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Symptoms of Depersonalization-Derealization Disorder

Symptoms of Depersonalization-Derealization Disorder



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Many people have felt disconnected from themselves and their surroundings. But if these feelings arise regularly, you might have depersonalization-derealization disorder.

At one time or another, all of us have found ourselves lost in our daydreams, thinking pleasant thoughts about our lives and our futures.

Maybe you’ve gotten lost in a book or become hyper-focused on a fascinating project.

Occasionally, maybe you’ve even felt disconnected from yourself, having an out-of-body experience during a stressful time in your life.

If these feelings are happening more frequently, you may have depersonalization-derealization disorder. Feeling disconnected from reality or yourself are two of the main symptoms of this condition.

Depersonalization-derealization disorder is classified as a dissociative disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In depersonalization-derealization disorder, people experience one or both of these states:

  • Depersonalization: feeling detached from your own body, thoughts, or feelings
  • Derealization: feeling detached from your surroundings

Unlike psychotic disorders, people with depersonalization-derealization disorder know that their experience isn’t reality. People with the condition realize that something is off, which usually causes them to feel distressed.

It’s estimated that depersonalization-derealization disorder affects 1-2% of the population.

According to the DSM-5, some people with depersonalization-derealization disorder have discrete episodes, while others have continuous symptoms. Or, some individuals may start out experiencing episodes that eventually become continuous symptoms.

People with depersonalization-derealization disorder may have a tough time describing their symptoms. They might also think they’re odd or unusual or fear they have irreversible brain damage, according to the DSM-5.

Understandably, experiencing depersonalization-derealization symptoms can feel unnerving. Some common symptoms include:

Depersonalization symptoms
  • feeling like you’re completely detached from yourself, even believing that you have no self
  • feeling detached from parts of yourself such as your thoughts, as in, “My thoughts don’t feel like my own,” or “My head is filled with cotton”
  • feeling like you’re outside of your body, watching yourself in a movie or from above
  • having a distorted sense of time – time is either too fast or too slow
  • feeling mentally, emotionally, or physically numb
  • feeling like you have no control over your body, including your movements or speech
  • feeling like you’re a robot
Derealization symptoms
  • feeling detached from reality
  • experiencing others or objects as foggy, artificial, cartoonish, or dreamlike
  • experiencing sounds or voices as muted or heightened
  • experiencing objects as flat or two-dimensional
  • seeing objects as distorted in size or distance
  • feeling like you’re trapped in a glass bell or like there’s a veil between you and the world

In some cases, depersonalization-derealization symptoms go away on their own. But for others, symptoms are persistent and can develop into depersonalization-derealization disorder.

Treatment may include psychotherapy, medication, or a combination of both.

Psychotherapy

Research on treatment for depersonalization-derealization disorder is limited. Still, existing research stresses the importance of psychotherapy.

According to this older study, strengthening coping skills is helpful when individuals are experiencing intense or acute symptoms, such as frequent dissociation or severe anxiety or depression.

When symptoms are milder or relatively stable, therapy may help delve into – and over time resolving – why individuals become disconnected from reality or themselves.

Other helpful therapies include:

  • cognitive behavior therapy (CBT) for changing negative thoughts and unhealthy behavior
  • dialectical behavior therapy (DBT) for tolerating difficult emotions, reducing self-destructive urges, and improving relationships
  • eye movement desensitization and reprocessing (EMDR) for reducing distress from traumatic experiences

Grounding techniques that can help you reconnect to reality and yourself may also be addressed in therapy. These in-the-moment strategies may include practicing deep breathing exercises or holding an ice cube.

Overall, a range of approaches may be used, depending on your needs, specific symptoms, and if you have another mental health condition.

Medication

The Food and Drug Administration (FDA) hasn’t approved any medication to treat depersonalization-derealization disorder.

A 2019 review that looked at medication for dissociative disorders found that paroxetine (Paxil) and naloxone (Narcan) may be effective for depersonalization and dissociative symptoms that co-occur with post-traumatic stress disorder (PTSD) and borderline personality disorder.

