Overcoming Depersonalization and Feelings of Unreality: Treatment for Dissociation and Depersonalization
Depersonalization is a dissociative disorder; depersonalization is when someone has episodes of feeling like they are not in their body, their limbs, or are watching themselves from afar. Dissociative disorders like depersonalization and derealization often occur as a result of psychological trauma and ongoing periods of distress. Dissociation is an instinctive trauma response that activates when we’re under intense distress but can’t get away from the trigger, as a way for our body to help us tolerate being stuck in it. But when these responses are prolonged, chronic, or occur during times where there isn’t an environmental trigger or threat, it can be really alarming and disruptive to our lives. Kelsey Harper, trauma therapist and clinical psychologist dives into depersonalization and derealization, and gives recommendations for next steps to get help.
Therapy for DP DR
Depersonalization and derealization are specific types of dissociative disorders. Dissociation is when we don’t feel present inside our bodies, the situation, or our emotions and thoughts. This is a natural response to threats in the environment and triggers of past trauma as a way of helping us survive and get through a traumatic experience when we can’t leave it.
What is Dissociation?
Dissociation is a trauma response that occurs in moments when we’re not able to get away from the threat or fight it off. Children are more likely to experience dissociation during traumatic experiences, and we see that it is by far the most common response to surviving sexual violence.
All of us can experience dissociation, as it is a natural response for our brains to have. It also occurs during everyday experiences, particularly if there’s elevated stress. An example many of us can relate to is when we’re at the end of a long work day and we drive home, our usual daily commute, and when we arrive we realize we don’t really remember what that commute was like.
Another example is when we arrive home and stay in our cars, putting off stepping out of car by either mentally drifting away or scroll on our phones without really paying attention to what’s passing by our eyes.
Dissociative disorders occur when dissociation occurs beyond times of distress and trauma, when it’s not needed for survival. This can look like prolonged periods of feeling disconnected from yourself, not present with your surroundings, difficulty paying attention and reacting slowly. Dissociative disorders happen when someone is unable to change or get out of the dissociation, or dissociation occurs in ways and times that significantly disrupt their lives. Many people who have trauma have experienced dissociation symptoms in their recovery from trauma, and in some instances, these symptoms can linger past when the brain is needing it.
What is Depersonalization and Derealization?
Depersonalization and derealization are specific dissociative responses that can occur as part of surviving a traumatic experience. However, depersonalization and derealization disorder may have unknown origins, often causing some confusion for people experiencing this.
Depersonalization is when someone does not feel connected to their body, their limbs, their mind or emotions, and may perceive themselves as though from a distance or outside their bodies. Depersonalization is dissociation from the self.
Derealization is when someone does not feel connected to the environment around them and who and what’s in that environment. People experiencing derealization often report feeling like they’re living in a dream, or their environment is perceived as foggy, lifeless and at times comes with visual distortions.
Depersonalization and derealization disorder is when these dissociative symptoms occur frequently, persistently, and interfere with life functioning. Despite feeling out of touch with themselves or the world, people with DP DR disorder are still grounded in reality, often making these symptoms stressful to experience.
Can You Have DP and DR?
You can have both DP and DR (depersonalization and derealization). As dissociative disorders are complex disruptions to how our brain perceives ourselves and the world, it’s possible to experience both DP and DR, and is relatively common for people with DPDR disorder.
Sometimes someone experiences primarily one over the other with less frequent symptoms of the other. People can feel their perception change from one to the other, or feeling a disconnection wholly.
There are also differences in how people experience DP and DR as well. Some people experience episodes of depersonalization or derealization, in specific situations or with stress, with a beginning and end.
There are times when people experience chronic DPDR, where episodes of depersonalization and derealization are prolonged, occur daily, and sometimes throughout the whole day with little to no breaks in active symptoms.
If you’re reading this and feel some of what I’m describing, this can be very concerning but please know that DPDR disorder is treatable and you can get effective help. I’ll share more about this below.
