How to Support a Teenager with Depersonalization/Derealization Disorder

Chronic feelings of derealization in teenagers may indicate a dissociative condition known as depersonalization/derealization disorder (DPDR).

Depersonalization/derealization disorder (DPDR) is one of several dissociative disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, text revision (DSM-5-TR).

It affects approximately 1% of the population and is most prevalent among teenagers, young adults, and those living with other mental health conditions.

While it’s natural for teens to display a number of detached behaviors often attributed to “growing up,” regular derealization can be more than just teenage discontent.

DPDR is a type of dissociative disorder, a condition where you feel a disconnection to your surroundings and the things that make you “you.”

This includes key components of “self,” like your memories, behaviors, thoughts, emotions, and your sense of who you are.

Preventable medical errors kill about 22,000 patients a year, according to research from the Yale School of Medicine. That’s much less than a previously reported number of 250,000 deaths a year where medical error is to blame.

Depersonalization and derealization are both experiences of unreality that makeup DPDR, but only one needs to be present to receive a diagnosis. You can have derealization, depersonalization, or both.

Unreality vs. psychosis

Unreality and psychosis both involve reality perception, but they aren’t the same.

Unreality is a term used to describe things occurring in reality that feel unreal. Psychosis involves an inaccurate view of reality.

In DPDR, reality testing remains intact, which means you accurately perceive reality even though you feel detached from it.

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Signs and symptoms of derealization in teenagers

DPDR can involve symptoms of depersonalization and/or derealization.

Depersonalization occurs when you feel disconnected from your identity or self, like you’re on the outside, looking in.

Derealization is often described as a dream-like sensation. You feel separated from your surroundings as if everything is artificial. In derealization, your environment may appear distorted, blurred, or even exaggerated in dimension.

Symptoms of depersonalization in teenagers can include:

• memory loss
• feeling as though thoughts aren’t their own
• having their head feel “filled with cotton,” or otherwise muffled/stifled
• lack of awareness/acknowledgment of bodily sensations like hunger, thirst, or libido
• feeling robotic or not in control of themselves
• emotional numbness

Symptoms of derealization in teenagers can include:

• time distortion
• a sense of unfamiliarity in regular surroundings
• feeling as though they’re existing in a dream or watching a movie
• remarking about surroundings that appear blurry, distorted, or unrealistic
• hearing voices and sounds as muffled or unclear
• feeling an unnaturally close connection to the environment, as if they were part of the landscape
• déjà vu
• believing they’ve already spoken when they have not
• feeling familiarity or a sense of revisiting in a new place
• worrying about “going crazy”

What causes derealization in children?

The exact cause of DPDR is unknown. The DSM-5-TR indicates there’s a clear link between DPDR and childhood interpersonal trauma, particularly emotional abuse and neglect.

But this does not mean all cases of DPDR are related to traumatic events.

“Derealization in children can be caused by a number of factors, including stressful life events (such as abuse or trauma), psychiatric illnesses, physical illnesses, and drug use,” explains Steve Carleton, a licensed clinical social worker and executive director at Gallus Detox, Denver, Colorado.

“Children may also experience derealization as a result of psychological issues such as anxiety and depression.”

Like in other dissociative disorders, DPDR may be your brain’s way of coping with overwhelming circumstances by creating a separation between you and your stressor.

Chronic derealization can be an indication your teen is in significant distress, but you can help them through this challenging experience.

Validating their feelings

Carleton recommends listening to teenagers and taking their feelings seriously.

“This demonstrates to them that you have heard what they have said and understand their experience, which can be incredibly reassuring for a teen who may feel overwhelmed by their symptoms,” he says.

It can also help build communication and trust, which may make them more likely to come to your when they need support.

Engaging in mindfulness with your teen

Dr. Breylan Haizlip, a licensed professional counselor and psychology professor from Puyallup, Washington, explains mindfulness and meditation are some of the most effective tools in managing DPDR.

“The most powerful way for an adult to engage a teen is by developing a meditation and mindfulness practice for themselves,” she says.

Haizlip says that setting the example helps lessen the association of mindfulness with treatment and, instead, portrays it as an overall approach to positive well-being.

Making home a sanctuary

Carleton suggests creating a calm environment for your teen. He says this might include:

• quiet, comfortable places for them to relax and unwind
• avoiding stressful conversations or activities
• providing them with the space and time they need to process their feelings

Being a part of their lives

Spending quality time together and encouraging healthy coping skills like yoga, journaling, and art therapy, can also help teens feel supported, Carleton says.

When to seek help

Haizlip points out that because the unpredictability of puberty can look — and feel — like a mental health disorder, it’s not always easy for parents to know when their teen needs help.

Ultimately, it’s never too soon to speak with a mental health professional, especially if symptoms of derealization in teens are causing significant distress or interfering with daily activities and interpersonal relationships.

There’s no medication specifically for DPDR, though certain prescriptions may help manage mood symptoms.

Treatment is most commonly done through psychotherapy. Cognitive behavioral therapy (CBT) is a popular therapy that helps you learn to recognize, understand, and control thoughts and feelings in DPDR.

Mindfulness, grounding techniques, and stress reduction can all be a part of CBT.

Eye movement desensitization and reprocessing (EMDR) may also be helpful for conditions of dissociation. EMDR, often used in post-traumatic stress disorder (PTSD) uses specific eye movement sequencing to help the brain process traumatic memories.

DPDR is a type of dissociative disorder commonly seen in teens and young adults. It’s often associated with trauma, but can also be caused by extreme stress, drug use, co-existing mental health challenges, and underlying medical conditions.

DPDR can be intense and scary for teens. You can help alleviate their fears and offer support by listening, openly communicating, and encouraging them to engage in alternative coping strategies.

When DPDR is causing your teen significant impairment and distress, speaking with a mental health professional can help.

Last medically reviewed on March 9, 2023