However, researchers noted that these findings were modest and “should be interpreted with caution” because of limited data.

In some cases, doctors might prescribe medication to reduce accompanying symptoms of anxiety or depression.

If your doctor suggests taking medication, consider asking these questions at your next appointment:

  • What specific symptoms should this medication reduce or relieve?
  • When can I expect to experience these improvements? Weeks or months from now?
  • What are common and less common side effects?
  • How can I reduce or prevent possible side effects?
  • When is my follow-up appointment?
  • How long should I take this medication?
  • Is it OK to stop abruptly, or will I need to slowly and gradually take a reduced dose to avoid withdrawal syndrome?

If your symptoms are stressing you out or interfering with an area of your life – like your work or relationships – consider talking with a mental health professional.

It’s common for depersonalization-derealization disorder to co-occur with depression and anxiety disorders. So, it’s important to let your doctor know if you’re also experiencing these symptoms.

Remember that you don’t have to wait until your symptoms worsen or experience a crisis before you consider reaching out to someone for help.

Therapy, if it’s available to you, can be helpful. A therapist can help you:

  • address specific symptoms or situations that are bothering you
  • learn to cope with stress
  • build a healthier lifestyle

Experiencing symptoms of depersonalization or derealization can lead you to feel alone – even if intellectually you know that others also have similar experiences.

Connecting with others to share your story, asking questions about possible treatments, or reminding yourself that you’re not alone can be helpful.

These online communities may be helpful:

  • Depersonalization community forum
  • Depersonalization/derealization support group on Facebook
  • Depersonalization group on Facebook

Understandably, dealing with symptoms of depersonalization or derealization can bring up a range of emotions – from fear and frustration to confusion.

If possible, consider working with a mental health professional and connecting with others. With treatment and support, you can reduce your symptoms of depersonalization or derealization and feel better.


Symptoms of Depersonalization-Derealization Disorder - Psychology

2nd edition as of August 2020

Module Overview

In Module 6, we will discuss matters related to dissociative disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will consist of dissociative identity disorder, dissociative amnesia, and depersonalization/derealization. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of models to explain psychopathology (Module 2), and descriptions of the various therapies (Module 3).

Module Outline

  • 6.1. Clinical Presentation
  • 6.2. Epidemiology
  • 6.3. Comorbidity
  • 6.4. Etiology
  • 6.5. Treatment

Module Learning Outcomes

  • Describe how dissociative disorders present.
  • Describe the epidemiology of dissociative disorders.
  • Describe comorbidity in relation to dissociative disorders.
  • Describe the etiology of dissociative disorders.
  • Describe treatment options for dissociative disorders.

7.1.2 Epidemiology

While many individuals experience brief episodes of depersonalization/derealization throughout their life (about 50% of adults have experienced depersonalization/derealization at least once), the estimated number of individuals who experiences these symptoms to the degree of clinical significance is estimated to be 2%, with an equal ratio of men and women experiencing these symptoms (APA, 2013). The mean age of onset is 16 years, with only a minority developing the disorder after the age of 25. About 1/3 of people with the disorder have discrete episodes, 1/3 have continuous symptoms from their onset, and 1/3 have an episodic course that progresses to continuous.


Contents

The core symptom of depersonalization disorder is the subjective experience of "unreality in one's sense of self", Η] and as such there are no clinical signs. Patients who suffer from depersonalization also experience an almost uncontrollable urge to question and think about the nature of reality and existence as well as other deep philosophical questions. Α]

Individuals who experience depersonalization can feel divorced from their own personal physicality by sensing their body sensations, feelings, emotions and behaviors as not belonging to the same person or identity. Also, a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which can intensify these perceptions even further.

Common descriptions: Feeling disconnected from one's physicality feeling like one is not completely occupying the body not feeling in control of one's speech or physical movements and feeling detached from one's own thoughts or emotions experiencing one's self and life from a distance a sense of just going through the motions feeling as though one is in a dream or movie and even out-of-body experiences. ΐ] Patients suffering from depersonalization disorder have also certain visual stimulations such as hallucinations and rapid fluctuations in lighting. While the exact cause of these hallucinations has not yet been determined, it is generally accepted that patients suffering from them is caused by previous drug usage. These hallucinations differ from true hallucinatory phenomena as they are closer to being optical distortions or illusions rather than psychotic breaks. Α] Individuals with the disorder commonly describe a feeling as though time is 'passing' them by and they are not in the notion of the present. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious.

