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Depersonalization-Derealization Disorder: Causes, Symptoms, Diagnosis And Treatment

Depersonalization-derealization disorder is a feeling wherein one feels detached from one's thoughts, feelings and the surrounding environment [1] . People having this condition do not lose contact with reality. Instead, they realize that their perceptions are odd or not real. This condition can also occur as a symptom of other disorders.

This condition belongs to a group of conditions known as dissociative disorders [2] . These kinds of disorders refer to mental illnesses that involve disruptions of consciousness and awareness. Depersonalization-derealization disorder can be triggered by excessive stress [1] . Treatment usually consists of psychotherapy. This disorder occurs equally in men and women.

Read on to know more about this condition and how it can be treated.

What Is Depersonalization-Derealization Disorder?

This disorder is a mental health condition that can cause a person to experience a feeling of being outside of their body (depersonalization) or a sense that the happenings around them are not real (derealization) [1] .

The feelings associated with depersonalization and derealization can get very disturbing. You might have a feeling like you are living a dream. This disorder appears to be common in people who have had traumatic experiences in the past. This disorder can get extremely severe at times affecting relationships, work and daily activities.

Causes Of Depersonalization-Derealization Disorder

The exact cause of this disorder is not well understood yet. Some people might be more vulnerable to this disorder due to genetic and environmental factors. Excessive stress and fear can also act as a trigger for episodic symptoms of this disorder [3] . Sometimes, the symptoms can be related to childhood trauma.

Symptoms Of Depersonalization-Derealization Disorder

The feelings accompanying this disorder can be difficult to explain. The symptoms usually begin to show during mid to late teens. This disorder is rare in children and older adults.

The symptoms of depersonalization include the following [4] :

  • Feeling like a robot where you are not in control of your speech and movement
  • Feeling like you are an outside viewer of your thoughts and feelings
  • Emotional or physical numbness
  • A sense of having distorted or enlarged body parts
  • A sense that your memories have no emotion

The symptoms of derealization include the following [5] :

  • Distortions of distance or size/shape of objects
  • A feeling of being alienated from your surrounding
  • Feeling emotionally disconnected from people you care about
  • Distortions in the perception of time
  • Perceiving distorted and blurry surroundings

The episodes of this condition may last hours, weeks or days.

Risk Factors Associated With Depersonalization-Derealization Disorder

Factors that may increase the risk of this condition include the following [6] :

  • Severe trauma: Experiencing a traumatic event can lead to this condition [7] .
  • Depression: Severe depression or anxiety can lead to panic attacks.
  • Personality traits: Facing difficulty in adapting to changes can lead to episodic symptoms of this condition.
  • Severe stress: Stress related to work or personal life can worsen the symptoms of this condition.
  • Recreational drugs: Use of certain drugs can trigger episodes of depersonalization or derealization [8] .

Complications Of Depersonalization-Derealization Disorder

Repeated episodes of this condition can lead to the following [9] :

  • Anxiety or depression
  • A sense of hopelessness
  • Problems in relationships
  • Difficulty focusing on tasks
  • Difficulty remembering things
  • Interference with routine activities

Diagnosis Of Depersonalization-Derealization Disorder

To confirm the presence of this disorder, your doctor would first make sure that there are no other reasons behind these symptoms. Your doctor may perform the following:

  • Physical examination: The symptoms of this condition can be linked to other underlying health issues or the use of alcohol and recreational drugs [10] .
  • Psychiatric evaluation: The symptoms, feelings, thoughts and behavioural patterns are observed to determine the severity of this condition.
  • Lab tests: Tests conducted can help in determining if the symptoms are related to other medical issues.
  • DSM-5: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have set forth certain criteria for the depersonalization-derealization disorder [10] . These criteria are used by the mental health professional for an assessment of the patient.

Treatment For Depersonalization-Derealization Disorder

The primary treatment is psychotherapy. Nevertheless, doctors can sometimes prescribe medications as well.

Psychotherapy: Also known as counselling or talk therapy, psychotherapy tries to gain control over the symptoms. The benefits of psychotherapy are as follows [12] :

  • Understanding why depersonalization and derealization has occurred
  • Learning techniques that can distract one from the symptoms
  • Learning to cope with stressful situations
  • Addressing the emotions related to past trauma
  • Addressing mental health conditions such as depression or anxiety
  • Medications: Although no specific medications have been approved for the treatment of this disorder, medications might be prescribed for treating specific symptoms such as anti-anxiety and anti-depression drugs [13] .

Prevention Of Depersonalization-Derealization Disorder

This condition cannot be prevented. However, it is always beneficial to begin treatment as soon as one begins to show symptoms. Also, quick intervention following a traumatic event can help in the reduction of dissociative disorder development.

View Article References
  1. [1] Somer, E., Amos-Williams, T., & Stein, D. J. (2013). Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD).BMC psychology,1(1), 20.
  2. [2] Saxe, G. N., Van der Kolk, B. A., Berkowitz, R., Chinman, G., Hall, K., Lieberg, G., & Schwartz, J. (1993). Dissociative disorders in psychiatric inpatients.American journal of Psychiatry,150, 1037-1037.
  3. [3] Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wölfling, K., … Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome.BMC psychiatry,16, 203.
  4. [4] Michal, M., Koechel, A., Canterino, M., Adler, J., Reiner, I., Vossel, G., … Gamer, M. (2013). Depersonalization disorder: disconnection of cognitive evaluation from autonomic responses to emotional stimuli.PloS one,8(9), e74331.
  5. [5] Kolev, O. I., Georgieva-Zhostova, S. O., & Berthoz, A. (2014). Anxiety changes depersonalization and derealization symptoms in vestibular patients.Behavioural neurology,2014, 847054.
  6. [6] Medford, N., Sierra, M., Stringaris, A., Giampietro, V., Brammer, M. J., & David, A. S. (2016). Emotional Experience and Awareness of Self: Functional MRI Studies of Depersonalization Disorder.Frontiers in psychology,7, 432.
  7. [7] Gentile, J. P., Snyder, M., & Marie Gillig, P. (). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder.Innovations in clinical neuroscience,11(7-8), 37–41.
  8. [8] Puxty, D. J., Ramaekers, J. G., de la Torre, R., Farré, M., Pizarro, N., Pujadas, M., & Kuypers, K. (2017). MDMA-Induced Dissociative State not Mediated by the 5-HT2AReceptor.Frontiers in pharmacology,8, 455.
  9. [9] Weiner, E., & McKay, D. (2013). A preliminary evaluation of repeated exposure for depersonalization and derealization.Behavior modification,37(2), 226-242.
  10. [10] Michal, M., Sann, U., Niebecker, M., Lazanowski, C., Aurich, S., Kernhof, K., & Overbeck, G. (2004). Assessment of the depersonalization-derealization syndrome using the German version of the Dissociative Experiences Scale.Zeitschrift fur Psychosomatische Medizin und Psychotherapie,50(3), 271-287.
  11. [11] Spiegel, D., Loewenstein, R. J., Lewis‐Fernández, R., Sar, V., Simeon, D., Vermetten, E., ... & Dell, P. F. (2011). Dissociative disorders in DSM‐5.Depression and anxiety,28(9), 824-852.
  12. [12] Gentile, J. P., Snyder, M., & Marie Gillig, P. (). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder.Innovations in clinical neuroscience,11(7-8), 37–41.
  13. [13] Somer, E., Amos-Williams, T., & Stein, D. J. (2013). Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD).BMC psychology,1(1), 20.
Story first published: Monday, June 17, 2019, 17:45 [IST]
Read more about: disorder mental health
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