Depersonalization-Derealization Disorder: Symptoms, Diagnosis, and Treatment

Having an experience of feeling detached from one’s surroundings or even oneself may happen to some people. That may include experiences of feeling emotionally numb, for example. 

But for those with depersonalization-derealization disorder, these experiences happen frequently and tend to cause significant distress. Symptoms may interfere with many aspects of their life, such as work or interpersonal relationships. 

Treatment for this disorder can help individuals manage their symptoms effectively and improve their quality of life. In the following sections, we’ll discuss depersonalization-derealization disorder, including its symptoms, possible causes, and treatment approaches. 

What is depersonalization-derealization disorder? 

This disorder involves feeling detached from oneself or detached from reality or one’s surroundings. Those who have this disorder might experience the world around them as dreamlike. Or they might feel like they’re observing their thoughts and/or body from the outside.    

Having this disorder can make it difficult to function in everyday life. Individuals who experience these symptoms may feel deep distress that affects their mental and emotional well-being. But the right treatment can help them manage this disorder. 

Depersonalization-derealization disorder vs. dissociative identity disorder

Depersonalization-derealization disorder and dissociative identity disorder are considered dissociative disorders. Dissociation refers to the mental experience where a person feels disconnected from their emotions, thoughts, or personal identity. However, while both disorders share a category, there are distinct differences between them.

Depersonalization-derealization disorder involves feeling disconnected from one’s surroundings or self. Dissociative identity disorder (DID) involves having two or more separate identities, rather than feeling like an outside observer of one’s own self. Individuals with DID can switch between these identities. 

Diagnostic criteria for depersonalization-derealization disorder

How is depersonalization-derealization disorder diagnosed? An isolated or occasional feeling of disconnection or dissociation isn’t enough. Those who have this disorder meet the diagnostic criteria that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides, and have been diagnosed by a licensed professional. Below, we’ll go over the criteria for a diagnosis of depersonalization derealization disorder.

1. Ongoing or recurring episodes of depersonalization, derealization, or both:

• Depersonalization: Detached or unreal experiences from oneself, such as feeling physically or emotionally numb or having a distorted sense of time
• Derealization: Detached or unreal experiences from surroundings, such as seeing other people or objects in a dreamlike or visually distorted state 

1. Symptoms cause considerable impairment or distress that affects one’s relationships, job, or other areas of life. 
2. Symptoms are not caused by any substances, such as medication or drugs, or any medical conditions.
3. Dissociation doesn’t only happen during the course of other psychiatric disorders, such as schizophrenia spectrum disorders with episodes of psychosis or psychotic disorders.

Symptoms of depersonalization-derealization disorder

The dissociative symptoms of this disorder mainly include depersonalization symptoms or derealization symptoms. However, other symptoms can also occur. We’ll explore the different types of symptoms that people with depersonalization-derealization disorder may experience. 

As you read, note that it’s important to recognize that exhibiting one or more of these symptoms does not guarantee that someone has depersonalization-derealization disorder — that diagnosis can only be made by a licensed professional.

Depersonalization symptoms 

These symptoms involve a feeling of detachment or disconnection from oneself or reality. Individuals with depersonalization-derealization disorder might experience any of the following:

• Feeling detached from oneself: People with this symptom might feel like they’re watching themselves from the outside. They might feel like their body or self isn’t real or that they’re observing their physical self, emotions, and/or thoughts from an outside vantage point.  
• Emotional numbing: Those with this symptom might feel emotionally detached or disconnected. They might have an incredibly difficult time experiencing emotional responses or an inability to feel any emotions. 
• A sense of unreality: Individuals with this symptom might feel like their memories really aren’t their own. Their thoughts might also not feel like they have any sense of realness. . 

Derealization symptoms 

These kinds of symptoms involve feeling disconnected from other people, objects, or other aspects of one’s surroundings. For those with depersonalization-derealization disorder, these symptoms may include the following:

• Altered perception of the environment: People with this symptom might feel like they’re living in a dream. Their surroundings might not seem real. For example, objects and people around them might look flat and two-dimensional or lack color. 
• Distorted sense of time: Those who have this symptom might feel like time has sped up or slowed down. For example, events that just happened might feel like they really occurred in the distant past. However, it’s important to note that this distortion is markedly different from losing a sense of time while enjoying your favorite hobby.
• Emotional disconnection: Individuals with this symptom might feel emotionally detached from their surroundings. For example, it might seem like there’s a veil between them and the world around them.  

Other potential symptoms 

In some cases, individuals with this disorder might have symptoms that have characteristics of both depersonalization and derealization. A few of these might include the following:

• Dissociation triggered by stress or trauma: Individuals with this symptom might use it as a coping mechanism to help them escape overwhelming situations or emotions, such as those associated with a past traumatic experience. 
• Feeling a sense of unreality or confusion about one’s identity: Those with this symptom might question their sense of self, who they are, or what their place is in the world. 
• Memory lapses or blackouts: People with this symptom might unexpectedly and suddenly forget actions or events, without any explanations for these periods.  

