Depersonalization-derealization disorder

Depersonalization-derealization disorder occurs when you always or often feel that you're seeing yourself from outside your body or you sense that things around you are not real — or both. Feelings of depersonalization and derealization can be very disturbing. You may feel like you're living in a dream.

Many people have a passing experience of depersonalization or derealization at some point. But when these feelings keep occurring or never fully go away, and they make it hard for you to function, it's likely depersonalization-derealization disorder. This condition is more common in people who experience trauma, such as violence, abuse or other kinds of extreme stress.

Depersonalization-derealization disorder can be serious and may get in the way of your relationships and work. It also can disrupt other daily activities. The main treatment for depersonalization-derealization disorder is psychotherapy, also known as talk therapy. Sometimes medicines also are used.

Short experiences of depersonalization or derealization are fairly common. But lasting and returning bouts of these symptoms can cause problems at work or school, or in other important areas of your life. During these bouts, you know that your sense of not being connected to your body or your surroundings are only feelings and not reality.

The experience and feelings of the condition can be hard to describe. Worrying about "going crazy" can cause you to become focused on checking that you exist and finding out what's real.

Symptoms usually begin in the middle or late teenage years, or in early adulthood. Depersonalization-derealization disorder is rare in children and older adults.

Depersonalization symptoms

Symptoms of depersonalization include:

• Feelings that you're seeing your thoughts, feelings, or body or parts of your body from the outside. For example, you may feel like you're floating in the air above yourself.
• Feeling like a robot or that you're not in control of what you say or how you move.
• The sense that your body, legs or arms appear twisted or like they're not the right shape. Or they may seem larger or smaller than usual. You also could feel that your head is wrapped in cotton.
• Emotional or physical numbness of your senses or responses to the world around you.
• A sense that your memories lack emotion, and they may or may not be your own memories.

Derealization symptoms

Symptoms of derealization include:

• Feeling that people and your surroundings are not real, like you're living in a movie or a dream.
• Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall.
• Surroundings that appear out of their usual shape, or are blurry or colorless. Or they may seem like they only have two dimensions, so they're flat with no depth. Or you could be more aware of your surroundings, and they may appear clearer than usual.
• Thoughts about time that are not real, such as recent events feeling like the distant past.
• Unrealistic thoughts about distance and the size and shape of objects.

Bouts of depersonalization-derealization disorder may last hours, days, weeks or months. In some people, these bouts turn into ongoing feelings of depersonalization or derealization that may get better or worse at times.

When to see a doctor

Passing feelings of depersonalization or derealization are common and are not always a cause for concern. But ongoing or serious feelings of detachment and distortion of your surroundings can be a sign of depersonalization-derealization disorder or another physical or mental health condition.

See a doctor if you have feelings of depersonalization or derealization that:

• Are disturbing you or are disrupting your emotions.
• Do not go away or keep coming back.
• Get in the way of work, relationships or daily activities.

The cause of depersonalization-derealization disorder is not well understood. Some people may be more likely to experience depersonalization and derealization than others. This is possibly due to genetic and environmental factors. High levels of stress and fear may cause bouts.

Symptoms of depersonalization-derealization disorder may be related to childhood trauma or other experiences or events that cause severe emotional stress or trauma.

Factors that may raise the risk of depersonalization-derealization disorder include:

• Certain personality traits that make you want to stay away from stressful situations or make it hard to describe your emotional experience.
• Serious trauma as a child or an adult, like going through or seeing a traumatic event, such as violence or abuse.
• Serious stress, such as major relationship, financial or work-related issues.
• Depression or anxiety, especially serious depression, depression that lasts a long time or anxiety with panic attacks.
• Drug misuse, which can cause bouts of depersonalization or derealization.

Bouts of depersonalization or derealization can be scary and make it hard to function. They can:

• Make it hard to focus on tasks or remember things.
• Get in the way of work and other routine activities.
• Cause problems in relationships with your family and friends.
• Make you feel anxious, depressed or hopeless.

Your doctor may determine or rule out a diagnosis of depersonalization-derealization disorder based on:

• Physical exam. In some cases, symptoms of depersonalization or derealization may be linked to another physical health problem, medicines, recreational drugs or alcohol.
• Lab tests. Some lab tests may help find out whether your symptoms are related to medical or other issues.
• Mental health evaluation. Talking about your symptoms, thoughts, feelings and behavior patterns can help determine if you have depersonalization-derealization disorder or another mental health condition.

Depersonalization-derealization disorder is mainly treated using talk therapy. But medicines may be added to your treatment plan sometimes.

Talk therapy

Talk therapy is the main treatment for depersonalization-derealization disorder. The goal is to control the symptoms to make them better or make them go away. Two types of talk therapy are cognitive behavioral therapy and psychodynamic therapy.

Talk therapy can help you:

• Learn why depersonalization and derealization occur.
• Learn techniques that take your mind off your symptoms and connect you to your world and feelings.
• Learn coping strategies to deal with stressful situations and times of extreme stress.
• Talk about the emotions related to past trauma that you've experienced.
• Learn about other mental health conditions you may have, such as anxiety or depression.

Medicines

No medicine has been proven to effectively treat depersonalization-derealization disorder. But medicines may be used to treat specific symptoms or treat depression and anxiety that often are related to the condition.

While depersonalization-derealization disorder can feel scary, knowing that it can be treated may make you feel better. To help you cope with depersonalization-derealization disorder:

• Follow your treatment plan. Talk therapy may involve practicing certain techniques daily to help reduce or stop the feelings of depersonalization and derealization. Seeking treatment early can make it more likely that you'll use these techniques successfully.
• Learn about the condition. Books and internet resources are available that talk about why depersonalization and derealization occur and how to cope. Ask your mental health professional to suggest educational materials and resources.
• Connect with others. Stay connected with supportive and caring people, such as family, friends or faith leaders.

You're likely to start by first seeing your primary care doctor or another primary care professional. It may be suggested that you see a doctor who specializes in brain and nervous system conditions, also known as a neurologist. Or you may see a doctor who specializes in diagnosing and treating mental health conditions, also known as a psychiatrist.

You may want to take a family member or friend along, if possible. Someone who goes along with you may remember something that you missed or forgot.

Here's some information to help you get ready for your appointment and learn what to expect.

What you can do

Before your appointment, make a list of:

• Any symptoms you have, even if they're not related to the reason for your appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbs and other supplements that you're taking, including doses.
• Questions to ask your doctor.

Some basic questions to ask include:

• What's most likely causing my symptoms?
• Are there other possible causes?
• Do I need any tests to confirm the diagnosis?
• What treatments are available? Which do you recommend?
• Are there other options to the main approach that you're suggesting?
• Do I need to see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you some questions, such as:

• When did you first begin feeling symptoms?
• Have your symptoms been constant, or do they only occur once in a while?
• How serious are your symptoms?
• What, if anything, seems to make your symptoms better?
• What appears to make your symptoms worse?
• Do you have any long-term health conditions?
• Do you have any mental health conditions, such as anxiety, depression or post-traumatic stress disorder (PTSD)?
• What medicines or herbal supplements do you take?
• Do you drink alcohol or use recreational drugs?

Be ready to answer questions so you'll have time to talk about what's most important to you.