Understanding and Treating Depersonalization and Derealization

Imagine the feeling of being under water, trapped in a hole, being aware that you are speaking to your loved ones but unable to fully perceive or emotionally connect with them.  Imagine living a life where you are fully aware that you used to have emotions but now feel blunted.  Combine this with the feeling that you are somehow separate or distant from your experience and/or your own body.

I am a therapist who treats this experience.  It's name: Depersonalization-derealization disorder DPDR.  I am also someone who once experienced this due to Lyme disease. I once described it as watching life through a straw. It is one of the more terrifying experiences I have personally ever had in my life.


An individual suffering from depersonalization may experience:

  • Detachment from emotions

  • Distorted body image

  • Difficulty recognizing their own reflection

  • Loss of sensation in parts of the body

  • Feeling unreal or like a spectator in their own lives

Sufferers of derealization may experience:

  • Feeling detached from their surroundings

  • Feeling that general life events are unreal

  • Perceiving objects as changing in shape, size or color

  • Feeling that people they know are strangers

  • Feeling that environments they know are unfamiliar(1)


There isn't a ton of research exclusively done on DPDR. This is because mental health providers believe it s a symptom of another mental or physical illness such as anxiety or brain injury like epilepsy. There is no single known cause of DPDR, however it is generally understood that periods of severe stress or trauma as well as substance abuse can trigger DPDR.(2)

The National Association of Mental Health (NAMI) states: 

Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.



The literature tells us that there basically is no known, consistent , effective treatment for DPDR.  However, there have been some examples of things that have worked for some people. The best tools therapists have to work with and treat DPDR revolve around the possibility the scenario in which DPDR is brought on by severe anxiety and trauma. In this case, there has been some success with Trauma Focused Cognitive Behavioral Therapy (TF-CBT). This involves taking a look at and slowing down the thoughts, feelings and emotions we are having on a daily basis that could be keeping us in a place of elevated stress.  

Another option is assisting those who have chronic DPDR to live with the experience, much like chronic pain.  Treatment like this includes mindfulness based interventions including breathing, meditation, journaling, and body oriented therapies such as yoga therapy and creative therapies.


The literature on effective medications for DPDR is also pretty inconsistent. I am generally not a practitioner that advocates for the use of pharmaceuticals right away, however, if someone has struggled with DPDR, I find that testing medications can be an indication of which direction to go in all aspects of treatment. 

A small study conducted on 14 clients showed a reduction in symptoms of DPDR in in 4 patients with the use of Naltrexone.(3) There has also been some evidence that Lamictol as an addition to therapy couldreduce symptoms of DPDR.(4) It may be helpful to find a therapist and psychiatrist who are willing to experiment with some combination of medications and therapies.  

Finding answers to complex medical and mental health issues can be very frustrating, overwhelming and leave us feeling defeated.  I propose we take a step back, find a way to find relief right now, in the moment, with DPDR or not, then put together a plan to continue searching for answers. I fully understand if this were something I lived with on a daily basis it would probably be impossible to just say I could not recover.  I would want answers and I would keep trying.  However, just like chronic pain, I would not want to deprive myself of the present moment just because it's there. 

If you are seeking answers to DPDR or other chronic mental pain, please contact a healthcare provider today. Some options: 

In need of emergency support: National Suicide Prevention Hotline 1.800.273.8255

A little Relief from DPDR: YouTube Video "Tapping to Reduce Depersonalization" - https://www.youtube.com/watch?v=4ANHr_T7GpA

Ongoing Therapy in NYC or Online Counseling in New York State: My office 347.994.9301



1. Theravive. https://www.theravive.com/therapedia/depersonalization-or-derealization-disorder-dsm--5-300.6(f48.1)

2. Simeon, D. Depersonalisation disorder: a contemporary overview. CNS Drugs. 2004;18(6):343-54. Cited at: https://www.ncbi.nlm.nih.gov/pubmed?term=15089102 Date Accessed: 04/01/2017

3. Simeon D, Knutelska M. An open trial of naltrexone in the treatment of depersonalization disorder. J Clin Psychopharmacol. 2005;25(3):267-70.

4. Sierra M, Baker D, Medford N, et al. Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases. Clin Neuropharmacol. 2006;29(5):253-8.

Ruschelle KhannaComment