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Depersonalization and Derealization Disorder & How to Recover

We've been talking a lot recently about dissociation, and many of you have asked follow-up questions about the different types of dissociative disorders. Now, dissociative disorders involve a breakdown in awareness, consciousness, or memory, and they are the result of our brains doing the best they can to cope with the trauma and overwhelm.

Now, after my recent articles on dissociation, I saw a lot of comments about depersonalization and derealization disorder, otherwise known as DPDR. So I'm going to talk you through what it is, the symptoms of derealization and depersonalization, the causes for it, and finally, how to treat it. So let's get into it and first talk about what it is.

Depersonalization-derealization disorder is a disorder where we can feel that breakdown in awareness that comes with dissociation, in relation to two core things, ourselves and our surroundings. It can be a really strange and deeply distressing experience. And those of us going through it can feel like we're going crazy.

What is Depersonalization and Derealization (DPDR) and How to Recover
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We can think that we're having a mental breakdown, or that we've developed a psychotic disorder. It can really feel uncomfortable and odd. But depersonalization and derealization are not a form of psychosis. And the key distinction is that when you're experiencing depersonalization or derealization, you are aware that the detachment or distortion you're experiencing isn't reality, versus in psychosis, we can often believe we are detached from our bodies or our surroundings. We believe it's really happening instead of just feeling that way if that makes sense. 

A lot of us might have experienced moments of depersonalization or derealization. Brief, transient experiences like that are actually fairly common, occurring in at least 50% of people. Have you ever felt like you were watching yourself in a movie, or like you're floating above your body watching your life unfold? Or maybe feeling like there's a big glass bubble between you and the people or the things surrounding you? I would love to hear your stories and your thoughts on this in the comments.

Sensations like this last only for a few seconds, and are gone before we can even grasp what happened, and we can shrug it off. But when these experiences linger for more than a few seconds or occur more frequently, they can interrupt our lives and do significant damage to our mental health. That is when we move into the camp of depersonalization or derealization disorder.

For those of us with this disorder, these episodes of detachment can last for hours, days, weeks, and sometimes even months. Let's talk about the symptoms. How do we know if we're being affected by depersonalization or derealization? 

The Mayo Clinic lists the symptoms of depersonalization as feeling outside of yourself like you're watching your thoughts or feelings, or even your own body parts, almost like you're floating in the air above yourself. 

Next, you can have the sensation that you are a robot, or sensing you are not in control of your speech or movements. And I've heard from a lot of you that this is the component of it that can make it embarrassing, or we can do and say things that we're just not really aware of. 

Third, you can have a feeling like your body parts are distorted, bigger or smaller than they are, or a sensation that your head is wrapped in cotton. You can have a physical or emotional numbness, and when it comes to memories, you may have the sense that the emotion associated with that memory has been sucked right out of it or even a feeling like they aren't your memories like you're watching someone else's life.

Derealization is a little bit different. If depersonalization deals with the sensations we have in relation to ourselves, derealization is more about the sensations that we have in relation to the world and the people around us. We may feel disconnected from our surroundings like we're living in a movie or a dream, and some people have described it as if there's this clear wall between them and the people that they care about. Almost like a sense of emotional disconnection. And surroundings can appear different too, distorted, blurry, gray, or artificial in some way. You might experience a shift in your relationship with time. 

Events that happened recently may feel like they were years ago. Also, objects around you may seem distorted as well. They can be further away or closer, or their size and shape are altered. So what causes Depersonalization and Derealization? The exact cause is hard to pin down. Certain kinds of drugs like hallucinogens can definitely trigger it, or extreme sleep deprivation or sensory stimulation.

One of the big factors associated with Depersonalization and Derealization is childhood trauma, specifically emotional abuse or neglect. Moments of intense trauma are so terrifying and hard to navigate, especially for our child's brains. So we tend to dissociate as a way to cope. In the same way fight, flight, freeze, and the fawn is our body's way of protecting ourselves against physical threats, dissociation can be a way of protecting our minds against psychological threats. And it's commonly connected to our freeze response. Almost like we can't get away physically, so we run away psychologically.

We may be at a higher risk for developing dissociative disorders like Depersonalization and Derealization because a biological factor is like a nervous system that is more reactive to emotions, meaning our level of resilience is just lower than others. Or if we are predisposed to certain conditions like seizures or other mental illnesses like anxiety, depression, et cetera.

