Depersonalisation

What is depersonalisation?

Depersonalisation means that you don’t feel like yourself anymore, feeling yourself as strange or unreal, or feeling empty and detached from reality. It might seem as though your mind and body are operating separately from one another.

Depersonalisation may take the form of emotional and/or physical numbing, a sense of watching yourself from a distance or ‘being in a play’, or changes in how you sense things, such as a distorted sense of time.

The difference between depersonalisation and derealisation

Derealisation is slightly different to depersonalisation. Derealisation means experiencing other people, objects, or the world as strange or unreal (eg, dreamlike, distant, foggy, lifeless, colourless, or visually distorted).

Depersonalisation and derealisation can be very unsettling and explaining the experience to others can be very difficult, with a fear of being thought of as ‘mad’ when trying to describe the sense of disconnection and hazy thinking. It can be easy to be convinced that you're losing touch with reality completely.

Temporary feelings of depersonalisation or derealisation can occur when you are under stress, during extreme emotional states or exhaustion, when physically ill, or under the influence of recreational drugs. it's only when these experiences are persistent or keep happening that the diagnosis of depersonalisation-derealisation disorder is used. Episodes of symptoms in depersonalisation-derealisation disorder may be associated with adverse life events or conflicts with others.

Symptoms of depersonalisation

The onset of Depersonalisation-Derealisation Disorder can occur in childhood but more often it starts in the mid-teenage years, with an average age at onset of about 16 years of age. Developing symptoms for the first time after 25 years of age is very rare.

The onset of depersonalisation-derealisation disorder can vary from sudden to gradual, with initial episodes of limited severity and frequency, gradually replaced by symptoms that are more severe and persistent.

Episodes of depersonalisation-derealisation disorder can vary in duration, ranging from brief (hours or days) to prolonged (weeks, months or years). Factors such as emotional stress, anxiety, lack of sleep or recreational drug use can make symptoms much worse. The problem is usually long lasting (chronic) and persistent.

The symptoms of depersonalisation may include:

• Feeling unreal and that you're an outside observer of your thoughts, feelings and your body, as if you were floating in air above yourself.

• Feeling like a robot or that you're not in control of your speech or movements.

• The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton wool.

• Unable to feel emotion and a numbness of your senses or responses to the world around you.

• A sense that your memories lack emotion, and that they may or may not be your own memories.

A common associated symptom in depersonalisation-derealisation disorder is an altered sense of time, such as a feeling of time slowing down or speeding up. There may also be frequent fears of ‘going crazy’, as well as a loss of the sense of ‘ownership’ of some of your personal memories, or reduced emotional responses.

Depersonalisation-derealisation disorder often occurs with other mental health disorders including depression, anxiety disorder, panic attacks, obsessive compulsive disorder (OCD), or phobias, or with a personality disorder.

Causes of depersonalisation

While there is no known single, identifiable cause for depersonalisation, there are some common risk factors associated with it:

• Trauma.

• Severe stress.

• Depression.

• Anxiety.

• Panic disorder.

• Emotional maltreatment in childhood.

• Marijuana (cannabis) use.

• Hallucinogenic or psychedelic use.

Recreational drug use, especially of marijuana or hallucinogens, is a common trigger for depersonalisation and derealisation symptoms. However, depersonalisation-derealisation disorder can only be diagnosed if the symptoms persist beyond the period of intoxication or withdrawal from these substances.

Therefore, depersonalisation can be caused by a range of different factors and each person will have different circumstances leading to their symptoms.

Diagnosing depersonalisation

The diagnosis of depersonalisation-derealisation disorder can also only apply if the symptoms cannot be explained by any other mental health or other problem, or any effect of recreational drugs or medications.

For the diagnosis to be made, the symptoms of depersonalisation-derealisation disorder should result in significant distress or problems with personal, family or social life, and with education or work. If it is possible to function normally, it is only through a great deal of additional effort.

A mental healthcare professional (such as a psychologist or psychiatrist) will make an assessment of your symptoms to see whether they are consistent with the diagnosis. The assessment will include a very thorough history of your symptoms and an assessment of the possible underlying causes of your symptoms.

The assessment for the diagnosis of depersonalisation will also be used to gain understanding of the circumstances leading up to your symptoms, in order to identify potential triggers. In this way, specific ways to target the underlying problems that are driving your symptoms can be considered.

Treatment for depersonalisation

The way you experience depersonalisation and derealisation is specific and unique to you, which is why a personalised approach is most effective in treating depersonalisation. The different treatments can be used in combination.

Lifestyle changes

• Improving sleep patterns.

• Getting enough sunlight exposure.

• Having regular exercise.

• Sticking to a healthy diet.

• Finding ways to relax and reducing stress.

Psychotherapy

Psychotherapy can be very effective for treating depersonalisation, even if you have severe symptoms. Like all treatments, psychotherapy needs to be adapted to the specific needs of each individual person.

Sometimes the type of psychotherapy needs to be changed between being supportive when symptoms are particularly difficult to deal with, and then more dynamic when symptoms are much less severe.

Therefore, during times of severe difficulty with depersonalisation symptoms or severe depression and anxiety, supportive interventions (crisis interventions and reinforcing coping skills and strategies) are usually the most appropriate.

During periods of relatively mild symptoms a more dynamic (psychodynamic) approach, such as cognitive behavioural therapy (CBT), may be used, focusing on self-reflection and self-evaluation, to explore effective coping strategies and relationship patterns.

Medication

There is no recognised medicine to help treat depersonalisation. However, there is some evidence to support the use of selective serotonin reuptake inhibitor (SSRI) antidepressants, and more recently the combination of a medicine called lamotrigine with an SSRI has shown some benefit.

What is the outcome?

The outcome for derealisation and depersonalisation is often good. A large number of people get better with time and others respond well to treatments, particularly to psychotherapy.