MichaelBakonyi: Text partly taken fromWikipedia.org

What DDD is

Sufferers of Depersonalisation/Derealisation Disorder (DDD) experience the symptoms of depersonalization and/or derealisation permanently or recurringly in a way where they interfere with the social and/or occupational functions of daily life.

MichaelBakonyiifrecurringly: how often do you have to experience them to get diagnosed?


In psychology, dissociation is described as any of a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional experience. The major characteristic of all dissociative phenomena involves a detachment from reality.

Dissociation can be diveded in two major parts of experiences:


If you feel depersonalized you may experience sensations as if you were somehow detached/distant from yourself — e.g. your body, your emotions, behavoir and thoughts. It may feel as if your feelings and sensations got numbed, as if you were only living in your head, as if you could not connect to your feelings and sensations anymore, as if they were not as intense anymore as they might have been before. You may feel divorced/estranged from your own personal self by sensing your body sensations, feelings, emotions, behaviors etc. as not belonging to yourself, as if you were kind of an outside observer of your own thoughts or body. You may also sense feelings of a loss of control over your thoughts or actions. You may also be unable to accept your reflection in the mirror as your own, or you may have out-of-body experiences.


If you feel derealized you may experience sensations as if your surroundings (objects, people, events etc.) seem unreal, distant, artificial, colourless, lifeless. You may feel detached from the outer world, as if the world around you was surreal, foggy or visually distorted.

MichaelBakonyi: I think it makes sense to add more descriptions of how DP/DR feels to DDD-sufferers if they differ from the explanations above so that we have a wide range of descriptions. Hopefully this helps sufferers to find this page more easily and to sufferers who are new to DDD recognize their feelings as DP/DR more quickly.

General feelings/sensations

In general DDD may feel like as if you were living in a dream or delirium. You may experience the feeling as if you were not here/on this world at all, as if you were living in some kind of a parallel universe compared to the people around you.

People who are diagnosed with depersonalization often also experience an urge to question and think critically about the nature of reality and existence.[11]

Other possibly resulting symptoms

Especially first experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment.1) The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety experienced by the patient, and obsession, which contributes to the worsening of symptoms.2)

In addition the inner turmoil coming from the disturbing experiences can result in depression, self-harm, low self-esteem, phobias, etc.

It can also cause a variety of physical symptoms, including chest pain, blurry vision, visual snow, nausea, and the sensation of pins and needles in one's arms or legs.

Some people with depersonalization disorder also have visual alterations such as rapid fluctuations in light. While the exact cause of these perceptual changes has not been determined, it is thought that they may be due to previous drug use. These perceptual changes differ from true hallucinatory phenomena, as they are closer to being optical distortions or illusions rather than psychotic breaks from reality.[11]

Individuals with the disorder commonly describe a feeling as though time is “passing” them by and they are not in the notion of the present.

What DDD is not

Not only fear, great tiredness, stress and emotional turmoil but also meditation or taking drugs can result in feelings and sensations of depersonalization and derealization to mentally and neurologically healthy people aswell. The difference to sufferers of DDD is that for mentally healthy people these sensations only last temporarily and usually don't recur unexpectedly or even stay permanently. It is estimated that 30% to 50% of the general population experiences temporary symptoms of dissociation during their lifetime.

MichaelBakonyi: TODO I think following paragraph from Wikipedia has to be rewritten as “normal”/temporary experiences of DP/DR during/after drug-use are excluded but Cannabis can be a triggeroflongtermDDDas far as I know.

Although the use of cannabis can lead to symptoms of depersonalization,[30] [31] the DSM-5 excludes cases of depersonalization due to using substances, including episodes of post-marijuana or post-psychotomimetics depersonalization.[32]

There are several mental and neurological disorders with which symptoms of depersonalization/derealization can occur aswell.

Mental disorders include:

  • anxiety disorder
  • panic disorder
  • depression
  • posttraumatic stress disorder
  • obsessive compulsive disorder
  • schizophrenia
  • schizoid personality disorder
  • schizotypal personality disorder
  • dissociative identity disorder
  • borderline personality disorder
  • burnout syndrome

Neurological disorders include:

  • epilepsy
  • migraine
  • brain lesions
  • vestibular disorders
  • multiple sclerosis
  • Kleine Levin Syndrome

This is why it is important that a detailed diagnoses is made.

Michael Bakonyi: TODO Here tips for the sufferers would be nice how to find a therapist which can make diagnosis and what one can do to support the doctor with the necessary information.

Although the DDD is an alteration in your experience of reality, it is not a form of psychosis, as you maintain the ability to distinguish between your own internal experiences/fantasy and the objective reality of the outside world. As sufferer you may feel as if you were disconnected from yourself and/or the outer world but you don't take it for real that you are actually e.g. physically disconnected from yourself or that there is a magic wall between you and your surroundings.


