Introduction

Have you ever felt disconnected from yourself or your surroundings? If you deal with persistent or recurrent feelings of unreality and detachment, you may be dealing with depersonalisation derealisation disorder (DPDR). While you may feel afraid or confused by these feelings, around 1% of the population are thought to experience this disorder, so you are not alone.¹

Overview: DPDR

DPDR is a dissociative disorder, which causes an individual to feel detached or unreal, patients have described feeling as if they are “living in a dream” or “like a robot”.² A person with DPDR may experience only depersonalisation, only derealisation or a mixture of both of these dissociative symptoms.

• Depersonalisation is the feeling of being detached from oneself. A person experiencing depersonalisation may feel disconnected from their thoughts, actions, or bodies. They can also feel like they are watching themselves from the outside
• Derealisation is the feeling of being detached from one’s surroundings. The world and people around may appear foggy, lifeless, dreamlike or unreal

It can be a very distressing experience and can last anywhere from a few minutes to many years. Some people with the condition may fear that they have developed psychosis or schizophrenia, but there are some distinct differences.

While those suffering from a psychotic episode may experience dissociation, they will likely experience additional symptoms, such as hallucinations (seeing, hearing, tasting or feeling things that aren’t really there) and delusions, for example, the unshakeable belief that someone or something is trying to kill them.

Causes of DPDR

Dissociation can be triggered by stressful or traumatic events, for example:³

• Physical, sexual or emotional abuse
• Neglect/abuse during childhood
• War or kidnapping
• An invasive medical procedure
• The death of a loved one

Additionally, DPDR is often comorbid with other mental health issues, such as:⁴

• Post-traumatic stress disorder (PTSD)⁵
• Obsessive-compulsive disorder (OCD)⁶
• Borderline personality disorder (BPD)⁶
• Depression
• Panic disorder⁷

Drug use can also lead to dissociative symptoms.⁸ For example, marijuana use can lead to temporary symptoms of DPDR, which generally subside within 2 hours, however, these symptoms have been known to last months or years in some cases.⁹ This is particularly true for individuals using marijuana during or after a stressful or traumatic experience, who appear to be more at risk of developing marijuana-induced DPDR.¹⁰

However, in some instances, DPDR symptoms can occur as a result of physical problem called vestibular dysfunction. The vestibular (or inner ear) system controls coordination and balance. Therefore, issues with this system, such as vestibular neuritis, can result in feelings of dizziness and vertigo. This disorientation, and consequent anxiety, can lead to symptoms of DPDR.¹¹

Treatments for DPDR

The good news is that DPDR is treatable. The main treatment options are medications or psychotherapy. Research suggests that in terms of drug treatments, selective serotonin reuptake inhibitors (SSRIs) and lamotrigine may be helpful, however, medications are not considered to be the best option. Psychotherapy is widely accepted to be the most beneficial treatment, this can include:¹²

• Cognitive behavioural therapy (CBT)
• Mindfulness-based cognitive therapy (MBCT)
• Psychoanalytic therapy
• Psychoanalysis combined with abreaction (reliving the traumatic event in a safe, therapeutic setting)

Treatment for those with vestibular dysfunction will vary depending on their specific issue, but physiotherapy with an inner ear specialist physiotherapist is commonly used to help reduce or eliminate symptoms.¹³

FAQs

IS DPDR the same as psychosis?

No, although psychosis and DPDR can share feelings of dissociation, psychosis has the additional symptoms of hallucinations and/or delusions.

Is DPDR permanent?

No, DPDR can be treated and complete recovery is possible.

Summary

DPDR is a distressing, but relatively common, dissociative disorder that causes persistent or recurring feelings of detachment from oneself or one’s surroundings. It can be triggered by stress, trauma, drug use, or vestibular dysfunction, and is often comorbid with other mental health issues. Thankfully, DPDR does not have to be permanent and is usually treated with psychotherapy or, in the case of vestibular issues, physiotherapy.