Arriving In Presence: Overcoming Depersonalization — Derealization Disorder

This comprehensive guide is dedicated to anyone and everyone out there who’s dealing with depersonalization-derealization. I know exactly how it feels to be there — in the darkness, often hopeless, scared, desperately looking for answers. I put together this guide to help you navigate this poorly-understood condition that affects so many of us, sometimes for years on end with no significant relief in sight. We’ll talk about the possible mechanism behind DPDR, the neurobiology and physiology of stress and how it affects our nervous systems. We’ll look at the most common denominators of the DPDR equation — trauma, anxiety and depression, as well as nutritional deficiencies that affect hormone and neurotransmitter production and gene expression. But most importantly, I’ll lay out all the strategies that can be used to deal with this condition, so you can have all the necessary tools to heal yourself and others around you!

“Depersonalization disorder (DPD), also known as depersonalization/derealization disorder (DPDR), is a mental disorder in which the person has persistent or recurrent feelings of depersonalization or derealization. Depersonalization is described as feeling disconnected or detached from one’s self. Individuals experiencing depersonalization may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. […] Derealization is described as detachment from one’s surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike/surreal, or visually distorted.” — Wikipedia

Physiology of Stress — The Fight-Flight-Freeze Response

Located in the middle of the brain, the limbic system is comprised of the amygdala, hippocampus, thalamus, olfactory cortex, and hypothalamus. Your limbic system is largely responsible for both your physical and emotional responses to any/all situations in life. The number of functions regulated by the limbic system is truly astounding — from learning and storing memories, to emotions, sensory perception, stress response, and sexual and motor functions, to name but a few. Most importantly, the limbic system is closely connected to your autonomic nervous system (ANS) and plays an important role in regulating the fight-flight-freeze response.

Faced with a threatening situation, whether emotional or physical in nature, the amygdala (often called your brain’s “panic alarm”) prepares your body to “fight”, “fly”, or “freeze” depending on the context. Once your body is in full-blown survival mode, it secretes all sorts of chemicals to increase your heart rate, raise your blood pressure, slow down your digestion and immune function, release extra glucose for energy, and produce more adrenaline and cortisol. This survival mechanism, though healthy, can wreak havoc on both your physiological and emotional health if not regulated properly. Being stuck in a fight-flight-freeze pattern often leads to fatigue, anxiety, panic attacks, dissociation disorders, emotional trauma, and other chronic health conditions.

The Freeze Response and DPDR

One of the hallmark symptoms of DPDR is dissociation (both emotional and physical), as well as emotional numbness. I’d experienced it myself for a number of years even before developing severe DPDR, although it was definitely on a different level during my DPDR journey. It’s also important to note that often the onset of DPDR is accompanied by a period of high stress and anxiety, leading to a major panic attack which in turn kicks off a lot of the DPDR symptoms (chemically-induced triggers like recreational drugs or medicaments can also have the same effect). This makes perfect sense in terms of nervous system function. Let’s take a look at how things work.

The Polyvagal Theory

Our autonomic nervous system has two branches — the parasympathetic nervous system (“rest-and-digest”) and the sympathetic nervous system (“fight-and-flight”).

The parasympathetic nervous system consists of a number of cranial nerves (CN III, CN VI and CN IX), the vagus nerve and the pelvic splanchnic nerves.

The vagus nerve has two branches as well — the dorsal vagal branch and the ventral vagal branch. The ventral vagal branch is responsible for dampening the fight-and-flight response to make you feel safe, relaxed, calm and engaged, whereas the dorsal vagal branch is in charge of immobilization (the freeze response). This is so that you can protect yourself from an overwhelming amount of danger, fear, anxiety, metabolic stress, trauma, etc.

Think about the state of shock, whether psychological or physiological (oftentimes they occur together). In this state, your body is trying to protect you from being overwhelmed by what’s happening to you. Your nervous system assesses the situation around you (in a process called neuroception) and decides that it’s not the right time to “fight” or “fly”, and that it would be best for you to conserve your energy and literally “freeze”.

DPDR is a state of immobilization, or hyperactivity of the dorsal vagal system

Normally, when presented with a threat, our nervous system follows a hierarchical pattern — first the ventral vagal response, then the sympathetic nervous system response and then only the dorsal vagal response.

“The hierarchy is composed of three neural circuits. One circuit may override another. We usually react with our newest system, and if that doesn’t work, we try an older one, then the oldest.” — Dr. Stephen Porges, PhD

But how come a lot of us get DPDR in what seems like an instant? One minute we’re here — and the next one we’re totally gone? How do we bypass the first two systems? My guess is that it’s chronic stress, both emotional and metabolic.

Stress

Suppressing emotions is one of the patterns that I’ve noticed with myself and many others who ended up developing DPDR at some point in their lives. My whole life I was always “fine” and “doing well”, telling people “I’m okay”. And while the world might’ve been exploding around me, I never allowed myself to go there — where my emotions resided. To be completely honest, I didn’t even know that it was possible, but that’s a whole different story.