Possible causes of depersonalization-derealization disorder symptoms 

The exact cause of depersonalization-derealization disorder isn’t known or fully understood. But in many cases, it’s associated with extreme stress or trauma. Those with certain risk factors, such as depression, anxiety disorders, substance use, personality disorders, or complex post-traumatic stress disorder (C-PTSD), may have an increased risk of developing symptoms of depersonalization-derealization disorder. 

Potential causes of these symptoms may include any of the following:

• A loved one dying suddenly
• Serious accidents 
• Abuse, such as physical or emotional abuse  
• Natural disasters 
• Experiencing or seeing domestic violence 
• Having a parent with a serious mental disorder 

Treatment for depersonalization-derealization disorder

This disorder may cause serious problems in a person’s life. They might have a hard time maintaining relationships, holding down a job, or handling challenges. 

Symptoms of depersonalization-derealization disorder can also interfere with adaptive coping mechanisms, like the ability to make healthy lifestyle choices, or practicing grounding techniques to help the individual feel more connected to reality and their surroundings.  

But there are ways to treat this disorder in order to help reduce feelings of depersonalization and derealization and improve day-to-day functioning. The right treatment plan for individuals with depersonalization-derealization disorder varies based on different factors. For example, a specific type of therapy might work better than other types for someone who has experienced abuse or domestic violence. 

Treatment for this disorder often includes talk therapy or psychotherapy. Different types of talk therapy may be used, depending on an individual’s symptoms, severity of their condition, and other factors. 

In the following sections, we’ll discuss some of the therapeutic approaches that are used for depersonalization-derealization disorder. Note that responsiveness to these therapies may depend on the severity of symptoms, and some people with this diagnosis may benefit from medication management consultations. 

Cognitive behavioral therapy (CBT)

CBT is a type of therapy that involves learning to recognize unhelpful thought patterns and replace them with more adaptive ones. Those who go through this therapy learn how their thoughts, behaviors, and emotions are connected. They learn to identify cognitive distortions they might engage in, such as all-or-nothing thinking or catastrophizing. 

How does this help people with depersonalization-derealization disorder? CBT helps them become aware of the thought processes and patterns that may cause them to experience depersonalization or other symptoms. Once they’re able to identify these, they can work on changing them to adaptive thoughts.

Replacing maladaptive or negative thought patterns may help reduce the emotional distress they experience with this disorder. For example, someone who thinks they’re losing control while having depersonalization symptoms can challenge this thought and replace it with thoughts that are more accurate. 

Dialectical behavior therapy (DBT)

DBT is similar to CBT, but it focuses more on emotions and social aspects of a person’s life. This therapeutic approach includes the principles of mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance.

Mindfulness helps people learn to focus on the present instead of the past or future. Emotion regulation helps with managing strong emotions to prevent them from affecting thoughts and behaviors. Interpersonal effectiveness teaches people how to set boundaries with others and communicate assertively. Distress tolerance helps people cope with difficult or challenging situations in adaptive ways. 

DBT helps individuals with depersonalization-derealization disorder examine troubling or intense emotions in a safe, nonjudgmental environment. They also learn how to effectively manage these emotions. Learning to be mindful may help them feel connected to themselves and their surroundings again. 

Eye movement desensitization and reprocessing (EMDR)

EMDR is a type of treatment that’s used for treating PTSD due to its focus on addressing underlying trauma. It involves having people think about and discuss past trauma. While doing this, their eyes follow something that moves from side to side past their field of vision. 

How does this work at resolving trauma? These eye movements are linked to the mechanisms associated with rapid eye movement (REM) sleep. Recalling traumatic events while making these eye movements helps individuals process these memories. Doing this helps break the powerful hold that past trauma has on the individual’s current emotions, thoughts, and behaviors. 

For those with depersonalization-derealization disorder, EMDR may help them work through the underlying traumatic or distressing event that triggers their symptoms. This may be helpful in cases where this disorder is linked to past trauma, such as being in a natural disaster or experiencing physical abuse. 

Acceptance and commitment therapy (ACT)

ACT is a type of therapy that focuses on helping people learn to accept life’s challenges and difficulties. It also helps individuals identify their values and commit to taking actions that align with them. Examples of values people might have include gratitude, kindness, respect, trust, courage, or compassion. 

For individuals with depersonalization-derealization disorder, ACT can help them work on accepting their symptoms and emotions. This helps reduce the power these have on their behaviors and thoughts. 

ACT also helps these individuals identify the values that are most important to them. Once they know what these values are, they can commit to taking actions that are aligned with them. For example, someone whose value is compassion may focus on practicing self-compassion through positive self-talk as a way to reconnect with their sense of self.  

Connect with a therapist today with SonderMind 

Depersonalization and derealization symptoms may make many areas of life challenging for those who have this disorder. Clinicians can determine the most suitable treatment method to help these individuals manage and reduce their symptoms. With the right help, they can reconnect with themselves and feel fully present in their surroundings. 

Therapy offers an effective way to treat depersonalization-derealization disorder. But it’s also effective for addressing many other mental health problems, such as anxiety or depression. If you’re looking for help with a mental health condition or other issues, SonderMind can connect you with a licensed mental health professional quickly.

Find the right therapist with SonderMind today.