Written by Sara Lai, Edited by Emily Begnel, MPH, Edited by Courtney Coleman
Depersonalization/derealization disorder (DPDR) is characterized as a dissociative disorder by the American Psychiatric Association. With a prevalence of 1%-3% worldwide, DPDR may be as common, or even more common, than schizophrenia and bipolar disorder, yet, it is still not a well-known nor well-studied condition. DPDR shares symptoms with other dissociative disorders, including discontinuity in consciousness and memory, and disruptions in perception, identity, and motor control. A hallmark symptom is the feeling of detachment from one’s body (depersonalization) and the world appearing unreal (derealization)1.
Common symptoms of DPDR include decreased emotional response, detachment from senses, feeling as though events are unfolding through a screen, objects appearing the wrong size or color, time feeling altered, and sound appearing louder or softer than usual. Symptoms can be described as one being “too” sane by some and “unalive” by others, and can appear gradually or suddenly. Individuals are hyper-aware of both their outer experiences and sensation and their inner thoughts3, 4. Two-thirds of people diagnosed with DPDR experience symptoms on a chronic basis. Symptoms can last from minutes to days, and even to years in extreme, chronic cases7.
Interestingly, around 50% of adults experience transient episodes of DPDR symptoms in their lifetime, but this does not meet the criteria for diagnosis. To be diagnosed, symptoms must persist for at least 1 month, must be severe enough to cause distress and/or impair function, and must not occur simultaneously with another mental disorder, medical condition, or substance use. Individuals must be aware their experiences do not mirror reality. To be diagnosed more systematically, the Cambridge Depersonalization Scale—a 29-item questionnaire—is used to measure the frequency and duration of symptoms6. However, as a largely unnoticed condition, DPDR takes an average of 7-12 years to diagnose. Studies have shown there is equal occurrence between men and women, and it is most prevalent in adolescence. Around 5% of those with this condition are diagnosed after 25 years old, and diagnosis is rare after 40. DPDR is not a lifelong condition, although it can last for years if left untreated2.
DPDR may be caused by severe trauma and emotional abuse, especially emotional neglect during childhood, and prolonged anxiety and depression5. In rarer cases, it may be caused by head trauma and brain injury. Episodes are usually triggered by substance use, extreme stress, and panic attacks. Some researchers believe DPDR is a behavioral or survival response to psychological trauma. Studies have proven the disorder to be largely anxiety-based and in as many as 30% of cases, often a precursor to PTSD. Others believe DPDR to be an early sign of psychosis1. Studies have also shown a lack of interconnectedness between the mind and body caused by abnormalities in the sensory cortex and cortical areas.
This disorder is usually treated with different forms of therapy: psychotherapy, cognitive behavioral therapy, exposure therapy, somatic therapy, and dance movement therapy (DMT). Extensive research has been conducted showing DMT, a form of psychotherapy, has the ability to reduce DPDR symptoms as it increases interconnectedness between the mind and body5. DPDR has a poor response to pharmacotherapy, making medication (antidepressants/mood stabilizers) only a tentative treatment3.
In summary, DPDR is a prevalent, yet often overlooked, condition characterized by dissociative symptoms from oneself and the world. Despite its significant impact on individuals' daily lives, DPDR often goes undiagnosed for years, highlighting the need for greater awareness and understanding of this disorder.
References:
(1) Depersonalization Disorder/Derealization Disorder. Scottlilienfeld. (n.d.). https://scottlilienfeld.com/wp-content/uploads/2021/01/lynn2015-2.pdf
(2) The prevalence of depersonalization-derealization disorder. (n.d.). https://discovery.ucl.ac.uk/id/eprint/10150602/1/David_The%20Prevalence%20of%20Depersonalization-Derealization%20Disorder_AOP.pdf
(3) Depersonalization: Everything you need to know. Columbia University Irving Medical Center. (2023, July 10). https://www.cuimc.columbia.edu/news/depersonalization-everything-you-need-know
(4) Sussex Publishers. (n.d.). Depersonalization / Derealization disorder. Psychology Today. https://www.psychologytoday.com/us/conditions/depersonalizationderealization-disorder
(5) Author links open overlay panelL.S. Merritt Millman a c, a, c, b, Highlights•Depersonalization-derealization disorder (DDD) involves feelings of disembodiment.•Reduced mindfulness and interoceptive awareness in DDD compared to healthy controls.•Dance/movement tasks reduce dissociative symptoms in DDD.•Lower levels of sy, & AbstractBackgroundDepersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body. (2023, March 30). Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder. Complementary Therapies in Clinical Practice. https://www.sciencedirect.com/science/article/pii/S1744388123000300
(6) GE;, S. M. (n.d.). The Cambridge Depersonalization Scale: A new instrument for the measurement of Depersonalization. Psychiatry research. https://pubmed.ncbi.nlm.nih.gov/10725532/
(7) Cleveland Clinic. (2024, March 19). 5 ways to cope with depersonalization. https://health.clevelandclinic.org/how-to-cope-with-depersonalization
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on December 24, 2024.
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