Depersonalization Derealization Therapy

Depersonalization Explained

By: 2SC Staff

Depersonalization (also referred to as derealization) is a common reaction among those who live with anxiety and experience panic attacks. The symptoms of depersonalization are difficult to describe because they can be so insidious. If you have ever had the sensation that what is happening to you isn’t real during a time of panic, you know how strange and disturbing the experience can be.

This article will offer a working definition of depersonalization and offer facts about this condition that you might not know. I have tried to remove as much of the clinical jargon as possible as a way of cutting to the chase.

Ready to learn more about depersonalization/derealization? OK, let’s jump right in!

Depersonalization: What is it?

Depersonalization can be defined as having the feeling that you are detached from your body while observing yourself. This is why depersonalization is also referred to as derealization because it can seem like what is happening isn’t real – almost like you are watching a movie or in some type of dream.

Quick Facts on Depersonalization

• Women experience depersonalization at a rate of 2x more than men.
• Approximately 200,000 people experience an episode of depersonalization every day in the United States.
• Clinical studies suggest the onset of depersonalization happens at age 16.
• Combat veterans are 2x more likely to have an episode of depersonalization than their non-combat counterparts.
• The experience of a severe life trauma increases the likelihood of depersonalization.

(Source: Health Research Funding – HRF, 2015).

Depersonalization Example:

A client of mine named Clint recently shared with me his experience of depersonalization while walking over the Michigan Avenue Bridge full of passersby in Chicago during the lunch hour.

When describing his experience, he said everything was going just fine when suddenly he felt detached from his surroundings. He started to experience a panic attack and wondered if he was still attached to his body. “I could see myself and it freaked me out,” he said, “like I was watching a slow motion movie.”

Other Descriptions of Depersonalization

What follows are several examples of depersonalization that clients have shared with me over the years. I’ve left out any identifying information. Can you relate to any of these?

Janet

I’ve suffered from social anxiety disorder all my life. When I get into super crowded situations, the symptoms of things not feeling real starts to kick in.

I get confused and my neck starts to get hot. It’s like someone flipped on a switch and suddenly I’m watching myself on a projector screen. The weird thing is I know what’s happening because I feel my heart racing.

Bob

I’m embarrassed to share my experience with depersonalization but here it goes. It usually happens to me from out of the blue, like when I go to the bathroom to brush my teeth. I’ll look in the mirror and suddenly get the feeling: Is this real? I go numb inside with a stark nothingness. It usually takes me a few moments to bring myself back into the moment and “reattach”. It is only later that I realize that I was having a panic attack.

Crystal

I work in a high rise office building in the Loop. There have been times that I have waked past a window while looking at the skyline and slipped into bodily disconnect. I start to get tunnel vision and can feel my heart palpitating. It’s almost as if I am floating outside of myself and watching what I am doing at the same time. Nothing seems real when it happens.

Tommy

My depersonalization is very much connected to my OCD and panic attacks. The more I try to compensate for not feeling in control, the more I start detaching from my body. Try having this experience when you are flying on a plane at 30,000 feet. Do you know what it is like to see yourself sitting in a seat while zooming through the air at 530 miles an hour? It feels like it takes forever for me to reconnect with myself.

Beverly

I am one of those people who have a mixture of anxiety and depression. When the depression part kicks in, I am more prone to depersonalization, according to my therapist. The way it comes up in me is through distortions of time.

Here, I talking about feeling like things that happened just yesterday occurred 100 years ago. Time itself slows down dramatically, almost as if I am in a different universe. On a rational level, I know this isn’t “real” but that is how it feels.

Other Symptoms of Depersonalization

There are a number of other symptoms that can be associated with episodes of depersonalization. These include:

• Feeling robotic as if you are not in control of your movements or speech.
• Feeling like you are floating above yourself as an outside observer.
• Difficulty experiencing emotions when thinking about memories from the past. You may wonder if these are really your memories at all.
• Distortions of body parts; feeling like they are enlarged, shrunken.
• Distortions of time and space or both.
• Suddenly feeling “blank” inside, devoid of emotions.

What Causes Depersonalization?

We don’t know the exact causes of depersonalization-derealization. The research suggests that it commonly occurs among people with anxiety.

On a bio-physical level, there is some evidence to suggest an imbalance of neurotransmitters, which sensitizes the brain to increased states of stress. Some have hypothesized that this is the brain’s way of protecting itself from harm or coping with a past trauma.

Here are some additional potential reasons that depersonalization can happen:

• Post-Traumatic Stress Disorder or PTSD (see our post on PTSD)
• Severe psychological/emotional trauma from the past.
• Intense periods of stress related to work, finances or relationships.
• The sudden loss of a loved one through an accident or suicide.
• Individuals who report being highly empathic.

