Dissociation occurs when the conscious mind attempts to block out troubling thoughts, painful memories of stress or trauma, or parts of the identity that are difficult to incorporate into present reality (Keltner, 2019). During an episode of dissociation, there will be a disruption in how memories, thoughts, experiences, emotions, sense of identity and behavior are perceived and recalled (Potter, 2020).
Depersonalization is a response to stress or trauma where feelings of altered reality create detachment from the self (Keltner, 2019). Specific aspects of the self, including feelings, thoughts, actions or body parts, are separated or split out of body, as if being observed from a distance (DSM-5).
Derealization occurs when someone experiences their surroundings as unreal or detached, as if in a bubble, fog, haze or otherwise visually altered. The outside world may feel dreamlike or it may feel empty or lifeless (DSM-5). Some sights and sounds may be distant, blurred or muted, others may have higher resolution or appear closer or larger (Keltner, 2019).
Signs and Symptoms of Depersonalization and Derealization
Dissociation is the physical state of being disconnected from ourselves or our immediate environment (King, 2012). Dissociative symptoms may include intrusive thoughts and behavior, loss of subjective continuity, loss of ability to recall historical narrative beyond normal forgetting, and loss of cognitive function that should otherwise be available (DSM-5).
Altered consciousness, blunted or high acuity emotions, and changes to motor control and body tension may also occur (Keltner, 2019).
Origins of Depersonalization and Derealization
Symptoms of dissociation, depersonalization and derealization typically develop after prolonged stress or a traumatic event (Myers, 2020). The psychological function of dissociation is to protect ourselves physically and emotionally from a traumatic event or extreme, overwhelming stress (King, 2012).
Acute stress and post traumatic stress both cause dissociative symptoms, and temporal or physical proximity to the trauma may exacerbate the condition (DSM-5). Transient symptoms that last hours to days are considered common, with at least half of the United States population expected to experience such symptoms at least once in their life. These minor episodes will not likely warrant treatment (DSM-5).
The more severe manifestations of dissociation symptoms, specifically dissociative identity disorder, often develop in response to prolonged early childhood abuse (Potter, 2020). Dissociative identity disorder is characterized by two or more distinct personality states, and may be considered as a possession by some cultures (DSM-5).
Prevalence of These Conditions in the United States
While symptoms of dissociation are considered to be a fairly common response to stress and trauma, clinically dissociative behavior is considerably more rare (Myers, 2020). Depersonalization and Derealization Disorder have an estimated 0.8% to 2.8% lifetime prevalence. Dissociative amnesia has an impact on an estimated 1.0% of males and 2.8% of females in a given year, and dissociative identity disorder impacts an estimated 1.5% of the general population in a given year (DSM-5).
Long Term Health Impact of Depersonalization and Derealization
Dissociative symptoms often co-occur with a number of other trauma related symptoms, and feelings of confusion, guilt and embarrassment are common (DSM-5). Without treatment, the dissociative state may be prolonged or may increase in severity, and may lead to an increased risk of depression and anxiety (Michal, 2016).
Because depersonalization and derealization cause changes to perception and memory, experiencing this state can mask symptoms of other psychological conditions and reduce treatment effectiveness (DSM-5).
Strategies to Overcome Depersonalization and Derealization
Treatment for depersonalization and derealization begins with stabilizing physical and emotional symptoms. For information on how we can stabilize ourselves in the moment, click here.
Once stable, the traumatic experience is processed, and daily functioning is assessed and enhanced (Keltner, 2019). Processing the trauma includes confronting the reality of the traumatic event, establishing its meaning, and incorporating the trauma into the identity. One strategy that can aid in this process is cognitive behavioral therapy (CBT). For more information on CBT, click here.
Our ability to function day-to-day is enhanced by learning ways reduce time spent in depersonalized and derealized states. This involves connecting with ourselves and our surroundings, and learning coping strategies that work for us (Mayo Fndn, 2017). For more information on adaptive coping strategies, click here. For more information on mind/body connectedness, click here.