DPDR Specialist
Signs of Dissociation in Therapy Sessions
There are signs that dissociation is happening in therapy sessions. Trauma therapy will involve your therapist keeping a close watch on your window of tolerance, or how you are processing the work. Dissociation is a sign that someone is outside of their window of tolerance and needs help getting grounded.
Signs I see of dissociation in therapy sessions include:
slowed blinking
staring
slow response to prompts or questions
“glazed over” facial expression
“500 yard stare” their gaze appears fixed upon a long distance
diminished emotional responses
Difficulty identifying the presence of body sensations
looking like they’re falling asleep
In therapy sessions, sometimes dissociation comes on quickly or changes in big ways and can cause alarm. So some signs can be someone suddenly appearing confused, distressed, or holding their head.
When dissociation happens during a therapy session, I help clients gently get grounded. We set aside the current topic that may have triggered it, and practice grounding, mindfulness, and somatic processing skills. Dissociation happens in therapy sessions, and no one should be embarrassed or worried about it interfering; dissociation is a part of the healing process and trauma therapists are very skilled at helping clients through it.
What causes Depersonalization and Derealization?
Depersonalization and derealization can be caused by a number of different things. The most common cause of depersonalization and derealization is complex trauma. Complex trauma is when trauma is in the nature of a relationship and environment and the person experiencing it is unable to leave or change it, and may even need to try to navigate traumatic incidents in order to get survival and emotional needs met. You can read more about complex trauma in my post Understanding Someone with BPD and Complex Trauma.
Depersonalization and derealization are caused by experiencing stress or distress that a person is unable to tolerate without dissociation. Depersonalization and derealization can occur especially if this stress is occurring inside their bodies (chronic illness or pain) or in surroundings they can’t leave.
Depersonalization and derealization disorder is caused by the nervous system “getting stuck” in the stress-induced dissociation or this dissociation activating at times when there is no apparent stressor present. These are trauma triggers and getting triggered by something the nervous system has related to past trauma.
Triggers can be sensory (smells, sounds, etc) as well as internal events (memories, thoughts, emotions). The nature of trauma triggers is that they are linked to our traumatic experiences by our survival nervous system, and therefore may be perceived by our instinctual system before we consciously realize it.
Trauma triggers occur before we know it, so depersonalization and derealization can occur before we know why it happens.
This can make depersonalization and derealization feel out of our control, happen out of nowhere, and difficult to cope with.
DPDR Specialist
Overcoming Depersonalization
Overcoming depersonalization and derealization is possible, with practicing specific trauma-informed skills and effective trauma-focused therapy.
When a depersonalization and derealization episode occurs, it can feel very alarming. For many people, they want to make it stop and refocus as soon as possible. But it’s this exact pressure that creates additional stress and can prolong activation of depersonalization and derealization. It can be hard to slow down when all you want is to make it stop, and that is the first step.
Practices of mindfulness helps reduce that additional pressure, and pull our focus to the present moment. Specifically, mindfully focusing on external anchors, like sounds you hear outside of yourself, can help us return to the present moment without getting re-triggered by stressors.
Mindfulness practices help with getting grounded, but may not make depersonalization or derealization episodes end. The next step is to engage practices of radical acceptance, accepting these symptoms are present here, with mindfulness - do not get swept up into fear thoughts about the future or past, stay in the moment right now. You can get ideas for radical acceptance in my post here.
Following mindfulness and acceptance, practice self-validation of the emotions you’re feeling about depersonalization and derealization, and willingness to engage in the world with these symptoms alongside you. It’s understandable to feel frustrated, anxious, angry, sad that these symptoms occur and that you have to continue life with them disrupting your experience of life. Offering yourself this validation can help reduce distress tremendously.
The practice of skills of willingness mean to proceed in your day accepting the experience as it is; your day has depersonalization and derealization veils over it. It’s not easy to be willing to experience really uncomfortable symptoms, and when we move toward living through acceptance, we can both reduce the activation of dissociation and reclaim the life we want to live.
