Depersonalization-Derealization Disorder: Symptoms, Causes And Treatments

DDD is a type of dissociative disorder, or a condition that involves feeling unreal or disconnected from yourself, explains Shara Sand, Psy.D, director of Counseling Services at Manhattan School of Music and in private practice in New York. “It’s almost like you are above looking down on yourself as if you’re an actor in a play.” DDD can involve one or both of these feelings:

• Depersonalization: Feeling disassociated from yourself
• Derealization: Feeling disconnected from reality

While these feelings are distinct, depersonalization and derealization coexist in about 80% of patients, which is why they’re classified as one disorder, explains Elaine Hunter, Ph.D., a consultant clinical psychologist at The Depersonalisation Clinic and co-author of Overcoming Depersonalization and Feelings of Unreality.

Depersonalization and derealization are psychological states that come and go, says Dr. Sand. Any form of distress severe enough could trigger a DDD episode.

This may be because dissociation is one way of coping with feeling overwhelmed, adds Dr. Hunter. “It seems to be an innate psychological mechanism, which can be triggered at a certain point. Anyone could experience it given the right circumstances because it’s something we’re all able to do.” The issue is when dissociation becomes chronic enough to constitute a disorder.

According to a 2021 article in the Journal of Trauma and Dissociation that reviewed the prevalence of DDD among different populations, “the prevalence rate of DDD is around 1% in the general population^[1]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. .”

To warrant a diagnosis, Dr. Sand looks for people who don’t seem present in reality and experience this sensation often. For her, a diagnosis is typically made “when it happens frequently and interferes with a person’s ability to function.”

Here are four common causes or risk factors for DDD both experts have noticed over many combined years of study:

Trauma

“Most victims of child [abuse] or sexual abuse will report going somewhere else in their minds—like, ‘I am not here, this is not happening,’” says Dr. Sand, who adds that she’s mostly seen DDD in people suffering from trauma. DDD can also develop in adults who experience traumatic events, such as health emergencies.

According to the Journal of Trauma and Dissociation paper, the highest rates were found in people who experienced interpersonal abuse^[2]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. . “DDD is more prevalent amongst adolescents and young adults as well as in patients with mental disorders,” the researchers write, adding that “there is also a possible relationship between interpersonal abuse and DDD.”

Depression

“When people are severely depressed, they disconnect from themselves because it feels too hard to be an embodied self,” says Dr. Sand. In other words, when life seems painful, there can be an urge to escape from reality. The prevalence of DDD in those with depression was 50%, notes the Journal of Trauma and Dissociation^[3]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. .

History of Anxiety

“Lots of people experience depersonalization and derealization when they have panic attacks,” says Dr. Hunter, adding that the diagnostic criteria for a panic attack includes both depersonalization and derealization. “Some people having a panic attack might worry about having a heart attack. But others experience a sense that things are not real.” Social anxiety can accompany DDD. Per the Journal of Trauma and Dissociation research, DDD was found in between 3% and 20% of people with anxiety^[4]Sirvent C. Depersonalization Disorder in Former Addicts (Prevalence of Depersonalization-Derealization Disorder in Former Addicts). J Addict Res Ther. 6:225. doi:10.4172/2155-6105.1000225. .

Recreational Drug Use (with Panic Attacks)

On its own, recreational drug use can trigger or prolong symptoms of DDD. According to a research article in the Journal of Addiction Research and Therapy, “nearly 25% of drug-free addicts (former addicts) suffer or have suffered from severe depersonalization disorder^[5]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. .”

DDD prevalence rates for people with substance abuse stood between 2% and 6%, the journal’s findings shoe^[6]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. . When people react negatively to drugs and have a panic attack, they sometimes experience depersonalization, adds Dr. Hunter.

Other Mental Health Conditions

Symptoms of DDD may overlap with the symptoms of other mental health disorders. The Journal of Addiction Research and Therapy article marked the prevalence of DDD between 4% and 20% in individuals with other dissociative disorders such as dissociative amnesia, dissociative fugue and dissociative identity disorder, 16% in people with schizophrenia and 17% for those with borderline personality disorder (BPD)^[7]Jinyan, Y., Merritt Millman, L.S., David A. et. al. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. Journal of Trauma and Dissociation. 2021. doi.org/10.1080/15299732.2022.2079796. .

“Two main features or symptoms characterize DDD: A sense that things are not real and/or disconnection,” explains Dr. Hunter. “These can be about yourself or your body (depersonalization) or about the world around you (derealization).” You can also experience the following:

• Feeling like an outside observer with respect to their thoughts, feelings, sensations, body or actions (depersonalization)
• Experiences of detachment with respect to their surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless or visually distorted)
• Emotional and physical numbness
• Problems with cognitive processes including memory, focus/attention and thinking logically
• Visual distortions, such as objects appearing fat, two-dimensional, or larger or smaller than they are

“DDD can be serious if it occurs very frequently and is really disruptive to a person’s actual, lived reality,” says Dr. Sand. For example, disassociating on a minor level could mean missing your highway exit; however, it could be a serious problem if you crash your car, she explains. “The intensity of the disorder is what makes it problematic. DDD can be paralyzing—when it’s interfering with life, it’s time to seek help.”

DDD is a medical diagnosis, as it’s included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), says Dr. Sand. “In order for a patient to be diagnosed with DDD, they need to have had key symptoms over a period of time,” adds Dr. Hunter. “Their symptoms should be associated with distress and functional impairment and can’t be explained by other causes, like being under the influence of drugs or having another condition.”

DDD is treatable, explains Dr. Hunter. “Lots of people will have it as a temporary problem and then recover spontaneously. The key thing is understanding that it’s … your brain’s clever way of trying to protect you. Being anxious about the symptoms can perpetuate DDD.”

To help people combat DDD in the long term, Dr. Hunter recommends talk therapy, cognitive behavioral therapy (CBT) and mindfulness, which can teach individuals how to increase their awareness of the present moment and help prevent future DDD episodes. When it comes to prescription medication, “there’s no actual medication for DDD,” she says, “but medication for depression can be helpful and most also work with anxiety.”

Always reach out to your doctor for guidance, who can help identify the right treatment plan for you. Doctors that can help with treatment include therapists or psychologists and psychiatrists.

If you think you might be experiencing DDD symptoms, there are ways to snap back to the moment, experts say:

• Fight the fear of the symptoms: A DDD episode will come and go if you work to ease your anxiety around the symptoms, says Dr. Hunter. Try relaxing your body and mind.
• Be mindful: Mindfulness is “almost the opposite of detachment,” says Dr. Hunter. “It’s all about being in the present moment.” Ground yourself in the here and now by focusing on your breath and observing your surroundings.
• Find someone to talk to: If you’re at a party, for example, seek out someone who will make you feel more aware of the situation and present in your body, suggests Dr. Sand.

It’s often impossible to tell if someone is experiencing a DDD episode, says Dr. Sand, but a key tell is their level of engagement in the present moment. If you think someone you know is experiencing DDD, “support them to engage with the world around them,” says Dr. Hunter. Ask them questions to help pull them back into reality, suggests Dr. Sand. “You could say something like, ‘Wow, you look like you were far away. Where were you?’”