Depersonalization/ Derealization Disorder: What It Is, Risks, Symptoms, Causes and Treatment

Published On November 4, 2024 | Last Updated: November 4, 2024

Depersonalization/Derealization Disorder (DDD) is a disorder characterized by persistent feelings of detachment from one’s thoughts, body, or surroundings. DDD is more frequently observed in adolescents and young adults, with prevalence rates ranging from 5% to 20% in outpatient settings and as high as 17.5% to 41.9% among inpatients with specific mental health disorders, according to Jin Y., et al in a study published in the PubMed Central in 2023 titled “The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review”

The main symptoms of DDD include distorted perceptions of time, emotional numbing, and a feeling of being outside oneself. People with DDD experience feelings of unreality (derealization) and detachment from themselves (depersonalization).

The risks of DDD significantly impair the social and occupational functioning of a person. The complications of Depersonalization/Derealization include heightened anxiety, depression, and difficulty with interpersonal relationships.

The exact causes of DDD are not fully understood, but it is linked to extreme stress, trauma, or adverse life experiences, based on a study by Columbia University Irving Medical Center in 2023 titled “Depersonalization: Everything You Need to Know.” Certain personality traits, such as high levels of neuroticism, also increase susceptibility.

To diagnose DDD, the psychologist implements a thorough clinical assessment, including a review of symptoms and medical history, to rule out other mental health conditions. Diagnostic criteria from the DSM-5 are used to confirm the disorder.

Treatment options for DDD include psychotherapy, such as cognitive-behavioral therapy (CBT), and mindfulness techniques, which have shown effectiveness in reducing symptoms. Medications, including antidepressants and anti-anxiety drugs, are prescribed, but their efficacy varies.

Individuals manage DDD by practicing grounding techniques, engaging in regular physical activity, maintaining a healthy lifestyle, and seeking support from mental health professionals and support groups. DDD co-occurs with other mental health conditions, such as anxiety disorders, depression, and post-traumatic stress disorder (PTSD), complicating the diagnosis and treatment process.

What is Depersonalization/ Derealization Disorder?

Depersonalization Disorder is a dissociative disorder characterized by persistent feelings of detachment from one’s thoughts, body, or sense of self (depersonalization) and a sense of unreality or disconnection from one’s surroundings (derealization). Individuals with depersonalization feel as though they are observing themselves from outside their bodies or that their thoughts and emotions are not their own.

Derealization, on the other hand, involves a sense of detachment from one’s surroundings. People experiencing derealization perceive their environment as dreamlike, foggy, or distorted, feeling as though they are in a movie or that the world around them is not real.

The key difference between depersonalization and derealization lies in the focus on detachment; depersonalization is centered on the self, while derealization pertains to the external environment. Both experiences occur simultaneously, leading to the diagnosis of Depersonalization/Derealization Disorder (DDD).

Depersonalization and derealization have been recognized in psychiatric literature for over a century. Initially described in the context of psychosis, these phenomena were later classified as dissociative disorders. The formal recognition of DDD as a distinct disorder occurred in the DSM-III in 1980, and it has since been included in subsequent editions, including the DSM-5.

Depersonalization/Derealization Disorder is relatively common, with lifetime prevalence rates estimated at 1% to 2% in the general population. In the United States, a study published by Wikipedia in 2023 titled “Depersonalization-derealization disorder” suggests that approximately 1.5% of adults experience DDD at some point in their lives. Brief episodes of depersonalization or derealization are even more common, occurring in response to stress or anxiety.

People experience either depersonalization, derealization, or both at the same time, according to an article published by the NHS in 2023 titled “Dissociative Disorders. These sensations occur for just a few moments or fluctuate over an extended period, sometimes lasting for years. When both symptoms are present simultaneously, they lead to the diagnosis of Depersonalization/Derealization Disorder (DDD).

Why is Derealization So Scary?

Derealization is so scary because a lot of people fear losing control over their thoughts and actions, worrying that they might be “going crazy.” Many individuals fear losing control over their thoughts and actions, worrying that they might be “going crazy.” This sense of detachment from their surroundings creates feelings of isolation, making them feel as though they are merely observing their lives from a distance, which is both distressing and alienating.

The altered perception of reality associated with derealization also leads to confusion and uncertainty, leaving individuals struggling to differentiate between what is real and what is not. This uncertainty provokes significant anxiety, particularly the fear that these feelings of unreality might become permanent. Statistics from an article by Shruthi N., published in WebMD in 2024 titled “Derealization Explained” indicate that between 3.3% and 20% of people living with anxiety disorders report experiencing dissociative symptoms, including derealization.

Also, derealization is accompanied by physical sensations, such as dizziness or a sense of floating, which intensifies feelings of fear and panic. Overall, the pervasive sense of unreality inherent in derealization is deeply unsettling, leading to considerable emotional distress and making it difficult for individuals to cope effectively with their daily lives and relationships.

Is Derealization a Dissociative or Mental Disorder?

Yes, derealization is classified as a dissociative disorder under the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). It falls within the broader category of dissociative disorders, which are characterized by a disconnection between thoughts, identity, consciousness, and memory. These disorders include depersonalization/derealization disorder, which involves persistent experiences of feeling detached from oneself or one’s surroundings.

Dissociative amnesia is another related condition, characterized by an inability to recall important personal information, linked to trauma or stress. Further, dissociative identity disorder (DID), formerly known as multiple personality disorder, involves the presence of two or more distinct personality states.

In the case of derealization, individuals experience a profound sense of detachment from their environment, leading to a perception that the world around them is unreal or distorted. While derealization occurs in various contexts when it is persistent and significant enough to warrant a diagnosis, it is classified as part of the depersonalization/derealization disorder category, as highlighted in research by David S. et al. published in PubMed Central titled “Dissociative disorders in DSM-5.”

