Depersonalization/Derealization Disorder

Depersonalization/Derealization (DPDR) Disorder is a Dissociative Disorder clinically recognized within the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Those affected often feel empty or numb and have difficulty expressing full ranges of emotions. The symptoms of DPDR are the 3rd most common psychological symptom of mental conditions next to depression and anxiety. It has been acknowledged since the late 1800’s, but is still largely unrecognized within society and the medical community. The average length of time it takes to receive a diagnosis is 10 years and there are no documented cures or treatments.

The Freeze Response

DPDR is the freeze response within the fight, flight, or freeze responses and sufferers often experience a reduction in their emotions and ability to express themselves. It is a coping mechanism used when your body is in a stressful state; like pulling the rip cord on a parachute when your brain is overexerted. It decreases certain brain functions that are not essential to survival to get you through the situation and often, it does not relinquish, even after the stressful event has passed. It is frequently misdiagnosed as anxiety or depression and people that struggle with the disorder will often be impacted for years without any diagnosis or idea of what is causing their symptoms.

Disruption In Cognitive Function

Many feel empty or numb, like you are on autopilot, or watching yourself from inside your head. It may cause those affected to question reality and individuals may feel as if they are dreaming or as if the outside world is unreal or distorted. Cognitive function is impaired and memories of yourself feel distant. You may not feel like yourself or like you are not fully in control of your actions and individuals may have a more deadpan or monotone voice. It is often characterized by rational, straightforward thought processes and an absence of emotional, subjective thought processes. Those affected will often forget what it is like to be clear headed and to be able to focus on other things; to be in the moment and enjoy the things they are doing.

Arrested Development

It can lead to arrested psychological and emotional development, and the symptoms that present may depend on the age and developmental period of when a trauma took place.  Many of those impacted feel guarded and colloquially, it is often called The Lonely Disorder. As time goes on, impacted emotional brain regions may lead to social withdrawal and emotional blunting. Individuals may have difficulty maintaining important friendships and relationships with significant others to the same degree that they used to and feel more content being alone.  They may have more difficulty being emotionally supportive and forming deeper levels of intimacy, as well as display more aggressive behaviors as it progresses.

As a result, one of the dangers of Depersonalization is that individuals may engage in more uncharacteristic, emotionally reckless, and/or destructive behaviors as time goes on, such as an increased number of sexual partners, heavier drinking, and substance abuse. These uncharacteristic behaviors are often a result of over-rationalization and the individuals may not view them as detrimental due to changes in identity as a result of the disorder. These changes in behavior are very often uniform across those affected. Even when affected individuals recognize something as wrong, whether it be changes in personality, patience, or otherwise, they may still be unable or less able to change their behaviors due to the disruptions in their affected brain regions.

Physical Health Problems

It is a common experience and can lead to Chronic Fatigue or Burnout. Depersonalization and Chronic Fatigue are separate disorders, but DPDR shares many symptoms of Chronic Fatigue as the disorder progresses. In addition to fatigue, individuals may experience changes in heart rate, blood pressure, perspiration, sexual activity/arousal, parenting behavior, and sleep.  It has been found to be induced through traumatic experiences, moments of high anxiety/stress, and recreational drug use.

Psychological Detachment

Some may feel that the disconnected feelings brought on by the disorder are symptoms of psychosis, but DPDR is not psychosis. It is indicative of being detached from your surroundings. Individuals may describe their mental state as foggy, fuzzy, or a blur, but they do not lose contact with reality. They are acutely aware of their surroundings and know that what they are experiencing is abnormal, while someone experiencing psychosis will not typically be aware that what they are experiencing is abnormal.

According to the DSM-V, DPDR does not occur exclusively during the course of another mental disorder, such as depression, schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder, and is not due to the direct physiological effects of a substance (e.g. a drug of abuse or medication) or a general medical condition (e.g. temporal lobe epilepsy).

Diagnosis And Treatment

There are no documented cures or treatments, but therapy and certain medicines may help some. However, because most patients never receive a diagnosis, therapy is usually not effective for the disorder itself.  Therapy will generally not help it resolve and the patient’s changes in identity will continue to progress as time goes on. Without an understanding of their symptoms, individuals may view these changes in behavior and identity as more acceptable than they had previously as the disruptions in their affected brain regions progress. Medicines will often exacerbate symptoms and result in further dulling of emotions and ineffective prescriptions are often prescribed due to the constant misdiagnosis of this disorder.

Individuals who are able to recover, depending on the length of time affected and the severity of changes in personality, may have an outpouring of emotions as recovery engages brain regions important for emotional processing. Diagnosing and treating DPDR in a timely manner is of great importance, as individuals will have to emotionally process any events that took place before or during their dissociative experience, including any uncharacteristic changes in behavior. Time is of the essence, as the longer an individual is affected, the more significant changes in personality may become and the more difficult recovery may be.

What Causes DPDR?

Further research is needed as the exact cause of DPDR Disorder is not well understood. Current research has pointed towards up to 2% of the population experiencing DPDR as a chronic disorder and that the cause is typically trauma related. As our knowledge of mental health grows, we are finding that number may be higher and the Dissociation is not always trauma related. Our current understanding of DPDR suggests that it is usually related to moments of high stress or anxiety and the following may be risk factors for development of the disorder.

  • Avoidant personality traits. Avoiding or denying difficult situations or an inability to adapt to difficult situations
  • Severe trauma, during childhood or adulthood, such as experiencing or witnessing a traumatic event or abuse
  • Severe stress, such as a major relationship, financial, or work-related issues
  • Depression or anxiety, especially severe or prolonged depression, or anxiety with panic attacks
  • Using recreational drugs, which can cause high levels of stress, anxiety, paranoia, etc.