Depersonalization-Derealization Disorder (DPDR): Symptoms, Causes, & Treatments

What is Depersonalization-Derealization Disorder (DPDR)?

Depersonalization-Derealization Disorder causes a disruption in self-awareness and temporary feelings of disconnect from oneself or experiences.^2,4 These symptoms occur during dissociative episodes that are usually chronic in nature and involve depersonalization, derealization, or both.¹ Many people with DPDR develop symptoms in childhood, often in response to traumatic experiences or abuse.^2,3,5

Depersonalization is the feeling of being disconnected or separate from yourself or from your own thoughts, feelings, or body. On the other hand, derealization is the sense of detachment from other people, places, and surroundings.^1,2 DPDR often co-occurs with other mental illnesses like anxiety, depression, and substance use, which are all associated with more severe DPDR symptoms.³ People with DPDR often report that symptoms of depersonalization and derealization are triggered or worsened by stress or anxiety.⁵

Many people have had symptoms of depersonalization or derealization, but only about 1-2% of the population can be diagnosed with DPDR.^2,6 The disorder is equally common in both men and women, and is more likely to affect those who have a history of childhood trauma or abuse.^2,3,5 When left untreated, symptoms of DPDR can become debilitating, keeping people from being able to function, focus, and interact normally with others.^1,2

4 Types of Dissociative Disorders

There are four main types of dissociative disorders listed in the DSM 5, the reference book that clinicians use to diagnose all mental health conditions. These include Depersonalization-Derealization Disorder, Dissociative Amnesia, Dissociative Identity Disorder, and Dissociative Fugue.¹ The shared symptom of these disorders is the experience of dissociation, which involves feeling mentally detached from yourself, your surroundings, or your experiences.⁴

Symptoms of the four dissociative disorders may include:^1,3,5

• Depersonalization-Derealization Disorder: DPDR involves derealization and/or depersonalization, which is when someone feels detached from themselves or their surroundings.
• Dissociative amnesia: Dissociative amnesia is memory loss that results from a dissociative episode, making it difficult or impossible for someone to remember some or all of their experiences. Sometimes, this memory loss is associated with PTSD or trauma.
• Dissociative identity disorder (DID): DID (formerly known as multiple personality disorder) is a rare condition where a person describes having two or more distinct identities inside of them that each have different thoughts, feelings, memories and personalities.
• Dissociative fugue: Dissociative fugue (also called psychogenic fugue) is an uncommon form of dissociation that involves a loss of awareness, loss of memory, or loss of identity. After a dissociative fugue, a person may report having no memory of what they did or where they went for the past few hours, days, or even months.

Depersonalization-Derealization Disorder Symptoms

In order to diagnose someone with DPDR, their symptoms must be severe or frequent enough to cause significant distress or impairment.^1,2,5 During DPDR episodes, people either experience depersonalization, derealization, or both. Most people describe DPDR episodes as being relatively short-lived and temporary; but, it’s possible for these episodes to last for hours, days, weeks, or even months at a time.^2,3,5

Symptoms of DPDR may include:^1,2,3,4,5

• Feeling detached from your body or having out-of-body experiences
• Alexithymia (an inability to identify or describe your feelings)
• Numbness or inability to feel bodily sensations
• Not recognizing yourself or feeling like your body is strange or unfamiliar
• Not feeling in control of your own thoughts, feelings, or actions
• Feeling far away or like an outside observer of your surroundings
• Feeling as though your experiences are strange, ‘unreal’, or dreamlike
• Sounds or voices seeming louder or softer than normal
• Distorted perception or things seeming different in size or shape
• Time seeming to pass slower or faster than normal
• Being unaware of things happening or unable to remember the recent past
• Being more or less aware of your surroundings or things happening around you

Depersonalization-Derealization Disorder Causes

Dissociative symptoms usually begin in childhood or adolescence, with the average age of onset for DPDR being 16 years old.^3,5,7 The causes of DPDR aren’t fully known, but many people with DPDR have a history of childhood trauma or posttraumatic stress disorder (PTSD).^3,5,7 Dissociation often occurs during highly traumatic or stressful experiences, and is believed to be a defense mechanism that happens automatically in some people.³

Other possible causes of  Depersonalization-Derealization Disorder include:

• Childhood abuse or neglect: Being abused or neglected in childhood greatly increases the likelihood of developing DPDR later in life. Most people with DPDR report that their symptoms began in childhood or adolescence, often in response to traumatic experiences such as abuse or neglect.^2,3,5,8
• Anxiety disorders: High levels of anxiety or panic attacks can cause chemical changes in the body and brain that alter perception and lead people to temporarily dissociate and experience symptoms of depersonalization or derealization.^2,3,5
• Mood disorders: Depression or bipolar disorder can also cause symptoms of derealization in someone during either manic episodes, depressive episodes, or both. Those with severe cases of these conditions may be more likely to develop symptoms of DPDR.^2,5
• Prescribed or illicit substances: Mind or mood-altering drugs like alcohol, marijuana, or psychedelics can also cause derealization or depersonalization symptoms.^2,8 In some cases, even prescribed medications can contribute to dissociative symptoms.
• Physical pain, injuries, or illnesses: Being very ill, severely injured, or in a lot of physical pain can lead to dissociation from your body and surroundings, a full or partial loss of consciousness, and other symptoms of dissociation and derealization.³
• Personality disorders: Certain personality disorders like Borderline Personality Disorder can cause people to experience dissociative episodes or symptoms of DPDR.¹
  Also, BPD is closely linked to childhood trauma, which is a known risk factor for DPDR.^2,3,5
• Extreme stress: Dissociative symptoms are sometimes a natural defense mechanism that occur in response to extreme stress or danger. When this is the cause, symptoms of DPDR will almost always resolve without treatment.^2,5

How Is Depersonalization-Derealization Disorder Diagnosed?

