Derealization Disorder- Causes, Symptoms, and Treatment.

What Is Derealization Disorder?

Derealization disorder or depersonalization-derealization disorder (DPDR) is a mental disorder wherein the person has persistent or recurrent episodes (feeling) of disconnection or detachment from one’s self or surroundings. It is disorder in which the individual reports a feeling of experiencing or observing their own self, body, or thoughts like an outside observer with a loss of control over their actions (movements) or thoughts. Depersonalization disorder is often a result of childhood abuse or children coming from a damaged home. Those suffering from the disorder could be in a state of detachment ranging from a few seconds to a few minutes (duration similar to a panic attack). However, in certain cases, this state of mind can last for a few hours, days, and in the worst of situations, even weeks.

Diagnostic criteria for depersonalization disorder include episodes of detachment. Brief episodes of the disorder are commonly observed in the general population, but a chronic form of the disorder is observed in people with a history of anxiety and depression, causing a rift in the personal and professional life of the person suffering.

What Causes Derealization Disorder?

The causative factors of derealization disorder have been proven to be stress and anxiety. However, some other trigger factors to have caused derealization disorders are:

• History of being emotionally abused (emotional trauma).

• Positive history of domestic violence.

• Having a severely impaired (physically or mentally) or ill parent.

• Positive history of deep trauma (death of a family member or close friend).

• Stress (linked to personal, financial, or professional).

• History or present symptoms of depression.

• Illegal elicited (recreational) drugs (such as marijuana, hallucinogens, or side effects of other medications).

• Positive genetic factors.

• Fear (may be logical or illogical as in the case of phobia).

• Specific personality traits (such as difficulty accepting or denying or borderline personality disorder).

• Panic attacks.

• Psychosocial disorder (such as dissociative disorder).

• Post-traumatic stress disorder (PTSD).

• Major depressive disorder (MDD).

• History of seizures, dementia, and amnesia.

• A positive diagnosis of schizophrenia (or symptoms of schizophrenia).

• Defense mechanism (a way to micromanage stress and anxiety).

What Are the Symptoms of Derealization Disorder?

Episodes of derealization are often brief, which depicts that the symptoms are acute in onset, and they come and go. Symptoms of derealization disorder are:

1. Confusion about being in a dream.

2. Foggy mind.

3. The surroundings appear to be fake or lifeless, too loud or mute, too big or small.

4. A deranged sense of time seems either the time has sped up, slowed down, or is at a standstill.

5. Feeling like an outside observer (of thoughts, body, or actions).

6. Feeling out of control about speech and movements.

7. Anxious feeling about extremities or body being distorted, enlarged or shrunken.

8. Physical numbness of motor and sensory abilities.

9. Unstable remembrance of memories (memories without emotions).

10. Feeling alienated.

11. Emotional disconnection with surroundings and oneself.

12. Out-of-body experiences.

Episodes usually last for hours or days or even for weeks, months, and sometimes years (usually in the worst-case scenario). But in some patients, symptoms are constant and are at an unchanging intensity.

How to Diagnose Someone With Derealization Disorder?

The diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) created criteria for the diagnosis of derealization or depersonalization disorder. The criteria involve:

• Recurrent episodes of derealization or depersonalization.

• The patient realizes their episodes are not real (in the sense of the reality of surroundings).

• Symptoms cause distress in the professional and personal life of the patient.

In addition, the symptoms are not linked to another medical or psychiatric disorder. Different diagnostic tests are performed, such as magnetic resonance imaging (MRI) and electroencephalogram (EEG), to rule out structural causes (physical deformity), particularly if the symptoms are progressive and atypical. Urine toxicology tests are performed to test out the side effects caused due to a medication.

What Is the Treatment of Derealization Disorder?

A licensed medical professional might suggest the following treatment options for the treatment of derealization disorder. Treatment plans or options are-

1. Psychotherapy- Since the main cause of derealization disorder is stress. Psychotherapy is the main line of treatment for the disorder. Psychotherapy, also called talk therapy, helps manage stress and deal with the different mental illnesses causing the disorder. Various psychotherapies suggested are:

• Cognitive-Behavioral Therapy- Cognitive-behavioral therapy helps block obsessive thinking about the unreal state of mind. Different techniques are employed to engage patients to talk about their fears, issues, thinking, and phobias and help them to distract from them.

• Grounding Technique- The technique utilizes five basic senses to help the patient be more comfortable in their own skin and helps to manage them to be more real in the surroundings and moment.

• Psychodynamic Therapy- This therapy helps the patient deal with negative feelings, overthinking, or traumatic experiences from the past.

2. Medications- Usually, the patient feels better with psychotherapy. However, some medicinal help is required and suggested to help the patients. Different medications prescribed are-

1. Selective serotonin reuptake inhibitors (SSRIs).

2. Opioid antagonists.

3. Antidepressants.

4. Anti-anxiety.

5. Benzodiazepines.

Usually, medicines are prescribed to help the patient with past stress, trauma, or other trigger factors causing derealization disorder.

How to Stop Derealization?

A person suffering from derealization must consider self-help to avoid or lessen the episodes of derealization disorder:

• Touching something warm or cold (focusing on the sense of touch and temperature).

• Getting a real sense of surroundings (pinching, squeezing, or tweezing oneself helps).

• Figuring out the surrounding (trying to focus on one single object from the surrounding).

• Counting, remembering, or verbally talking to oneself.

• Utilizing the basic senses (touch, sight, hearing, smelling, and tasting).

What Are the Complications of Derealization Disorder?

Episodes of derealization or depersonalization are horrifying and disabling. If and when left untreated, derealization disorder can lead to:

1. Lack of concentration (difficulty focusing on tasks).

2. Difficulty remembering things.

3. Symptoms causing intrusion into daily activities and life.

4. Issues in personal life and issues with relationships and family.

5. Anxiety.

6. Depression.

7. Anxiety attacks.

8. Low self-esteem.

9. A recurring feeling of hopelessness.

Conclusion:

Episodes of derealization or depersonalization disorder make one have an out-of-body experience. The main cause of the disorder is stress and anxiety, whereas different trigger factors have been established to cause the disorder. Treatment criteria involve psychotherapy and medication therapy. Even though the symptoms include anxiety and depression, antipsychotics have been advised against the use, as they tend to worsen the situation. In addition, opioids and benzodiazepines have been proven to be effective and make the situation and the causative factor a lot better. Derealization disorder is a type of dissociative mental disorder with recurrent episodes of detachment.