A Stranger In The Mirror: Derealisation and Depersonalisation
The comorbid disorders that make you feel like an alien in your own body
I look in the mirror and recoil from my own gaze. I hold my partner and am emotionally numb. At dinner, I sit opposite my father and shrink backward in fear because his eye contact is deeply unnerving. I am displaced from my own body- viewing life through a dirty lens and feeling as if I am reclined in the bath with ears beneath the waterline. At its worst, I awake and am hanging onto reality by a thread; simple tasks are overwhelming and I am paralysed with a sense of alienation from life and body. I overthink thought and am terrified of existence. The world seems “off” and the edges blurred.
The sensation I am describing is a mixture of two dissociative disorders which are often the result of trauma and anxiety. Though separate, they are bedmates, and usually occur simultaneously. They are called derealisation and depersonalisation, or DPRD for short. Derealisation is the sensation of feeling as if you are in a dream; life may be perceived as hazy or foggy, and familiar people and places may seem unreal and lifeless. Depersonalisation is the feeling of being out of body or distant from others.
It is responsible for the feeling of being a step back from your vision. Common buzzwords associated with this unique disorder include feeling robotic, behind glass, or out of body. I could throw similes and metaphors at you ad infinitum, or direct you to well-meaning but clumsy visual simulations, but suffice to say, none do justice to the impotent dread that it evokes in sufferers.
For many, the transition into a state of unreal is sudden and dramatic. My own was prompted by the break up of my parents marriage over an affair. Oftentimes it’s a result of extreme trauma, panic attacks, and depression. Recreational drug use can also prompt an episode, with cannabis being cited repeatedly as a catalyst. Before diagnosis, the sensation can seem inexplicable and spell personal disaster.
If you didn’t know it was a natural — and surprisingly common — response to anxiety, it is easy to believe that your grip on reality is slipping. I remember feeling powerless, confused, and utterly fearful at this new state of mind that had befallen me, and believing I had permanently detached from my own humanity. It was as if someone had changed the controller settings on a game and I didn’t know how to reverse it, but of course, the stakes were much, much higher.
This numbness can exacerbate other disorders; with OCD, feeling disgusted by intrusive thoughts is a reassuring testament to how at odds they are with your own beliefs. When you are anaesthetised to them through depersonalisation and derealisation it can further fuel fears that you agree with the thoughts.
My harm OCD was intensified by derealisation as I felt I was going mad and losing my sense of morality. Naturally, this made violent thoughts more powerful. Ironically, this terrifying sensation may be the bodies defence mechanism against trauma and anxiety; when reality grows overwhelming, the mind plugs out and disassociates. Unfortunately, the alien sensations provoked by the disorders then create a vicious cycle; you overanalyse the feeling, despair it will never fade, and in stressing, reinforce the sensation.
Whilst DPRD is relatively obscure, it is certainly gaining exposure, albeit slowly; NHS treatment plans for derealisation were discussed in parliament last year. During this discussion on the floor, the Labour MP for West Ham noted that for one of her constituents who had suffered from derealisation:
“Learning the name of the condition was a crucial step in understanding it, living with it, and eventually learning ways of dealing with it.”
This was certainly a turning point for me in dealing with the disorder.
Unfortunately, there is plenty of work to be done in increasing literacy around DPRD; the extent of the problem can be gauged by the fact that the average time it takes for diagnosis is 8–12 years. Any attempt to explain how one is feeling relies upon metaphor and similes and GP’s are often not equipped to identify the disorder the patient is articulating. Stories abound of sufferers visiting multiple GP’s who are perplexed by their abstract descriptions of feeing disembodied, and more often than not prescribe antidepressants after conflating DPRD with depression.
The Parliamentary Under-Secretary of State for Health and Social Care noted that going forward, “we should not just medicalise treatment through prescribing drugs”, and pressed home the fact that medication isn’t the best treatment plan for Disorders like DPRD. Hopefully, this article will go some way to raising awareness around this debilitating dissociative disorder and close that gap in diagnosis for sufferers.
No one should face a decade of unreality completely in the darkness about their symptoms, especially when simply gaining awareness of the disorder does so much to disempower it. Jane Charleton, the sufferer mentioned in parliament, makes clear how effective naming the disorder can be: “It’s slightly different to most other disorders, where people say we don’t have the right treatments or the right doctors to help us. We do. All we need is awareness”.
Moreover, if you are suffering from either of these two disorders, rest assured that you are not going mad, nor is the disorder dangerous or a sign of mental decline. In fact, many people have temporary experiences of depersonalisation and derealisation in their life, 75% in fact, though for those with the disorders discussed the change of perception endures far beyond the event that triggered it.
It is the length and intensity of the feeling that separates the roughly 2% of people with DPDR and 75% of people who have had a passing sensation of zoning out. If you are currently feeling disembodied or permanently in a dream state, you needn’t stress that you’re “stuck” like this, regardless of how long you have had the disorder.
Although I still have the odd moment where I can feel my vision dimming and the world growing foggy, I no longer despair as I once did. I often take it as a sign that I am overworked or anxious and take time out to recapture a sense of calm and repose. The first step in the process which has allowed me to accept and manage DPD was having a name for it that validated my experience. In addition, I have found that avoiding coffee and alcohol are good bulwarks against the disorders, but most importantly, performing frequent exercise and staying well-rested is my main line of defence.
There is a supportive community out there of those who have been struck with the disorder, as well as a charity offering education and testimony; reading the stories on these sites often gives me comfort during the darkest hours. With any luck, this piece can offer some hope to those suffering and be a small but necessary move in the right direction towards giving derealisation and depersonalisation the attention they deserve but are not currently accorded.
