Depersonalization-derealization disorder (DPDR), sometimes referred to as depersonalization/derealization syndrome, is a mental health condition that involves feeling distant or detached from yourself, mentally or physically, and/or having a reduced sense of reality.
It reflects the two major issues people experience:
• Depersonalization affects how you relate to yourself. It can make you feel as if you aren’t real.
• Derealization affects how you relate to other people and things. It can make you feel like your surroundings or other people aren’t real.
Together, these issues can leave you feeling distanced or disconnected from yourself and the world around you.
It’s not unusual to feel this way from time to time. But if you have DPDR, these feelings can linger for long periods of time and get in the way of day-to-day activities.
The main symptom of depersonalization-derealization disorder is feeling disconnected. You may feel:
• Disconnected from your thoughts, feelings and body (depersonalization).
• Disconnected from your surroundings or environment (derealization).
• As if you’re observing yourself from outside your body.
• As if you’re living in a dream world.
• Depressed, anxious, panicky or like you’re going crazy.
Some people experience mild, short-lived symptoms. Others have chronic (ongoing) symptoms that may last for years. The symptoms may interfere with your ability to function. They may even lead to a disability.
Often, people with DPDR have experienced past trauma in their lives, including:
• Emotional or physical abuse or neglect in childhood
• Having a loved one die unexpectedly
• Witnessing domestic violence
Episodes of depersonalization-derealization can be frightening and disabling. 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
• Anxiety or depression
• A sense of hopelessness
It’s normal to feel a little “off” or removed from the world sometimes. But at what point do these feelings start to signal a mental health condition?
Generally, your symptoms may be a sign of DDD if they start to interfere with your daily life. Before making a diagnosis of DDD, your primary care provider (PCP) will first ask if you:
• have regular episodes of depersonalization, derealization, or both
• are distressed by your symptoms
They’ll also likely ask you whether you’re aware of reality when you experience symptoms. People with DDD are generally aware that what they’re feeling isn’t quite real. If you aren’t aware of reality in those moments, you may have another condition.
The goal of depersonalization-derealization treatment is to address the stressors that trigger the symptoms. Your healthcare provider plans your treatment based on your –
• General health.
• Symptom severity.
Treatment often includes a combination of:
▪︎ Psychotherapy: Talk therapy is the main treatment for dissociative disorders. Your provider may opt for one or more of these methods:
• Cognitive-behavioral therapy: CBT focuses on changing thinking patterns, feelings and behaviors that aren’t serving you.
• Dialectic-behavior therapy: DBT may help with severe personality disturbances. It may help you tolerate difficult emotions, including dissociative symptoms. DBT is useful if you’ve experienced abuse or trauma.
• Eye movement desensitization and reprocessing: EMDR can help you cope with post-traumatic stress disorder (PTSD). It can reduce persistent nightmares, flashbacks and other symptoms.
• Family therapy: Working together, your family learns about the disorder. The group learns how to recognize signs of a recurrence.
• Creative therapies: Art or music therapy can help you explore and express your thoughts and feelings in a safe, creative environment.
▪︎ Other treatments:
• Meditation and relaxation techniques: Mindfulness may help you tolerate symptoms. You can learn to tune in to your thoughts and feelings. It also can help settle your body’s responses.
• Clinical hypnosis (hypnotherapy): This treatment uses intense relaxation, concentration and focused attention. The goal is to achieve an intense state of awareness. A provider can help you explore deep thoughts, feelings and memories. It can help find the root of a problem.
• Medication: There isn’t a medicine for depersonalization disorder. But treating depression or anxiety can help. Your provider may prescribe antidepressant or anti-anxiety medications such as desipramine (Norpramin®).
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