Depersonalization-derealization disorder occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real, or both. Feelings of depersonalization and derealization can be very disturbing and may feel like you're living in a dream.
Many people have a passing experience of depersonalization or derealization at some point. But when these feelings keep occurring or never completely go away and interfere with your ability to function, it's considered depersonalization-derealization disorder. This disorder is more common in people who've had traumatic experiences.
Depersonalization-derealization disorder can be severe and may interfere with relationships, work and other daily activities. The main treatment for depersonalization-derealization disorder is talk therapy (psychotherapy), although sometimes medications also are used.
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Persistent and recurrent episodes of depersonalization or derealization or both cause distress and problems functioning at work or school or in other important areas of your life. During these episodes, you are aware that your sense of detachment is only a feeling and not reality.
The experience and feelings of the disorder can be difficult to describe. Worry about "going crazy" can cause you to become preoccupied with checking that you exist and determining what's actually real.
Symptoms usually begin in the mid- to late teens or early adulthood. Depersonalization-derealization disorder is rare in children and older adults.
Symptoms of depersonalization include:
- Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body — for example, as if you were floating in air above yourself
- Feeling like a robot or that you're not in control of your speech or movements
- The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton
- Emotional or physical numbness of your senses or responses to the world around you
- A sense that your memories lack emotion, and that they may or may not be your own memories
Symptoms of derealization include:
- Feelings of being alienated from or unfamiliar with your surroundings — for example, like you're living in a movie or a dream
- Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall
- Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings
- Distortions in perception of time, such as recent events feeling like distant past
- Distortions of distance and the size and shape of objects
Episodes of depersonalization-derealization disorder may last hours, days, weeks or even months at a time. In some people, these episodes turn into ongoing feelings of depersonalization or derealization that may periodically get better or worse.
When to see a doctor
Passing feelings of depersonalization or derealization are common and aren't necessarily a cause for concern. But ongoing or severe feelings of detachment and distortion of your surroundings can be a sign of depersonalization-derealization disorder or another physical or mental health disorder.
See a doctor if you have feelings of depersonalization or derealization that:
- Are disturbing you or are emotionally disruptive
- Don't go away or keep coming back
- Interfere with work, relationships or daily activities
The exact cause of depersonalization-derealization disorder isn't well-understood. Some people may be more vulnerable to experiencing depersonalization and derealization than others, possibly due to genetic and environmental factors. Heightened states of stress and fear may trigger episodes.
Symptoms of depersonalization-derealization disorder may be related to childhood trauma or other experiences or events that cause severe emotional stress or trauma.
Factors that may increase the risk of depersonalization-derealization disorder include:
Certain personality traits that make you want to avoid or deny difficult situations or make it hard to adapt to difficult situations
Severe trauma, during childhood or as an adult, such as experiencing or witnessing a traumatic event or abuse
Severe stress, such as major relationship, financial or work-related issues
Depression or anxiety, especially severe or prolonged depression, or anxiety with panic attacks
Using recreational drugs, which can trigger episodes of depersonalization or derealization
Episodes of depersonalization or derealization can be frightening and disabling. They can cause:
- Difficulty focusing on tasks or remembering things
- Interference with work and other routine activities
- Problems in relationships with your family and friends
- Anxiety or depression
- A sense of hopelessness