
Second-generation, or atypical, antipsychotic medications are frequently used to treat a wide range of conditions other than psychotic disorders. The way these drugs rebalance essential brain chemicals including dopamine and serotonin gives them many clinical applications.
Atypical antipsychotics most commonly prescribed for non-psychotic disorders include:
- Aripiprazole (Abilify)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
These medications can provide a number of desirable effects for people with depersonalization-derealization disorder, including mood stabilization, anxiety reduction, and improved range of affect. They may even target and reduce depersonalization and derealization symptoms.
Therapy for Depersonalization-Derealization Disorder
Depersonalization and derealization symptoms can make someone feel unreal. At various times, the self, body, emotions and the external world may all feel like they don’t exist or as if they are distorted or distant. The extent to which any of these symptoms are present can point to a diagnosis of depersonalization-derealization disorder.
There is a depersonalization-derealization disorder test a therapist may use to diagnose the disorder. While a specific test like the structured clinical interview for dissociative disorders may be used, the main depersonalization disorder test is the Steinberg Depersonalization Questionnaire. There is a similar derealization test, the Steinberg Derealization Questionnaire.
While philosophical inquiries can lead to questions about what is real, the feeling that the self and the external world aren’t real is usually a dissociative response, often one that was learned to detach from terrifying or painful traumatic experiences. The goal of any therapeutic treatment of depersonalization-derealization disorder is to help individuals regain access to their full emotional range, which often requires establishing both safety and insight.
Psychotherapy is the general term used to describe any form of talk therapy in which a client explores their thoughts and feelings by speaking to a therapist about them.
While significant advances have been made in the pharmacotherapeutic treatment of mental health conditions, psychotherapy remains the primary and essential psychiatric intervention. This is especially true in the treatment of depersonalization-derealization disorder, which may not be fully treatable with any medication. Psychodynamic psychotherapy is one of the oldest styles of therapy. This form of therapy is now much less popular than it once was, but it still can be effective in particular therapeutic contexts.
Psychodynamic psychotherapy focuses on exploring the past to gain insight into what caused a person to think and feel in certain ways. By making the unconscious sources of emotional reactions conscious, someone with depersonalization-derealization disorder can start to understand the reasons they feel disconnected from reality and take steps to remedy this.
Insight may be the most effective tool to treat depersonalization-derealization disorder, opening the door to once-blocked emotions. By unlearning previously unconscious ways of responding to the world, people can start to experience emotions and thoughts that they once found intolerable and that previously triggered their dissociative symptoms.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most well-researched therapeutic modalities and is considered an evidence-based practice for the treatment of many psychiatric disorders. It works by helping people identify cognitive distortions and irrational beliefs. By challenging and reframing these thoughts, people can reduce or eliminate the negative emotions and behaviors caused by them.
Individuals with depersonalization-derealization disorder usually respond well to CBT. Many symptoms of the disorder have a cognitive basis. Obsessive thinking about the self and the world intensifies feelings of unreality. People with depersonalization-derealization disorder can use CBT to examine and question thoughts that exacerbate derealization and learn grounding and breathing techniques that counteract disembodiment and other dissociative symptoms.
Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) was developed for the treatment of borderline personality disorder, which is a trauma-related condition. DBT combines cognitive-behavioral tools and techniques with mindfulness practices and a philosophy of acceptance.
By shifting from the CBT approach of labeling certain thoughts or feelings as negative, DBT helps people with histories of abuse and trauma to explore painful emotions without guilt or shame and to feel more comfortable in sharing what they think and feel. Interventions in DBT help people develop distress tolerance and improve emotional regulation.
This kind of behavioral therapy yields key insights and benefits for the treatment of depersonalization disorder. People with this dissociative disorder often learned to mistrust their thoughts or feelings and to label them as bad. This mistrust is what makes them feel as if these inner states or even their very selves aren’t real.