What’s the Difference Between Dissociation and Derealization?

The difference between dissociation and derealization is that while dissociation involves a lack of connection in thoughts, memory, and sense of identity, derealization specifically relates to feeling disconnected from one’s surroundings. Dissociation is a mental process that causes a lack of connection in a person’s thoughts, memory, and sense of identity. For example, someone might feel as though they are observing themselves from outside their body during a stressful event. Derealization, on the other hand, is a specific dissociative symptom where a person feels disconnected from their surroundings, experiencing the world as dreamlike, foggy, or visually distorted. An example of derealization is someone walking through a familiar neighborhood and feeling as if it is an unfamiliar, surreal landscape.

The table below succinctly outlines the key distinctions between these two concepts, highlighting their definitions, symptoms, and treatment approaches.

Aspect	Dissociation	Derealization
Definition	A disconnection between thoughts, identity, and consciousness.	A specific experience of feeling detached from one’s surroundings.
Focus	Involves detachment from self, memories, or surroundings.	Focuses solely on the perception of the external environment.
Symptom	Includes feelings of unreality, amnesia, or identity confusion.	Specifically involves the sensation that the environment is unreal.
Typical Experiences	Observing oneself from outside the body or having gaps in memory.	Feeling as if one is in a dream or that the world is distorted.
Types	Includes depersonalization, dissociative amnesia, and identity fragmentation.	A subset of dissociation, primarily related to environmental perception.
Cause Triggers	Triggered by trauma, stress, or overwhelming emotions.	Commonly triggered by anxiety, panic attacks, or acute stress.
Duration	Is transient or chronic, depending on the individual and context.	Is brief or persistent, lasting during moments of anxiety.
Treatment	Typically involves psychotherapy, grounding techniques, and medication as needed.	Treatment includes cognitive-behavioral therapy and stress management strategies.

What Are the Symptoms of Depersonalization/ Derealization Disorder?

The symptoms of Depersonalization/Derealization Disorder include emotional numbness or a lack of emotional response, perceiving oneself as robotic, struggling to connect with their identity, feeling that the world is foggy, and experiencing a sense of detachment from familiar places or people.

Depersonalization Symptoms

People with depersonalization feel detached from their bodies and thoughts. Common symptoms include:

Feeling detached from one’s body or thoughts, leading to a sense of disconnection from self.
Experiencing a sense of observing oneself from outside the body, which creates feelings of alienation.
Emotional numbness or a lack of emotional response, making it difficult to engage with feelings or experiences.
Perception of oneself as robotic or lacking real agency. This contributes to feelings of powerlessness.
Difficulty connecting with one’s identity or sense of self, leads to confusion about personal beliefs and values.

Derealization Symptoms

In addition to depersonalization, individuals frequently experience derealization, characterized by a distorted perception of the external world. Symptoms include:

Perceiving the surrounding environment as dreamlike or distorted, makes familiar places feel strange.
Feeling as though the world is foggy, blurry, or artificial, creates a sense of unreality.
Experiencing a sense of detachment from familiar places or people leads to feelings of isolation.
Difficulty processing sensory information (e.g., sounds, visuals), which can exacerbate feelings of confusion.
Believing that time is moving slowly or too quickly, contributes to a disorienting experience of reality.

What Are the 4 Stages of Derealization?

The 4 stages of derealization are onset, acute phase, chronic phase, and resolution. Understanding these stages helps individuals recognize their experiences and seek appropriate support. The four stages of derealization are as follows:

1. Onset: The onset stage marks the beginning of derealization experiences. Individuals suddenly or gradually become aware of feeling disconnected from their surroundings. Common sensations include perceiving the environment as dreamlike or surreal, triggered by stress, trauma, or anxiety. During this phase, individuals typically retain insight into their condition, recognizing that their perceptions are altered but not entirely losing touch with reality.

2. Acute Phase: In the acute phase, derealization symptoms intensify. Individuals find it increasingly challenging to engage with their surroundings, feeling as though they are observing life from a distance. Emotional responses become dull, leading to heightened anxiety and distress. This phase is particularly disorienting, as individuals struggle to connect with their environment and feel overwhelmed by their altered perceptions.

3. Chronic Phase: During the chronic phase, individuals learn to cope with persistent feelings of detachment, but the experience remains a consistent aspect of their daily lives. Chronic derealization impacts various aspects of life, including relationships, work, and overall well-being. Co-occurring mental health conditions, such as depression or anxiety disorders, further complicate the experience during this phase.

4. Resolution or Management: The resolution or management stage involves psychotherapy, lifestyle adjustments, and addressing underlying factors contributing to derealization. However, for some, derealization persists to some degree, requiring ongoing management and support to navigate daily life effectively.

How do Depersonalization/ Derealization Disorder Symptoms Affect Daily Life?

Depersonalization/Derealization Disorder (DDD) symptoms affect daily life by creating feelings of detachment from oneself and the environment. This leads to difficulties in concentrating at work, resulting in decreased productivity and increased errors. Relationships suffer due to emotional disconnection, making it hard to connect with loved ones, which causes misunderstandings and loneliness.

In their work life, people with DDD struggle with concentration and productivity. The feelings of detachment make it hard to engage with tasks fully, leading to errors and decreased performance. For example, a person in a high-pressure job finds it challenging to make quick decisions, which jeopardizes job security and professional relationships.

Daily tasks become overwhelming, as familiar activities trigger feelings of unreality. For instance, going grocery shopping might feel disorienting, making it hard to focus on selecting items or navigating the store. This detachment leads to neglect of self-care routines, as individuals lack the motivation or awareness to maintain hygiene and health, as outlined in a study by Columbia University Irving Medical Center in 2023 titled “Depersonalization: Everything You Need to Know.”.

