What is depersonalisation disorder?

Depersonalisation disorder is a dissociative disorder where people feel disconnected from themselves: their thoughts, feelings and actions are observed from outside of themselves.

In this article, we will explore what it is, how to recognise it and how it is treated.

What does it feel like?

Depersonalisation is where you feel like you are observing from outside of yourself. You are aware of your actions, thoughts and feelings but that awareness seems to happen from a distance.

If you play computer games, a useful analogy might be that of switching from a first-person to a third-person perspective.

Another possible way to conceptualise it for those who have never experienced it is to consider how you feel when heavily intoxicated: your actions, sensations and thoughts do not quite feel like your own.

It is closely linked with derealisation in which people feel that their thoughts and actions are not real, or happening automatically.

Episodes of depersonalisation can last anywhere from a couple of minutes to several years, although the latter is rare. People struggling with depersonalisation disorder are aware of everything that is happening to them and maintain a clear memory, even though the thoughts and actions may not feel like their own.

Who does it affect?

There do not seem to be any differences across genders and it typically affects adults with different studies placing onset from between 16 and 30 onwards (but the age range could be much wider). Clinically significant depersonalisation is estimated to affect 1-2% of the population (Hunter, Sierra, & David, 2004).

What causes it?

It is not clear what causes depersonalisation disorder. However, there is a correlation between childhood traumatic experiences and childhood abuse so this could be an indicator.

Other indicators include depression and anxiety, family history, and use of alcohol and other drugs.

How is it treated?

Treatment pathways for depersonalisation disorder have not yet been fully established.

Talking therapies including cognitive behavioural therapy and trauma-focused therapy may be the most helpful.

There are no specific medications, although some doctors will prescribe antidepressants. It is not yet clear whether this simply tackles the accompanying anxiety and depression, or whether SSRIs such as fluoxetine and clomipramine can help with the depersonalisation as well.

It is also worth considering that depersonalisation may be connected to anxiety, depression, or substance misuse, and therefore by treating the comorbid condition we may see reduced depersonalisation as well.

References

Baker, D., Hunter, E., Lawrence, E., Medford, N., Patel, M., Senior, C., . . . David, A. (2003). Depersonalisation disorder: Clinical features of 204 cases. British Journal of Psychiatry, 182(5), 428-433. doi:10.1192/bjp.182.5.428

Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. A systematic review. Social psychiatry and psychiatric epidemiology, 39(1), 9–18. https://doi.org/10.1007/s00127-004-0701-4

Medford, N., Sierra, M., Baker, D., & David, A. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11(2), 92-100. doi:10.1192/apt.11.2.92

Simeon, D. Depersonalisation Disorder. CNS Drugs 18, 343–354 (2004). https://doi.org/10.2165/00023210-200418060-00002