Factors that tend to diminish symptoms are comforting interpersonal interactions, intense physical or emotional stimulation, and relaxation. ⎖] Some factors are identified as relieving symptom severity such as diet or exercise alcohol and fatigue are listed by others as worsening symptoms. ⎗]

First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment. Γ] The majority of patients suffering from depersonalization disorder misinterpret the symptoms, thinking that they are signs of serious mental illness or brain dysfunction. This commonly leads to an increase of anxiety experienced by the patient which contributes to the worsening of symptoms. ⎘]

Occasional moments of mild depersonalization are normal ⎙] strong, severe, persistent, or recurrent feelings are not.


Living with DDD

DDD is chronic for many patients. However, some basics of ACT are beneficial in approaching this frightening fact with confidence.

There are two broad approaches in ACT: acceptance of your condition, and commitment to your values and life. Similarly, two powerful tools from DBT are radical acceptance (the complete and total acceptance of something that may be painful), and one-mindedness (acting mindfully and entirely on everything you do). These are not quick skills to learn, and take years to work into the fabric of our lives, but are worthwhile to practice daily.

In order to radically accept DDD, there are several things I’ve found helpful to accept:

  • DDD is a disorder of perception. I will perceive things differently from other people, or from how I would normally perceive things.
  • DDD is uncomfortable, and sometimes painful. This pain is not permanent, even if the disorder might be.
  • Living with DDD may mean having to take control of my life more carefully than I might without the disorder, in order to avoid triggers for anxiety and emotional dysregulation that worsen DP/DR. This effort also ensures I’m living my best, most healthy life.
  • Dwelling on and thinking about my DDD or adjacent ideas (like existential questions) is not a good use of my time. It’s better for me to refocus on something of value to me.

DBT also includes a distress-tolerance skill called turning the mind, in which each time your mind goes to a thought you have no need for, you draw your attention back to some object of focus. This is more difficult and painful at first, but over several months becomes second nature. When you find yourself focused on your dissociation, focus on something of value to you. As you find yourself focusing again on your dissociation, bring the attention back quietly without anger or disappointment. If you continue to have trouble, bring your attention to something grounding, like focusing on the taste of your favorite fruit or an essential oil you love the smell of—this in DBT is a distress-tolerance skill called self-soothing. Self-soothing means taking care of your needs and improving your environment to allow you to suffer less when faced with escalated distress.

ACT has a second focus beyond acceptance—commitment. Depersonalization is terrifying because it appears to completely erase your identity, your sense of self, and as a result your values in life. This is not the case your perception is what has changed. Take for example this interaction with my psychologist:

Me: I feel like I don’t have values anymore.
Psychologist: *pointing to my purple dyed hair* why did you dye your hair?
Me: Oh, because I want to be read as queer visibly, and safe to women and other minorities at first glance as a result.
Psychologist: And what is that?
Me: Oh, that’s one of my values!

This was a major revelation in the moment: we continue to do things because of our life values, even when we feel disconnected from them! If we fail to identify our values, we can look at our automatic actions and the things we prioritize in our lives, and deconstruct our values from our actions. In ACT, one practice we observe is value assessment, also known as “value clarification”. By using this approach (often aided by a worksheet or list of possible life values), we can begin to identify the values most important to our day-to-day life.

From this assessment, we can see which values DDD interferes with, or which values we might be ignoring. ACT then asks that we plan actions based on these values. I find it helpful to identify short and long term goals (or at the least, long term goals) that align with my values and improve my life in those areas. This is part of what DBT describes as “building a life worth living” and is beneficial because it gives us things to focus on beyond DDD that slowly rebuild a sense of identity and pride in our actions, ensuring we’re living our life as fully as possible.