What are the Duration and Frequency of Symptoms of Depersonalization/Derealization Disorder?

The duration of symptoms of depersonalization and derealization is from brief episodes of a few minutes to several hours, usually triggered by stress, fatigue, or trauma, according to a research paper by Dr. Abbas S. PhD., et al published in Science Direct in 2020 titled “Symptoms of depersonalization/derealisation disorder as measured by brain electrical activity: A systematic review.” In some cases, individuals experience chronic symptoms that persist for months or even years.

Frequency also differs widely; some people have sporadic episodes, while others experience symptoms daily or weekly. This variability is influenced by factors such as personal history, co-occurring mental health conditions, and environmental triggers. Overall, the experience of DPDR ranges from occasional, transient symptoms to more persistent and disruptive ones.

What Are the Risks of Depersonalization/ Derealization Disorder?

The risks of depersonalization and derealization disorder are mental health deterioration, increased anxiety, comorbid conditions, and functional impairment.

The risks of depersonalization/derealization disorder are given below:

Mental Health Deterioration: Individuals with DDD experience significant distress and impairment in daily functioning, which leads to worsening mental health conditions over time, as stated in a report by Dr. Matthias M., et al published in 2016 in BMC Psychiatry titled “A case series of 223 patients with depersonalization-derealization syndrome.”
Increased Anxiety: The feelings of detachment and unreality heighten anxiety levels, as individuals fear losing control or experiencing psychosis.
Comorbid Conditions: DDD is frequently associated with other mental health disorders, including:
- Depression: High rates of comorbidity with depressive disorders have been observed.
- Anxiety Disorders: Many individuals with DDD also suffer from anxiety disorders, which exacerbates their symptoms.
- Post-Traumatic Stress Disorder (PTSD): There is a notable overlap between DDD and PTSD, particularly in individuals with a history of trauma.
Functional Impairment: The disorder leads to severe functional impairment in social, occupational, and other important areas of life, affecting relationships and overall quality of life.

DDD is a serious condition. It leads to chronic symptoms that significantly impact an individual’s quality of life and mental health. The disorder is underdiagnosed, and individuals struggle for years before receiving appropriate treatment, as noted by Dr. Jinyan Y., et al in 2022 titled “The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review.” The persistent nature of the symptoms and their association with other mental health issues underscore the seriousness of DDD.

Can Derealization Lead to Psychosis or Other Disorders?

No, derealization does not directly lead to psychosis, according to information by Shruti N, MD published in WebMD in 2024 titled “Derealization Explained.”

The potential for misdiagnosis is significant due to the overlap between derealization and psychotic symptoms. Individuals experiencing derealization report feelings of unreality and detachment from their environment, which resembles psychotic experiences. This overlap leads to misdiagnosis, especially in individuals under high levels of stress or anxiety.

Derealization is prevalent among individuals with schizophrenia, with rates as high as 66% in this population, as indicated in a study by Rachael J. M., published in Innovations in Clinical Neuroscience in 2023 titled “Depersonalization/Derealization Disorder and Neural Correlates of Trauma-related Pathology: A Critical Review.” This suggests that while derealization itself does not cause schizophrenia, it is present in individuals who have psychotic disorders.

Regarding the relationship between depersonalization and schizophrenia, it is important to clarify that depersonalization itself does not turn into schizophrenia. While depersonalization is a symptom experienced in the early stages of schizophrenia, it is not a direct precursor to the disorder. Depersonalization is primarily a psychological experience characterized by feelings of detachment from oneself, whereas schizophrenia is a complex organic brain disorder involving psychotic symptoms such as hallucinations and delusions.

Depersonalization leads to heightened anxiety and panic attacks, but it does not directly cause hallucinations. Individuals experiencing depersonalization feel intense anxiety about their mental state, which triggers panic attacks. However, hallucinations are typically associated with psychotic disorders like schizophrenia rather than with depersonalization itself.

What Are the Long-Term Effects of Living with DDD?

The long-term effects of living with DDD are persistent feelings of detachment from oneself and reality, which hinders emotional connections and relationships. Individuals with DDD experience chronic anxiety and depression as a result of their symptoms, impacting their overall mental health, based on a research published by Innovations in Clinical Neuroscience in 2014 titled “STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder.”

Many individuals with DDD report feelings of emotional numbness, making it difficult to connect with their own emotions or empathize with others. This detachment hinders personal relationships and social interactions, leading to a diminished sense of self where individuals struggle to maintain a coherent identity. This results in feelings of confusion and disconnection from one’s life experiences. Furthermore, due to the discomfort associated with derealization and depersonalization, individuals avoid social situations, leading to isolation and loneliness. This withdrawal significantly impacts their quality of life, making it challenging to maintain a routine or engage in fulfilling activities.

Living with DDD also influences neuroplasticity in various ways, including cognitive impairments such as problems with concentration, memory, and emotional regulation. These cognitive effects hinder the ability to engage in therapeutic practices and daily tasks. Chronic feelings of detachment similarly affect how the brain processes emotional stimuli, potentially leading to difficulties in recognizing and responding to emotions in oneself and others.

How Does DDD Affect Your Brain and Vision?

Depersonalization and derealization disorders affect your brain and vision by altering how sensory information is processed and perceived. People with DDD experience feelings of detachment from their surroundings, which leads to changes in sensory experiences. The disorder is associated with altered brain activity in areas such as the anterior cingulate cortex and insula, regions involved in self-awareness and emotional regulation. This disruption contributes to the feelings of unreality that characterize DDD, as highlighted by a study by Sisi Z. MD., et al published in BMC Psychiatry in 2024 titled “Unraveling the Brain Dynamics of Depersonalization-Derealization Disorder: A Dynamic Functional Network Connectivity Analysis”

Regarding brain damage, DDD is primarily a dissociative response to stress, trauma, or anxiety, rather than a neurological condition that results in structural changes in the brain. While it impacts cognitive functioning temporarily, it is not linked to permanent brain injury.

