Written by Suvetha Anand
Edited by Sweta Jha
Imagine not recognizing the person staring back at you when you gaze into a mirror. Imagine your surroundings, including your bedroom, your classmates, and your own speech, suddenly seeming distant, as if you were viewing everything through a thick layer of glass. These are not merely metaphors or brief periods of alienation for those with Depersonalization-Derealization Disorder (DPDR). They are persistent, troubling realities which rob life of its warmth and tangibility. Despite the prevalence of dissociative episodes, this disorder is still frequently misdiagnosed, undervalued, and misunderstood. Many patients with DPDR are left to manage their illness alone, ensnared in a mist of unreality, because its symptoms are hard to describe and more difficult to evaluate. This article seeks to bring DPDR into focus—by explaining what it is, how it feels, what causes it, and why greater awareness is so critical to helping those who silently endure it.
Depersonalization-Derealization disorder is categorized as dissociative disorder, meaning it impacts a person's perception of reality, themselves, or both. The feeling of being cut off from one's own body, ideas, or identity—as if one were merely a spectator rather than an active participant in their life—is known as depersonalization. On the other hand, derealization is the perception that the world is artificial, hazy, far away, or unreal. People who are going through these symptoms may say things like, "Everything looks flat, fake, or off," or "I feel like I'm watching a movie of my life." The persistent, upsetting character of DPDR's symptoms sets it apart from periodic dissociative episodes, which many people encounter under stressful circumstances and separation. The Mayo Clinic (2022) states that DPDR episodes can linger for hours, weeks, months, or even years, significantly impairing a person's capacity for emotional, social, and intellectual functioning. Crucially, individuals with DPDR usually have awareness that something is off with their view; they are not delusional. The experience is paradoxically made worse by this self-awareness, which feeds a vicious cycle of anxiety, confusion and alienation.
Although the exact origin of DPDR is still unknown, research indicates that a mix of environmental, neurological, and psychological factors may be involved. The disorder is common in those who have experienced extreme stress, trauma, or anxiety, particularly as children. A person may be more susceptible to developing DPDR as a defensive mechanism—a means for the mind to disengage from overwhelming experiences—if they experienced emotional neglect, physical or sexual abuse, or persistent feelings of insecurity as a child. In adulthood, episodes are frequently brought on by panic attacks, significant life stressors, or identity difficulties. Furthermore, there is a substantial correlation between the development of DPDR and substance usage, particularly marijuana and hallucinogens like LSD. Sometimes a drug's dissociative effects don't go away completely, leaving the user in a persistently detached state. A recent feature by The Guardian (de Freytas-Tamura, 2024) investigated a Berlin clinic where individuals seek help after "bad trips" that never truly ended—people who stay stuck in a dissociative state for months or even years. DPDR is most frequently linked to attempts to psychologically "numb" overwhelming distress, while it can occasionally occur without a clear reason.
The most difficult aspect about DPDR, is how tough it is to describe how it feels. Many people describe it as feeling as though they are not completely alive, stuck inside their own thoughts, or viewing life through a fog. People who are depersonalized may feel disconnected from their own reflection when they look in the mirror or perceive their thoughts as belonging to someone else. One may describe physical sensations as dull, saying, "It's like I'm controlling a body that isn't mine." The world may seem visually changed during derealization—too flat, too colorless, too sharp, or too hazy. Time can seem to be moving more quickly, more slowly, or not at all.
A common experience involves feeling like life is “just a dream,” but one that the person is painfully aware can't wake up from. These encounters are frightening in addition to being uncomfortable. Those who suffer frequently worry that they are "going insane" or that their mental health has been permanently harmed. People who seek help are frequently misunderstood, rejected, or misdiagnosed since DPDR is not well known. This denial simply serves to intensify the feelings of alienation and hopelessness, transforming DPDR into a profound existential crisis rather than merely a mental health condition.
Since DPDR cannot be confirmed by blood tests or imaging scans, the diagnosis is primarily made clinically using interviews and self-reported symptoms. Mental health practitioners must rule out other potential causes, such as epilepsy, psychotic illnesses, or brain injury, in order to meet the diagnostic criteria listed in the DSM-5. Before being given the proper diagnosis, many people with DPDR are misdiagnosed as having anxiety, sadness, or even schizophrenia, according to the Mayo Clinic (2022). The greatest evidence-based treatment for DPDR at the moment is cognitive behavioral therapy (CBT), particularly when it coexists with anxiety or panic disorders. In addition to teaching patients grounding practices that encourage reconnection with their bodies and environment, cognitive behavioral therapy (CBT) assists patients in recognizing and reframing harmful thought patterns. Selective Serotonin Reuptake Inhibitors (SSRIs) are sometimes recommended, especially when the disorder is accompanied with obsessive thoughts or depression. Many people do experience improvement over time, even though recovery can be gradual, particularly with regular therapy and lifestyle modifications. Symptom management can be greatly aided by methods such as mindfulness meditation, sensory grounding (e.g., holding ice or focusing on textures), and abstaining from drugs (Healthline, 2019).
Even though DPDR affects about 2% of people, which is the same percentage as obsessive-compulsive disorder, it is still not well known and is misinterpreted (Psychology Today, n.d.). There are severe repercussions for this lack of knowledge. Individuals with DPDR sometimes suffer in quiet and confusion for years without receiving a diagnosis. Many people with the disorder are able to "mask" their illness while feeling profoundly alienated on the inside because it doesn't physically alter behavior. Because of the stigma and lack of visibility associated with DPDR, persons may be discouraged from getting treatment or from being taken seriously by friends, family, or even themselves. Raising awareness involves more than just increasing diagnostic expertise; it also entails lowering resentment, granting access to care and support, and recognizing lived experiences. With better education in both medical and public spheres, we can make sure that DPDR is viewed not as an unclear occurrence, but as a real and detrimental mental health disorder that deserves attention, research, and empathy.
References
Love, S. (2024, September 6). The clinic for psychedelic difficulties: where people go when the trip never really ends. The Guardian; The Guardian. https://www.theguardian.com/wellness/article/2024/sep/06/psychedelics-side-effects-risks-clinic-berlin
Raypole, C. (2019, February 1). Depersonalization Disorder: Symptoms, Causes, Treatment & Support. Healthline. https://www.healthline.com/health/depersonalization-disorder
Mayo Clinic. (2017, May 16). Depersonalization-derealization disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depersonalization-derealization-disorder/symptoms-causes/syc-20352911
Psychology Today. (2014). Depersonalization/Derealization Disorder | Psychology Today. Psychology Today. https://www.psychologytoday.com/us/conditions/depersonalizationderealization-disorder
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