These skills are also a way of practicing exposure to depersonalization and derealization episodes. The more we are exposed to a trigger, the less triggering it becomes. So by exposing to DP DR, these episodes become less disruptive, and eventually our nervous system becomes desensitized to triggers that activate dissociation. Over time, episodes of depersonalization and derealization reduce.
Treatment for Dissociation and Depersonalization
Treatment for dissociation and depersonalization occurs with consistent and ongoing trauma-focused therapy. This involves engaging trauma-focused interventions and skills to help you process the trauma that underlies dissociation symptoms, and expanding your practice of self regulation skills outside of therapy. In addition, as discussed before, these skills will also involve ongoing practice of mindful acceptance of symptoms occurring in the present moment, creating an ongoing exposure practice to reduce sensitivity to triggers.
An important component to treatment for dissociation and depersonalization is willingly engaging in a value-based life worth living. When we radically accept these symptoms, then we no longer have to wait till they’re controlled in order to live. When we’re taking action on goals that matter to us and building a life we love living, trauma symptoms, including and especially dissociation, can resolve.
An additional intervention that can be very helpful for dissociation and depersonalization is Somatic experiencing. Somatic Experiencing is a trauma-focused therapy that can be offered by people who may or may not be therapists. In order to be a somatic experiencing therapist, someone has to engage in three years of training and supervised practice, so they’re very well trained. Somatic Experiencing involves engaging body-focused awareness and exercises to work through activation of the fight, flight, freeze responses.
How to Find a Therapist That Specializes in Dissociative Disorders
Finding a therapist that’s a good fit already is very challenging for many of us. Under the best possible circumstances, we can meet with a few therapists to get an idea how each of them approach therapy and what feels right. Often, we don’t have that time, space, and resources to do this. It’s especially difficult when we’re looking for someone who specializes in dissociative disorders as this takes specific focus; you’ll need to know what to look for.
A good place to start with finding a therapist that specializes in dissociative disorders is narrowing the search to therapists who specialize in treating trauma. Therapists who work with dissociative disorders also work with trauma specifically, and have extensive training in trauma-focused care. Looking for this specialty is also important because treatment for depersonalization and derealization needs sensitivity and careful monitoring of trauma activation and symptoms throughout.
I specialize in working with trauma, and offer highly effective approaches like EMDR and DBT. I also specialize in working with dissociative identity disorder, depersonalization and derealization, and other dissociative disorders. You can read more about working with me for therapy for DPDR here.
For more options, there are excellent referral lists on websites that train therapists in trauma treatments. This can include EMDRIA, Parnell Institute, Somatic Experiencing International, and DBT Prolonged Exposure (click any of these links to be directed to their therapist directory).
It’s always helpful to consult or speak with possible therapists prior to starting to work with them. This gives you a chance to see what therapy might be like with them, ask any questions you have, and see if it’s a good fit. I talk with all potential clients prior to their initial session to share about my approach, answer any questions they have and make sure it’s a good fit to work together. Learn more about that process here.
Depersonalization and derealization are dissociation a type of dissociative disorder. These dissociation symptoms occur when we are unable to leave a threatening situation or fight off a threat. Our nervous system can get overwhelmed by chronic complex trauma in a way that set us up to experience dissociation symptoms like depersonalization and derealization in times when we don’t want or need to, and can interfere with our lives. The good news is that depersonalization and derealization can be resolved with consistent coping skills practice, and trauma therapy.
Ready to start trauma focused therapy today? Sign up to work with me here. I offer trauma therapy with multiple approaches to best meet the needs of trauma survivors, including specialized approaches for depersonalization and derealization (DPDR), dissociative identity disorder (DID), and dissociative disorders. Read more about working with me here.
You can also try out my online group offers: Group Therapy for Trauma and DBT Skills for LGBTQ to connect with a supportive community and learn helpful trauma coping skills from home.
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