Derealization: Comprehensive Guide to Understanding, Diagnosing, and Treating the Disorder

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Derealization disorder, often coupled with depersonalization, is a type of dissociative disorder that significantly affects daily life. This condition, which can be triggered by various factors including interpersonal trauma and posttraumatic stress disorder (PTSD), creates a persistent feeling of being detached or disconnected from oneself. Despite its prevalence, derealization remains misunderstood by many. It’s crucial to shed light on this issue not only for those living with the disorder but also for their support networks who play a vital role in managing its impact.

Symptoms and Signs of Depersonalization/Derealization Disorder

Common Symptoms Experienced by Patients

Depersonalization/derealization disorder (DDD) is often characterized by a set of common symptoms. These include feelings of being detached or disconnected from oneself, experiencing the world as unreal or dreamlike, and having an altered perception of time. Some people describe it as feeling like they’re watching themselves in a movie.

For example, a patient might say they feel like they’re observing their own body from an outside perspective. This subjective experience can be both confusing and frightening for those who suffer from DDD.

Physical Manifestations of the Disorder

In addition to these psychological symptoms, DDD can also have physical manifestations. These may include dizziness, lightheadedness, or even physical numbness. It’s not uncommon for individuals with DDD to report feeling ‘floaty’ or ‘ungrounded’.

A case study demonstrated this when a 16-year-old girl reported feeling as if she was “floating above” during her episodes of derealization. She also experienced periods where she felt physically numb and had difficulty recognizing herself in the mirror.

Variance in Symptoms Between Individuals

While there are common themes in the symptoms experienced by those with DDD, it’s important to note that these can vary greatly between individuals. For instance, some may primarily experience depersonalization symptoms such as feeling detached from their own body or thoughts. Others might predominantly experience derealization symptoms like feeling that external reality is unreal.

A survey conducted on 204 patients diagnosed with DDD revealed this diversity in symptom presentation. While all reported some form of dissociative symptoms, no two individuals had exactly the same combination or intensity of symptoms.

Understanding the Neurobiology of Depersonalization/Derealization Disorder

Depersonalization/derealization disorder (DPDR) involves a complex interplay of brain structures and neurochemicals. Recent advancements in neurobiological research have shed new light on this condition.

The Brain’s Role in DPDR

The brain is an intricate network, with each structure playing a specific role. In DPDR, certain areas are more active than others. For instance, hyperactivation of the dorsal anterior cingulate cortex and prefrontal cortex has been observed in people with this disorder.

These regions are involved in self-awareness and emotional regulation. Overactivity here might explain why sufferers feel detached from their own thoughts, emotions, or physical presence – as if they’re watching themselves from an outside perspective.

Studies using functional magnetic resonance imaging (fMRI) have also found reduced activity in other parts of the brain like the insula and amygdala. These areas are key to processing emotions and bodily sensations. This could account for feelings of emotional numbness common among those with DPDR.

Neurochemical Imbalances Linked to DPDR

Just as crucial as brain structures are the chemicals that facilitate communication between nerve cells – neurotransmitters. Research suggests that imbalances in these substances might contribute to DPDR.

Serotonin, a neurotransmitter linked to mood regulation, appears to play a significant role. Some studies suggest that people with this disorder may have lower levels of serotonin compared to those without it.

Another important player is glutamate, which is involved in memory formation and learning processes. Excessive amounts can overstimulate nerve cells causing them to become damaged or die – a potential factor in the development of DPDR symptoms.

Advances in Neurobiological Research

Our understanding of DPDR has significantly evolved thanks to advancements in neuroscience technology like fMRI and positron emission tomography (PET). These tools allow researchers to observe brain activity in real-time, providing invaluable insights into the disorder’s neurobiology.

For instance, a 2015 study using PET scans found that patients with DPDR had decreased blood flow to certain brain regions linked to self-perception. This finding further supports the theory that altered brain activity is a key factor in this disorder.

Causes and Risk Factors of Depersonalization/Derealization Disorder

Depersonalization/Derealization disorder (DPDR) is a complex mental health condition. It’s influenced by genetics, environmental factors, stress, trauma, and other mental health disorders.

Genetic Predisposition and Environmental Triggers

The role of genetics in DPDR isn’t fully understood. However, research suggests that individuals with a family history of DPDR or other dissociative disorders are at higher risk. This implies a genetic predisposition to the disorder.

