Depersonalization/Derealization Disorder Symptoms, Diagnosis

What it is

Depersonalization/derealization disorder (DDD) is an uncommon type of dissociative disorder where you feel detached from your thoughts, feelings, body, sensations, or your surroundings.

DDD is most often a response to a trauma. A person disconnects from reality because the reality is too painful and overwhelming (such as during sex abuse or physical abuse). These periods of disconnection happen during the trauma and after, and then are triggered by other stressful events. DDD is a normal response to a traumatic event.

It often starts during the early or late teen years. People with DDD often have experienced a trauma in childhood, such as sexual, emotional, or physical abuse, or neglect.

The main treatment is psychotherapy (talk therapy). Medications can be helpful when there is also another mental health issue.

Most common symptoms

DDD is defined by two sensations: episodes of depersonalization (you're watching yourself from outside your body) and derealization experiences (everything around you feels fake, foggy—as if you’re dreaming).

Many people experience these feelings at some point in their life without it ever becoming a problem. When these symptoms do not go away, cause significant distress, or interfere with daily activities or relationships, it may be considered DDD.

Symptoms may start suddenly or worsen over time. The sensations of depersonalization and derealization might only last for a few hours (but they return often), or they might go on continuously for months or years. During episodes, you know these are just feelings and not reality. But the feelings are upsetting (for example, may cause anxiety about losing control) or interfere with your daily activities.

Main symptoms

Depersonalization

• Feeling detached from your thoughts, feelings, body, actions, or sensations (touch, taste, etc.).
• Your thoughts may not seem like they belong to you.
• Time may seem to be moving unusually fast or slow.
• You may be physically or emotionally numb—a lack of feeling in your brain or body.
• You may feel like a robot with no control over what you do.
• You may feel like you are watching yourself, having an “out of body” experience.

Derealization

• You’re disconnected from what’s around you.
• People and objects seem not real, foggy, or lifeless.
• The world around you seems “off”—colorless, two-dimensional, smaller or larger than real life.
• You feel like you are living in a dream, behind a glass wall, or in a bubble.

Other symptoms you may have

• Being worried about brain damage.
• Worrying about if you really exist or you are “going crazy.”
• Heaviness in the head.
• Tingling sensations.
• Lightheadedness.

Next steps

Talk to a psychiatrist or other mental health specialist if you repeatedly experience depersonalization or derealization. Or if the feelings are upsetting or making it hard to live your life.

These sensations can make you feel trapped. If you have thoughts about ending your life or are unable to function, call 988 (the new Suicide and Crisis Lifeline) or 911, or go to the nearest ER.

There are some other events that can cause feelings of depersonalization and they all don’t mean you have the disorder. A doctor will help determine your diagnosis. Feelings of depersonalization might come about after:

• A very scary event.
• While using drugs (especially hallucinogens, marijuana, or ecstasy).
• During anesthesia for surgery.
• When you’re sleep deprived.
• When your senses are deprived (meaning you don’t hear, see, touch, smell, or taste very much, like if you’re stuck in the hospital for a long time).
• Because of a seizure disorder or other health issues that involve your nervous system.

Depersonalization/derealization disorder treatment

Psychotherapy (talk therapy) is the main way to treat it. There are no approved medications for the disorder. Some anti-anxiety medications can make symptoms worse. But if you have trouble with other mental health problems (like anxiety, depression, or PTSD), your psychiatrist might suggest medications to treat these problems. Sometimes symptoms go away completely. Other people learn to live with the symptoms.

DDD is the body’s way of coping with a trauma. Therapy can help a person assess whether or not their current coping (DDD) is working, and learn different tools that allow them to be more present. In therapy, you will learn:

• “Coping skills,” or ways to deal with symptoms and their impact.
• How to deal with worry about going into a depersonalization or derealization state.
• How to distract yourself from the feelings to help them go away.
• “Grounding” skills to make you feel more connected to your body and reality.
• Addressing the emotions or trauma that might be causing the disorder.

There are over-the-counter options to manage anxiety, which can sometimes accompany or exacerbate derealization episodes. Here are some products that may help:

• Magnesium Supplements - Known for their calming properties, magnesium can help manage anxiety and improve sleep quality.
• Herbal Teas (Chamomile or Lavender) - These teas have natural soothing effects that might help you relax.
• Essential Oils (Lavender or Peppermint) - Aromatherapy can reduce stress and promote a sense of calmness, helping to ground you during derealization experiences.

Causes of depersonalization/derealization disorder

There are different reasons DDD happens. For some, brain chemistry can be changed after taking a substance. But for many, it is a response to trauma—the body's way of coping with an experience or information that is too painful to process and experience in the moment. It is a trauma response and is thought of as a normal response to an abnormal event.

You’re more likely to have it if you experienced emotional or physical abuse, neglect, or witnessed domestic violence or other trauma during childhood. Growing up with a severely mentally ill parent or guardian can increase the chance of having it. Or experiencing the sudden death of friends or family.

Studies show the brains of people with the disorder may have a hard time processing sensory information (what we touch, hear, feel, see, or smell).