People often talk about depersonalisation and derealisation together, but they actually refer to different things. Depersonalisation is when someone feels detached from or outside of their body or mind. In periods of derealisation, a person feels like their inner world, body, or surroundings are unreal, dream-like, or altered in some way.
That said, depersonalisation and derealisation usually happen in similar situations, and people who experience one often experience the other. Depersonalisation and derealisation can happen among young people without a mental health disorder at times of intense stress or physical danger. They may also be brought on by drug or alcohol use, fatigue, and physical exhaustion.
But some young people experience depersonalisation and derealisation more frequently, so that it significantly affects their daily life. That might be because they live with a mental health disorder like anxiety or depression for which depersonalisation and derealisation are secondary symptoms. Other young people may have depersonalisation-derealisation disorder where some or all of their symptoms happen independently of another disorder.
This blog offers some information about depersonalisation and derealisation, its causes, and its treatment. It also explores the diagnosis of depersonalisation and derealisation disorder and how common it is among different groups of people today.
How Do People Describe Depersonalisation and Derealisation?
Depersonalisation and derealisation can be experienced quite differently by one person than another. But they always involve alternations of a person’s experience of themselves or their environment. These experiences are often strange, disturbing, and unpleasant.
Someone experiencing depersonalisation may:
- feel like a robot, different from everyone else, or separate from themselves
- feel half asleep or as if their mind is foggy
- find it hard to concentrate
- lose some or all of their bodily feelings
- experience a reduced intensity of hunger, thirst, and physical pain
- experience a reduction or loss of emotional responses
Someone experiencing derealisation may:
- feel like they are in a dream
- be unsure if they are awake or asleep
- feel like everything is surreal
- see external reality as 2-D, painted, or otherwise altered
- see colours as altered
- feel like everyone else is acting out a play and they are just a spectator
What Causes Experiences of Depersonalisation and Derealisation?
Some experts think that experiences of depersonalisation and derealisation are normal responses to very threatening situations. Most individuals who have been in life-threatening danger report at least some individuals of depersonalization.
When we perceive an overwhelming threat, depersonalisation may be our mind’s way of protecting itself from the intensity of emotions or physical feelings it is experiencing, or expects to experience. This may also explain why depersonalisation happens at times of intense stress, which is another physical and mental response to external or internal threats.
Studies have found that people with PTSD who don’t dissociate when they encounter triggers of traumatic memories experience changes we associate with emotional hyperarousal, such as an increased heart rate, increased activity in the amygdala region of the brain, and decreased activity in the pre-frontal cortex region, a part of the brain involved in decision making, focus, and attention.
Those who dissociate experience the opposite. This suggests that dissociative symptoms may protect against anxiety in threatening situations and help individuals stay focused and use the reasoning part of their brain.
But some young people may start to experience depersonalisation even in situations that aren’t threatening or very stressful. Biological and psychological models suggest that during depersonalisation, normal emotional responses shut down, causing a loss of the emotional ‘tone’ of their experience of their mental processes, body, and surroundings.
These strange, unpleasant, and unfamiliar feelings may cause increased anxiety that can intensify depersonalisation. Depersonalisation may start to be triggered more and more easily until it becomes frequent and pervasive.
Some researchers think that the expectation of depersonalisation could itself become a ‘threat’ to a young person, triggering the onset of the experience.
What Is the Link Between Derealisation, Depersonalisation and Childhood Trauma?
Derealisation and depersonalisation are both types of dissociative symptoms. Research has found that children with a history of neglect, abuse, and stressful life experiences are much more likely to have dissociative symptoms than those who did not. Another study found that over half of women who had experienced domestic violence had dissociative experiences.
Some experts think young people and adults may be unable to fit very stressful experiences into their understanding of themselves, others, and the surrounding world. This may cause them to disassociate from their experience and separate from their consciousness, protecting themselves from painful memories.
How Common Are Depersonalisation and Derealisation Symptoms in Mental Health Disorders?