When it comes to vision, people with depersonalization experience symptoms like blurred vision or disturbances in visual perception. These symptoms arise due to heightened anxiety or stress, which interferes with visual processing and creates a sense of unreality. While depersonalization itself isn’t a direct cause of blurred vision, the anxiety accompanying it contributes to visual disturbances, making individuals feel as though their surroundings are distorted or unreal, says a report by neuroscientist Fedal S., et al published in 2022 in Science Report titled “Depersonalization disorder as a systematic downregulation of interoceptive signals.”

Does Depersonalization Affect Memory?

Yes, depersonalization affects memory. Individuals with Depersonalization report memory difficulties, including problems with short-term memory and recall. They forget what they are doing or have trouble remembering recent events, according to a report by Dp Manuals titled “Depersonalization + Memory Loss”.

Dissociative symptoms, including depersonalization, lead to difficulties in encoding and retrieving memories. People with depersonalization struggle with recalling specific events or details, which contributes to a fragmented sense of self and reality, as found in a study published in Mental Health.com titled “Top Dissociative Disorder Articles – Amnesia, Depersonalization & More.”

The emotional detachment associated with depersonalization further complicates memory formation. When individuals are unable to fully engage with their experiences emotionally, it hinders their ability to create strong, lasting memories. This results in feelings of confusion or a sense of living in a dream-like state, where past experiences feel distant or unreal.

Does Depersonalization Make You Dizzy or Tired?

Yes, depersonalization makes you feel dizzy or tired. A 2019 study published in Frontiers in Neurology examined 319 adults with chronic dizziness and found that those with visual and vestibular hypersensitivity reported significantly higher scores on the Depersonalization/Derealization Inventory (DDI). This indicates that individuals experiencing feelings of unreality also report heightened dizziness due to sensory sensitivities.

Dizziness arises from the heightened anxiety and stress accompanying depersonalization. When individuals feel detached from their surroundings, they often experience disorientation, contributing to sensations of lightheadedness or vertigo that make it difficult to maintain balance or focus.

Fatigue is another common symptom associated with depersonalization and derealization disorder (DDD). The mental and emotional strain of coping with persistent feelings of unreality can be exhausting. Individuals may constantly battle anxiety or work to ground themselves in reality, leading to physical tiredness. Disruptions in sleep patterns, exacerbated by anxiety and stress, further contribute to overall fatigue.

What Causes Depersonalization/ Derealization Disorder?

The causes of DDD are trauma, chronic stress, anxiety disorders, substance use, mental health conditions, neurobiological factors, and sleep deprivation.

The common causes of DDD are explained below:

Trauma: Experiencing traumatic events, such as abuse, accidents, or the loss of a loved one, triggers episodes of depersonalization or derealization as a coping mechanism.
Chronic Stress: Prolonged exposure to stress or anxiety leads to dissociative symptoms, as the mind detaches to protect itself from overwhelming emotions.
Anxiety Disorders: Conditions like generalized anxiety disorder or panic disorder are associated with DDD, as feelings of intense fear trigger dissociative experiences.
Substance Use: Certain substances, including hallucinogens, marijuana, or alcohol induce feelings of unreality or detachment, leading to symptoms of DDD.
Mental Health Conditions: Other mental health disorders, such as depression or PTSD, increase the likelihood of experiencing depersonalization and derealization symptoms.
Neurobiological Factors: Changes in brain function and structure, particularly in areas related to self-awareness and emotional processing, contribute to DDD.
Sleep Deprivation: Lack of sleep impairs cognitive functioning and increases feelings of disconnection, potentially triggering episodes of depersonalization.

What Are the Triggers and Potential Risk Factors for Depersonalization/ Derealization Disorder?

The triggers and potential risk factors for DDD are trauma, severe stress, major life changes, and chronic illness. Understanding these triggers and risk factors is essential for recognizing the potential onset of DDD and for developing effective coping strategies. The triggers and potential risk factors of DDD are explained below:

Trauma: Experiencing traumatic events, such as physical or emotional abuse, accidents, or witnessing violence leads to profound feelings of detachment as a coping mechanism. The mind dissociates to protect itself from the overwhelming emotional pain associated with these experiences.
Severe Stress: High levels of stress from significant life changes—like divorce, job loss, or financial difficulties overwhelm an individual’s coping mechanisms. This stress triggers episodes of depersonalization or derealization as the mind seeks to escape the intensity of the situation.
Major Life Changes: Significant transitions, such as moving to a new city, starting a new job, or experiencing a major health change serve as triggers. These changes create feelings of uncertainty and instability, leading to episodes of depersonalization.
Chronic Illness: Living with chronic health conditions leads to feelings of physical and emotional disconnection. The persistent nature of illness makes individuals feel detached from their bodies or their sense of self, contributing to symptoms of DDD.

Can Anxiety Cause Depersonalization?

Yes, anxiety can cause depersonalization and exacerbate symptoms of depersonalization disorder. When a person experiences anxiety, their body enters a fight-or-flight mode. This physiological response leads to changes in blood flow, resulting in sensations of unreality or detachment, characteristic of depersonalization, as indicated by research from Karin Gepp, PsyD, published in Healthline in 2023.

Individuals with anxiety disorders exhibit heightened sensitivity to stressors, leading to feelings of unreality as a coping mechanism. Overwhelming anxiety triggers dissociation to protect against emotional distress, resulting in depersonalization or derealization symptoms.

