Depersonalization/Derealization Disorder

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KEY POINTS

• Depersonalization/derealization disorder is a sense of being detached or disconnected from yourself or your surroundings.
• Seeing a therapist is helpful. Several medicines can help. Your healthcare provider will work with you to select the best medicine.
• Contact a healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

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What is depersonalization/derealization disorder?

Depersonalization/derealization disorder is a sense of being detached or disconnected from yourself or your surroundings.

Depersonalization means that you feel detached from your own mind, body, or actions. You feel like you are watching yourself from the outside. Your thoughts may not feel like your own, or you may feel like a robot.

Derealization means that you feel detached from your surroundings. Things around you may feel dreamlike or distorted. People and places may seem unfamiliar and unreal.

You may have only depersonalization, only derealization, or both.

What is the cause?

The exact cause of this disorder is not known.

• Severe stress may trigger the disorder. For example, after an accident; assault; emotional, physical, or sexual abuse; seeing violence; or having a serious illness or injury.
• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Depersonalization/derealization disorder tends to run in families. It is not known if this is caused by genes passed from parent to child.
• Some drugs, like marijuana and hallucinogens, can also sometimes trigger symptoms.

It often starts between puberty and the mid twenties. You may have symptoms once or twice and then never again, or it may keep happening for many years.

What are the symptoms?

Symptoms of depersonalization may include:

• Feeling like your body and thoughts are part of a dream, and not under your control
• Feeling out of touch with what is happening around you
• Feeling like the past and future don’t exist, or that recent events happened long ago
• Feeling emotionally or physically numb
• Feeling like a robot when you move
• Seeing yourself from a distance, as if you were outside of your body watching a movie of yourself
• Purposely hurting or cutting yourself in order to feel real
• Being aware that your symptoms are only a feeling and not real, which can be very frightening

Symptoms of derealization may include:

• Feeling like sizes and shapes in your surroundings are distorted
• Seeing common and familiar things as strange
• Feeling like things around you are unreal, colorless, or blurry
• Feeling like you’re in a bubble or behind a veil or glass wall
• Hearing sounds as softer or louder than usual

Sometimes people with this disorder also have panic attacks or get depressed.

How is it diagnosed?

Your healthcare provider or a mental health therapist will ask about your symptoms, medical and family history, and any medicines you are taking. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms. You may have tests or scans to help make a diagnosis.

How is it treated?

This disorder may get better without treatment, but it may take a long time.

Therapy

Seeing a therapist is helpful. Cognitive behavior therapy (CBT) is a way to help you identify and change how you see yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn positive ways to think and act. A therapist can help you learn how to:

• Test the reality of your thoughts
• Cope with stress
• Identify early warning signs that symptoms are getting worse

Medicine

Several medicines can help. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine.

Other treatments

Hypnosis may help some people with this disorder. Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

How can I take care of myself?

• Get support. Talk with family and friends. Join a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs because they can make your symptoms worse. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

For more information, contact:

• The National Alliance on Mental Illness (NAMI)
  800-950-NAMI
  http://www.nami.org
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/