So what do I do about it? Isn't that the million-dollar question? And does everyone out there get tired of hearing therapists give the same answer to questions like this, but the reality is the answer is often the same when it comes to dissociation? And that answer is leaning into therapy and specialists. When treating any underlying trauma, we can look to three types of therapy that have been proven effective. 

The first is talk therapy. It can help you unravel past trauma, and also learn to manage distressing sensations that come with Depersonalization and Derealization or related conditions. We can put together a timeline of our trauma and work through the process of putting our trauma into a cohesive narrative. Overall, we find this to be effective for about 40% of people. 

The second is psychodynamic therapy. Often we may not be able to consciously address the trauma because it can be overwhelming and lead to more dissociation. So there are treatments available in psychodynamic therapy that help us access those unconscious barriers that can keep us from integrating past experiences. And this is when we look for patterns in the way that we interact with others or things that come up for us in our relationships with our therapist and also acknowledge any of our defense mechanisms. This can be a sneaky way of getting us to work through some of our past issues without having to address the trauma head-on.

And third, somatic experiencing therapy. Again, if words are difficult to come by or talking about the trauma only increases our dissociation, which is really common, using movement to unfreeze ourselves can be healing. In short, we are hoping to change our trauma response from the freeze, which is where dissociation comes from, to fight or flight. So offering our body the movement that it's been wanting can be the release that we've been waiting for. 

Additionally, there have been amazing breakthroughs in medication, and there are some that may be helpful. Specifically, medication to support related symptoms like anxiety or depression, think SSRI, SNRI. Those may be helpful, but please reach out to a psychiatrist in your area to see if medication is right for you. Finally, there are coping skills that you can try here at home, such as grounding techniques. 

Now, we've talked about these a lot before, and these are things like counting colors. So you look around the room, how many things in your space are brown, blue, or black? You can also do the ABCs. Look for things that start with the letter A, the letter B, and so on. And even changing your temperature, like holding ice cubes or putting a cold washcloth on your face or your neck to change your body's temperature. That can be really helpful when we're struggling with dissociation. 

The next coping skill is distress tolerance because we're gonna try to allow ourselves to tolerate the distress a little bit better, right? It's the distress that causes our dissociation. Now, a little tip that I have for this is called tipp, T-I-P-P. Now, it stands for temperature, intense exercise, paced breathing, and impaired muscle relaxation. Overall, this tool can help us calm our nervous system down and keep us present. And it's like a grounding technique, to be honest. Another tool is accepts, A-C-C-E-P-T-S. And it's another distress tolerance skill that helps us manage a negative emotion until we're able to actually do something about it. It stands for activities, right? 

Distract ourselves from what we're going through, contributing, meaning take some time to help somebody else out. Comparisons can give us perspective, right? We can look at someone else's situation and be like, ours actually isn't that bad. Emotions, meaning we can take some time to force an opposite emotion. Just because I'm feeling sad doesn't mean I have to ruminate on it. I can force myself to think and feel a different way. 

Next is push away, which is otherwise known as the back burner. Right now, I can't do anything about this. I can't cry in my meeting, that's not gonna be helpful. But I can make time to do that later today. And so, mentally I do that, I push it away. 

The next is thoughts. So we're gonna stop those anxious thoughts, and we can use bridge statements to move them in a more neutral position, we've talked about those before, and we can also use thought distractions. So think about something else. Tell me about one of your favorite memories. 

And finally is sensation. Use your five senses to help calm you down. Maybe that means we pop a peppermint candy in our mouth or we smell some lavender, or maybe we just notice how our clothes feel on our body. All of that can be extremely helpful when we're trying to tolerate some of that distress. And the final coping skill, mantras. 

Sometimes having a few phrases to repeat over and over can be helpful. I know my personal mantra is life's got my back, and it's something that my therapist said to me when I was stressing about work and money and just life in general. She asked me if I had ever not made it through before, and if life had ever done me so wrong that I couldn't recover or keep going. And the answer, obviously, even though I didn't like it was no, it hasn't gotten that bad. 

And she said that's 'cause life's got your back. And so I use that phrase as a mantra when I'm worrying or even freaking out because something isn't quite going the way that I thought it would. It's a reminder that I'll get through, and I'll be okay. So what are some mantras that have helped you? Please leave those in the comments down below. You never know who it could help. Thank you so much for watching. I hope you found this helpful. And as always, feel free to share your own thoughts in those comments down below. Have a wonderful rest of your week, and I will see you next time.