Derealization / Depersonalization
When we’re dreaming, things normally don’t feel all that tangible. You can pick up your phone or a trophy or a puppy and they won’t feel as solid as those things would in the real world. Then, when you wake up and grab your phone to turn off the alarm, everything goes back to normal. There’s nothing to suggest your phone isn’t real, or that the hands you use to touch it don’t belong to you. That is. . . usually.
Sometimes, even when we’re awake, our brains decide it might be in our best interest for our environment, or even our bodies, to just, not feel real for a while. This isn’t a rare thing, either. It’s actually a super common experience. However, when it sticks around for longer than it should, it can merit its own diagnosis. This condition is called depersonalization-derealization disorder, and it’s sometimes abbreviated as DDD. According to the DSM-5, which psychologists use to diagnose disorders, the name of this condition is pretty descriptive. DDD is defined by persistent or frequent episodes of depersonalization and/or derealization.
Depersonalization is the feeling that your body, thoughts, sensations, or actions aren’t your own, or aren’t real — even though you logically know they are. Derealization is a similar feeling, but it’s about your surroundings and the things in them. Some people say that experiencing these things are like having a glass wall between themselves and the world. For others, everything might feel far away and dream-like, or it might feel like their head is stuffed with cotton. Regardless of what they feel like though, these symptoms aren’t actually uncommon.
Experiences of depersonalization or derealization are thought to be the third most common mental health symptom after anxiety and depression, and they occur equally in men and women. When these experiences don’t go away, that’s where DDD comes in…and this is much rarer. It’s estimated to occur in only around 1-2% of people. Unfortunately, the factors that lead to its development and what triggers the symptoms are still fairly unknown. It’s often been associated with cannabis usage, but there are plenty of purely psychological causes, too.
Some research has suggested that childhood trauma could play a role in developing DDD later in life, especially when that trauma involves emotional mistreatment. Anecdotally, many people have also reported that their symptoms are related to periods of extreme stress or anxiety. That’s led some scientists to believe that depersonalization and derealization are mechanisms the brain uses to protect the mind from potential threats. While they can’t say what specifically triggers these episodes, they are recognizing some general patterns.
Research is finding that certain types of triggers were more likely to induce either depersonalization or derealization. In one study, 73 participants were tested who were prone to either of these experiences, trying to find out if their symptoms would begin in response to different kinds of threats. To do this, they performed something called an implied body-threat illusion task, which, in this case, was a simulated blood-test procedure. In it, the researchers don’t actually draw blood, but they used fake needles and special effect blood to make it look like they did. Everything was made pretty realistic, because the point was to see how participants responded physiologically to threats.
First, participants had this procedure done to them alone. Then, they witnessed it being performed on a person sitting next to them. The whole time, the researchers were measuring their temperature and how their skin conducted electricity, also called skin conductance. While that may seem odd, it’s partly because feeling threatened makes us sweat, and water is a good conductor. When the scientists looked at the data, they found that those predisposed to depersonalization showed normal skin conductance when someone else got a blood test, but decreased conductance when someone was about to perform the test on them. That likely means that their brains were making everything seem farther away and less real— and their dampened physiological response showed it.
On the flip side, in those prone to derealization, their threat response was only dampened when they saw someone else experience the blood test. Even though the threat wasn’t aimed at them, it still existed, so it could have psychological consequences. In order to shield them from that fallout, their brains chose to make their environment seem less real. These findings support what’s known as the threshold model for these experiences. It suggests that when we detect a threat, the regions in our brain responsible for emotional processing — called the frontolimbic regions — may suppress our stress response to it. As a result, the stress is more dull and easier to handle.
In those that are prone to depersonalization and derealization, the threshold for this response is thought to be way lower. So their brains might think things like talking to a cashier at a store are enough of a threat to cause those numb and unreal sensations. Sometimes, these symptoms can be managed with psychotherapy. In many cases, the usual treatments aren’t actually effective, so scientists have been looking into other techniques. One promising method is called transcranial magnetic stimulation or TMS. It uses powerful magnets to disrupt the electrical activity of small brain areas. Specifically, using TMS on a brain region called the right temporoparietal junction seems to help symptoms — at least it has so far in a small study of patients. However, the studies’ authors do admit to its limited scope and that they still can’t rule out placebo effects.
Researchers are just beginning to use TMS to target different brain areas. Another promising candidate is an area involved in the brain’s executive control system called the right ventrolateral prefrontal cortex. A recent study showed that using TMS on this area improved symptoms in six of seven patients after 20 sessions, with few side effects reported. Scientists think that damping down the activity in this region of the brain bumps up the threat threshold mentioned earlier, stopping symptoms from being triggered so easily. While there aren’t yet larger studies to further back this up, psychologists will need to keep working on it. Sometimes, it can feel frustrating when scientists don’t totally understand a phenomenon or how to treat it — especially with something like DDD. However each small experiment does get us closer to understanding and therefore effective treatment.