Environmental triggers also play a part. Exposure to severe stressors or traumatic events can trigger symptoms of DPDR. These could include neglect during childhood or witnessing violence.

For instance, studies have shown that children who experience emotional abuse are more likely to develop DPDR later in life. This confirms the significant impact of environmental factors on this disorder.

Impact of Stress and Trauma on Onset

Stress and trauma are closely linked with the onset of DPDR. High levels of stress can lead to feelings of unreality or detachment from self — key symptoms of this disorder.

In fact, many people first experience these symptoms during times of extreme stress or following traumatic events like accidents or natural disasters.

A case study published in the Journal of Traumatic Stress found that nearly half the participants developed depersonalization after experiencing a traumatic event. This highlights how stress and trauma can directly contribute to the onset of DPDR.

Correlation with Other Mental Health Disorders

DPDR often co-occurs with other mental health disorders such as anxiety and depression. The relationship between these conditions is complex and multidirectional.

Anxiety may exacerbate feelings of unreality while depressive episodes might intensify feelings of detachment from self — both characteristic symptoms of DPDR.

Research shows that up to 50% percent people diagnosed with an anxiety disorder also meet criteria for a dissociative disorder like DPDR. This suggests a strong correlation between these conditions.

Emotional Numbing and Frontolimbic Inhibition in the Disorder

Understanding Emotional Numbing

Emotional numbing is a symptom of derealization. It’s when you feel detached from your emotions. You may find it hard to feel joy, sadness, or even anger. This can make life seem unreal or dreamlike.

For instance, imagine watching a heart-wrenching movie but not feeling any sadness. Or picture yourself at a party where everyone is laughing and having fun, yet you feel nothing. That’s what emotional numbing can be like for people with derealization.

Research shows that emotional numbing can stem from childhood trauma. It’s as if the brain shields itself from painful feelings by turning off emotional responses.

The Role of Frontolimbic Inhibition

Frontolimbic inhibition plays a big role in our emotional response. It involves two parts of the brain: the frontal lobe and limbic system.

The frontal lobe helps us think logically and control our actions. The limbic system handles emotions and memory. When these two work together, we have balanced emotional reactivity.

However, in derealization disorder, this balance might be disrupted due to frontolimbic inhibition. Studies suggest that areas like the anterior insula and amygdala (part of the limbic system) show reduced activity in people with this disorder.

This means their brains might suppress emotional responses leading to feelings of unreality or detachment.

How These Factors Contribute to Derealization

Both emotional numbing and frontolimbic inhibition contribute significantly to derealization experience.

Emotional numbing creates a sense of disconnection from one’s own feelings, making things seem unreal or distant. On top of that, changes in frontolimbic activity could further intensify this feeling by inhibiting normal emotional reactions.

In other words, it’s not just about feeling numb; it’s also about not reacting emotionally the way you used to. This combination can make life seem like a dream or a movie, rather than a real experience.

Diagnosis and Prognosis for Depersonalization/Derealization Disorder

Professional Diagnostic Criteria

Depersonalization/derealization disorder is a complex mental health condition. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a guide to diagnose it. The criteria include persistent or recurrent experiences of depersonalization, derealization, or both. The person must be aware that these experiences are a deviation from their usual self.

For example, they might feel detached or disconnected from themselves, their feelings, thoughts, sensations, body, or actions. They may also perceive their surroundings as unreal, dreamlike or distorted in some way.

Challenges in Diagnosis

Diagnosing depersonalization/derealization disorder can be challenging due to overlap with other conditions. Symptoms often mimic those of other psychiatric disorders such as anxiety disorders, mood disorders like depression and bipolar disorder, certain personality disorders and even psychotic disorders like schizophrenia.

Therefore careful assessment is needed to rule out these conditions before diagnosing depersonalization/derealization disorder. In addition to this complexity, many people with this disorder also have one or more coexisting psychiatric conditions which further complicates the diagnostic process.

Long-term Prognosis

The long-term prognosis for individuals with depersonalization/derealization disorder varies greatly. Some people experience symptoms for only a short period while others may struggle with them for years.

However research shows that treatment can significantly improve quality of life and functionality over time. Cognitive behavioral therapy (CBT), mindfulness techniques and certain medications can all help manage symptoms effectively.

A study published in the Journal of Clinical Psychology found that 50% of people diagnosed with this disorder showed significant improvement after undergoing CBT treatment. This shows that despite the challenges faced during diagnosis there’s hope for recovery and leading a normal life post-diagnosis.

