What is Depersonalization Disorder?

Depersonalization disorder is a type of dissociative disorder where an individual temporarily loses a sense of self, both physically and mentally. They feel separate from their reality. This temporary loss of self is sudden and drastic, leaving the individual feeling unreal or robotic. Many sufferers report feeling like they are living in a dream or movie during a depersonalization episode.

Nearly 50% of people experience a mild form of depersonalization at least one time in their life, typically due to severe stress or sleep deprivation, when the episodes become persistent and recurrent is when a diagnosis is often given.

On average the onset of depersonalization disorder is seen around 23 years of age and nearly 80% of cases the disorder is fairly chronic, meaning that there is little to no change in intensity.

Depersonalization is one of the more common types of dissociative disorders. Approximately 2% of the population suffers from depersonalization disorder; depersonalization symptoms are often found within other disorders, such as: post-traumatic stress disorder, borderline personality disorder, panic disorder, schizophrenia, and acute stress disorder.

Symptoms of Depersonalization Disorder:

The length of these episodes varies greatly, from just a few minutes to months, to even years.

Those with depersonalization disorder may feel like these episodes are indicators of imminent mental collapse, this is most often not true. Symptoms of depersonalization disorder include:

• Constant and peristant feeling that you are not in control of your own body, thoughts, or actions
• Feel like you live in a dream or movie
• The numbing of your senses and/or responses to the world around you
• Being aware that your sense of detachment is not real but only a feeling
• Feeling your body, or parts of it, are "wrong" (for instance, shrunken or enlarged)
• An emotional disconnection to those close to you

Types of Depersonalization Disorder:

Episodic depersonalization is an adaptive, coping mechanism often used in times of extreme stress or trauma.  A single episode of depersonalization, or even several episodes, does not warrant a diagnoses as depersonalization disorder.

Chronic depersonalization is when the episodes of depersonalization are no longer adaptive but are instead impairing daily functioning and causing distress to the individual.

Diagnosis of Depersonalization Disorder:

A diagnosis of depersonalization disorder is given when a person meets a specific set of criteria after a thorough evaluation from a mental health professional. According to the Diagnostic and Statistical Manual (IV-TR), the following criteria are required for a diagnosis of depersonalization disorder.

• Persistent or recurrent feeling of being detached from one's body and mental processes. 
• During the experience, reality testing or the ability to distinguish between actual perception and hallucination, remains intact.
• Causes significant distress or impairment in functioning.
• Symptoms are not related to a medical condition or substance abuse.

Typically, symptoms of depersonalization disorder don't go away, or continually come back, and it is considered a chronic disorder.

Causes of Depersonalization Disorder:

The cause of depersonalization disorder is unclear, but there is belief that it is caused by an imbalance within neurotransmitters in the brain.

The feelings, or episodes, of depersonalization aren't associated with, or because of, things such as substance abuse or a medical condition.

An episode of depersonalization can be triggered by things such as:

• Severe stress (psychological and physical)
• Panic attack
• Social and/or relationship problems
• Trauma

Related Disorders:

There are several disorders that are found to be related to depersonalization disorder, or frequently occur in tandem with depersonalization disorder. They include:

Anxiety disorders

• Panic disorder
• Obsessive-Compulsive disorder
• Generalized anxiety disorder
• Acute stress disorder
• Post-traumatic stress disorder

Mood disorders

• Depression
• Bipolar disorder

Personality disorders

• Avoidant Personality Disorder
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder

Derealization, or the temporary loss of reality/connection with the world around you. (the DSM-IV-TR recognizes derealization as a separate disorder, diagnosed under Dissociative Disorder – Not Otherwise Specified. However, the International Statistical Classification of Diseases and Related Health Problems (ICD), recognizes depersonalization and derealization as one disorder.)

Risks of Depersonalization Disorder:

Depersonalization disorder can be diagnosed in anyone, at any point in their life, but there are a few things that can put you at a higher risk of developing the disorder.

• Age: those who are in their mid- to late-teens and early adulthood are at higher risk for the disorder, as it is rare in children and older adults.
• You've experienced or witnessed a life-threatening or traumatic event. (car crash, rape, extreme violence, etc.)
• You have a disorder such as; post-traumatic stress disorder, anxiety, depression, avoidant personality disorder, etc.

Treatment of Depersonalization Disorder:

There have been very few, virtually no, systematic, controlled scientific studies on the treatment of depersonalization disorder; thus, there is little known about how to effectively treat the disorder. It is even often thought of as a treatment resistant disorder. But treatment may include: medication, hypnosis, psycho- and congnitive therapies, and family therapy.

• Medication:There is no medication to treat depersonalization, however, the use of medication to treat associated disorders or symptoms is common.
• Hypnosis:The technique of "self-hypnosis" is believed by some to allow an individual to gain some control over the disassociation and learn how to reassociate.
• Psychotherapy:This is the most common form of treatment for depersonalization disorder
• Cognitive Therapy:this type of therapy focuses on changing dysfunctional thinking and in turn behaviors and feelings.
• Family Therapy:this therapy is used as a way to teach the family about the disorder and how to recognize occurences.

Depersonalization and Derealization:

According to the DSM-IV-TR depersonalization and derealization are regarded as two different, but often comorobid, disorders.

Derelization disorder, the temporary loss of one's sense of reality in regards to the external world (ie., thinks others are actors), is diagnosed as a Dissociative disorder - Not Otherwise Specified.

However, in the ICD-10 the two disorders are diagnosed together (as one in the same) under the classification of "other neurotic disorders; depersonalization/derealization disorder"

The current DSM-V task force is questioning the separation and may integrate the two disorders in the DSM-V, which is to be released next year.

Related Resource Pages on Band Back Together:

Anxiety Disorders

PTSD

Personality Disorders

Additional Resources:

Pubmed is a searchable database of disorders. Many free, full, research articles are available here.

Anxiety Disorders Association of America has information, including podcasts, about depersonalization disorder.

Overcoming Depersonalization Disorder a book that looks at both trauma-based and non-trauma based depersonalization. (book)

Stranger to Myself a book that examines depersonalization disorder using case histories and treatment. (book)

International Society for the Study of Trauma & Dissociation society that publishes the "Journal of Trauma & Dissociation," offers information for professionals and the public on dissociation and trauma.

Potteridge Centre of Dissociation and Trauma (UK based) offers training and information to professionals and the general public, has information on choosing a therapist.