What is depersonalization-derealization disorder?
Why does it happen?
That's what I'm going to be talking about today.
I'm Dr. Tracey Marks, a psychiatrist,
and I publish weekly videos on mental health
education and self improvement.
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Today's video is based on several viewer questions.
JaztheZ says, can you make a video about
derealization and depersonalization.
SadieGirl says, hi doctor,
could you do a video on
depersonalization-derealization please.
I came off medication and now have it.
Sadly, it's been almost two years,
and it hasn't left yet.
Then someone who will remain anonymous
described her experience like this.
I somehow got stuck in my mind.
It was kinda like my physical self was in my mind
and I was not able to get back into my physical body.
I was swerving on the road without knowing it for a bit,
and driving slow then fast at times,
almost out of control because I could not
physically get back into my body.
(horror music)
Obviously I was freaking out and I kept
telling myself I needed to get back into
my physical body and out of my head,
like I could visually see myself in my head
floating around not being able to get into my body.
I go home safely but was still out of it for a bit.
I was kind of light feeling,
and could feel my soul being put back
into my physical body.
Then the light feeling went away
and I was present again.
I think you can get a sense from her description
what this is like.
Depersonalization is defined as feeling
unreal and detached from your body's thoughts
and sensations and actions.
It's like you're observing yourself in your thoughts.
Things don't seem real.
Some examples of this are looking in a mirror
and not recognizing yourself,
or seeing yourself as an observer in the room.
But you can also feel a distorted sense of time
as if things are moving slower,
or you can feel physically numb.
Derealization is defined as feeling
unreal and detached but this time it's
with respect to your surroundings
and your environment.
And in this case you aren't looking at yourself
or feeling out of body,
but your environment doesn't seem real.
It might seem like you're in a dream,
like it's actually foggy,
even though when we dream it's generally not foggy.
But that's how we think of dreams.
You can also feel like you're looking at things
through a glass or you have tunnel vision.
You can also feel like the things that
you're looking at are distorted.
I had someone tell me that it's like
the world is tilted like this.
For depersonalization-derealization disorder,
you can have either of these or both,
and it's a psychological disturbance all on it's own.
It can be due to something else like medication
or an illness.
Another key feature of this is that you are able to know
what's real and what's not real.
We call this reality testing.
So you have the experience but you're aware
that your surroundings,
you're aware of your surroundings
and you know that what you're feeling is not normal.
Our diagnostic manual doesn't put a period of time on this
but we generally would call this
depersonalization-derealization disorder
if you had these symptoms for at least a month,
so it's not something that's just fleeting.
Some people though will have it pop in and pop out,
but some people will experience it all the time,
to the point where they feel like they've
lost themselves or they're dead inside.
Depersonalization-derealization disorder
tends to start in adolescence or early adulthood,
and it would be very unusual for someone
to have this disorder for the first time
in their forties or fifties,
unless the symptoms are the result of something else.
So this brings me to the next point,
there are other things that can cause
derealization or depersonalization symptoms
where it's not a separate disorder.
And so you can have these symptoms just come and go.
Some things that can cause this are drug use.
Marijuana is a big one.
Check out this video on marijuana
and its effect on the brain.
This can also happen though with medications
such as antidepressants.
Sometimes it can be subtle,
I did a video on emotional blunting
with antidepressants and I'll like that
in the corner as well as in the description.
But this flattening feeling that you
can't express yourself fully is a subtle
for of depersonalization.
It's an isolated symptom though
that can be related to the medication use,
and so it doesn't mean that you have this
depersonalization-derealization disorder.
I had a patient tell me that
when she didn't take her depression medication that
the colors in her environment looked dull.
Then when she took her medications everything became
brighter and sharper.
That's an example of derealization due to depression.
In this case, she experienced the derealization,
or the dulling of colors when she was depressed.
You can also see this with medication withdrawal.
I did a video on brain shocks with antidepressants
and sometimes part of the withdrawal can be
either one of these symptoms
not the brain shocks but these
derealization or depersonalization symptoms
and that's what SadieGirl was talking about
in her comments.
Now SadieGirl says she's been dealing with this
for two years, and one possibility, Sadie,
is that you have depersonalization-derealization disorder
that's not related to the medication.
Another possibility is that your depersonalization
and or derealization symptoms are a part of
depression that has come back now that
you're off medication.
Of course these are just thoughts off
the top of my head with the little information that I have,
but it is something to think about
and talk with your doctor about.
So you can also experience either of these
symptoms with not only depression but
with anxiety disorders like panic disorder,
and obsessive-compulsive disorder.
It can just be another symptom that goes
along with these problems.
It can also be present with personality disorders
like borderline personality disorder
and avoidant personality disorder.
Then lastly, you can also experience this
from medical problems, like seizures, or multiple sclerosis.
These are just a couple of examples of illnesses
that affect your brain.
What do we do about this?
If you have these symptoms from another disorder,
then the focus of treatment is on the other disorder
because you can kind of think of
depersonalization and derealization in this context
as tag along symptoms of these other disorders.
Sometimes though, if they become prominent enough,
like in the case of SadieGirl,
you could address the symptoms separately
as its own disorder.
If you have the disorder,
sadly we don't have a lot of sure-fire treatments.
But rest assured that as bizarre
as some of the experiences are,
they're not just a starting point
for a more serious mental illness.
And it's not gonna turn into a full blown
psychotic episode.
Also as physical as they seem,
they're not a sign of a brain disorder.
These are some of the concerns that
people have about this.
Some therapies have been shown to be helpful,
such as Cognitive Behavior Therapy
and Hypnotherapy.
These are specialized therapies usually
delivered by a non-physician therapist.
Cognitive Behavior Therapy tends to work better
though for people who have anxiety with their symptoms.
As for medication, medications that we can use
for this are selective serotonin reuptake inhibitors
but there hasn't been a lot of robust studies
showing their usefulness.
And these are antidepressants like Zoloft and Lexapro.
We've also used lamotrigine also called Lamictal,
and now Traxone which is a medication
used to help people get off opioids.
If someone has a lot of anxieties
sometimes the benzodiazepines are helpful.
That's depersonalization-derealization disorder.
Leave me a comment about your experience
and what's helped you with it.
I like hearing from you,
and your comments also help others.
Like the video if you like it,
and see you next time.
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