Psychotherapy can be complicated and may require a unique approach or a change between supportive and psychodynamic approaches.

Psychotherapy and DDD

Supportive interventions consist of crisis interventions and shoring up existing coping skills and strategies. These are a better fit during periods of acute stressors, frequent dissociation, and/or severe depression and anxiety.

Supportive Interventions and DDD

During periods of relatively mild symptoms, a psychodynamic approach may be used in which the patient focuses on self-reflection and self-examination.

Psychodynamic Approach and DDD

There’s no known pharmacotherapy for treating DDD. Most medications prescribed to patients with DDD fall into the categories of antidepressant and anxiolytic and are used to alleviate comorbid anxiety and mood symptoms (especially panic and obsessions), but don't treat the dissociative psychopathology. Stabilization of mood may contribute to a more tolerable affective state with DDD.

Pharmacotherapy and DDD

- Psychotherapy
- Supportive interventions
- Psychodynamic approach
- Pharmacotherapy

The most effective treatment for DDD is specifically adapted to address the complex traumas and high level of dissociation among DDD patients.

Boston University

Sense of feeling detached from the body and environment. Individual feels as if they are an observer in their own body, as if thoughts and feelings aren't their own. Objects, people, and surroundings feel unnatural to them.

Depersonalization/ Derealization

Sierra, M., & David, A. S. (2011). Depersonalization: A selective impairment of self-awareness. Consciousness and Cognition, 20(1), 99–108. https://doi.org/10.1016/j.concog.2010.10.018

Depersonalization: A selective impairment of self-awareness

Gentile, J. P., Snyder, M., & Gillig, P. M. (2014). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/ Derealization Disorder. Innovations in Clinical Neuroscience, 11(7–8), 37–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/pdf/icns_11_7-8_37.pdf

STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder

- Depersonalization: pronounced distinctions from the self
- Derealization: disconnections from external environment/reality

Depersonalization vs. Derealization

- Transient experiences (NOT depersonalization-derealization disorder)
- Long-term/enduring experiences (depersonalization-derealization disorder)

Depersonalization-Derealization Causes

- Physiological or emotional numbing
- Sensory impairments feelings of disembodiment
- Distorted experience of time
- Feeling as if one is in a dream
- Visual perceptual distortions
- An unreal/absent sense of self
- May hear voices (dissociative episodes; distinct from the auditory hallucinations experienced in psychosis)
- DON’T have psychosis and HAVE intact reality testing
- Symptoms often overlap with both anxiety and other dissociative disorders (PTSD or panic disorder, OCD, depression, schizophrenia)

Depersonalization-Derealization Disorder Symptoms

Depersonalization-Derealization Disorder Treatments

Sierk, A., Daniels, J. K., Manthey, A., Kok, J. G., Leemans, A., Gaebler, M., Lamke, J.-P., Kruschwitz, J., &amp; Walter, H. (2018). White matter network alterations in patients with depersonalization/derealization disorder. Journal of Psychiatry and Neuroscience, 43(5), 347–357. https://doi.org/10.1503/jpn.170110 

White matter network alterations in patients with depersonalization/derealization disorder.

Dysfunction in frontolimbic systems are found in individuals with DPD. This has shown a relationship with hyperactivity in the fronto regions of the brain compared to non DPD controls.

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