I’ve also found it incredibly helpful to list out the good experiences I’ve had each month—writing a year-in-review letter for my friends made me realize that the year I’d described to myself as being entirely me coping actually was made up of a lot of joyful moments and more initiatives in traveling and trying new things than any other year in my life. I reached out and tried those things as a method of coping saying yes to pleasant experiences even when I felt awful helped me drown out repeated thoughts about DDD. In ACT, we point out that given the choice between being in distress while engaging with nothing and being in distress while engaging with something pleasant, we should choose the latter every time.

There are pharmaceutical treatments for DDD as well. Studies of patients with DDD show their brains behave differently, indicating a neurlogical or neurochemical component to dissociative disorders. Unfortunately, no pharmaceutical solution exists that is approved by the FDA, and options are still lacking. DDD is often comorbid with other mood disorders, though, so treating any target is a good way to improve one’s life quality. Prescriptions that have been most studied for DDD include:

  • Lamotrigine (Lamictal), usually used as a mood stabilizer
  • Fluoxetine (Prozac) and other SSRIs, first-line medications for unipolar depression and anxiety
  • Olanzapine (Zyprexa), typically prescribed as an anti-psychotic
  • Clomipramine (Anafranil), a tricyclic antidepressant with proven results for sufferers of OCD
  • Benzodiazepines (like Clonazepam/Klonopin), typically taken as needed for intense anxiety and panic rather than daily, due to their addictive quality
  • Naltrexone (Revia or Vivitrol), an opioid antagonist

Which medications will have which effects is a subject that is largely personal, so you should consult with a trained physician. I have found some relief from Lurasidone (Latuda, a drug similar to Olanzapine) and starting an SSRI intended to target OCD (Fluvoxamine). Treating my existing ADHD (with Vyvanse) has helped me stay focused on the important things around me, and less focused on dissociation. Transcranial magnetic stimulation has also been studied and presents some efficacy in treating DDD. All of these, however, are the results of small studies that lack repetitions and attention from the medical community, so our understanding of how to treat the disorder is still inchoate.

None of these are cures. DDD may be chronic and lifelong, terrifying in its intensity, but these skills are ways of dealing with it in the long term, while DBT distress tolerance skills provide a good way of coping in the short term. One other fantastic strategy that has helped me is simple: surround myself with people I love, who know what I am going through.


Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study

Background: Symptoms of depersonalization (DP) and derealization (DR) have a high prevalence in patient and community samples. Previous studies suggested that DP/DR symptoms might represent a marker of disease severity and poor prognosis. However, population-based studies investigating the impact of DP/DR symptoms on the course of depression and anxiety are sparse. Therefore, we aimed to analyze whether symptoms of DP/DR are longitudinally associated with the persistence or incidence of elevated symptoms of depression/anxiety.

Methods: We analyzed observational data from a sample of 13.182 participants of the Gutenberg Health Study. The outcomes were elevated symptoms of depression/anxiety at the 2.5 years follow-up as determined by the 2-item depression scale (PHQ-2), the 2-item anxiety scale (GAD-2), and the compound measure PHQ-4 respectively. The predictor was the 2-item Cambridge Depersonalization Scale (CDS-2).

Results: 8.7% of the sample were bothered by symptoms of DP/DR at baseline. They had an increased risk for elevated symptoms of depression/anxiety at the 2.5-year follow-up beyond baseline depression/anxiety and other factors. Each point increment in the CDS-2 scale, ranging from 0-6, was associated with a 21% increase of risk for PHQ-4 ≥ 3 at the follow-up (odds ratio 1.21, 95% confidence interval 1.11-1.32).

Limitations: The study was mostly questionnaire-based.

Conclusion: Symptoms of DP/DR are independent risk factors for the persistence or incidence of elevated symptoms of depression/anxiety. Symptoms of DP/DR represent an easily assessable risk factor for the course of mental disorders. Treatment and prevention of mental disorders might benefit from the broader recognition of these phenomena.

Keywords: Anxiety Depersonalization Depression Derealization.

Copyright © 2020 Elsevier B.V. All rights reserved.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.


