What to Know About DPDR (Depersonalization/Derealization Disorder)

Depersonalization/derealization disorder (DPDR), sometimes referred to as depersonalization/derealization syndrome, is a mental health condition that involves feeling distant or detached from yourself, mentally or physically, and/or having a reduced sense of reality.

DPDR can cause you to experience a persistent or recurring feeling of being outside of your body (depersonalization), a sense that what's happening around you isn't real (derealization), or both.

Unlike with other psychotic disorders, people with DPDR know that their experiences of detachment aren't real. This can leave them feeling concerned about their mental health.

What Is Derealization vs. Depersonalization?

Although DPDR is considered a single diagnosis, it has two distinct aspects that may or may not apply to one person. Therefore, DPDR symptoms can vary depending on whether depersonalization or derealization are experienced.

Derealization Symptoms

Derealization is a sense of feeling detached from your environment and the objects and people in it.

DPDR symptoms of derealization can include:

• Distortion of the distance and the size or shape of objects
• A heightened awareness of your surroundings
• Feeling as if recent events happened in the distant past
• Surroundings that seem blurry, colorless, two-dimensional, unreal, larger-than-life, or cartoonish

Episodes of depersonalization/derealization disorder can last for hours, days, weeks, or even months. For some, such episodes become chronic, evolving into ongoing feelings of depersonalization or derealization that can periodically get better or worse.

Depersonalization Symptoms

Depersonalization refers to feeling detached from yourself. It may feel as if you're watching your life take place from the sidelines or like you are viewing yourself on a movie screen.

DPDR symptoms of depersonalization can include:

• Alexithymia, or an inability to recognize or describe emotions
• Feeling physically numb to sensations
• Feeling robotic or unable to control speech or movement
• Feeling unconnected to your body, mind, feelings, or sensations
• Inability to attach emotions to memories or to "own" your memories as experiences that happened to you
• The sense that your body and limbs are distorted (swollen or shrunken)
• The sense that your head is wrapped in cotton

Diagnosis of DPDR

According to the National Alliance on Mental Illness (NAMI), roughly three in four adults have had a dissociative episode in their lives, but only around 2% meet the criteria for DPDR.

To diagnose DPDR, a doctor first makes sure there aren't other reasons for symptoms. DPDR symptoms can appear with drug use, a seizure disorder, or other mental health problems like depression, anxiety, post-traumatic stress disorder (PTSD), or borderline personality disorder.

Sometimes, imaging and other tests are done to rule out physical issues. Psychological tests, special structured interviews, and questionnaires can also help to diagnose DPDR. 

Once other potential causes are ruled out, a clinician considers DPDR criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including:

• Persistent or recurrent episodes of depersonalization, derealization, or both
• An understanding by the person that what they're feeling isn't real
• Significant distress or impairment of social or occupational functioning caused by symptoms

Main Causes of DPDR

Often, people with DPDR have experienced past trauma in their lives, including:

• Emotional or physical abuse or neglect in childhood
• Having a loved one die unexpectedly
• Witnessing domestic violence

Severe stress, anxiety, and depression are common triggers for DPDR. A lack of sleep or an overstimulating environment can also make DPDR symptoms worse.

Risk Factors of DPDR

Some people are more vulnerable to psychiatric disorders than others. For instance, women are more likely than men to experience depersonalization/derealization or some other type of dissociative occurrence.

Other risk factors for DPDR include: 

• A history of recreational drug use, which can trigger episodes of depersonalization or derealization
• An innate tendency to avoid or deny difficult situations; trouble adapting to difficult situations
• Depression or anxiety, especially severe or prolonged depression or anxiety with panic attacks
• Experiencing or witnessing a traumatic event or abuse as a child or adult 
• Severe stress in any area of life, from relationships to finances to work

Types of DPDR

DPDR is one of four types of dissociative disorders. These disorders are diagnosable conditions in which there's a fragmented sense of identity, memories, and/or consciousness. If left untreated, dissociative disorders can lead to depression and anxiety and are believed to be linked to a history of trauma.

According to the DSM-5, other dissociative conditions include:

• Dissociative amnesia: A condition that involves the inability to remember important information about your life
• Dissociative fugue: A form of reversible amnesia that involves personality, memories, and personal identity
• Dissociative identity disorder (DID): A condition marked by the presence of two or more distinct personalities within one individual

Treatment of DPDR

For some, recovery takes place organically, without formal treatment. Others require targeted, personalized treatments to completely recover from DPDR. Chances of this recovery are best when the underlying stressors that contributed to and triggered the depersonalization and derealization are successfully dealt with.

Psychotherapy

The most effective way to deal with DPDR is with psychotherapy. Cognitive behavioral therapy (CBT), for instance, teaches strategies for blocking obsessive thinking about feeling things that aren't real. CBT also teaches distraction techniques, including:

• Grounding techniques that call on the senses to help you feel more in touch with reality—playing loud music to engage hearing, for instance, or holding an ice cube to feel connected to the sensation
• Psychodynamic techniques that focus on working through conflicts and negative feelings that people tend to detach from, and moment-to-moment tracking (focusing on what's happening at the moment) along with labeling of dissociation and effect

EMDR

While eye movement desensitization and reprocessing (EDMR) therapy was originally designed to treat PTSD, it is often used to treat a variety of mental health conditions, including DPDR.

Medications

There are no medications approved specifically for treating depersonalization/derealization disorder. However, your healthcare professional may prescribe anti-anxiety drugs and antidepressants to help ease or relieve DPDR symptoms.

Coping With DPDR

In addition to psychotherapy, there are a few strategies that can help keep you grounded and/or bring you back to reality when you’re experiencing symptoms of DPDR.

• Pinch the skin on the back of your hand.
• Use temperature to shift your focus; place something that's really cold or really warm (but not too hot) in your hand.
• Look around the room and count or name the items you see.
• Keep your eyes moving to stop yourself from zoning out.
• Slow your breathing—or take long, deep breaths—and pay attention as you inhale and exhale.
• Practice meditation to develop greater awareness of your internal state.
• Reach out to a friend or loved one and ask them to keep talking to you.

Supporting a Loved One With DPDR

If your loved one has DPDR, do your best to remain supportive. Additionally, encourage them to seek treatment, whether through psychotherapy, medication, self-help, or a combination of these options.

A diagnosis of depersonalization/derealization disorder can be upsetting and confusing. However, once you understand that the symptoms you're experiencing have a recognizable and reasonable cause, you may begin to feel less worried and anxious. It's also important to remind yourself that psychotherapy and perhaps medication can help treat DPDR.