As we grow, our nervous system develops with us. It learns to process information, store it, categorize it, and it learns when to relax and when to jump. We teach it when it’s safe and when we need to hide. In my case, my inability to feel safe or to be with my emotions put me in a chronic state of sympathetic dominance (fight-or-flight), where I was always “on” and checking for potential danger around me. I had rapid wit, a quick mind, and an unparalleled ability to solve problems on the spot. I was constantly running (though not literally), doing, solving. My nervous system had no idea how to rest or digest, I was only ever switching between sympathetic and dorsal vagal branches. I couldn’t sit still for a second, let alone truly feel my emotions.

But what does that do to a body? It depletes hormones (especially adrenaline, noradrenaline, and cortisol), exhausts adrenal glands, imbalances neurotransmitters and creates ongoing inflammation because of the high-volume demand for nutrients and chemicals needed to produce all of this.

To get into a fight-and-flight response your body requires a lot of different chemicals. But what if you’re running low? This is when your chronic nervous system disregulation becomes a very real problem. Just like you can’t start a car with no gas in the tank, you need some sort of fuel to fight or fly. Freezing, on the other hand, doesn’t require a ton of resources. It’s basically hibernating, so your metabolic demands are pretty low at this point.

So how do you recover from this state and go back to being fully engaged and present again?

Coming back to your senses

Addressing the root cause of your stress

The number one thing that you can do to help yourself recover from DPDR is teach your nervous system to feel safe. How does one go about that?

Body-oriented psychotherapy

You can try regular talk therapy or CBT, which in general is great, but in my experience can create even more issues for people with DPDR. See, talk therapy is all about rationalizing things, experiences, traumas, etc., learning from them, changing your outlook, processing and moving ahead, which works amazingly well for many of us, but not for people that are already chronically stressed out. Going back there to address your childhood traumas or your day-to-day stressors can be triggering enough for your nervous system to disassociate even more. There are, however, specialists who work with PTSD and are often better trained in noticing whether or not their client is dissociating during the session.

I believe the most important thing you need to do is to learn how to be in your body again — how to live with those day-to-day emotions, those fears, and to process any past traumas. You need to start teaching your nervous system that it’s safe. Here and now it’s actually safe. One of the most helpful tools I’ve found for learning how to actually assess and process things, how to be in my body and stay present when I’m overwhelmed, and for dealing with my day-to-day life is Somatic Experiencing — a type of body-oriented psychotherapy. The process itself is not drastically different from talk therapy, however a Somatic Experiencing practitioner will ask you to focus on physical sensations while you’re working on processing an emotion. Also, they will pay close attention to whether or not you’re dissociating. The goal of SE is to let you feel the emotions fully but also come back to the present moment, thus teaching your nervous system that an overwhelming experience or a big emotion is not an actual threat and that you have all the necessary tools to deal with it. Somatic Experiencing practitioners will use the titration approach, helping you process emotions little by little, so you don’t overwhelm your nervous system and don’t stress yourself out even more. By focusing on physical sensations you’re actually re-training your nervous system and working on a neurobiological level.

Grounding or embodied-mindfulness techniques

Grounding refers to simply focusing your attention on a part of your body or a sensation. Feeling both of your feet on the floor, or your back against a chair, or your fingers touching your face. Whatever it is for you that feels safe and soothing — go for it. When you catch yourself obsessing over your DPDR, just feel your feet rooted deeply in the floor for a second, or the cool air entering your nostrils when you inhale. I would recommend that your grounding resource is a physical one — that way you can start learning to go back into your body, and slowly start feeling like it’s a safe space. Remember, your foot/arm/chest is not experiencing DPDR. Your body is your fortress and a safe space for you to rest and restore. We’re teaching our nervous system to down-regulate, even if it’s just for a second or two, but we’re slowly training it to have options when it comes to a stress-response.

External resources or distractions

A lot of DPDR recovery strategies involve distracting yourself whenever you feel like you’re constantly noticing your symptoms. And I totally agree — the power of distraction is not to be underestimated in combatting this condition. Do whatever feels most pleasurable and relaxing to you! You’re going through some heavy stuff — allow yourself to indulge in something, and create those moments for yourself.

Noticing

Again, learning to notice your DPDR without panicking about it or obsessing over it is key. It takes a village though. This idea seemed completely unrealistic to me for the longest time, even though my therapist had been mentioning it during almost all of our sessions for a year. But as I learned to become generally less stressed out and anxious (through therapy, grounding, distracting myself, self-care and mindfulness), my brain started developing a greater capacity to just be present (at first, for two seconds at a time). And then, I started noticing, and becoming curious about what was happening to me. And eventually my symptoms stopped feeling terrifying and started slowly dissipating. I started looking at them from a neurobiological standpoint — my body is so overwhelmed right now and is doing its best trying to protect me from any other potential threat or danger. I even felt somewhat grateful in those moments. Of course, they didn’t last forever, but step by step, my muscles started relaxing and my body started learning that there is safety somewhere here, and we can deal with this big crazy world again.

