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Understanding Depersonalization and Derealization

Understanding Depersonalization

Imagine being stuck inside a small glass box 24 hours a day wherever you go. Imagine feeling as if you're about to float away or disappear into thin air because you have no human body to tether you to the real world. Imagine being unable to hold a real conversation because you can't interpret the other person's words or register what they're saying. Imagine exchanging eye contact with a loved one and seeing nothing but a 2D comic-book image, devoid of emotion or meaning. Imagine seriously considering whether or not you might have died because you're unable to feel anything - physically or emotionally. Imagine looking in the mirror and not recognizing the person staring back at you. We feel so separated from both our body and mind that our reflections might as well be different people.

The hypotheticals we gave you are all common descriptions of different people's experiences of depersonalization (often abbreviated to DP). But it is not a condition of delusion as it may initially sound. We understand that our symptoms are part of our condition ('in our minds'). This fact can actually make depersonalization even harder to cope with. We know we love our friends and family so why can't we feel it? We know that our unreal sensations are a product of our brains so why can't we just change them? It seems like recovery should be very easy but it's actually very hard and can take a long time.

   
Depersonalization is far more common than most people believe. The vast majority of people will actually experience temporary, insignificant depersonalization at some point in their lives. Clinically significant depersonalization is more common than schizophrenia and at least as prevalent as bipolar disorder and is believed to be the third most common overall mental health problem behind only depression and anxiety. Clinically significant depersonalization spans a spectrum from mild to severe. Mild depersonalization can disrupt a person's life and ability to function optimally. Severe depersonalization can leave them barely able to function at all. In some severe cases, sufferers are no longer able to work (often, they get fired) and can no longer care for themselves properly. For all intents and purposes, the most extreme forms of depersonalization can render a person disabled (just as in severe cases of schizophrenia).

Depersonalization Symptoms

Depersonalization (DP) is best described as a syndrome, which is a set of symptoms that frequently occur together. Even the best clinical definitions aren't the same as listening to sufferers describe the way these symptoms actually feel through first-hand experience. 

Some of the most common symptoms of depersonalization as described by sufferers are:
  • Feeling as though their body is weightless, ghost-like or physically non-existent
  • Feeling as though their movements are robotic or unnatural or not their own
  • Feeling as if their life is on auto-pilot and that they are merely zombies or automatons stumbling through life
  • Feeling as if their emotions are non-existent, invalid or pointless
  • Feeling as though their mind is 'blank' and that they have no conscious or natural thoughts
  • Feeling as though their body does not belong to them
  • Feeling as though they have lost themselves and their identity
  • Feeling as if their surroundings are somehow altered and unnatural (e.g. the world appears 2D)
  • Feeling as if they're observing their own body from the outside (similar to an out-of-body experience)
  • Feeling as though time is distorted (e.g. slow-motion vision or speeding up of time while seemingly doing nothing)
  • Feeling as though everything is unreal including their body, mind, thoughts, emotions and environment
  • Experiencing deep existential or nihilistic rumination leading to panic, despair and suicidal
  • Experiencing thick brain fog affecting cognition and memory (one common metaphor is "a head full of cotton wool")
Notice the recurring theme of similes and metaphors in describing the symptoms of depersonalization (which can also be observed in the more illustrative descriptions found at the start of this article). This use of language is no coincidence and reflects the awareness that DP sufferers have of the disconnect between their perception and what they know to be true. DP is not a delusional state. Sufferers know that their body still has weight and that their surroundings are real but they don't feel that way. The input they receive from their senses and from their mind doesn't match up to what they rationally and intuitively know to be objective reality.

DP is a subjective change in how one experiences oneself and the world. There are no words in the English language to adequately and directly describe DP, which is why we often resort to analogies and why the clinical definitions rarely have the necessary descriptive power. DP is something that must be experienced first-hand to be understood and this is an absolutely key point for anyone attempting to support a sufferer.

Depersonalization and Derealization

Strictly speaking, depersonalization refers to perceptual distortions and feelings of unreality involving the self (i.e. the body and the mind) and derealization refers to perceptual distortions and feelings of unreality involving everything outside the self (i.e. one's surroundings and environment). Clearly, these are complementary states. Sometimes, sufferers have difficulty separating the two because they are so tightly linked.