Depersonalisation and derealisation are relatively common symptoms of some mental health disorders like anxiety disorders, OCD, major depression, borderline personality disorder, and PTSD. When depersonalisation and derealisation happen as a symptom of another disorder, they are known as ‘secondary symptoms’.
This means that the symptoms are fully explained by another mental health disorder: for example, they might happen as part of a panic attack or when someone with PTSD encounters a trigger of a traumatic experience.
What Is Depersonalisation-Derealisation Disorder and How Common Is It?
Someone with a diagnosis of depersonalisation-derealisation disorder (DDD) experiences symptoms of depersonalisation that don’t seem to be explained by another mental health disorder. In the DSM-5, other criteria for a diagnosis include:
- Experiences of detachment or unreality about one’s mental processes, body, or surroundings
- Distinguishing real from unreal experiences
- Experiencing significant distress and impairment in everyday life
Data suggests that about 1-2% of people live with depersonalisation-derealisation disorder. Most people begin developing symptoms during late adolescence or young adulthood, although symptoms can also start much earlier. One study found that 30% of people experienced symptoms before the age of 16.
Young people with the disorder usually experience occasional episodes of depersonalisation at first. These episodes typically become more and more common until they significantly affect a young person’s everyday life. However, it’s still normal for the intensity and frequency of symptoms to vary over time.
Sometimes certain internal or external events can make depersonalisation experiences more intense or more likely. For example, artificial lights, crowds, and psychological stress might trigger or exacerbate symptoms. For many young people, depersonalisation disorder develops after a period of stress or a series of distressing events.
Depersonalisation-derealisation disorder is more common among people with other mental health disorders than among the general population. Studies have found that between 3% and 20% of people with anxiety disorders (including general anxiety disorder and panic disorder) may also live with DDD.
Research also shows that DDD is more common among young people than adults, with about 11% of young people meeting the criteria for the disorder. Some researchers think that this might be linked to the high levels of anxiety that many young people experience during adolescence, as they navigate changes in their bodies and social roles and explore their identities.
How Can Young People Cope With Experiences of Derealisation or Depersonalisation?
When a young person is experiencing derealisation or depersonalisation, some things may help bring them back to reality. Different techniques work for different people and it’s important for each young person to understand what works for them.
Many people find that using their senses or interacting with something concrete and outside themselves can help take them back to the present.
Some helpful techniques might include:
- listening to music
- humming or singing
- feeling their own body, by clapping their hands, stomping, or clenching their fists
- breathing deeply
- touching and feeling something, like soft material or cold water
What Treatments Are Available for Depersonalisation-Derealisation Disorder?
Living with depersonalisation-derealisation disorder can be scary and distressing for young people. The good news is that with the right support, young people can learn to manage and reduce symptoms and live a productive, fulfilling life.
For many people, receiving a diagnosis of DDD can help to reduce stress and anxiety and, in turn, make symptoms more manageable. It’s normal for young people with DDD to feel scared about their experiences and not understand why it is happening.
Learning that DDD is a disorder that many people experience – and that episodes of DDD are not in themselves dangerous – can be a big relief.
While there are currently no evidence-based methods that are proven to treat depersonalisation-derealisation disorder, young people may benefit from both medication and different types of therapy.
Some studies suggest that SSRIs (a type of antidepressant) can help to reduce symptoms, especially in combination with lamotrigine, a type of mood stabiliser.
Young people may also benefit from psychotherapy sessions that address the underlying causes of depersonalisation episodes, reducing the frequency and intensity of their experiences. In particular, cognitive-behavioural therapy (CBT) can help to identify triggers for depersonalisation episodes and identify thought patterns and behaviours that might intensify symptoms.
This might involve overcoming avoidant behaviours (that can sustain or increase anxiety) and challenging negative thought patterns, such as ‘my brain is not working’ or ‘something is wrong with me’. By understanding and changing these behaviours, young people may disrupt negative cycles of increasing anxiety and consequent depersonalisation episodes and begin a journey of recovery.
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