Cognitive distortions also play a significant role. Individuals misinterpret their experiences, perceiving their surroundings as strange or unreal, which exacerbates feelings of derealization. This creates a feedback loop where anxiety leads to depersonalization, increasing anxiety further. Anxiety disorders frequently co-occur with depersonalization and derealization disorder; individuals with depersonalization report higher levels of anxiety compared to those without dissociative symptoms.

Furthermore, alterations in brain function related to anxiety, particularly in areas associated with self-awareness and emotional processing, contribute to the development of depersonalization symptoms. These neurobiological changes disrupt the integration of sensory information, leading to feelings of unreality.

Can Stress, Lack of Sleep, or Fatigue Cause Depersonalization?

Yes, stress, lack of sleep, and fatigue cause depersonalization. These factors play a huge role in triggering symptoms of Depersonalization Disorder by affecting the brain’s ability to process experiences and emotions, as mentioned in a paper by David S, MD, Stanford University School of Medicine published in MSD Manuals in 2023 titled “Depersonalization/Derealization Disorder.”

Stress is a primary trigger for depersonalization. When individuals experience high levels of stress, the body activates its fight-or-flight response, which leads to dissociative symptoms as a coping mechanism. The mind detaches from reality to protect itself from overwhelming emotional pain or anxiety. Research has shown that individuals under severe stress are more likely to experience episodes of depersonalization as a way to manage their emotional state. For instance, a study found that traumatic experiences and significant life stressors are frequently reported by individuals who experience depersonalization.

Lack of sleep and fatigue further contribute to the risk of depersonalization. Sleep deprivation impairs cognitive functioning, emotional regulation, and the brain’s ability to process sensory information effectively. When individuals are sleep-deprived, they feel disoriented or disconnected from their surroundings, leading to symptoms of derealization. Studies suggest that people who consistently experience sleep issues are at a higher risk of developing dissociative symptoms, including depersonalization. The cumulative effect of fatigue exacerbates feelings of unreality, making it challenging to maintain a grounded sense of self.

Can Drugs or Alcohol Trigger Depersonalization?

Yes, drugs and alcohol trigger depersonalization. Certain substances induce feelings of detachment or unreality, leading to or exacerbating existing symptoms of depersonalization.

Commonly linked substances include:

Cannabis (Weed): Many users report experiencing depersonalization after consuming cannabis. While some use it for relaxation, it leads to heightened anxiety and altered perceptions of reality, triggering episodes of derealization. Consuming cannabis makes users feel detached from their thoughts, body, or surroundings, which are hallmark symptoms of depersonalization and derealization, as suggested by a study published by the American Journal of Psychiatry Residents’ Journal in 2018 titled “Cannabis-Induced Depersonalization-Derealization Disorder”
Hallucinogens: Substances like LSD, psilocybin (magic mushrooms), and PCP cause intense alterations in perception and consciousness, resulting in feelings of detachment from reality.
Stimulants: Drugs such as cocaine and amphetamines lead to increased anxiety and paranoia, which provokes dissociative symptoms, including depersonalization.
Alcohol: While alcohol is associated with relaxation, excessive consumption leads to altered states of consciousness and increased feelings of disconnection.

Can Antidepressants or Other Medications Cause Depersonalization?

Yes, antidepressants and other medications cause depersonalization as a side effect, according to a 2021 research published in Risk titled “Side Effects of AntiDepressants”. While these medications are primarily prescribed to alleviate symptoms of depression and anxiety, they sometimes lead to dissociative symptoms, including depersonalization and derealization.

Many medications, particularly those that affect neurotransmitters in the brain, alter perception and emotional processing. For example, selective serotonin reuptake inhibitors (SSRIs), commonly prescribed antidepressants, lead to feelings of detachment or emotional blunting in some individuals. This manifests as depersonalization, where a person feels disconnected from their thoughts or body.

Additionally, other classes of medications, such as benzodiazepines, which are used to treat anxiety and panic disorders, also induce dissociative symptoms. While these medications reduce anxiety in the short term, they lead to a sense of unreality or detachment as a side effect, especially during withdrawal or if taken in high doses.

Can Caffeine or Dehydration Cause Depersonalization?

Yes, caffeine and dehydration contribute to depersonalization. High doses of caffeine can lead to jitteriness and racing thoughts, with a positive correlation between caffeine use disorder and poor sleep quality, as noted in a study by Busra S. et al published in 2024 in BMC Health titled “Exploring the link between physicians’ caffeine use disorders with sleep quality and professional burnout: a cross-sectional study”, involving 240 physicians, where 60% reported poor sleep quality.

Additionally, a case study by neurologist Shigehiro O. et al. in 2016 highlighted that dehydration in a 70-year-old male patient resulted in elevated creatinine levels and cognitive decline, contributing to increased feelings of confusion. The patient reported a distorted sense of time, stating, “days have gone by without me noticing,” which aligns with depersonalization experiences.

Dehydration also heightens anxiety levels, further precipitating feelings of unreality and detachment. Thus, maintaining proper hydration is essential for mitigating the risk of depersonalization, especially in vulnerable populations like the elderly.

Can Trauma Lead to Depersonalization?

Yes, trauma leads to depersonalization. Depersonalization is linked with stress or traumatic experiences such as physical abuse, exposure to domestic violence, or being involved in accidents and natural disasters, based on information published by Cleveland Clinic in 2023 titled “Depersonalization-Derealization Disorder”.

When a person experiences a traumatic event—such as physical or emotional abuse, severe accidents, or natural disasters—the mind employs dissociation as a protective mechanism. This dissociative response manifests as feelings of detachment from oneself or the surrounding environment, which are hallmark symptoms of depersonalization. For many individuals, this dissociation serves to shield them from the intense emotional pain and distress associated with the trauma.

