.png)
Depersonalisation / Derealisation Disorder — Do You Zone Out?
You: *sitting in a dreary meeting led by stakeholders with whom you negotiate a potential partnership trying to pay attention*
Your brain: That's the ideal time to realise that you exist and everyone around you exist and that all of you're alive and holy molly, you're breathing. Let's talk more about how your very existence is unfolding right now.
You: *dissociates*
Your blood is pounding in your ears, the blabber of your collaborators-to-be grows muffled. Your heart is thudding in your chest and your hands tremble. Your vision distorts, as if you're peeking through a fish-eye lens.
Your colleague notices and nudges you out of a situation in which you feel like you've been thrown into an alternate reality where you get glitches in the Matrix.
‘Sorry, I spaced out,’ you whisper panting and hasten to restore your professional demeanour. You're having a hard time streamlining what you just went through into a single flow of words.
Allow me to do it for you then!
This spacing-out from yourself and the world around you may be psychologically explained as depersonalisation and derealisation. I know that's a mouthful, so let's break down the phenomenon into digestible morsels of information.
*grabs DSM-5 tome and clears throat*
Be aware that the definitions and denominators listed are not the end-all be-all — not two cases of depersonalisation/derealisation are the same. However, the “Bible” of psychology helps us get a tighter grasp of the condition. Also, I might be separating the two words with a slash, but the terms have distinct diagnoses and shouldn't be used interchangeably. (Though again, it's not impossible for both of them to cohabitate with one another).
What is depersonalisation / derealisation?
Depersonalisation refers to
[e]xperiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
It's almost like you're outside of and disengaged from your own person, as though you're viewing life from the sidelines or on a film screen.
Now, let's pick up the second segment — derealisation. It defines
[e]xperiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, life less, or visually distorted).
According to ‘Criterion B [...] reality testing remains intact’ during episodes of DPDR. Unlike other psychotic irregularities like dissociative amnesia, DPDR sufferers are totally awakened towards what's going on, which can make them concerned about their mental health. They recognise reality, but it's as if they can't dissipate the mental fog or reconnect with themselves to evade the state of detachment.
Now, the third diagnostic criterion clarifies that
the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Regardless of its frequency, duration and intensity — whether it's chronic or strikes as a flash when you least expect it — DPDR can affect many, if not all, facets of one's life. Finally, the fourth is that
[t]he disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.
In addition to the above, DPDR is not ascribable to substance abusive side effects. That said, it doesn't always occur because you're intoxicated, high or hallucinatory, and thus it requires what experts call ‘differential diagnosis.’ Usually, this is the prime reason why many people hesitate to seek professional help or emotional aid from their loved ones. They fear that nobody will understand them and, much worse, that they may question their sanity.
What are the symptoms of depersonalisation / derealisation?
Swiss philosopher Henri-Frédéric Amiel describes an out-of-body experience some hundreds of years ago:
I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift. Is this madness?
Is this adjacent to an identity crisis, a loss of continuity to one's personality? It may very much be. In this respect, you might:
have difficulty defining what kind of person you are
experiencing somatic symptoms like a pronounced pressure on forehead, insomnia, nausea, muscle twitching, tightness in the chest
feeling disorientated in a heightened/artificial world that is tilted and you're walking sideways or upside down
fear that you might go mad or that you'll disintegrate into non-existence.
looking at your body parts and feeling like they aren't your own
people, even family and friends, looking alien or robotic to you
being unable to recognise yourself in the mirror or that your reflection is disfigured
when talking, you feel as if you're speaking nonsense though you're objectively coherent
your memories appear in tunnel vision: you can recall certain chunks of your life and formulate new memories, yet the latter carry a dream-like dimension, e.g., you deal with the trauma as an observer, because you're out of your body and watching it. It's your mind falling on safe mode to shield you from the irreparable damage the anguish of the experience can cause.
you're extremely sensitive to alcoholic and/or caffeneited drinks and other stimulants.
obsessing over deep existential questions, such as “Why am I here? How do I exist? Am I real or in a dream?”
having trouble concentrating
panicking when DPDR intensifies
Remember, everyone's predicament vis-à-vis dissociation is different. In many instances, however, it's an offshoot of stress, shock (sudden death of a loved one) and/or trauma. It could be both a way that the mind copes with anxiety and one-off traumatic events or ongoing abuse and neglect (especially in childhood). It's our brain's way of protecting us; it unhooks us from the clingy stressor or agony so that we can survive.
Conclusion: Healing the wounds
As far as therapy is concerned, there is not medication that's specifically designed to handle DPDR. Similarly, there's little clinical research and literature on what feels like being a shell of a human. If DPDR returns home, either in full swing or in light doses, don't let it bang on the door while you're curled on the floor with your face buried in your palms going hysterical.
Open the door and meet it straight in the eyes. Confront it. This is an essential leap to healing the wounds. Acceptance is king, queen, you name it! Mental healthcare professionals have grouped together treatment modalities for you. Here's what you can typically find in the DPDR coping toolkit:
Mindfulness strategies through the 5 senses
DPDR can uproot you and you might need grounding. If you feel like you're about to float, fidget with a tactile object like a pen or a stim-toy (stress balls and puzzles). Not only will this stimulate and keep you present in the external world, but it'll also teach you how resilient the human spirit can be via these mindfulness strategies.
Distraction-focused behavioural techniques
If you find yourself wanting to pull away, cast your focus on different colours and shapes in a room, and start counting them. These distraction-focused behavioural techniques will help you stay grounded in moments of crisis.
This can be an omen of hope for your DPDR. Breathwork is a set of meditative practices that instructs you to manipulate your breathing depth and rate to lessen stress levels and increase alertness.
Cognitive-behavioural therapy
Cognitive-behavioural therapy, or “talk” therapy, includes the traditional counselling that ferrets out what your triggers are and helping to better manage them.
When you're in the throes of DPDR or fully on it, you feel that the carpet is suddenly pulled out from under you and you find yourself standing on molten lava. I get it! What you tend to forget, though, is that you've been there before and came out of it unscathed. Therefore, anxiety is just adrenaline and the unpleasant sensation won't last an eternity.
A lot of your emotional outbursts are never a response to a single moment. Rather, it's a buildup of all the times you went through something comparable and didn't have the safety equipment to fend for yourself, take ownership of your voice, acknowledge your pain and vocalise your emotions.
Now that you have clear-cut recovery guidelines at hand, act on them but be patient with yourself. It takes plenty of mental digging and excavating with the right psychotherapist, and even more trial and error. But trust me, at some point you won't approach your anxiety struggles as a traumatic ordeal. They'll be something you outgrew from and moved on stronger than ever.
Comments