DPDR Specialist, Symptoms of DPDR, Diagnosis, Medications & Treatment
What is Depersonalization/Derealization Disorder (DPDR)?
Depersonalization/derealization disorder (DPDR), sometimes referred to as depersonalization/derealization syndrome is a mental health condition that 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.
Depersonalization/Derealization Disorder (DPDR) Symptoms
Although DPDR is considered a single diagnosis, it has two distinct aspects that may or may not apply to one person.
Depersonalization refers to feeling detached from yourself as if you’re watching your life take place from the sidelines or viewing yourself on a movie screen. It 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
Derealization is a sense of feeling detached from your environment and the objects and people in it. The world may seem distorted and unreal as if you’re observing it through a veil. You may feel as if a glass wall is separating you from people you care about. This aspect of disassociation can also create distortions in vision and other senses.
- Distance and the size or shape of objects may be distorted.
- You may have a heightened awareness of your surroundings.
- Recent events may seem to have happened in the distant past.
- Surroundings may seem blurry, colorless, two-dimensional, unreal, larger-than-life, or cartoonish.
Episodes of depersonalization/derealization disorder (DPDR) 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.
Unlike 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.
Diagnosis – DPDR Specialist
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, such as 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 Statistic Manual of Mental Health 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
Causes and Risk Factors of the Depersonalization/Derealization Disorder (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. Severe stress, anxiety, and depression are common triggers for DPDR. A lack of sleep or an overstimulating environment can also make symptoms worse.
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
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 Dissociative Disorders
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
Depersonalization/Derealization Disorder (DPDR) Treatment
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 dissociation are successfully dealt with.
Psychotherapy for Depersonalization/Derealization Disorder (DPDR)
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 for Depersonalization/Derealization Disorder (DPDR)
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 for Depersonalization/Derealization Disorder (DPDR)
There is no depersonalization cure, but treatment can reduce distressing symptoms and even lead to full remission of the disorder. It’s important for people experiencing depersonalization or derealization to talk to a professional about their symptoms so they can begin treatment and start feeling like themselves again. Antidepressant and antipsychotic medications may be prescribed to help with symptoms of depersonalization.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Most people with dissociative disorders have co-occurring conditions, and depression is one of the most common. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are frequently prescribed to treat comorbid depression. Popular SSRIs for dissociative disorders include:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
These SSRIs can treat several symptoms specific to depersonalization-derealization disorder (DPDR). The sense of detachment that accompanies depersonalization is often closely linked with flat affect and blunted emotion, all of which can be improved with SSRIs. Antidepressants can also stabilize mood and reduce the intrusive symptoms that trigger dissociative symptoms.
Research shows that a combination of an SSRI and lamotrigine, a mood stabilizer, is an effective treatment for dissociative disorders, especially depersonalization-derealization disorder. SSRIs can also be used to treat anxiety, which is another commonly co-occurring condition with the depersonalization-derealization disorder (DPDR). They are often the best medical option for treating dissociative disorders with comorbid anxiety.
One of the defining features of dissociative disorders like depersonalization is that they are not psychotic disorders. People who experience them maintain an intact sense of reality. However, antipsychotic drugs can be an effective option for treating these disorders.
Antipsychotics can provide several desirable effects for people with depersonalization-derealization disorder (DPDR), including mood stabilization, anxiety reduction, and improved range of affect. They may even target and reduce depersonalization and derealization symptoms.
What to expect from your DPDR Specialist?
Your doctor is likely to ask you several questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What appears to worsen your symptoms?
- Do you have any long-term (chronic) health conditions?
- Do you have any mental health disorders, such as anxiety, depression, or post-traumatic stress disorder (PTSD)?
- What medications or herbal supplements do you take?
- Do you drink alcohol or use recreational drugs?
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 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
If your loved one has DPDR, do your best to remain supportive and encourage them to seek treatment, whether through psychotherapy, medication, self-help, or a combination of these options.
Reclaim Your Life From Depersonalization/derealization disorder (DPDR)
Depersonalization/derealization disorder (DPDR) is a condition that should not be taken lightly. We Level Up Treatment Center can provide you, or someone you love, the tools to treat Personality disorders with professional and safe care. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
 Gentile JP, Snyder M, Marie Gillig P. Stress and trauma: Psychotherapy and pharmacotherapy for depersonalization/derealization disorder. Innov Clin Neurosci. 2014;11(7-8):37-41. PMID:25337444.