What Keeps Depersonalization And Derealization Going?

It’s normal to have brief experiences of depersonalization and derealization, but if they become regular, more severe, and interfere with your ability to live your life, you may be suffering from depersonalization-derealization disorder. Symptoms of depersonalization and derealization include:

• You feel remote and detached.
• Your emotions feel numbed or superficial.
• The world feels unfamiliar or artificial.
• Images and sounds are distorted.
• You know these experiences aren’t felt by other people, and aren’t caused by real changes in the world.
• Your body feels numb, weightless, or hollow.
• You struggle to concentrate.
• You keep thinking about what is real and what isn’t.

The psychological treatment for depersonalization and derealization that has the strongest research support is cognitive behavioral therapy (CBT). CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. 

In 2003, Elaine Hunter and her colleagues at the Institute of Psychiatry in London published a model of depersonalization and derealization, which explains the ‘parts’ that make its symptoms more distressing for some people. The What Keeps Depersonalization and Derealization Going? information handout describes some of the key factors which act to maintain depersonalization and derealization. It illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes is an essential part of cognitive therapy for depersonalization and derealization. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

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