Lifting the veil on depersonalisation-derealisation disorder
Case study / by Diana Marin
Some mental health issues are far better understood than others, providing a greater appreciation of how they can be effectively managed. But for others, in particular those that involve a detachment from reality or self, this can prove to be a far more difficult task. Diana Marin explores one such condition in depersonalisation-derealisation disorder, from its signs and symptoms through to its representation in society.
Have you ever had a feeling that the world around you is unreal or unfamiliar? That living is like navigating the dream world, that there’s a veil between you and the rest of the world, or that you are an external observer of your own mental processes or body sensations?
Perhaps you felt detached from reality or from your sense of self after a long period of sleep deprivation or sensory deprivation, during a particularly stressful time, following an instance of emotional shock, or after a traumatic event – all of which can trigger temporary uncanny feelings of derealisation and depersonalisation.
These feelings are actually not uncommon, affecting 50–75% of the human population at some point in their lives. However, for other people (1–3% of the population), depersonalisation-derealisation (DPDR) lingers and becomes chronic, shaping the way they perceive reality in the long term, rather than being a fleeting state of consciousness. It is what is termed a ‘dissociative disorder’ which are characterised by a dream-like detachment and alienation from reality or one’s sense of self, as well as a feeling of disconnection from others.
The challenges of diagnosing DPDR
Most people who experience DPDR often go through life without being aware that there is a name and a label encompassing their symptoms, or that there are other people out there who can identify and empathise with their experience. They know something is wrong, but find it difficult to articulate it. They may think others would not understand them or feel like they are going crazy. This tendency to keep their thoughts and experiences within the confines of their own minds can accentuate feelings of alienation even further. Moreover, not knowing the nature of what you are experiencing can actually deepen and prolong the condition, as you might be assuming the worst. This is why it’s important to shed light on it, raise awareness and understanding of DPDR, and encourage meaningful, connection-enhancing discourse on this topic.
One challenge that people with DPDR might face is that, when they eventually find a way to open up about their condition, external interpretations of their perception of reality often merge it with depression or other mental health conditions – even within a psychiatric context, where they might be misdiagnosed. It is true that depersonalisation and derealisation can be symptoms of anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSD), and other pathologies. However, DPDR is also a disorder in itself, which is recognised by the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM).
It was introduced as a psychiatric disorder of the dissociative type in the 20th century and has been updated and re-interpreted several times in various psychiatric diagnosis manuals. It is also a mental health condition that affects people differently, in some cases causing a lot of distress, as it makes them feel disconnected from everyone around them, including their loved ones, as well as from their self-concept.
Two sides to the story
Although quoted together in the DPDR moniker, derealisation and depersonalisation are distinct concerns in and of themselves.The essence of derealisation is the feeling of detachment from the world around you and perceiving it as unreal, whereas depersonalisation is the feeling of detachment from and unreality of the self..
Some people experience both simultaneously, whilst others might only experience one of them. Symptoms of depersonalisation can encompass emotional numbness, uncanny visual or temporal perceptual distortions, feeling like you are a character in a film, feeling robotic, like you are not in control of your movements, or like you are an external observer of your thoughts and emotions. If you have derealisation, you may have the impression that reality is other-worldly or Matrix-like, the world is artificial or foggy, situations, places, and people around you seem mechanical, unreal, or lacking emotional depth, the familiar becomes unfamiliar, there is a veil between you and the rest of the world, and again, you might experience slight temporal, auditory, or visual distortions. They can also both lead to memory and attention issues.
The key differences between depersonalisation and derealisation
DPDR vs psychosis
It is important to distinguish DPDR disorder from psychosis in our discourse, as they are different states of consciousness, despite sounding similar if we only describe DPDR superficially, without providing further clarifications.
First of all, DPDR disorder often involves being acutely aware that something is off, that your experience is a strange way of experiencing the world. This awareness, which implies intact reality testing, is the main distinguishing factor between DPDRand psychotic states. It leads to philosophical questions on the nature of reality and the self. In the process, you might indeed feel like you are “going insane”, but your self-awareness, self-questioning, and cognitive processes constitute telling signs that you are not.
Although they are not mutually exclusive and both DPDR and psychosis can imply a distorted, dream-like, surreal state of mind, an altered perception of reality and the self, DPDR doesn’t generally involve delusional thinking, hallucinations, or a psychotic level of loss of contact with reality. The condition might include some minor perceptual distortions, but the blurring line between reality and dream is more of a vague, elusive, undefinable feeling that you are fully aware of.
