Exploring the Complex Causes and Triggers of DPDR
Depersonalization-Derealization Disorder (DPDR) arises from a complex interaction of psychological, biological, and environmental factors. Psychological triggers, such as trauma, anxiety, depression, and panic attacks, often play a central role. Biological influences, including brain function disruptions, sleep deprivation, and neurological conditions, may also contribute. Environmental stressors and substance use, like drugs or alcohol, can exacerbate symptoms. Rather than a single cause, DPDR results from these factors interacting uniquely in each individual. While research has highlighted some underlying mechanisms, the precise causes remain unclear, emphasizing the need for further study.
Anxieties and panic attacks
DPDR is often linked to anxiety and panic disorders, particularly panic attacks, which can trigger dissociative symptoms like detachment from oneself or reality. During a panic attack, the intense fear and physical symptoms can cause the mind to dissociate as a protective mechanism. Recurrent panic attacks can create a cycle of heightened anxiety and dissociation, reinforcing DPDR symptoms over time. However, while panic attacks can trigger DPDR, they are not the sole cause, and other factors may contribute to the disorder’s development.
(Sierra, 2009), (Hunter et al., 2004), (Berrios & Sierra, 1997)
Depression and OCD
Depersonalization-Derealization Disorder (DPDR) is common in individuals with depression and OCD. In depression, emotional numbness and hopelessness can lead to detachment from oneself and reality. Similarly, in OCD, intrusive thoughts and compulsive behaviors generate anxiety, which can result in feelings of dissociation. In both conditions, DPDR may serve as a coping mechanism to manage intense emotional distress. However, the severity of DPDR can vary, depending on the individual’s emotional state and the underlying disorder.
(Michal et al., 2024), (Boysan, 2014), (Hunter et al., 2004), (Simeon et al., 2003)
Trauma
Trauma, including physical, emotional, or sexual abuse, is a common trigger for DPDR. Survivors often dissociate to cope with the overwhelming emotional distress caused by the trauma. This dissociation can lead to a sense of detachment from reality, and is often linked to PTSD, where unprocessed memories trigger flashbacks and intensify DPDR. The cycle of trauma and dissociation can complicate recovery, as the mind struggles to process the trauma while managing the dissociative response. Effective treatment requires addressing both the trauma and the dissociation.
Cannabis, MDMA
The use of psychoactive substances such as cannabis or MDMA (ecstasy) can trigger or worsen DPDR. Cannabis, in particular, is suspected of causing persistent symptoms not only during use but also afterward. Similarly, hallucinogenic substances like LSD or psilocybin can induce DPDR experiences. Those affected often report intense, unexpected panic reactions during intoxication that transition into DPDR. Alcohol abuse, especially in connection with withdrawal, can also contribute to the development of symptoms.
(Madden & Einhorn, 2018), (Van der Kloet et al., 2015), (Hürlimann et al., 2012)
Medications
Certain medications, especially antidepressants like SSRIs (e.g., sertraline or escitalopram), can, in rare cases, trigger DPDR symptoms, particularly when starting the medication, increasing the dose, or abruptly discontinuing it. Other medications, such as benzodiazepines when used long-term or in cases of dependence, are also suspected of triggering DPDR. Particularly in sensitive individuals or those with pre-existing anxiety issues, changes in medication can intensify the symptoms.
In many cases, DPDR does not occur in isolation but accompanies other psychological or physical challenges such as anxiety disorders, depression, trauma, or chronic stress.
(Simeon et al., 2003)
Comorbiditys
DPDR often occurs alongside other mental health conditions. Comorbidity refers to the simultaneous presence of two or more disorders in a person. In the following, the most common comorbidities associated with DPDR are presented along with their respective percentage rates:
28.2 %
Social Phobia
Social Phobia, or Social Anxiety Disorder (SAD), is a mental health condition marked by an intense fear of being judged or embarrassed in social situations. People with social phobia experience significant anxiety when interacting with others, such as speaking in public or meeting new people.
23.1 %
Dysthymia
Dysthymia, also known as Persistent Depressive Disorder (PDD), is a chronic form of depression characterized by a low mood lasting for at least two years. While the symptoms may be less severe than those of major depressive disorder, they can still significantly affect a person’s quality of life.
16.2 %
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is a mental health condition characterized by persistent, excessive, and uncontrollable worry about a wide range of everyday situations and events. People with GAD often feel anxious about things like work, health, social interactions, or minor matters, even when there is no clear reason for concern.
12.0 %
Panic Disorder
Panic Disorder is a mental health condition characterized by recurrent and unexpected panic attacks—sudden episodes of intense fear or discomfort. These attacks can occur without warning and often lead to significant anxiety about when the next one will happen.
10.3 %
Major Depression
Major Depression, also known as Major Depressive Disorder (MDD), is a common and serious mental health condition characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities once enjoyed. It can affect how a person thinks, feels, and functions on a daily basis.
8.5 %
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or rituals (compulsions) that a person feels compelled to perform to reduce anxiety or prevent a feared event.
A range of physical conditions, including inflammatory brain diseases, thyroid disorders, brain injuries, epilepsies, and severe sleep disorders, should be ruled out.
Explanatory models of the development
The following presents different explanatory approaches to the development of DPDR, considering both social and psychological factors.
Behavioral Model
The behavioral explanation for DPDR assumes that the symptoms arise from a vicious cycle of negative thoughts, intense self-monitoring, and maladaptive coping mechanisms. Those affected tend to catastrophize normal but uncomfortable bodily sensations or thoughts, interpreting them as signs of a serious illness, such as schizophrenia or brain diseases. This irrational appraisal leads to increased self-monitoring and attempts to control the state, which can, in turn, exacerbate the symptoms. The heightened self-observation and constant fear of losing control or reacting socially inappropriately foster increased dissociation and withdrawal from social interactions. As a result, the individual remains in a state of alienation from themselves and their environment, perpetuating the DPDR symptoms.
Biographical risk factors
Biographical risk factors play a crucial role in the development of Depersonalization-Derealization Disorder (DPDR). Studies have shown that individuals with DPDR often have a history of emotional abuse. A population-based study found that these individuals perceive their parents as more rejecting, stricter, controlling, and anxious compared to those without the disorder. Additionally, people with DPDR are more likely to have experienced their parents’ divorce before the age of 18. Further research highlights that DPDR patients often struggle with significant social anxiety, shame, and interpersonal problems. These difficulties are frequently accompanied by a high degree of helplessness, hopelessness, and negative expectations in relationships, which negatively affect the social interactions of those affected.
(Michal et al., 2009, 2006a, 2006b, 2005), (Simeon et al., 2001)
Psychodynamic Model
The Depersonalization-Derealization Disorder (DPDR) is often understood as a defense mechanism that protects against overwhelming emotions. From a psychoanalytic perspective, it can be seen as a reaction to shame and difficulties in regulating self-esteem. It involves a conflict between the desire for self-expression and the fear of rejection, which can lead to feelings of alienation and a cycle of shame. Additionally, DPDR may arise from internal struggles with contradictory self-images, often triggered by traumatic experiences. It is also associated with a withdrawal from emotional relationships as a way to avoid vulnerability and preserve a sense of self.