3 thoughts on &ldquoDepersonalization-derealization Disorder&rdquo

I am really glad this is your topic. So many people don’t understand these mental diseases and conditions and look to them as just being “emotional.” this is obviously not true. By helping people understand these conditions and stating facts, you are helping those affected by the disease. I personally was unaware of the depersonalization-derealization disorder and got a lot out of reading your article. Keep it up!

Before today I hadn’t even heard of this disorder. I think it is very important that we all understand these types of diseases in order to understand and help those that suffer from them. It’s great that I got to learn a little bit more about mental illness from reading your blog.

Not that mental disorders are “cool”, but honestly the details behind this one are pretty neat. I am not saying this would be something someone would want to have, but it is definetly something that makes me think about how fascinating the human brain is. Every species has one, yet all are so different. We don’t have the same brain as a fly obviously, however just because our species has similar brains, does not mean that they are the same at all.
What is also interesting to me are the different ways that people deal with childhood trauma. Two children can go through the same childhood, yet have completely different lives. One could have DDD, and the other could be completely unaffected.


DISSOCIATIVE IDENTITY DISORDER

Dissociative identity disorder (DID) is highly controversial. Some believe that people fake symptoms to avoid the consequences of illegal actions (e.g., “I am not responsible for shoplifting because it was my other personality”). In fact, it has been demonstrated that people are generally skilled at adopting the role of a person with different personalities when they believe it might be advantageous to do so. As an example, Kenneth Bianchi was an infamous serial killer who, along with his cousin, murdered over a dozen females around Los Angeles in the late 1970s. Eventually, he and his cousin were apprehended. At Bianchi’s trial, he pled not guilty by reason of insanity, presenting himself as though he had DID and claiming that a different personality (“Steve Walker”) committed the murders. When these claims were scrutinized, he admitted faking the symptoms and was found guilty (Schwartz, 1981).

A second reason DID is controversial is because rates of the disorder suddenly skyrocketed in the 1980s. More cases of DID were identified during the five years prior to 1986 than in the preceding two centuries (Putnam, Guroff, Silberman, Barban, & Post, 1986). Although this increase may be due to the development of more sophisticated diagnostic techniques, it is also possible that the popularization of DID—helped in part by Sybil, a popular 1970s book (and later film) about a woman with 16 different personalities—may have prompted clinicians to overdiagnose the disorder (Piper & Merskey, 2004). Casting further scrutiny on the existence of multiple personalities or identities is the recent suggestion that the story of Sybil was largely fabricated, and the idea for the book might have been exaggerated (Nathan, 2011).

Despite its controversial nature, DID is clearly a legitimate and serious disorder, and although some people may fake symptoms, others suffer their entire lives with it. People with this disorder tend to report a history of childhood trauma, some cases having been corroborated through medical or legal records (Cardeña & Gleaves, 2006). Research by Ross et al. (1990) suggests that in one study about 95% of people with DID were physically and/or sexually abused as children. Of course, not all reports of childhood abuse can be expected to be valid or accurate. However, there is strong evidence that traumatic experiences can cause people to experience states of dissociation, suggesting that dissociative states—including the adoption of multiple personalities—may serve as a psychologically important coping mechanism for threat and danger (Dalenberg et al., 2012).


Living With

How can I best take care of myself?

If symptoms interfere with your life, talk to your healthcare provider. The right treatment plan often gets rid of the symptoms, and you can get back to your life. Continue with the treatment to resolve the stressors that trigger your symptoms.

What else should I ask my healthcare provider?

If you have depersonalization disorder symptoms, ask your provider:

  • Do I need treatment?
  • Will these symptoms go away on their own?
  • What’s the best type of therapy for me?
  • What techniques can I use to help with the symptoms?
  • Do I need medication?
  • Can depersonalization disorder be cured?

A note from Cleveland Clinic

Depersonalization/derealization disorder may feel jarring. You may feel detached from yourself or your surroundings. If these feelings happen occasionally and for a short time, you may not need treatment. However, if the symptoms cause stress or interfere with your life, talk to your healthcare provider. Therapy can help you deal with the triggers and prevent the symptoms from returning.