Can ADHD, OCD, or PTSD Cause Depersonalization?

Yes, ADHD, OCD, and PTSD cause depersonalization. These comorbid conditions overlap and trigger symptoms of Depersonalization/Derealization Disorder (DDD) through mechanisms related to anxiety and emotional dysregulation.

ADHD (Attention-Deficit/Hyperactivity Disorder): People with ADHD experience challenges with emotional regulation and heightened sensitivity to stress. The hyperactive and impulsive symptoms of ADHD are linked to a higher incidence of trauma. This increased trauma exposure makes individuals more susceptible to dissociative symptoms, including depersonalization, as noted in a 2022 study conducted by Professor of Psychiatry, Ali K., et al published in Springer Nature titled “Heterogeneity of associations between dissociation and attention deficit symptoms.”
OCD (Obsessive-Compulsive Disorder): People with OCD experience intrusive thoughts and compulsive behaviors, leading to significant anxiety. This heightened anxiety triggers dissociative symptoms, including depersonalization, as a way to cope with overwhelming feelings. The constant mental strain of managing obsessions creates a disconnect from reality.
PTSD (Post-Traumatic Stress Disorder): PTSD is closely linked to depersonalization, as traumatic experiences lead to severe dissociative symptoms. Individuals with PTSD frequently report feelings of detachment from themselves or their surroundings as a protective mechanism against the emotional pain of their trauma. Research shows that a significant number of PTSD sufferers experience depersonalization as a symptom.

These comorbid conditions overlap and trigger Depersonalization/Derealization Disorder (DDD) in several ways. The emotional turmoil and dysregulation associated with ADHD, OCD, and PTSD heighten anxiety levels, a known trigger for depersonalization.

How is Depersonalization/ Derealization Disorder Diagnosed?

To diagnose Depersonalization/Derealization Disorder (DDD), the psychologist conducts a comprehensive assessment, focusing on specific diagnostic criteria and clinical evaluations.

Diagnostic Criteria

According to the DSM-5, the criteria for diagnosing DDD include:

1. Presence of depersonalization or derealization: The individual experiences persistent or recurrent feelings of detachment from their thoughts, body, or surroundings. This manifests as feeling like an outside observer of one’s own life (depersonalization) or experiencing the world as unreal or distorted (derealization).

2. Reality testing: During these experiences, the individual remains aware that their perceptions are not true. They recognize that these feelings are a dissociative symptom and not a loss of touch with reality.

3. Distress or impairment: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. Exclusion of other conditions: The symptoms do not occur exclusively during another mental disorder, such as PTSD, and are not attributable to the physiological effects of a substance (e.g., drug use or withdrawal) or a medical condition.

Clinical Assessments and Tests

The diagnosis process typically involves several clinical assessments such as:

Psychological evaluations: Mental health professionals conduct thorough interviews to assess the individual’s symptoms, history, and impact on daily functioning. This includes exploring the onset, frequency, and duration of depersonalization or derealization experiences.
Standardized questionnaires: Psychologists use standardized tools and questionnaires to evaluate the severity and impact of symptoms, such as the Cambridge Depersonalization Scale or the Dissociative Experiences Scale.
Medical evaluation: A physical examination is conducted to rule out medical conditions or substance use that could contribute to dissociative symptoms. These tests include electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI), and urine and blood tests to check the presence of illicit drug use, according to a paper by David S, MD, Stanford University School of Medicine published in MSD Manuals in 2023 titled “Depersonalization/Derealization Disorder.”
Clinical observations: Psychologists observe the individual’s behavior and emotional responses during the assessment, which provides additional insights into the symptoms and their effects.

When to Seek Help for DDD?

You should seek help for DDD when you notice persistent symptoms, significant distress, increased anxiety, and other signs that indicate that professional support is needed.

The signs that indicate you need help for DDD include:

Persistent symptoms: Having frequent feelings of depersonalization or derealization that have lasted for an extended period is an indication that you should seek professional help.
Significant distress: Experiencing emotional distress or discomfort due to dissociative symptoms that interfere with daily life and functioning warrants attention.
Impaired daily functioning: Once symptoms are affecting your ability to work, maintain relationships, or perform daily tasks, it is time to seek help.
Trauma history: Individuals with a history of trauma benefit from seeking help, especially if dissociative symptoms are triggered or worsened by reminders of the traumatic experience.
Cognitive difficulties: Experiencing problems with memory, concentration, or clarity of thought alongside depersonalization indicates a need for professional evaluation.

How to Treat Depersonalization/ Derealization Disorder?

To effectively treat depersonalization and derealization disorder, it’s important to consider a comprehensive approach that includes therapy, medications, lifestyle changes, and alternative treatments. Treatment for DDD is detailed below:

1. Therapeutic Approaches

Therapeutic approaches for treating Depersonalization-Derealization Disorder (DDD) focus on alleviating symptoms of detachment and unreality, helping individuals reconnect with their thoughts, feelings, and surroundings.

Here are several effective therapeutic approaches for treating Depersonalization-Derealization Disorder (DDD):

Cognitive Behavioral Therapy (CBT): CBT emphasizes changing negative thought patterns associated with depersonalization. A clinical case study of a 25-year-old male showed a 65% reduction in his Cambridge Depersonalization Scale score after three months of CBT combined with mindfulness techniques. This approach effectively addresses cognitive distortions and fosters present-moment awareness, per a case report published by the Indian Journal of Psychological Medicine in 2022 titled: “Mindfulness-Based Cognitive Therapy in Depersonalization-Derealization Disorder: A Case Report.”
Dialectical Behavioral Therapy (DBT): Combines cognitive-behavioral techniques with mindfulness to help manage intense emotions.
Eye Movement Desensitization and Reprocessing (EMDR): This helps individuals process traumatic memories, proving effective for trauma-related symptoms.

