What is Depersonalization Disorder and How can it be Treated

Tracy Smith, LPC, NCC, ACS
September 19, 2018

Depersonalization disorder is a dissociative mental health condition where individuals feel disengaged from their bodies, thoughts, and feelings, which occurs on a continual and recurring basis.  Depersonalization disorder can cause one to feel like they are floating in a dream-like state, watching themselves from outside their own body.  People lose control over cognition and actions and often relate their experiences to feeling like a robot without conscious control.  Individuals may experience a distorted perception of their body parts, can become numbed to emotions and senses, and feel like tangible objects are not real and that memories may not actually be their own.  Interestingly enough, despite overall feelings of disconnection, individuals never lose touch with reality and are able to retain awareness that their perceptions are merely feelings and have no basis in reality.  People suffering from this condition are consumed with trying to distinguish the authentic from the false and constantly attempt to confirm their own tangible existence.

Depersonalization Disorder

Depersonalization disorder is atypical to children and older adults and most often begins during the teenage years or in early adulthood.  Symptoms of depersonalization disorder include distorted or heightened perceptions of time, distance, size, and shape, emotional disconnection from loved ones, and estrangement from familiar surroundings.  Episodes of depersonalization disorder can vary in intensity and frequency, lasting anywhere from a few hours to a few weeks at a time.  Fleeting feelings of depersonalization can be common, but become problematic when they are enduring, distressing, and begin to interfere with relationships and daily functioning.

The precise origin of depersonalization disorder is still unknown, but is believed to be influenced by an amalgam of genetic and environmental factors.  Genetic factors include hormones, neurological chemicals, and personality characteristics, while environmental triggers can include severe stress, traumatic life experiences, and intense fear.  Studies have found that severe trauma in childhood, especially pertaining to emotional abuse, can be a strong predictor to the disorder’s onset.  Other environmental triggers can include depression, anxiety, or recreational drug use.

To diagnose the disorder, practitioners will often order a physical exam and laboratory tests to rule out medical causes.  These tests allow physicians to assess whether a physical health problem, medications, alcohol, or recreational drugs may be the actual cause of the dissociation.  The primary recreational drugs related to dissociation include marijuana, ketamine, and hallucinogens.  Either after the medical testing, or simultaneously, practitioners will order a psychiatric evaluation to assess whether the diagnostic criteria is met for a depersonalization disorder diagnosis.

Unfortunately, the psychiatric field has historically overlooked depersonalization disorder, resulting in minimal research and inconclusive findings.  Psychotherapy is the current treatment of choice for depersonalization disorder, as psychotropic interventions have not been determined to show any true efficacy.  Despite these findings, clinical research continues to investigate potential pharmacological interventions.  Some medications are used presently to treat anxiety and depression, which are frequently related to the condition.  The prognosis for this disorder can vary, as some individuals improve and experience full recovery without intervention, while others are fated to manage and treat their symptoms as a chronic condition.

Psychotherapeutic interventions seek to help individuals gain control over their symptoms so that they slowly dissipate and ultimately disappear.  Counseling helps individuals understand the etiology of their disorder, to process feelings related to past trauma, and equips them with coping strategies to manage symptoms and stressors.  Cognitive-behavioral therapy can be effective in quelling obsessive thoughts, while simultaneously prompting behaviors to divert depersonalization.  Mindfulness, meditation, and grounding techniques are other helpful interventions, as they promote connection to the here and now.  Deep breathing and awareness exercises improve focus to the present moment and can facilitate a strong connection between the self and the environment.

Tracy Smith, LPC, NCC, ACS

Tracy is a Licensed Professional Counselor and is a clinical supervisor for the Community YMCA, Counseling & Social Services branch. Tracy has over 12 years of experience working in many settings including partial care hospitalization and intensive outpatient programs, community agencies, group practice, and school-based programs. Tracy works with clients of all ages, but especially enjoys working with the adolescents. Tracy  facilitates groups using art therapy, sand play and psychodrama.

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