Understanding Depersonalization-Derealization Disorder: Symptoms, Causes, and Treatment Approaches

Dr. Tracey Marks delves into Depersonalization-Derealization Disorder (DPDR), a psychological disturbance characterized by feelings of unreality and detachment. Depersonalization involves feeling detached from one's own body, thoughts, sensations, and actions, often described as observing oneself from outside or experiencing a distorted sense of time or physical numbness. Derealization, on the other hand, refers to feeling unreal or detached from one's surroundings, where the environment might seem dreamlike, foggy, or distorted, as if viewed through glass or with tunnel vision. A crucial diagnostic feature of DPDR is intact reality testing, meaning individuals are aware that their experiences are not normal and that their surroundings are objectively real, despite their subjective feelings.

The episode distinguishes between DPDR as a standalone disorder, typically diagnosed if symptoms persist for at least a month, and transient depersonalization/derealization symptoms that can arise from other causes. These secondary causes are diverse, including recreational drug use (notably marijuana), side effects or withdrawal from medications like antidepressants (manifesting as emotional blunting or dulling of colors), and other mental health conditions such as depression, anxiety disorders (panic disorder, OCD), and personality disorders (borderline, avoidant). Furthermore, medical conditions affecting the brain, like seizures or multiple sclerosis, can also trigger these symptoms, highlighting the importance of a thorough differential diagnosis.

Regarding treatment, Dr. Marks emphasizes that if depersonalization or derealization symptoms are secondary to another disorder, the primary focus should be on treating the underlying condition, as these symptoms often resolve concurrently. However, if DPDR is the primary diagnosis, treatment options, while not always definitive, include specialized psychotherapies like Cognitive Behavioral Therapy (CBT), which is particularly effective for those with co-occurring anxiety, and Hypnotherapy. Pharmacological interventions have shown mixed results, but medications such as Selective Serotonin Reuptake Inhibitors (SSRIs like Zoloft and Lexapro), Lamotrigine (Lamictal), Naltrexone, and benzodiazepines (for anxiety) are sometimes used.

Dr. Marks offers reassurance that despite the bizarre and often frightening nature of these experiences, DPDR is not a precursor to more severe mental illnesses like psychosis, nor is it indicative of a physical brain disorder. The disorder typically emerges in adolescence or early adulthood, making a first-time onset in later life unusual unless linked to another condition. The discussion underscores the value of patient experiences and community support, encouraging viewers to share their stories and what has helped them, fostering a sense of shared understanding and mutual aid in navigating this complex condition.

Depersonalization is defined as feeling unreal and detached from your body's thoughts and sensations and actions.

Derealization is defined as feeling unreal and detached but this time it's with respect to your surroundings and your environment.

Another key feature of this is that you are able to know what's real and what's not real. We call this reality testing.

Our diagnostic manual doesn't put a period of time on this but we generally would call this depersonalization-derealization disorder if you had these symptoms for at least a month, so it's not something that's just fleeting.

Marijuana is a big one.

This flattening feeling that you can't express yourself fully is a subtle for of depersonalization.

If you have these symptoms from another disorder, then the focus of treatment is on the other disorder because you can kind of think of depersonalization and derealization in this context as tag along symptoms of these other disorders.

But rest assured that as bizarre as some of the experiences are, they're not just a starting point for a more serious mental illness. And it's not gonna turn into a full blown psychotic episode.

Also as physical as they seem, they're not a sign of a brain disorder.

Cognitive Behavior Therapy tends to work better though for people who have anxiety with their symptoms.