Treatment Options for Depersonalization/Derealization Disorder

Depersonalization/Derealization disorder is a challenging condition. However, it can be managed with proper treatment.

Cognitive-Behavioral Therapy in Focus

Cognitive-behavioral therapy (CBT) is often considered the first line of treatment. It’s a type of psychotherapy that helps patients understand and change thought patterns leading to harmful behaviors or distressing feelings.

In CBT, therapists help patients identify and challenge any dysfunctional beliefs they might have about their symptoms. For instance, people suffering from this disorder may believe they’re going ‘crazy’, which isn’t true. Therapists work to correct such misconceptions.

Studies show that CBT can significantly reduce symptoms of depersonalization/derealization disorder. In one study involving 32 individuals diagnosed with this disorder, participants reported significant improvements in symptoms after 12 weeks of CBT.

The Role of Mindfulness Techniques

Mindfulness techniques are another effective approach to managing depersonalization/derealization disorder. These techniques involve focusing on the present moment without judgment.

Practicing mindfulness encourages acceptance of one’s experiences, even if they are uncomfortable or distressing. This can help reduce anxiety associated with the symptoms and promote a sense of control over one’s mental state.

For example, a simple mindfulness exercise might involve focusing on your breath as you inhale and exhale slowly. You acknowledge any thoughts or feelings that arise without trying to change them.

Research supports the use of mindfulness techniques in treating this disorder. A 2016 study found that mindfulness-based cognitive therapy significantly reduced depersonalization/derealization symptoms among participants.

Medication as a Potential Aid

While there are no medications specifically approved for treating depersonalization/derealization disorder, certain drugs may be beneficial in managing symptoms.

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) can help manage any underlying anxiety or depression. Some antipsychotic medications may be used to alleviate severe symptoms.

However, it’s important to note that medication should not be the sole treatment approach. It’s most effective when combined with psychotherapy like CBT and mindfulness techniques.

Medications and Talk Therapy for Managing Symptoms

Commonly Prescribed Medications

Medications are often recommended for managing derealization symptoms. These include antidepressants, anti-anxiety drugs, and certain types of antipsychotic medications. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) can help by balancing brain chemicals that affect mood and emotions. Anti-anxiety drugs such as benzodiazepines can reduce feelings of anxiety and fear, common triggers of derealization episodes.

However, it’s important to understand that these medicines aren’t a cure-all. They work best when combined with other treatment methods like talk therapy.

Pharmacological Interventions: Pros and Cons

Pharmacological interventions come with both benefits and limitations. On the positive side, they can provide immediate relief from severe symptoms, making daily life more manageable for those struggling with derealization disorder.

On the downside, these medications may have side effects ranging from mild (like drowsiness or nausea) to severe (such as dependency issues). Moreover, they don’t address the root cause of the disorder but rather manage its symptoms.

The Power of Talk Therapy

Talk therapy is a crucial part of treatment for derealization disorder. Cognitive-behavioral therapy (CBT), in particular, has proven effective in managing this condition. CBT helps patients understand their thoughts and feelings better and equips them with strategies to cope with their symptoms.

For instance, grounding techniques taught in CBT can help individuals stay connected to reality during episodes of derealization. Regular sessions also provide an opportunity for patients to discuss their fears or concerns in a safe environment.

Coping Strategies and Support for Individuals Affected

Everyday Techniques to Manage Symptoms

Derealization can be overwhelming. It can make you feel detached from reality, like you’re living in a dream. But there are techniques that can help manage these symptoms in daily life. One such method is grounding. This technique focuses on bringing your attention back to the physical world around you. It could be as simple as focusing on the feeling of your feet touching the ground or the sensation of cold water running over your hands.

Another effective technique is mindfulness meditation. This practice encourages you to stay present and aware of your surroundings, helping to combat feelings of derealization.

Lastly, regular physical activity has been shown to reduce symptoms of severe stress and trauma related disorders like derealization.

The Role of Support Networks in Recovery

Support networks play a critical role in recovery from any mental health condition, including derealization. These networks could include family members, friends, mental health professionals or support groups.

Having someone who understands what you’re going through can provide immense relief. They can offer reassurance during episodes of derealization and remind you that what you’re experiencing isn’t permanent.