Approximately 75% of people with clinically significant DP also experience derealization (often abbreviated to DR). Only around 5% experience DR without DP. Due to their overwhelming concordance, depersonalization and derealization are usually simply brought under the umbrella of ‘depersonalization’. DP and DR would appear to have very similar causes and mechanisms and this homogeneity was highlighted in the DSM-V where depersonalization disorder was renamed depersonalization-derealization disorder. Both in research and in the depersonalization community, depersonalization is almost universally used to refer to depersonalization and/or derealization.

As in the general case, depersonalization and derealization do not warrant discrimination, which is why we've included DR symptoms in our DP symptoms list above.

Depersonalization disorder (DPD): Depersonalization-Derealization Disorder (DPDR)

Let's introduce a new term into the mix: depersonalization disorder. Whereas depersonalization is a syndrome that may occur for many, many reasons - including as a symptom of another illness - depersonalization disorder is the ‘pure’ form of depersonalization: it is not a symptom of another condition but a condition in its own right. When a depersonalization sufferer has depersonalization that is disruptive to that person's life and is not obviously caused by a psychological or organic illness or drug use (i.e. DP is the primary problem) then a diagnosis of depersonalization disorder is appropriate.

According to the DSM-V, the criteria for a diagnosis of Depersonalization Disorder (DPD) - now known officially as Depersonalization-Derealization Disorder (DPDR) - are:
  • Persistent or recurrent symptoms of depersonalization and/or derealization sufficient to cause distress and/or dysfunction
  • Reality testing remains intact (used to exclude a diagnosis of a psychotic disorder or a more severe dissociative disorder)
  • The depersonalization is not better explained by a physiological problem, drug use or another mental health problem including:
    Anxiety and panic disorders 
    Depressive disorders 
    Psychotic disorders 
    Substance abuse or withdrawal 
    A more severe dissociative disorder 
    Many others...

The other major collection of diagnostic guidelines, the ICD-10, has almost identical guidelines for depersonalization disorder (as does its successor, the ICD-11).

The depersonalization disorder subgroup contains a number of very unfortunate people who simply woke up one day with depersonalization and no idea why. This is called idiopathic depersonalization disorder and is obviously the purest form of depersonalization because it appears to have no underlying cause whatsoever. Cases like this may also be referred to as primary depersonalization disorder in order to really emphasize the fact that DP is the primary problem and seems to have no connection to anything else. Primary DPD is the hardest form of DP to treat because the sufferer has no idea where it came from. There are reports of people just walking down the street one day and then, bam, all of a sudden, they have long-term DPD. These stories - scarcely believable except for their widespread reportage - prove just how much we still need to figure out about DP.

How to Help Someone with Depersonalization

You can't imagine or understand depersonalization unless you've experienced it first-hand. Like many so-called ‘invisible’ illnesses the best you can do as someone trying to help out a sufferer is to listen to them and trust in what they say. If you've never experienced depersonalization, you may at least be able to empathize with the suffering, desperation and the terrible negative emotions it can create.

If someone you care about suffers with depersonalization, I hope you read this page thoroughly and really take the advice to heart. It could make all the difference to your relationship with them. Whether it's a friend, significant other or family member, the person you know who is suffering through this horrible condition may need your help and love and support.

It takes real love to stick things through with a depersonalization sufferer - you wouldn't believe how many people have lost long-term partners and spouses to this condition! - but if you come out the other side, you have every right to boast about the strength of your relationship. You're great...

One thing absolutely has to be clear at this point: someone with depersonalization may not appear to express love, affection or concern for you but that does not mean that they don't love you. A lot of people with depersonalization have a hard time experiencing, processing and expressing their emotions but I can guarantee you that it does not mean they don't care.

Depersonalization is serious

The significance of all mental health conditions is often drastically underestimated by those who have never experienced one. Due to a lack of awareness and understanding, this problem is magnified in depersonalization. You never have to explain depression to those around you. Imagine trying to explain such a strange and abstract condition as depersonalization, which can prove inconceivable to some. Many sufferers are reluctant to share anything about their condition with anyone for fear of sounding crazy, being disbelieved or not being taken seriously (this damages their support network and can even stop sufferers from seeking proper help). Unfortunately, even when sufferers do share what they're going through with friends and family members, they are often met with the expected reactions: disbelief and trivialization of their suffering.

Sadly, a number of people have ultimately committed suicide as a direct result of their depersonalization. Most people with moderate or severe depersonalization have at least some level of suicidal thinking on a semi-regular basis. It's possible that the nature of depersonalization - numbing emotions and making everything seem less real - increases the risk of a sufferer acting on their suicidal ideation. Anyone who believes that depersonalization isn't a serious condition is dangerously mistaken.

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