Depersonalization-derealization disorder occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both. Feelings of depersonalization and derealization can be very disturbing and 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 completely go away, it's considered depersonalization-derealization disorder. This disorder is more common in people who've had traumatic experiences.

Depersonalization-derealization disorder can be severe and may interfere with relationships, work and other daily activities. The main treatment for depersonalization-derealization disorder is talk therapy (psychotherapy), although sometimes medications also are used.

Persistent and recurrent episodes of depersonalization or derealization or both cause distress and problems functioning at work or school or in other important areas of your life. During these episodes, you are aware that your sense of detachment is only a feeling, and not reality.

The experience and feelings of the disorder can be difficult to describe. Worry about "going crazy" can cause you to become preoccupied with checking that you exist and determining what's actually real.

Depersonalization symptoms

Symptoms of depersonalization include:

  • Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body, perhaps as if you were floating in air above yourself
  • Feeling like a robot or that you're not in control of your speech or movements
  • The sense that your body, legs or arms appear distorted, enlarged or shrunken, or 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 that they may or may not be your own memories

Derealization symptoms

Symptoms of derealization include:

  • Feelings of being alienated from or unfamiliar with your surroundings, perhaps like you're living in a movie
  • Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall
  • Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings
  • Distortions in perception of time, such as recent events feeling like distant past
  • Distortions of distance and the size and shape of objects

Episodes of depersonalization-derealization disorder may last hours, days, weeks or even months at a time. In some people, these episodes turn into ongoing feelings of depersonalization or derealization that may periodically get better or worse.

In this disorder, feelings of depersonalization and derealization aren't directly caused by drugs, alcohol, a mental health disorder or a medical condition.

When to see a doctor

Passing feelings of depersonalization or derealization are common and aren't necessarily a cause for concern. But ongoing or severe feelings of detachment and distortion of your surroundings can be a sign of depersonalization-derealization disorder or another physical or mental health disorder.

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

  • Are disturbing you or are emotionally disruptive
  • Don't go away or keep coming back
  • Interfere with work, relationships or daily activities

The exact cause of depersonalization-derealization disorder isn't well-understood. However, it appears to be linked to an imbalance of certain brain chemicals called neurotransmitters, which can make a brain vulnerable so that heightened states of stress and fear may lead to the disorder.

Symptoms of depersonalization-derealization disorder may be related to:

  • Childhood trauma, such as verbal or emotional abuse or witnessing domestic violence
  • Growing up with a significantly impaired mentally ill parent
  • Suicide or unexpected death of a close friend or family member
  • Severe stress, such as relationship, financial or work-related problems
  • Severe trauma, such as a car accident

While anyone can develop depersonalization-derealization disorder, you're at increased risk if:

  • Your personality has traits that make you want to avoid or deny difficult situations or you have trouble adapting to difficult situations
  • You've been involved in or witnessed a traumatic or abusive experience
  • You're in your mid- to late teens or early adulthood — depersonalization-derealization disorder is rare in children and older adults

Even if you don't have depersonalization-derealization disorder, feelings of depersonalization or derealization can be triggered by:

  • Having other mental health disorders, such as depression or anxiety
  • Using substances, such as hallucinogens or marijuana
  • Having physical or medical conditions, such as seizures or a head injury

Episodes of depersonalization or derealization can be frightening. They can cause:

  • Difficulty focusing on tasks or remembering things
  • Interference with work and other routine activities
  • Problems in relationships with your family and friends

You're likely to start by first seeing your primary care doctor, but you may be referred to a doctor who specializes in brain and nervous system disorders (neurologist) or a doctor who specializes in diagnosing and treating mental health disorders (psychiatrist).

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

What you can do

Before your appointment, make a list of:

  • Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins and other supplements that you're taking, including dosages
  • Questions to ask your doctor

Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.

Some basic questions to ask your doctor include:

  • What's the most likely cause of 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 alternatives to the primary 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?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What appears to worsen your symptoms?
  • Do you have any long-term (chronic) health conditions?
  • Do you have any mental health disorders, such as anxiety, depression or post-traumatic stress disorder (PTSD)?
  • What medications or herbal supplements do you take?
  • Do you drink alcohol or use street drugs?

To be diagnosed with depersonalization-derealization disorder, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

The DMS-5 includes these definitions:

  • Depersonalization. You have experiences of unreality or feeling detached from your thinking, emotions or your body. Or you may feel like an outside observer watching your thoughts, feelings, sensations, body or actions.
  • Derealization. You have experiences of unreality or feeling detached from your surroundings, as if you were in a dream.

To be diagnosed with depersonalization-derealization disorder:

  • You must have persistent or recurrent experiences of depersonalization, derealization or both
  • During the depersonalization or derealization experience, you are aware that the experience is not real
  • Your symptoms cause significant distress or interfere with your social life, job or other important areas of your life
  • Your symptoms are not caused by another mental health disorder, such as schizophrenia or panic disorder
  • Your symptoms are not due to the direct physiological effects of alcohol, drugs or a medical condition

You may need further evaluation or tests to rule out other physical or mental health disorders and other causes, such as substance misuse.

Treatment of depersonalization-derealization disorder is primarily psychological counseling, also called talk therapy. However, sometimes medications may be added to your treatment plan.

  • Psychological counseling. This helps you understand why depersonalization and derealization occur, and helps you gain control over the symptoms so that they go away. Two such techniques include cognitive behavioral therapy and psychodynamic therapy. Depersonalization-derealization disorder may also improve when counseling helps with other mental health conditions, such as depression.
  • Medications. While there are no medications specifically approved to treat depersonalization-derealization disorder, certain medications that are used to treat depression and anxiety may help. Examples that have been shown to relieve symptoms include fluoxetine (Prozac), clomipramine (Anafranil) and clonazepam (Klonopin).

While depersonalization and derealization can be frightening, they aren't necessarily harmful. Realizing that you have a treatable mental health disorder can be reassuring. To help you cope with depersonalization and derealization:

  • Follow your treatment plan. Counseling may involve practicing certain techniques to help resolve feelings of depersonalization and derealization on a daily basis. Seeking treatment early can improve your chances of successfully using these techniques.
  • Learn about the condition. Books and Internet resources are available that discuss why depersonalization and derealization occur and how to cope. Ask your mental health provider to suggest educational materials and resources.
  • Connect with others. Stay connected with supportive and caring people — family, friends, faith leaders or others.
May 24, 2014