It’s fairly normal to experience occasional dissociative symptoms like depersonalization and derealization, so DPDR is only diagnosed when these symptoms become frequent and severe enough to cause significant distress or impairment.¹

To be diagnosed with DPDR, a person’s symptoms must not be the result of:^1,7

• The effects of a prescribed medication or illicit substance
• An underlying neurological disorder, brain injury, or cognitive impairment
• An underlying psychotic disorder like schizophrenia or brief psychotic disorder
• Biological issues like sleep deprivation, an infection or medical illness

When one of these causes is suspected, a patient may be asked to undergo additional testing like a urine drug screen, lab work, or an MRI or fMRI. DPDR can be diagnosed by a licensed medical or mental health clinician.^2,5,7,9 Testing is usually performed in an initial appointment with a therapist, psychiatrist, psychologist, or other licensed clinician.

A diagnosis of DPDR is typically made based on a person’s symptoms along with clinical observations. Surveys or assessment tools like the Steinberg Depersonalization Test  or Dissociative Experiences Scale may be used to help determine a diagnosis of DPDR.^2,5

Depersonalization-Derealization Disorder Treatments

More research is needed to determine which treatments are most effective for people struggling with DPDR, but initial investigations suggest therapy may help someone manage their symptoms. There are no FDA approved medications to treat dissociative symptoms, but medications may be used to treat those who are diagnosed with other mental illnesses.^2,3

Therapy Options for DPDR

Because of the close link between DPDR and trauma, trauma-informed therapies like EMDR, Cognitive Processing Therapy (CPT), or Accelerated Resolution Therapy (ART) may be helpful for some with this disorder. Other studies have suggested that Psychodynamic Therapy, Cognitive Behavioral Therapy (CBT) or traditional behavioral therapies may also be beneficial.^2,5,9

Medications for Depersonalization-Derealization Disorder

While there aren’t specific medications used to treat dissociative disorders, medications may be used to treat other symptoms that contribute to DPDR. For example, people who have depression or anxiety in addition to DPDR often benefit from SSRI antidepressants or anti-anxiety medications. A combination of medication and therapy may provide the most benefit in cases of DPDR, especially if another diagnosed mental health condition is present.^2,3,5

How to Cope With DPDR

Depersonalization-Derealization Disorder can be difficult to cope with. It’s normal for people with this condition to feel distressed, anxious, or even embarrassed about their symptoms. Sometimes, this can make a person reluctant to seek professional help for their condition, allowing more time for symptoms to worsen. Early treatment is important, and can help to reduce the frequency and severity of dissociative episodes. In addition to working with a therapist, psychiatrist, or both, making lifestyle changes can also help.

Below are some coping skills for managing symptoms of DPDR: ^2,10

• Find a support group: Finding a support group for trauma survivors, or for those diagnosed with a dissociative or other mental health condition can help you feel less alone. Talking with others who have similar issues can also allow you to identify new coping skills and techniques to feel more in control of your symptoms.
• Use grounding techniques: Grounding is a simple mindfulness exercise that can help prevent or lessen dissociative symptoms. Use this technique by focusing your full attention on one or more of your five senses (things you can see, touch, smell, taste, or hear) when you feel stressed or notice early dissociative symptoms.
• Avoid drugs and alcohol: Alcohol and other drugs can trigger or worsen dissociative symptoms. Steer clear of mind or mood-altering substances until you can manage your symptoms.
• Reduce your screentime: Spending a lot of time watching TV, scrolling through social media, or playing video games can put you in a mild dissociative state. Therefore, reducing screentime may be beneficial for anyone struggling with DPDR. Instead of using your devices, opt for activities that are more active and social, like exercising or spending time outdoors or with friends.
• Start a meditation practice: Meditation and mindfulness practices are proven to reduce stress levels and improve one’s mood, anxiety, and overall mental wellbeing. Scheduling 15-20 minutes per day for guided meditations or mindfulness exercises can help improve symptoms of DPDR.
• Lower your stress with relaxation techniques: Since stress can be a major trigger for dissociative symptoms like depersonalization and derealization, relaxation techniques are often helpful for people with DPDR. Progressive muscle relaxation or deep breathing exercises can help lower your stress or anxiety, reducing the likelihood of dissociating.

Final Thoughts

Depersonalization-Derealization Disorder involves periodic dissociative episodes in which a person becomes disconnected from themselves or their experiences. These episodes can make  focusing, functioning, and interactions challenging for those diagnosed with the condition. Therapy, medication, or a combination of the two can help reduce your symptoms.^2,5,9,10 Seeking professional help from a therapist is often the best way to begin the recovery process for DPDR.