Depersonalization happens when people are also living with a mental health condition, such as depression and/or anxiety.

And it goes without saying that use of certain substances, such as hallucinogens, amphetamines and benzodiazepines can bring about the onset of a derealization episode. Prescription meds also have been known to cause distortions in reality.

Depersonalization: Visiting Your Doctor

The most important thing you can do if you are experiencing episodes of depersonalization is to make an appointment with your medical doctor. The reason you will want to visit your physician is to find out if anything is physiologically or bio-chemically is going on inside of you that is causing you to detach.

Here are some things you should write down to help your doctor better understand your situation:

• Advise when the symptoms first started to happen
• Let your doctor know if your symptoms are recurrent
• Be ready to describe the intensity of your symptoms
• Jot down what makes things worse or better
• Inform your doctor of any other medical conditions
• Advise your doctor of any medications you are taking
• If you use recreational drugs or drink alcohol, disclose this material fully. Don’t be embarrassed and know that it is vital you share the type, use and frequency of the substance(s).

Your doctor will likely conduct a number of tests to rule in or rule out potential causes for your depersonalization episodes. She/he will probably synthesize your symptoms with other issues happening in your life in order to get an accurate clinical picture.

It is possible that in your doctor’s best judgement, you may benefit from taking certain prescribed medications. What those meds might be will largely depend upon an official diagnosis.

Common medications prescribed include:

• Anxiolytics
• Anti-depressants

Before you taking any prescription drugs, particularly for depression or anxiety, we encourage you to read our 7 things to do before taking depression medications.

Depersonalization Anxiety Related Treatment Options

One of the primary treatment options for anxiety related depersonalization episodes is counseling, commonly referred to as talk-therapy.

One of the things I work with clients on is helping them to better understand what they are feeling and experiencing. The goal is to figure out ways to work through and minimize the effects of derealization without making it overly complicated.

Here are a few approaches I use as well as other therapists here at Chicago’s 2^nd Story Counseling:

• Identification of specific triggers, such as people, places or things.
• Mindfulness based therapies that focus on the here and now.
• Cognitive behavioral therapy as a way of working through common thought distortions (see post on common thinking distortions).
• Deep breathing exercises with a mindful focus.
• If substance abuse is part of the mix, counseling around use.
• If a substance abuse disorder problem is apparent, referrals are offered for treatment and recovery.
• When necessary and with the client’s permission, working with your medical doctor or psychiatrist to coordinate care.

Depersonalization Depression Related Treatment Options

If your depersonalization is more of a function of your depression, similar approaches as described for anxiety are used. The focus shifts a bit, however, with an eye on episodic patterns of depression and situational manifestations.

Depersonalization and Panic Attacks

As you already know, depersonalization is a common feature among those experiencing panic attacks. There is a three step process to work through a panic attack that many help you:

1) Acknowledge and Accept

Acknowledge what is happening in the moment and accept it. Don’t try to deny you are having a panic attack. Doing so will only give your fear more power. Take a few deep breaths during this step.

2) Focus on the now

Using all five of your sense, ask yourself: “What am I aware of?” The goal here is not to push racing thoughts out of your mind. Instead, the idea is to incorporate the real things happening all around you.

For example, do you hear cars? Do you feel the cool wind blowing on your skin? Do you see clouds in the sky? Do you smell flowers in the distance? Does your mouth taste anything? Focus in these as a way of centering yourself in the moment.

3) Reengage with the environment

In this final step, the goal is to try and engage with the people and things that are around your immediate environment. This means talking and touching. For example, if you are at work, strike up a conversation with a coworker. If you are in a supermarket, touch a magazine and glance at an article. Again, the idea here is to refocus yourself in the here and now.

If you want to learn more about how to work through a panic attack, I encourage you to watch this brief video on how to stop a panic attack.

Depersonalization Book

If you are interested in learning more about depersonalization and its relationship to anxiety, I highly recommend the book: Feeling Unreal.

What I like about this read is how the authors present first-hand accounts of what it is like to depersonalize. This can help to universalize your experience so that you feel less alone and avoid isolating.

Final Thoughts

If you have experienced episodes of depersonalization, know that you are not alone. The research is all over the map but there is some evidence to suggest 50% people living in the United States will experience at least 1 episode of depersonalization.

If you are interested in getting support, guidance and help around your struggles with depersonalization, I encourage you to first talk to your medical doctor in conjunction with a talk-therapist.

There are very concrete things you can do to create positive change in your life, particularly when stress, anxiety and depression are contributing factors.

I hope you found the material presented in this article useful!