2. Medications

While no specific medications are approved for DDD, certain drugs help alleviate symptoms, especially when anxiety or depression is present. Medications enhance the effectiveness of therapy and improve overall functioning:

Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like sertraline (Zoloft) stabilize mood and reduce anxiety.
Mood Stabilizers: Drugs such as lamotrigine help manage mood swings and emotional dysregulation.

3. Lifestyle and Self-Help Strategies

Lifestyle modifications empower individuals and promote overall well-being:

Mindfulness Practices: Help individuals stay grounded and connected to the present moment.
Regular Exercise: Improves mood and reduces anxiety.
Healthy Sleep Hygiene: Establishing a consistent sleep routine enhances mental health.

4. Alternative and Emerging Treatments

Innovative treatments are being explored for managing DDD symptoms. These alternative approaches provide additional relief:

Neurofeedback: Trains individuals to alter brain activity through real-time feedback, with some promising results.
Transcranial Magnetic Stimulation (TMS): A non-invasive procedure that benefits those with dissociative symptoms.

Can Depersonalization/ Derealization Disorder Be Cured?

No, depersonalization and derealization disorder can not be “cured” in the traditional sense, However, effective management strategies significantly alleviate symptoms and improve quality of life.

The emphasis in treating DDD is on management rather than outright cure. Treatment typically involves a combination of psychotherapy, such as Cognitive Behavioral Therapy (CBT) and mindfulness-based approaches, along with medication to address associated symptoms like anxiety and depression, as outlined by a research published by Mayo Clinic in 2024 titled “Depersonalization-derealization disorder.”

How Long Does It Take for Depersonalization to Go Away?

The recovery time for depersonalization ranges from just a few moments and fluctuates over many years, depending on several factors, per a study published by the NHS in 2023 titled “Dissociative Disorders”. Those with mild to moderate symptoms experience improvements within a few weeks of initiating effective treatment, particularly through structured therapies like Cognitive Behavioral Therapy (CBT) and mindfulness techniques.

Conversely, people with severe or chronic depersonalization take much longer to see relief, potentially spanning several months or even years. The presence of co-occurring mental health conditions, such as anxiety or depression, further complicates recovery, making it essential to address these issues concurrently. Also, personal factors, such as resilience, support systems, and engagement in self-help strategies, influence the duration of recovery.

How to Prevent Depersonalization/ Derealization Disorder?

To prevent Depersonalization-Derealization Disorder (DDD), consider managing stress, establishing a routine, limiting substance use, seeking therapy early, practicing grounding techniques, building a support network, and educating yourself.

Here’s how to prevent DDD:

Manage stress: Implement stress-reduction techniques such as mindfulness meditation, yoga, and deep-breathing exercises. These practices help you stay grounded and reduce the likelihood of dissociative episodes triggered by anxiety or stress.
Establish a routine: Create a structured daily routine that includes regular sleep, meals, and activities. Consistency provides a sense of stability and helps mitigate feelings of unreality.
Limit substance use: Avoid excessive alcohol and recreational drug use, as these substances worsen feelings of detachment and increase the risk of developing DDD.
Seek therapy early: If you experience symptoms of anxiety, depression, or trauma, consider seeking therapy sooner rather than later. Early intervention helps address these issues before they escalate into more severe dissociative symptoms.
Practice grounding techniques: Use grounding techniques, such as focusing on your surroundings, describing objects in detail, or engaging in physical activities, to help anchor yourself in the present moment.
Build a support network: Maintain strong relationships with friends and family. Having a supportive social network provides comfort and reduces feelings of isolation, which contribute to depersonalization.
Educate yourself: Learn about DDD and its triggers. Understanding the disorder empowers you to recognize early signs and take proactive steps to prevent episodes.

How to Live with Depersonalization/ Derealization Disorder?

To live with Depersonalization-Derealization Disorder requires acknowledging your feelings, listening to music, reading a book, calling a friend, and challenging your intrusive thoughts based on a review by Mathew B, PhD. published in 2021 in Psych Central titled “10 ways to relieve depersonalization”.

Acknowledge your feelings: Accepting that your experiences of detachment are real helps reduce anxiety. Recognizing your feelings allows you to process them without judgment.
Listen to music: Music evokes emotions and memories, serving as a powerful tool to ground yourself. Creating playlists of your favorite songs helps shift your focus away from feelings of unreality.
Read a book: Immersing yourself in a compelling narrative provides an escape from unsettling feelings of detachment. Reading engages your mind and helps you reconnect with a sense of normalcy.
Call a friend: Reaching out to someone you trust helps combat feelings of isolation. Discussing your experiences with a friend provides emotional support and a sense of connection during challenging times.
Challenge your intrusive thoughts: When negative or intrusive thoughts arise, actively recognizing and reframing them helps diminish their power. Reminding yourself that these thoughts do not define your reality is crucial in managing DDD.

How to Get Out of a Derealization Episode?

To get out of a derealization episode, focus on your senses, practice deep breathing, use a grounding object, recite a mantra, engage in physical activity, and visualize a safe space.

Here’s how to get out of a derealization episode:

Focus on your senses: Identify and describe five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This helps anchor you in the present moment.
Deep breathing: Practice deep breathing exercises by inhaling deeply through your nose, holding for a few seconds, and exhaling slowly through your mouth. This helps calm your nervous system.
Use a grounding object: Hold onto a small, comforting object (like a smooth stone or a piece of fabric) and focus on its texture, temperature, and weight to bring your awareness back to reality.
Engage in physical activity: Stand up and stretch, walk around, or do jumping jacks. Physical movement helps reconnect your body and mind.
Recite a mantra: Use a calming phrase or mantra, such as “I am safe, and this feeling will pass,” to remind yourself that what you’re experiencing is temporary.
Change your environment: Move to a different location or step outside for fresh air, if possible. A change of scenery helps shift your perspective.

