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Depersonalization-derealization disorder

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, 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.

Symptoms Causes Risk factors Complications

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.

Depersonalization symptoms

Symptoms of depersonalization include:

  • Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body, perhaps 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

Derealization symptoms

Symptoms of derealization include:

  • Feelings of being alienated from or unfamiliar with your surroundings, perhaps like you're living in a movie
  • 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.

In this disorder, feelings of depersonalization and derealization aren't directly caused by drugs, alcohol, a mental health disorder or a medical condition.

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. However, it appears to be linked to an imbalance of certain brain chemicals called neurotransmitters, which can make a brain vulnerable so that heightened states of stress and fear may lead to the disorder.

Symptoms of depersonalization-derealization disorder may be related to:

  • Childhood trauma, such as verbal or emotional abuse or witnessing domestic violence
  • Growing up with a significantly impaired mentally ill parent
  • Suicide or unexpected death of a close friend or family member
  • Severe stress, such as relationship, financial or work-related problems
  • Severe trauma, such as a car accident

While anyone can develop depersonalization-derealization disorder, you're at increased risk if:

  • Your personality has traits that make you want to avoid or deny difficult situations or you have trouble adapting to difficult situations
  • You've been involved in or witnessed a traumatic or abusive experience
  • You're in your mid- to late teens or early adulthood — depersonalization-derealization disorder is rare in children and older adults

Even if you don't have depersonalization-derealization disorder, feelings of depersonalization or derealization can be triggered by:

  • Having other mental health disorders, such as depression or anxiety
  • Using substances, such as hallucinogens or marijuana
  • Having physical or medical conditions, such as seizures or a head injury

Episodes of depersonalization or derealization can be frightening. 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
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