Lifetime experiences with the disorder occur in approximately 1%–2% of the general population. The chronic form of this disorder has a reported prevalence of 0.8 to 1.9%.3)

In cultures with highly developed individualism the population may be more vulnerable to depersonalization, due to threat hypersensitivity and an external locus of control.4)


Until today (2017) it has not finally been clarified by the researchers what exactly causes DDD but signs indicate that severe traumatic lifetime events—including childhood abuse, accidents, natural disasters, war, torture, and bad drug experiences—can cause DDD. It is unclear whether genetics play a role.

Michael Bakonyi: The follwoing paragraph is coming from Kings College Researchers so we have to ask them for permission or rewrite it:

There are many theories about what causes depersonalisation. It might be induced by overwhelming anxiety or an early traumatic event. In these circumstances, becoming detached from one’s body may seem a useful means of coping, but in some people,the depersonalisation then may become autonomous and a chronic disorder.

MichaelBakonyi: In Wikipedia there's written:

The most common immediate precipitators of the disorder are severe stress; major depressive disorder and panic; and hallucinogen ingestion.

… but I wouldn't write it down as it interferes with the section “What DDD is not”

Michael Bakonyi: At least for me the following is not true:

One cognitive behavioral conceptualization is that misinterpreting normally transient dissociative symptoms as an indication of severe mental illness or neurological impairment leads to the development of the chronic disorder. This leads to a vicious cycle of heightened anxiety and symptoms of depersonalization and derealization.5)

MichaelBakonyi: the following is under “Cause” within Wikipedia.org but I would move it to “What DDD is not” as it has nothing to do with DDD:

The symptoms are sometimes described by those with neurological diseases, such as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), neuroborreliosis (Lyme disease), etc., that directly affect brain tissue.[28] [29]

Neurobiological processes

there is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the substrate of emotional experience.[21] A PET scan found functional abnormalities in the visual, auditory, and somatosensory cortex, as well as in areas responsible for an integrated body schema.[22] In an fMRI study of DPD patients, emotionally aversive scenes activated the right ventral prefrontal cortex. MichaelBakonyi: what does that indicate? Participants demonstrated a reduced neural response in emotion-sensitive regions, as well as an increased response in regions associated with emotional regulation.[23] In a similar test of emotional memory, depersonalization disorder patients did not process emotionally salient material in the same way as did healthy controls.[24] In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing.[25]

Depersonalization disorder may be associated with dysregulation of the hypothalamic-pituitary-adrenal axis, the area of the brain involved in the “fight-or-flight” response. Patients demonstrate abnormal cortisol levels and basal activity. Studies found that patients with DPD could be distinguished from patients with clinical depression and posttraumatic stress disorder.[26] [27]


Accurate descriptions of the symptoms are hard to find for reasearchers and doctors as for sufferers of DDD the fuzzy, vague, diffuse sensations and feelings often are difficult to be described. This results in a wide range of partly ambiguous descriptions. There are also other mental and physical disorders with with which symptoms of dissociation can appear.

These circumstances can lead to misdiagnosises.

MichaelBakonyi:how can one be sure to be diagnosed correctly?

However there are diagnosis-schemes with which practitioners and researchers work nowadays and in which diagnosis-criteria for DDD is implemented aswell:

International diagnosis standards

ICD is a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

The international version of ICD usually is not used as is by the countries using this classication standard. Countries usually make national modifications of the ICD that frequently include much more detail, and sometimes have separate sections for procedures of medical care.

Since the introduction of its 10th Revision (ICD-10) in 1983 DDD is called depersonalization-derealization syndrome and is classified as a neurotic disorder. Within the draft of the coming 11th Revision (ICD-11) the snydrome is classified as dissociative disorder.6)

National diagnosis tools

USA: Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM is to the American Psychiatric Association's (APA) classification and diagnostic tool. In the United States the DSM serves as a universal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance.

With the introduction of its Fifth Edition (DSM-5) in 2013 the DSM combined the formly known Depersonalization Disorder with Derealization Disorder which resulted in Depersonalization/Derealization Disorder (DDD). In DSM-5 DDD remains classified as a dissociative disorder.

MichaelBakonyi: What exactly is the relationship/ are the difference between the following measures and ICD/DSM?

  • Dissociative Experiences Scale, E. M. Bernstein & F. W. Putnam, 1986
  • Cambridge Depersonalization Scale, M. Sierra & G. E. Berrios, 2000
  • Multiscale Dissociation Inventory, J. Briere, 2002

In a study the CDS- and MDI-measure are said to be better than the DES7)


MichaelBakonyi:Followingparagraphcomesfromhttp://www.kcl.ac.uk/ioppn/depts/ps/research/neurobiologialmechanisms/depersonalisationresearchunit.aspxSo either we have to ask for permission or rewrite the text.

There is not yet evidence-based treatment for depersonalisation. Over the years, in-depth psychotherapy, electroconvulsive treatment, antipsychotic medication and antidepressants have all been tested. Two of the Unit’s recent studies have yielded promising results that are being further investigated: these involved Cognitive Behaviour Therapy and, in another trial, participants took lamotrigine, an anti-convulsant medication.