Can You Live a Normal Life with Derealization?

Yes, it is possible to lead a fulfilling life with Derealization Disorder. Many individuals with DDD manage their symptoms effectively, allowing them to engage in daily activities and maintain relationships. While derealization disrupts one’s perception of reality, it does not inherently prevent someone from pursuing their goals, enjoying hobbies, or forming meaningful connections.

The key to living a fulfilling life with DDD lies in effective management and support. Engaging in therapy, such as Cognitive Behavioral Therapy (CBT), helps individuals develop coping strategies and reduce symptoms. Additionally, medication can alleviate associated anxiety and depression, enhancing overall quality of life.

Support systems are important in this journey; friends and family who understand the disorder provide emotional support, while participating in support groups fosters a sense of community and connection with others who share similar experiences.

How to Help a Loved One with DDD?

To help a loved one with DDD, it is important to educate yourself, learn to listen actively, be patient, offer reassurance, maintain open communication, respect boundaries, etc.

Educate Yourself: Learn about DDD to better understand what your loved one is experiencing. This knowledge helps you empathize and respond appropriately.
Listen Actively: Provide a safe space for your loved one to express their feelings and experiences. Listen without judgment and validate their emotions, showing that you care.
Encourage Professional Help: Gently suggest seeking therapy or counseling. Professional support provides effective coping strategies and management techniques.
Be Patient: Understand that recovery takes time. Be patient with your loved one as they navigate their feelings, and avoid rushing them to “feel better.”
Offer Reassurance: Remind them that they are safe and that their feelings, while distressing, are a part of their condition. Reassurance helps reduce anxiety during episodes.

By employing these strategies, you provide meaningful support to a loved one with DDD, helping them feel understood and less isolated.

What Disorders Commonly Occur with Depersonalization/Derealization Disorder?

The disorders that commonly occur with DDD are Post-traumatic Stress Disorder, anxiety disorders, Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder (MDD), and Borderline Personality Disorder (BPD), as mentioned earlier. The disorders that occur with DDD are explained below:

Post-Traumatic Stress Disorder (PTSD): PTSD develops after experiencing or witnessing a traumatic event. It manifests through flashbacks, nightmares, and severe anxiety. Individuals with DDD have experienced trauma that triggers both dissociative symptoms and PTSD.
Anxiety Disorders: Anxiety Disorders includes various disorders, such as Generalized Anxiety Disorder (GAD) and Panic Disorder, characterized by excessive fear or worry. Anxiety aggravates feelings of depersonalization and derealization, creating a cycle of distress.
Obsessive-Compulsive Disorder (OCD): OCD involves unwanted and intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions). Individuals with DDD use compulsive behaviors as a coping mechanism to manage their feelings of detachment.
Major Depressive Disorder (MDD): MDD is characterized by persistent feelings of sadness, loss of interest, and fatigue. The emotional distress associated with DDD contributes to depressive symptoms, making it difficult to engage in daily activities.
Borderline Personality Disorder (BPD): BPD is marked by intense emotional instability, fear of abandonment, and difficulties in relationships. Individuals with BPD experience dissociative symptoms, including depersonalization and derealization, as a way to cope with emotional pain.

Is Depersonalization a Disability?

Yes, Depersonalization-Derealization Disorder (DDD) qualifies as a disability under certain circumstances.

In many regions, disabilities are defined by their impact on an individual’s ability to perform daily activities and engage in work. If the symptoms of DDD significantly impair a person’s functioning—such as their ability to maintain employment, engage in social relationships, or manage daily tasks—it is recognized as a disability.

For legal recognition, individuals need to provide documentation from healthcare professionals outlining the severity of their condition and its effects on their lives. Access to accommodations or support is then pursued through disability services or relevant governmental agencies.

What Famous People Have Depersonalization/Derealization Disorder?

Famous people who have depersonalization and derealization disorder include Bowen Yang, Adam Duritz, Dodie, Chester Bennington, Landon Barker, and Vinnie Paz.

Bowen Yang: Bowen Yang, a prominent cast member from “Saturday Night Live,” has openly discussed his struggles with depersonalization. He described experiencing “bad bouts of depersonalization,” which manifest as feelings of detachment from oneself or a sense of observing life as if it were a movie. This condition creates significant emotional distress, making it challenging to engage fully with the world.
Adam Duritz: The lead singer of Counting Crows, Adam Duritz, has candidly articulated his experiences with depersonalization. He described the sensation as feeling like he was “dreaming that things were happening around me,” highlighting the surreal quality of DDD where reality feels distorted. This led to a profound sense of isolation and confusion, affecting his emotional connections and daily life.
Dodie: Musician Dodie has also shared her journey with depersonalization-derealization disorder. By speaking out, she contributes to the dialogue about mental health within the music industry, an area where such discussions are stigmatized. Her openness helps to normalize these experiences and encourages others to seek help.
Chester Bennington: Chester Bennington, the late lead singer of Linkin Park, infused his experiences with numbness and detachment into his music. Lyrics echoing feelings of disconnection resonate deeply with those experiencing DDD. His work reflects the struggle many face when grappling with mental health issues, making his art a source of comfort for fans who share similar experiences.
Landon Barker: Landon Barker, son of drummer Travis Barker, has been vocal about his struggles with derealization. He emphasizes the importance of mental health awareness, particularly for younger audiences. By sharing his story, he highlights the significance of recognizing and addressing mental health challenges, which go unnoticed.

These public figures help in raising awareness about DDD. Their openness ensures the destigmatization of mental health issues, encouraging others who are suffering in silence to seek help.