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Depersonalization-Derealization Disorder (DPDR): Symptoms, Causes, Diagnosis & Treatment

Last Updated: November 6, 2023

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Depersonalization-derealization disorder (DPDR) is a diagnosable mental health condition that leads to dissociation symptoms. It is perhaps less commonly recognized when compared to conditions like depression or anxiety, but it can have a significant impact on a person’s daily life. Fortunately, treatment can make DPDR more manageable. 

What is Depersonalization-Derealization Disorder?

Depersonalization-derealization disorder (DPDR) is a mental health condition in which a person experiences episodes of depersonalization, derealization, or both. Depersonalization refers to the feeling of being detached from oneself, whereas derealization refers to being separated from one’s surroundings. 

Despite feeling detached, a person with DPDR remains in touch with reality, and they understand that the way they experience the world is unusual. They may feel significant distress related to their symptoms, even if they seem to show little emotion. 

Depersonalization-derealization disorder belongs to a class of mental health conditions called dissociative disorders. These conditions impact a person’s memory, emotions and sense of self. 

Symptoms of Depersonalization-Derealization Disorder

Symptoms of DPDR are related to either depersonalization or derealization. Common symptoms of the disorder include:

  • Feeling a sense of detachment from one’s own body or feelings
  • Having the sense that one is a “robot” or acting automatically 
  • Being emotionally numb or detached
  • Difficulty identifying emotions
  • Struggling to remember events clearly
  • Feeling as if one is dreaming or “in a fog” 
  • Perceiving a sense of separation from surroundings
  • Experiencing sensory distortion, such as viewing objects as blurry or perceiving things to be smaller or larger than they are

Causes of Depersonalization-Derealization Disorder

There is not one single cause of depersonalization-derealization disorder. Instead, several risk factors increase the likelihood that someone will develop this mental health condition. In many cases, DPDR develops in people who have experienced severe stress or trauma. Dissociating from one’s surroundings or emotions can help a person cope with a terrifying or otherwise unbearable event. 

Risk Factors for Depersonalization-Derealization 

In general, trauma and severe stressors increase the risk for DPDR. Some specific risk factors for the condition include:

  • Experiencing emotional abuse or neglect during childhood
  • Being a victim of physical abuse
  • Exposure to domestic violence
  • Growing up with a parent who was severely impaired or mentally ill
  • Experiencing the sudden death of a family member or close friend
  • Use of illegal drugs, including ketamine, marijuana, or hallucinogens (substance use may trigger an episode, but for a DPDR diagnosis, a person must experience dissociative symptoms separately from addiction)

How Is Depersonalization-Derealization Disorder Diagnosed?

Depersonalization-derealization disorder is diagnosed using criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A mental health professional, such as a psychologist, clinical counselor or clinical social worker, can make a diagnosis.

To be diagnosed a person must meet these criteria:

  • Recurrent episodes of either depersonalization, derealization, or both
  • The patient remains in touch with reality and understands their symptoms are unusual
  • Significant distress or impairment in daily functioning 
  • Symptoms not explained by another medical or psychiatric disorder 

A clinician may use a diagnostic tool, such as The Multidimensional Inventory of Dissociation (MID) to evaluate symptoms. They will also rule out alternative diagnoses, such as panic disorder, seizure disorders or ongoing substance use disorder, to ensure that one of these conditions does not better explain symptoms. 

While it’s important to rule out alternative diagnoses, some people may experience a co-occurring disorder alongside DPDR. Borderline personality disorder, post-traumatic stress disorder, substance use disorders, depression and anxiety are common among individuals with dissociative disorders, including DPDR. 

Depersonalization-Derealization Disorder Statistics

Prevalence data give us an idea of how common depersonalization-derealization disorder is. Consider the following statistics:

  • Just 2% of people meet the diagnostic criteria for depersonalization-derealization disorder during their lifetimes. 
  • The average age of onset for DPDR is 16 years of age.
  • Experiencing an onset of symptoms during adulthood is uncommon; only 5% of people have an age of onset after 25. 
  • Men and women are equally likely to be affected by this condition. 

Depersonalization-Derealization Treatments

Depersonalization-derealization disorder can cause significant distress, but with treatment, healing is possible. Psychotherapy is the most common treatment modality for DPDR. Some people may also take medication, especially to treat co-occurring conditions like depression or anxiety. 

Some specific treatments for DPDR include:

  • Cognitive-behavioral therapy: This modality can help patients change distorted or obsessive thoughts, which can alleviate distress. 
  • Behavioral modification: A therapist can teach you to change your behavior to distract yourself from symptoms or to improve your mood. 
  • Psychodynamic therapy: Your therapist may use psychodynamic techniques to help you recognize and process unresolved childhood trauma related to your dissociative symptoms. 

Since there is an overlap between trauma and dissociative symptoms, some patients benefit from trauma-specific modalities, such as EMDR (eye movement desensitization and reprocessing). EMDR allows patients to reprocess traumatic memories so they are less distressing.

For those in the Missouri area, The Recovery Village Kansas City offers a full continuum of mental health services. Our professional staff is trained to treat dissociative conditions, including DPDR, whether the condition occurs on its own or alongside a substance use disorder. Contact one of our recovery advocates today to begin the admissions process.


Drescher, Jack. “What Are Dissociative Disorders?” American Psychiatric Association, October 2022. Accessed October 27, 2023. 

Spiegel, David. “Depersonalization/Derealization Disorder.” Merck Manual, May 2023. Accessed October 27, 2023. 

Simeon, Daphne; Knutelska, Margaret. “The Multidimensional Inventory of Dissociation (MID) in Depersonalization Disorder: General Findings with a Clinical Emphasis on Memory and Identity Disturbances.” Journal of Trauma & Dissociation, 2023. 

National Alliance on Mental Illness. “Dissociative Disorders.” Accessed October 27, 2023. 

Lailotis, Deany; Shapiro, Francine. “EMDR Therapy for Trauma-Related Disorders.”  Evidence Based Treatments for Trauma-Related Psychological Disorders, June 17, 2022. Accessed October 27, 2023.