Depersonalization-derealization disorder

Diagnosis

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 an underlying physical health problem, medications, recreational drugs or alcohol.
• Lab tests. Some lab tests may help determine whether your symptoms are related to medical or other issues.
• Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns, which can help determine if you have depersonalization-derealization disorder or other mental health disorders.
• DSM-5. Your mental health professional may use the criteria for depersonalization-derealization disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of depersonalization-derealization disorder is primarily psychotherapy. However, sometimes medications may be added to your treatment plan.

Psychotherapy

Psychotherapy, also called counseling or talk therapy, is the main treatment. The goal is to gain control over the symptoms so that they lessen or go away. Two such psychotherapies include cognitive behavioral therapy and psychodynamic therapy.

Psychotherapy can help you:

• Understand why depersonalization and derealization occur
• Learn techniques that distract from your symptoms and make you feel more connected to your world and feelings
• Learn coping strategies to deal with stressful situations and times of extreme stress
• Address the emotions related to past trauma you've experienced
• Address other mental health conditions such as anxiety or depression

Medications

There are no medications specifically approved to treat depersonalization-derealization disorder. However, medications may be used to treat specific symptoms or to treat depression and anxiety that are often associated with the disorder.

Coping and support

While depersonalization and derealization disorder can feel frightening, realizing that it's treatable may be reassuring. To help you cope with depersonalization-derealization disorder:

• Follow your treatment plan. Psychotherapy may involve practicing certain techniques on a daily basis to help resolve feelings of depersonalization and derealization. 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 professional to suggest educational materials and resources.
• Connect with others. Stay connected with supportive and caring people — family, friends, faith leaders or others.

Preparing for your appointment

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).

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

Here's some information to help you get ready for your appointment and 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, herbs and other supplements that you're taking, including dosages
• Questions to ask your doctor

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. Be ready to answer them to 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 recreational drugs?