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Causes of DPDR and the effects of the pandemic
The causes of DPDR disorder vary. It has been linked with psychological trauma (arising from emotional or physical abuse, an accident, illness, war, and so on), stress, grief, sleep deprivation, alcohol withdrawal, neurological conditions (e.g. epilepsy), psychoactive substances, or even meditative practices. In the case of trauma, the onset of DPDR can be attributed to the building of a defence mechanism against an unpleasant or intense experience, feelings of being unsafe, or perceived dangers. The disorder might be experienced differently depending on the root cause or combination of factors.
Feelings of derealisation are likely to emerge or be exacerbated within the context of the pandemic. The dystopian shroud of unreality that has enveloped the world can suck you into an existential vortex under the ominously looming threat of disease and global tragedy. The impact of self-isolation, loss, stress, trauma, and the dream-like ambiguity and uncertainty that reality has been submerged in can all induce a sense of detachment, whilst making you question the nature of reality as its fabric, as you knew it, starts glitching, becoming unfamiliar and insubstantial. The uncanniness of vacant London streets that are normally vibrant and buzzing with energy, persistent and ever-present tragic news in the media, the mutating virus that divides the population on multiple levels, the sense of existing in a vague and undefined space, all inspired a surge in pandemic jokes about how everything feels like a simulation or a dystopian horror film.
This type of discourse is quite common and characteristic of the condition of derealisation, and, whilst for some people the remarks may not go beyond a fleeting, superficial feeling or may constitute a simple association, others can relate on a more visceral level. Moreover, if you have had DPDR disorder in the past and managed to escape it and return to your normal state of mind, the pandemic can make it resurface. Recovering can be trickier because of the limitations imposed, as recovering tends to be facilitated by having a well-balanced life, reducing stress, feeling safe enough to reconnect with your emotions, and engaging in activities that make you feel good and make you break the cycle of obsessive thinking – all of which are subject to limitations during the pandemic.
The differing perspectives of DPDR
To share a different perspective, not everyone perceives feelings of depersonalisation and derealisation in a negative light. As mentioned, they really differ from person to person in both symptoms and causes, as well as in perceptions and interpretations of its effects and impact.
For instance, the condition of DPDR has also been compared with spiritual growth, awakening, detaching from ego, and reaching higher altered spiritual states, since it involves a certain hyper-awareness of existence coupled with a detachment from earthly sensations and a bizarre sense of remoteness from the physical world. For the same reasons, it can also be channelled into art or other creative outlets, providing the right conditions to generate inspiration.
This, of course, doesn’t negate or undermine the intrusive, distressing feelings that some people with DPDR disorder experience and the negative ways in which they are affected. Often, for spiritual purposes within some cultures, feelings of derealisation or depersonalisation are intentionally induced and desired in order to enter a state of trance, which is different from the involuntary disconnection and the loss of control experienced by people who have to live with this condition chronically for extended periods of time.
What to do if you are, or think you are, living with DPDR
Whilst it is important to understand this rather obscure condition, to connect with your feelings, analyse your perception of the world, assess the nature of your thoughts, and open up about your experience, due to the self-perpetuating nature of the disorder, you should try not to obsess about it and constantly dwell on these thoughts. Hyper-awareness and hyper-fixation make the feelings linger for longer and strengthen the thought patterns: in essence, the process can be like a vicious cycle.
In order to break it, to move on, and shift to a different state of mind if that is your wish, you have to direct your attention towards external things that you enjoy and that make you feel connected to the world and to your self, reduce the elements of risk and stress, have a healthy life, and avoid possible triggers such as recreational drugs and sleep deprivation.
Don’t forget we can rewire our brains, as we are constantly creating new neural pathways, we can rewrite negative patterns and nurture positive ones by directing our attention and mental processes towards what is beneficial to us, until it comes naturally. Don’t neglect or try to suppress your feelings of DPDR – acknowledge them, but try to engage in mood-boosting activities that will bring you cognitive benefits and the feelings are likely to gradually, naturally fade away. However, if the feelings persist and interfere with your daily life in a distressing way, seek a mental health professional who is familiar with DPDR disorder.
If you're interested in learning more about DPDR disorder, here are some valuable comprehensive resources:
“Feeling Unreal: Depersonalization Disorder and the Loss of the Self” – 2006, Book by Daphne Simeon, Professor of Psychiatry, and Jeffrey Abugel, writer and DPDR researcher
“Overcoming Depersonalisation and Feelings of Unreality, 2nd Edition: A self-help guide using cognitive behavioural techniques” – 2007, by Members of the Section of Cognitive Neuropsychiatry at King’s College, Anthony David, Dawn Baker, Elaine Hunter, Emma Lawrence
Unreal is a UK charity with the mission of providing support and information and raising awareness of Depersonalisation and Derealisation Disorder.