Other things that I love to use for helping me to rewire the nervous system (NB! Make sure all the practices that you engage in are trauma-informed — that way whatever you’re doing is safe for you and will not cause more dissociation):

● Trauma-informed Mindfulness (try Headspace — it’s a great place to start developing your practice)

● Singing (it’s actually one of the best ways to stimulate the vagus nerve)

● Laughing (same here)

● Craniosacral therapy (extremely relaxing, and especially helpful if your DPDR is giving you sleep-related issues. It’s also one of the best ways to stimulate the vagus nerve and optimize nervous system function, but go slow!)

● Acupuncture

● Massage (anything that involves touch actually, since it releases oxytocin and stimulates your ventral vagal response, but go slow and only if you’re comfortable!)

● Tension and Trauma release exercise (a great tool to reset the fight-and-flight response, commonly used in PTSD treatment)

● Socializing

I can’t stress enough how important that last one is! When we’re socializing and engaged, we’re promoting a healthy ventral vagal state, which means we’re putting the brakes on both the fight-and-flight and the freeze responses. I know it’s immensely hard to be social with DPDR, and it makes total sense if we look at the physiology of our nervous system. When ventral vagal tone is low, things like direct eye contact, touch or just simply communicating with someone can be overwhelming and can stimulate the dorsal vagal or the sympathetic shift. But start slow and on your own terms — maybe by noticing, for example, when you’re talking to your therapist and you’re feeling safe, or when you’re talking to your significant other and feeling comfortable and not judged. This will help your nervous system learn that it’s a safe activity and you’ll start reaping the benefits of this life-changing therapy in no time!

Addressing metabolic imbalances

We’ve talked about how chronic stress creates a high demand for nutrients and chemicals in the body. This in turn creates deficiencies and imbalances that lead to ongoing inflammation. We need to address those first in order for your nervous system to have the resources to function properly. I strongly suggest you look into the following aspects of your health.

Gut health

Your gut is directly connected to your brain and vice versa — it’s a well-established scientific fact. So if you have digestive issues, or you’re simply not absorbing your nutrients well enough — you and your vagus nerve are in big trouble. Your nervous system needs a plethora of amino acids, essential fatty acids and other nutrients to produce the cocktail of chemicals that keeps you healthy and happy.

Your diet

There’s a lot great information out there on mental health and diet. Specific foods might cause inflammation in the gut, leading to inflammation in the brain (leaky gut > leaky blood brain barrier > CNS inflammation). On the other hand, there are plenty of foods that have strong therapeutic properties and can boost your neurotransmitter production, reduce inflammation, support nerve-impulse singling and myelination, etc.

I would suggest paying close attention to common triggers like gluten and dairy, and in case you already have some digestive issues, look at other potential sources of gut/brain inflammation like grains and legumes.

Make sure your diet is varied and nutrient dense. You need your fair share of different amino acids, vitamins and minerals to produce your neurotransmitters and hormones.

Your methylation status

Methylation is a biochemical process that involves the transmission of a methyl group from one molecule to another. This simple process affects a multitude of functions in the human body, among them the regulation of neurotransmitters (serotonin, dopamine, adrenaline) and healthy nerve-impulse transmission. It’s important to know your genetic status in order to optimize your methylation cycle by adding the necessary methylation cofactors like B12, B6, methylfolate, zinc and magnesium. Work with a healthcare professional when addressing genetic variations.

Mineral balance

One of the most common mineral imbalances in mental health conditions is found in the zinc-to-copper ratio. Copper toxicity and zinc deficiencies are often associated with conditions like bipolar disorder, anxiety, OCD, ADD and schizophrenia.

“A likely mechanism behind copper’s psychological and neurological effects is its induction of dopaminergic activity. Dopamine is a neurotransmitter that is often referred to as the ‘feel good’ neurotransmitter. However, dopamine is converted into the excitatory neurotransmitter norepinephrine, and copper is a major co-factor for this conversion. Research has found that norepinephrine levels are elevated in the cerebrospinal fluid (2), as well as in certain regions of the brain (3) among paranoid schizophrenics. Norepinephrine (also known as noradrenaline) induces ‘fight or flight’ stress responses, excitatory physiological responses (such as elevated heart rate) and greatly impacts large parts of the brain responsible for thinking, arousal, alertness, decision making and emotional responses. Elevated norepinephrine caused by copper toxicity may be a major culprit in attention deficit disorder (ADD), obsessive compulsive disorder (OCD) and schizophrenia, as well as other behavioral-related issues.” — Michael McEvoy, FDN-P

Conclusion

DPDR is truly complex, but you need to remember one thing and one thing only — that it’s merely a symptom of disbalance. Start working on the underlying physiology, supporting your emotional health, working through past and present traumas, and processing your emotions. And most importantly, give yourself a lot of love and attention — you deserve it the most.

Wherever you are in your DPDR journey, I hope the information that I’ve provided in this guide will give you hope and the right tools to heal. It’s one hell of a trip, but once you find yourself on the other side you’ll be blown away by how truly magnificent you are!