By teaching people to accept their inner states, DBT can help people reconnect to them. The mindfulness, breathing, and self-soothing techniques taught in DBT can also help people with depersonalization-derealization disorder to reconnect with their bodies and the sensations of being in the moment.
Eye Movement Desensitization and Reprocessing
Eye movement desensitization and reprocessing (EMDR) is another intervention developed specifically for people with trauma-related disorders. Its goal is to help people who have been repressing or avoiding traumatic memories, thoughts and feelings to gradually and safely process them.
In EMDR, clients talk or think about traumatic memories while tracking a back-and-forth visual or auditory cue designed to help their brains reprocess these events. While people debate the reasons this technique works, research shows that EMDR is an effective approach for people with histories of trauma, including people with depersonalization-derealization disorder.
Like CBT, EMDR can help people change their thought processes, and, like DBT, it can help them do so in a way that is nurturing and grounded in physical experience. Since this form of treatment specifically focuses on exploring trauma, it can help people who have repressed or avoided traumatic memories begin to address them in a safe environment.
Many people with symptoms of depersonalization and derealization have had experiences that caused them to invalidate their emotions and to repress thoughts and memories — traumatic or otherwise. EMDR can help them break through those defenses and feel their emotions more directly again.
Treatment for Depersonalization-Derealization Disorder and Co-Occurring Conditions
Most people with dissociative disorders have co-occurring conditions, with depression and anxiety being the most common. The symptoms of these disorders are deeply interconnected and are best treated simultaneously.
For example, depressive symptoms, like blunted emotions, naturally arise from the experience of depersonalization and derealization. When symptoms of derealization and depersonalization are caused by emotional abuse and trauma, they function as defenses. Anxiety can arise when repressed material starts becoming conscious.
When people have depersonalization-derealization disorder and co-occurring anxiety or depression, medication can be an especially effective tool in the therapeutic process. Taking medications is not always necessary or the best option, however, depending on the person being treated and the existence of any other comorbid medical or mental health conditions.
Most therapeutic techniques that treat dissociative symptoms can also treat depression, anxiety and other psychiatric disorders. One of the most important elements of treatment for co-occurring dissociative and other conditions is to examine how treating symptoms of one condition can trigger a recurrence of symptoms of the other. Dissociative symptoms have a psychologically protective function and can be triggered by progress in therapy. It is important for therapists to tailor interventions in a way that allows clients with co-occurring conditions to safely progress in treatment.
Depersonalization-Derealization Disorder and Addiction
Drug and alcohol addictions are common co-occurring conditions among people with dissociative disorders. Depersonalization-derealization disorder can drive substance abuse in one of two ways. People may take substances to intensify depersonalization and derealization symptoms as well as to further entrench their protective function. In some cases, they might use alcohol or drugs to break down dissociative defenses and feel emotions they normally can’t feel.
These dynamics can quickly lead to the development of substance dependence. Dissociative disorders can make comorbid addiction especially dangerous. Heightened dissociation can lead to periods of dissociative amnesia when combined with drug use. In addition, depersonalization symptoms can combine with substance use to further remove a sense of responsibility for a person’s actions, leading to increasingly reckless and self-destructive behaviors.
The effects of co-occurring disorders often require immediate treatment. The best and most effective way to treat co-occurring depersonalization-derealization and substance use disorders is to use an integrated approach. This means several interventions should be provided in a coordinated way, ideally by the same organization or treatment team.
An integrated approach can address the recurrence of depersonalization and derealization symptoms in the course of substance use disorder treatment, which is typically provided in groups. These treatment groups can be combined with individual therapy that addresses both conditions as well as medication management. Other complementary therapies, like movement or art therapy, can promote embodiment and reduce dissociation, as well as provide tools for preventing recurrence of use. Many treatment centers throughout the United States, like The Recovery Village, use an integrated approach to treating drug and alcohol addiction and co-occurring disorders, including those involving depersonalization derealization disorder. To learn more about the benefits of treating co-occurring disorders, contact The Recovery Village today.