Depersonalization / Derealization Disorder

What Causes Depersonalization/Derealization Disorder?

The precise cause of DPDR is unknown. However, it often occurs in people who have experienced traumatic situations, such as:

• Abuse
• Combat
• Torture
• Death of a loved one
• Natural disasters
• Accidents
• Severe stress or life-threatening experiences
• Having a parent with a mental illness

Sometimes, DPDR seems to be triggered by other circumstances, such as:

• Use of recreational drugs, especially hallucinogens such as marijuana or ketamine
• Sleep deprivation
• Other triggering mental or physical conditions such as seizure disorders or depression

Is Depersonalization/Derealization Disorder Hereditary?

DPDR does not appear to be an inherited disorder. However, scientists believe that the condition results from an interplay between multiple factors, and genetics may be one of them. Some studies have found possible connections between dissociative symptoms in general and specific genes, and these genetic connections may make certain people more susceptible than others to DPDR. However, research into the possible genetic links is ongoing, and no definitive connection has yet been found.

How Is Depersonalization/Derealization Disorder Detected?

Brief periods of feeling depersonalization or derealization are common. Approximately half of all people experience these types of feelings at some point. However, only about two percent of people experience symptoms that are severe enough to qualify for a diagnosis of DPDR. Dissociative symptoms are only of concern if they are recurring, persistent, and/or interfere with daily functioning.

How Is Depersonalization/Derealization Disorder Diagnosed?

There are no tests or exams that can definitively identify DPDR. Instead, to diagnose the disorder, medical doctors and mental health professionals will work together on several diagnostic steps to rule out other possible causes for the symptoms and confirm a DPDR diagnosis. The diagnostic process may include:

• Physical exams and medical histories to look for underlying neurological or physical problems that may be triggering the symptoms
• Psychiatric exams to compare the patient’s symptoms to the diagnostic criteria for DPDR
• Blood or urine tests to look for possible causes such as substance abuse
• Imaging scans or electroencephalogram (EEG) to look for brain abnormalities or physical conditions such as seizure disorders

The disorder’s diagnostic criteria include:

• The patient has recurring and/or persistent depersonalization and/or derealization symptoms.
• The patient understands that the symptoms are not real.
• The symptoms cause the patient distress and/or impair the patient’s daily functioning.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Depersonalization/Derealization Disorder Treated?

Standard treatment for DPDR involves psychotherapy. Commonly used therapeutic approaches include:

• Cognitive-behavioral therapy
• Dialectic-behavior therapy
• Psychodynamic therapy
• Art or music therapy
• Family therapy

In some cases, medications may improve symptoms. However, these medications are usually most effective at treating the symptoms of associated conditions such as anxiety, depression, substance abuse rather than the DPDR symptoms themselves. Commonly used medications include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Lamotrigine
• Opioid antagonists
• Anxiolytics
• Stimulants

Other treatment options sometimes include:

• Hypnosis
• Meditation and relaxation techniques
• Desensitization therapies

How Does Depersonalization/Derealization Disorder Progress?

In some cases, DPDR symptoms resolve on their own without treatment. In many cases, people with the disorder can completely recover if the underlying cause is identified and addressed. However, in some cases, symptoms persist over the long term and may cause significant mental and social complications. Long-term impacts of the disorder can include:

• Persistent problems with focus or concentration
• Sleep disruptions
• Work, school, or relationship problems
• Depression and/or anxiety

How Is Depersonalization/Derealization Disorder Prevented?

Sometimes people with DPDR can effectively control their symptoms and prevent episodes by using behavioral techniques to focus their attention on thoughts and activities apart from their feelings of dissociation.

Therapy may sometimes uncover specific triggers, such as substance abuse or stress, that cause the disorder’s symptoms. Avoiding these triggers may help to eliminate or lessen dissociative episodes.

Depersonalization/Derealization Disorder Caregiver Tips

Caregivers for children or adults who are experiencing symptoms of DPDR should keep these tips in mind:

• Learn about DPDR and its potential impacts.
• Encourage your loved one to seek help and be an active participant in treatment when it’s appropriate. For example, joining your loved one in family therapy or support group sessions can be beneficial.
• React calmly and provide a safe, comfortable environment when your loved one experiences dissociative episodes.