It’s also beneficial to connect with others who are experiencing similar challenges through online forums or local support groups. Sharing experiences and coping strategies can provide comfort and practical advice.

The Importance of Self-Care and Lifestyle Adjustments

Self-care is crucial when dealing with derealization. This involves taking care of your physical health by eating a balanced diet, getting regular exercise, ensuring adequate sleep and avoiding substances like alcohol and caffeine which may exacerbate symptoms.

Lifestyle adjustments may also be necessary for managing symptoms effectively. For instance, reducing exposure to stressful situations where possible can help prevent triggering an episode.

Preparing for Your Appointment Concerning the Disorder

Effective Communication with Healthcare Provider

When dealing with derealization, it is crucial to communicate effectively with your healthcare provider. The key is to be clear and concise. For instance, instead of saying “I feel weird”, you could say “It feels like I’m disconnected from my surroundings”. This precise description helps your doctor understand your symptoms better.

To ensure effective communication, prepare ahead of time. Write down all your symptoms and concerns. Also, note any changes in behavior or feelings since your last visit.

Honesty About Symptoms and Concerns

Being honest about your symptoms and concerns is critical when discussing mental disorders like derealization. It’s not uncommon for patients to withhold information due to embarrassment or fear of judgment. However, remember that doctors are professionals trained to handle health information confidentially.

For example, if you’re experiencing disturbing thoughts along with feelings of unreality, don’t hold back this information from your doctor. Being upfront about all aspects of your disorder can lead to a more accurate diagnosis and effective treatment plan.

What to Expect During an Appointment

Understanding what happens during a typical appointment can help alleviate anxiety or confusion. Initially, the doctor will likely ask about your medical history and current symptoms. They may use the DSM (Diagnostic and Statistical Manual) as a reference point during this process.

Next, they might perform some physical examinations or request lab tests to rule out other health conditions that could be causing similar symptoms.

Towards the end of the appointment, expect discussions around possible treatment options which could include therapy sessions or medications.


Depersonalization/derealization disorder can be a debilitating condition, characterized by distressing and persistent feelings of being detached from oneself. The disorder’s neurobiology, rooted in emotional numbing and frontolimbic inhibition, underscores its complexity. However, understanding these underlying mechanisms can aid in the development of effective treatment strategies. Medications and talk therapy have shown promise in managing symptoms, while coping strategies provide additional support to those affected.

Despite the challenges it presents, a diagnosis of depersonalization/derealization disorder is not a life sentence. With appropriate treatment and support, individuals can lead fulfilling lives. It’s crucial to seek professional help if you or someone you know exhibits signs of this disorder. Remember, mental health is as important as physical health; don’t hesitate to reach out for assistance. Your journey towards recovery starts with a single step.

Frequently Asked Questions

What is Depersonalization/Derealization Disorder?

Depersonalization/Derealization Disorder is a type of dissociative disorder that consists of persistent or recurrent episodes of depersonalization, derealization, or both.

What are the symptoms of Depersonalization/Derealization Disorder?

Symptoms include feeling detached or disconnected from oneself, experiencing an unreality in one’s self or surroundings, and emotional numbing.

How is Depersonalization/Derealization Disorder diagnosed?

Diagnosis involves a thorough evaluation including a medical history, physical examination, and sometimes, lab tests. The symptoms should not be attributable to another mental disorder or the physiological effects of a substance.

What causes Depersonalization/Derealization Disorder?

The exact cause is unknown but it may be associated with severe stress, trauma and certain types of personality. There might also be a genetic link.

What treatment options are available for Depersonalization/Derealization Disorder?

Treatment typically involves psychotherapy (talk therapy), cognitive behavioral therapy (CBT), mindfulness techniques, and sometimes medications like antidepressants.

How can I prepare for my appointment concerning this disorder?

Write down your symptoms including when they occur and what triggers them. List all medications you’re taking. Write down questions you want to ask your doctor.

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Dr. Linnea Passaler

Dr. Linnea Passaler

Dr. Linnea Passaler has dedicated 20+ years to serving patients, first to a small number of individuals as a successful surgeon and then to thousands of people worldwide as the CEO of a digital health startup. After overcoming her own struggles with a dysregulated nervous system, she created Heal Your Nervous System (HYNS) to empower others in their healing journey. Her combination of neuroscience and somatic work helps those struggling with overwhelm, trauma, burnout, and anxiety to heal their dysregulated nervous systems and thrive.