DPDR refers to a feeling of disconnection from yourself and the world around you.

Like you're seeing yourself from outside your body, or you feel like things around you aren’t real. One of the most common descriptions is feeling like there’s a pane of glass between you and the world.

It sounds scary, right? Well actually, these types of feelings are extremely common. They’re part of your body and brain’s correct and natural response to stress and anxiety, and people experience them (briefly) all the time. 

Think of someone who’s been involved in a car accident or a house fire. When they describe it afterwards, they’ll very often mention feeling “like it wasn’t really happening” or “like it was a dream” or “like I wasn’t really there”.

What they’re describing are the feelings of DPDR kicking in at the correct time, when you actually are in physical danger. It’s part of your brain’s flight or flight response. It’s the mental equivalent of heart palpitation and muscle tension.

Think of it like a temporary protective barrier that your brain puts up between you and the world around you, to stop you from being overwhelmed by the experience.

It’s sometimes referred to in psychology as “the airbag of the mind”. And it’s estimated that up to 75% of people will experience it at some point in their lives. In fact, there’s a good chance that you’ve experienced it before!

And for most of those 75% of people, the feelings of DPDR fade away and stop relatively quickly as they get away from the situation that triggered it. Just like all the other symptoms of anxiety do: your muscles relax, your heartrate gets back to normal, etc etc.

But, what can sometimes happen is that we can *focus* on those feelings of disconnection while they’re happening, and panic that they mean that something is wrong. You might worry that the feeling of disconnection means that you’re dying, that you’re stuck in a dream, going crazy etc.

This is much more likely to happen in the context of a panic attack, when there is no physical danger around. There’s no car crash or wild animal chasing you, nothing you can attribute the feelings to, and so the focus and the panic turns inward.

And remember that that’s all DPDR is: an anxiety-based condition.

And just like agoraphobia and claustrophobia, it’s not pleasant but it’s temporary and harmless. It doesn’t matter what caused it or how long it’s lasted: It’s still just a feedback loop between anxiety and the symptoms of anxiety.

It’s not permanent, it can't hurt your loved one and it won’t turn into anything worse. Your loved one can and will recover.

Now, with all that said, Depersonalization / Derealization Disorder is no picnic. It can be a very frightening experience, especially at the beginning, when your loved one has no frame of reference for what they’re experiencing.

The bizarre feelings of disconnection, combined with the racing, catastrophic thoughts that come with anxiety, can be absolutely overwhelming.

Your loved one may have described to you or is experiencing symptoms like the following:

 

Feeling like... there’s a pane of glass between them and the world

Like they’re not real

Like they don’t recognise themselves in the mirror

Like they’re on autopilot all the time

Familiar people and surroundings can feel strange and unrecognizable

Feeling like they’re living in a dream

Feeling like their vision is somehow off

Feeling like time is distorted or fragmented

Feeling like they’re watching themselves from outside of their body

Things just look ‘strange’

 

They may experience other symptoms like:

Existential thoughts, about the nature of reality and the universe

Floaters / Visual Snow

Static / Fuzzy Vision

Repeated / Ongoing Feelings of Deja Vu

 

They may experience some of the common fears that happen with DPDR, such as:

Fear that they're going insane

Fear that reality is slipping away

Fear that they don't really exist

Fear that they have died or are in purgatory

Fear that they have brain damage

Fear that they have developed schizophrenia or psychosis

Fear that they're going to fade away or disappear

Fear of social settings like school and work

Fear of brightly lit places like malls and supermarkets

They may also experience symptoms common to all anxiety-based conditions:

Light sensitivity

Feelings of exhaustion

Memory problems and difficulty concentrating

Muscle pain, often in tension points like shoulders and neck

Loss of appetite

Weight loss

Disrupted sleep and bad dreams

But what IS an anxiety disorder? How is it different from normal anxiety?

Normal day-to-day anxiety is perfectly natural, and it’s a part of life.

An anxiety disorder, on the other hand, is typically based on obsessive, catastrophic thinking. It tends to focus obsessively on a specific element, environment, experience or feeling; in this case, the feeling of disconnection that happens with DPDR.

It persists even when there’s no obvious reason for the anxiety to be there, which in itself is quite scary. It can feel difficult to control, and can impact your ability to enjoy and participate in day-to-day life.