Depersonalization/Derealization Disorder Brain Science

Scientists don’t understand precisely what is happening in the brains of people who experience dissociation, a feeling of being disconnected from a sense of self. Dissociation is at the heart of DPDR and other dissociative disorders, and it plays a role in some other neurological conditions such as epilepsy. Researchers hope that identifying a neurological mechanism underlying the experience of dissociation may lead to more effective treatment of all these disorders.

A recent study at Stanford University attempted to look for patterns of brain activity that may be associated with dissociative episodes. Experiments on mice and an epileptic patient who experienced dissociative episodes appeared to identify a pattern of electrical brain activity associated with the episodes. The researchers also identified a particular protein that seemed to generate the triggering brain activity. The scientists suggest that this protein might be a focus for further research into potential treatments.

Depersonalization/Derealization Disorder Research

Title: Treatment of Depersonalization Disorder With Transcranial Magnetic Stimulation (TMS)

Stage: Completed

Principal investigator: Antonio Mantovani, MD  

New York State Psychiatric Institute

New York, NY

The purpose of this study is to evaluate the clinical efficacy of transcranial magnetic stimulation in the treatment of Depersonalization Disorder (DPD).

This study is a research trial of an outpatient, non-medication, non-invasive investigational treatment called Transcranial Magnetic Stimulation (TMS). TMS applies a magnetic field to the brain for a brief period. TMS is a procedure that involves 30-minute-long daily sessions every weekday for a series of weeks. The investigators are testing whether TMS can treat Depersonalization Disorder (DPD).

This is an open-label study. All patients will receive active treatment. DPD symptoms will be monitored through weekly self-report questionnaires as well clinical ratings with a doctor.

Title: Study of Fluoxetine in Patients With Depersonalization Disorder

Stage: Completed

Study Chair: Daphne Simeon  

Icahn School of Medicine at Mount Sinai

New York, NY

The purpose of this study is to:

1) Determine the effects of fluoxetine in the treatment of depersonalization disorder, 2) Assess the durability of treatment response in these patients, 3) Assess the improvement in psychiatric disability in these patients, and 4) Assess the effects of comorbid Axis I disorders (depression, social phobia, panic/anxiety, obsessive-compulsive disorder) and Axis II personality disorders on treatment outcome in these patients.

In this trial, participants will be randomly assigned to receive either fluoxetine or a placebo. Treatment will consist of two phases (acute treatment and maintenance). In the acute treatment phase, participants will receive fluoxetine or a placebo daily for 12 weeks. Participants will be followed every 2 weeks. In the Maintenance phase, participants showing significant improvement after 12 weeks may continue treatment for an additional 6 months. In this phase, participants are followed every 4 weeks.

Participants who do not improve during the acute treatment phase may receive open fluoxetine, or another appropriate medication, for 3 months.

Title: Mechanistic Interventions and Neuroscience of Dissociation (MIND)

Stage: Not yet recruiting

Principal investigator: Negar Fani, PhD   

Grady Hospital

Atlanta, GA

The purpose of this study is to test the neurophysiological mechanisms of an intervention to reduce symptoms of dissociation in traumatized people. The intervention will be tested in dissociative traumatized people at Emory University and the University of Pittsburgh. The researchers are interested in whether neural networks associated with attentional control and interoceptive awareness can be enhanced in this population. In addition, the researchers propose to evaluate whether different body-focused and non-body-focused interventions can change these mechanisms.

People exposed to chronic trauma face devastating effects on the brain and body. Chronically traumatized people become highly distressed when attending to emotional stimuli, leading to feelings of detachment from their bodies and environment. It is challenging to engage highly dissociative traumatized patients in trauma-focused treatment; however, these patients benefit from acquiring basic emotion regulation skills, including present-centeredness and body awareness. Various practices that involve present-centeredness and body awareness (including mindfulness-based interventions) have been shown to demonstrate short-term and long-term improvement in cognition, emotion regulation, and clinical symptoms in dissociative people with trauma exposure.

To address this issue, the researchers will evaluate the effectiveness of interventions that engage present-centered awareness and/or body focus.