What is DPDR? Shedding Light on
the Hidden Struggle
Depersonalization-Derealization Disorder (DPDR), also known as DPD or DDD, is a mental health condition characterized by persistent or recurrent feelings of alienation. This disorder primarily manifests in two forms: Depersonalization, where individuals feel detached from their own body or thoughts, and Derealization, where the surrounding environment feels unreal or disconnected. DPDR can be triggered by factors such as stress, trauma, or substance use, though the exact causes remain poorly understood. While temporary feelings of depersonalization or derealization are common, those with DPDR experience these symptoms consistently or with recurring intensity, which can severely impact daily life and overall well-being.
Depersonalization
Depersonalization is a condition in which those affected feel detached from their own body, thoughts or feelings. They experience themselves as alien or distant, as if they were perceiving their own life from the perspective of an observer. Those affected often describe a feeling of unreality or the sensation of not being fully “there”. Despite this alienation, they remain aware that this perception does not correspond to objective reality.
Derealization
Derealization describes the feeling of alienation from one’s surroundings, in which those affected perceive their environment as unreal, strange or distorted. People who experience derealization often describe their surroundings as appearing through a veil, as if they were lifeless, artificial or distant. Although perception changes, awareness of reality remains intact, meaning that those affected know that their sensations do not correspond to objective reality.
Depersonalization-Derealization Disorder affects approximately 1-2% of the population, yet it is often left undiagnosed.
(Michal & Beutel, 2009)
Less than 1 in 10.000
people affected
receive a correct diagnosis, as the analysis of health insurance data from 2006 suggests. (Michal et al., 2010)
23
years
is the mean onset age for DP/DR disorder, marking a consistent trend observed across various studies and emphasizing the typical age range for the onset of symptoms. (Michal et al., 2016)
> 50 %
of adults
experience temporary symptoms at least once in their lives, often triggered by psychosocial stress, physical overload or sleep deprivation. (Simeon et al., 2003)
DPDR affects both men and women equally, with no major differences in symptoms or how it co-occurs with other conditions.
(Simeon et al., 2003)
Unseen and Misunderstood
Individuals with Depersonalization-Derealization (DPDR) often experience years of confusion due to misdiagnosis, as their symptoms — feeling detached from themselves (Depersonalization) or the external world (Derealization) — are frequently overlooked or misunderstood.
Although DPDR is often linked to anxiety and depression, it is a distinct disorder that requires a specialized diagnostic approach. Traditional tools for diagnosing anxiety or depression often fail to recognize the unique features of DPDR.
As a result, many patients are mistakenly diagnosed with other conditions, leading to inappropriate treatments and prolonged suffering. Tools like the Cambridge Depersonalisation Scale (CDS) are essential for accurately identifying DPDR, but they are not always utilized, leaving patients without the appropriate care they need for years. Early and accurate diagnosis is key to ensuring better outcomes for individuals living with DPDR.
Definition
The DSM-5 and ICD-11 are key systems for diagnosing mental and physical disorders. While the DSM-5 provides detailed criteria for mental health conditions, the ICD-11 classifies all diseases worldwide. Below is the definition of DPDR according to both systems.
DSM-V
A: The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
- Depersonalization: Experiences 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).
- Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, life less, or visually distorted).
B: During the depersonalization or derealization experiences, reality testing remains intact.
C: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D: The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g. – seizures).
E: The 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.
ICD-11
Depersonalization-derealization disorder is characterised by persistent or recurrent experiences of depersonalization, derealization, or both.
Depersonalization is characterised by experiencing the self as strange or unreal, or feeling detached from, or as though one were an outside observer of, one’s thoughts, feelings, sensations, body, or actions.
Derealization is characterised by experiencing other persons, objects, or the world as strange or unreal (e.g., dreamlike, distant, foggy, lifeless, colourless, or visually distorted) or feeling detached from one’s surroundings.
During experiences of depersonalization or derealization, reality testing remains intact.
The experiences of depersonalization or derealization do not occur exclusively during another dissociative disorder and are not better explained by another mental, behavioural or neurodevelopmental disorder. The experiences of depersonalization or derealization are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, and are not due to a disease of the nervous system or to head trauma.
The symptoms result in significant distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.
DPDR patients often struggle to describe their symptoms, either because they’re difficult to put into words or due to fear of not being understood or being labeled as crazy.
(Michal & Beutel, 2009)