But my loved one doesn’t seem anxious?

Well, remember that we do often have preconceived notions of ‘anxiety’. You might think that anxiety manifests as someone pacing the room, biting their nails, jumping out of their chair. That’s very rarely how it is!

For most people with an anxiety-based condition like DPDR, it can often be hard to tell that anything is wrong, at least at first glance. They look ok, they sound ok, they can watch TV, cook a meal etc. They may just seem distracted, unable to focus, maybe not eating or sleeping as well as they usually do.

But often, with anxiety-based conditions, those are just the signs that you can see. The anxiety is like an iceberg. The struggle is still happening, but it’s mainly underneath the surface. And it can be a struggle.

Constant feelings of disconnection, intrusive thoughts etc can be exhausting and difficult to deal with, even if they’re not manifesting as observable behaviours.

Why did it happen to them, and not someone else?

Well, there may be some genetic and environmental factors at play, but essentially, it’s quite random.

It’s the same as asking, why did that person have a panic attack and not that person? A better way to look at it is this: Panic attacks happen, anxiety-based conditions happen.

In fact, 1 in 3 people will develop an anxiety-based condition at some point in their lives. They’re super common, and people get them and recover from them all the time. You don’t need to figure out the exact reasons how and why it happened to a particular person in order for that person to recover.

Is this my fault? Could I have prevented this?

This is nobody’s fault! It happened because of a panic attack, or accumulated anxiety. Panic attacks are the most common thing in the world. If you go through life without having a panic attack, you’re in a very lucky minority.

And again, 1 in 3 people will develop an anxiety-based condition at some point in their lives. These experiences and conditions are extremely common. Assigning blame for them simply doesn’t make sense.

Is there some trauma, hidden or otherwise, that’s causing this? 

This is a very common misperception about anxiety-based conditions. The experience feels so massive and overwhelming that we assume it has to be the result of some awful event in the past. It doesn’t have to be that.

Again, it was triggered by a panic attack (or accumulated stress), and people get panic attacks for all sorts of different reasons: Because they’re stressed out at work, they’ve drank too much coffee, they haven’t been sleeping properly.

Again, panic attacks are the most common thing in the world and they can happen for the simplest, most innocuous reasons. You don’t need to try and find another hypothetical reason to explain it.

To be clear: If there is definite, serious trauma in the past that you’d like to address, please make sure that you do. But past trauma is not a prerequisite for a panic attack or an anxiety-based condition, and unpacking a traumatic past is not a prerequisite for addressing current symptoms of anxiety.

All of this lack of clarity and underdiagnosis has led to a lack of research into and awareness of DPDR in the medical community over the last few decades. 

But with that said, awareness of the condition is growing quite quickly. And I predict that in the near future we’ll get to a place where somebody with DPDR will get diagnosed and on the road to recovery as quickly as someone with agoraphobia, social anxiety disorder, etc etc.

Can DPDR turn into something worse? 

No, it cannot. Anxiety is not a pleasant experience, but it’s also self-contained.

It’s not going to turn into something worse, or trigger any other condition. It has nothing to do with say, schizophrenia, dementia or any other organic brain condition and it’s certainly not going to develop into those.

That’s like worrying that a panic attack is going to trigger Multiple Sclerosis. That’s not how anxiety works, and it’s not how the brain works.

So what I always say is this: If your loved one is experiencing depression, the strong likelihood is that it’s happening as a result of the anxiety and DPDR, and how frustrating and persistent it can feel. And the other strong likelihood is that as they address and recover from the anxiety, the depression will also fade away and stop.

The worst case scenario is that when they recover from anxiety and DPDR, which they can and will do, that the depression somehow persists. But even if that unlikely situation comes to pass, depression is absolutely treatable, and they will absolutely be able to address it separately.

And of course if you're feeling particularly depressed or distressed, please don't hesitate to speak to a medical professional.

But even if they do recover, what’s to stop this coming back in a year’s time? Or 10 year’s time? 

Fortunately, that’s not how recovery works! 

Remember that the reason this turned into a problem in the first place was a misunderstanding of what the symptoms were and what they mean. It was focusing on feelings of disconnection, panicking that they meant that something was wrong, and generating a feedback loop of anxiety.

