Feeling Disconnected
What is Depersonalization/Derealization Disorder?
Depersonalization: refers to feeling detached from yourself, as if you're watching your life take place from the sidelines or viewing yourself on a movie screen. Symptoms can include:
Alexithymia: an inability to recognize or describe emotions
Feeling physically numb to sensations
Feeling robotic or unable to control speech or movement
Feeling unconnected to your body, mind, feelings, or sensations
Inability to attach emotions to memories
The sense that your body and limbs are distorted (swollen or shrunken)
The sense that your head is wrapped in cotton
Derealization: a sense of feeling detached from your environment and the objects and people in it. The world may seem distorted and unreal as if you're observing it through a veil. You may feel as if a glass wall is separating you from people you care about. Symptoms may include:
Experiencing distortions in vision and other senses
Distance and the size or shape of objects may be distorted
You may have a heightened awareness of your surroundings
Recent events may seem to have happened in the distant past
Surroundings may seem blurry, colorless, two-dimensional, unreal, larger-than-life or cartoonish
When to see a doctor
Episodes of Depersonalization/Derealization disorder can last for hours, days, weeks, or even months. Passing feelings of depersonalization or derealization are common and aren't necessarily a cause for concern. However, if such episodes become chronic or you are experiencing severe feelings of detachment and distortion of your surroundings it can be a sign of depersonalization-derealization disorder or another physical or mental health disorder. People with this disorder know that these feelings of detachment are not real and often feel distressed by these symptoms, unlike other psychotic disorders.
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
Diagnosis
In order to properly diagnose Depersonalization/Derealization Disorder (DPDR), a doctor must first rule out any other reasons for symptoms that can include: drug use, a seizure disorder, or other mental health problems like depression, anxiety, post-traumatic stress disorder (PTSD), or borderline personality disorder.
Once other potential causes are ruled out, a clinician considers DPDR criteria as outlined in the Diagnostic and Statistic Manual of Mental Health Disorders (DSM-5), including:
Persistent or recurrent episodes of depersonalization, derealization, or both
An understanding by the person that what they're feeling isn't real
Significant distress or impairment of social or occupational functioning caused by symptoms
Causes and Risk Factors
Severe stress such as major relationship, financial or work-related issues
Depression or anxiety, especially severe or prolonged
Experiencing or witnessing a traumatic event or abuse as a child or adult
Witnessing domestic violence
A lack of sleep or an overstimulating environment can worsen symptoms
Having a loved one die unexpectedly
Using recreational drugs
Tendency to avoid or deny difficult situations; trouble adapting to difficult situations
Complications
Episodes of depersonalization or derealization can cause:
Difficulty focusing on tasks or remembering things
Interference with work and other routine activities
Problems in relationships with your family and friends
Anxiety or depression
A sense of hopelessness
Coping Mechanisms
There are a few strategies that can help keep you grounded and/or bring you back to reality when you’re experiencing symptoms of DPDR.
Pinch the skin on the back of your hand.
Use temperature to shift your focus; place something that's really cold or really warm (but not too hot) in your hand.
Look around the room and count or name the items you see.
Keep your eyes moving to stop yourself from zoning out.
Slow your breathing—or take long, deep breaths—and pay attention as you inhale and exhale.
Practice meditation to develop greater awareness of your internal state.
Reach out to a friend or loved one and ask them to keep talking to you.
Treatments
For some, recovery happens naturally, without formal treatment. Others require targeted, personalized treatments to completely recover from DPDR. Chances of recovery are best when underlying stressors that contributed to and triggered the depersonalization and dissociation are successfully dealt with.
Psychotherapy
The most effective way to deal with DPDR. It teaches you strategies for blocking obsessive thinking about feeling things that aren't real and can also teach you distraction techniques, including:
Grounding techniques call on the senses to help you feel more in touch with reality
Psychodynamic techniques focus on working through conflicts and negative feelings that people tend to detach from, and moment-to-moment tracking (focusing on what's happening at the moment) along with labeling of dissociation and effects
EMDR
While eye movement desensitization and reprocessing (EDMR) therapy was originally designed to treat PTSD, it is often used to treat a variety of mental health conditions, including DPDR.
Medications
There are no medications approved specifically for treating depersonalization/derealization disorder. However, your healthcare professional may prescribe anti-anxiety drugs and antidepressants to help ease or relieve symptoms of the condition.
How can you support a loved one?
Read up on the condition. Having general background information can help as symptoms of DPDR are often hard for people experiencing them to put into words.
Validate their experience. You can do this even if you don’t understand what they’re feeling. A simple “That must feel very uncomfortable, I’m sorry you’re dealing with this” can go a long way.
Offer to take them to a therapy session.
Understand it might be hard for them to reach out for help. Make sure they know you’re available for support if they need you. Don’t assume silence means they don’t need or want help.
Respect their boundaries. If they tell you they don’t want to talk about their symptoms or any past trauma, don’t push the subject or take it personally.