Part of recovery is understanding what those symptoms actually are: a common, temporary and harmless defence mechanism.

And in understanding it properly, we prevent that feedback loop from ever starting up again. Read this article for more information.

Are there specific treatments or therapies that are effective for Depersonalization Disorder?

Cognitive Behavioural Therapy and Acceptance and Commitment Therapy are two approaches proven to be very effective for all anxiety-based conditions. Currently there aren’t any specific medications that address DPDR; but only in the sense that no medication can target a specific fear or habit of thought.

However, SSRIs are often prescribed for anxiety-based conditions, and can be very effective in reducing the symptoms. But it’s a good idea to think of medication as a helping hand on the recovery journey, as it’s still necessary to train yourself away from the habits. 

Should we speak to a therapist? 

If you want to speak to a medical health professional, please don’t hesitate to do so. I would recommend finding an anxiety specialist if possible as they will likely be more familiar with DPDR. They’ll also be able to answer any questions you have about medication.

So what can I do to help my loved one recover?

The onset of anxiety and DPDR probably felt quite frightening and disruptive. For me, my whole life was put on pause for a long time. 

But this is important: You want to help your loved one gradually get back to living a normal life.

It’s important to acknowledge that your loved one is going through something difficult. But remember aswell that DPDR, like all anxiety-based conditions, is essentially a habit of thought. Part of recovery is replacing that anxious habit with a new one, and giving the body and brain enough space to let the old one go.

For your loved one, an important part of recovery is living life as if they didn’t feel anxiety. Why is that important? Because doing so demonstrates to the brain that it doesn’t need to have anxiety around anymore. 

Now -- that doesn’t mean that you need to immediately go on a 6 week road trip to prove a point! But you do need to start moving towards normality. If that’s taking a short trip down to the shops together, that’s fine.

And then a few days later you go to the cinema, that’s ok. But make sure that you’re making consistent progress, however slowly, and consistently building on it.

Is it ok to ask them how they’re doing? 

Yes, of course, but also, within reason. What you want to avoid is persistently asking them about anxiety, or getting into long-form conversations about anxiety and DPDR. 

To be clear: It’s important for both of you to be honest  about what’s happening and how they’re feeling. And if your loved one tells you they’re having a tough day, that’s ok. You can acknowledge that and address it if necessary.

But also, be constructive. Talk about what you and they are doing that day.

Make plans. Move forward. Again, be constructive, move towards a normal daily schedule and build on your progress consistently.

What should I avoid doing or saying that might worsen my loved one’s condition?

What you don’t want to do is start walking on eggshells all the time. You don’t want to start treating your loved one like they’re debilitated or they can’t live life as normal.

Again, it’s important to acknowledge what’s happening, but you don’t want to treat your loved one with kid gloves all the time, being overly cautious about what you say and do. 

All that communicates that anxiety / DPDR is very important and deserves everyone’s attention. That it gets to determine everyone’s plans for the day. It doesn’t deserve any of that.

Here’s a good way to think about it: Anxiety requires our attention in order to exist. Our attention is anxiety’s oxygen. So what you and your loved one should both be aiming to do is give anxiety less and less of that oxygen over time.  Again, you don’t need to immediately force everything back into place -- but just make sure that over time you’re both making small incremental improvements towards normality.

To Recap:

Depersonalization / Derealization Disorder is an anxiety-based condition. The symptoms sound scary, and they are certainly scary for the person going through them, especially at first. But they’re also super common, harmless and temporary. It’s not going to turn into anything worse and they can and will recover.

When speaking to your loved one, it’s important to speak honestly about the condition and how they’re doing, but try to avoid getting into long conversations about it. Focus on being constructive instead of constantly raking over or researching different symptoms and frustrations. 

Avoid constantly walking on eggshells or treating your loved one with excessive caution. It's ok to acknowledge their situation without letting anxiety and DPDR dominate daily life and conversations.

Strive to gradually reduce the attention given to anxiety, aiming for incremental progress towards normality. Remember that you’re both aiming for with recovery is to incrementally get life back to normal.

Make that your aim, and be focused and committed. But also, be patient and compassionate. There will be ups and downs along the way, and that’s ok. That’s part of the recovery process.

And yes, your loved one can and will recover, 100%!