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Does Depersonalization/Derealization Disorder Cause Drug or Alcohol Abuse?

Depersonalization/derealization disorder is a mental health disorder in which a person feels detached from their own body, mental processes, or surroundings.1

Temporary episodes of depersonalization/derealization are common in the general population. However, the disorder only occurs in about 2% of the population, and affects men and women equally.1

Woman with depersonalization disorder putting head in hand
Though there are not many published research findings on the prevalence of drug or alcohol abuse among people with this disorder, in general, people with mental health disorders often use drugs or alcohol to cope with their condition. People who develop depersonalization/derealization and addiction should seek out a dual diagnosis treatment center that can help them manage both issues.

What Are the Symptoms of Depersonalization Disorder?

The symptoms of depersonalization disorder include a sense of unreality, detachment, or being an outside observer of one’s own thoughts, feelings, or behaviors.1

The person may feel detached from their entire being or to specific aspects of themselves, such as their feelings, thoughts, body parts, or sensations. They may also feel like a robot or feel that they have no control over their speech or movements. In addition, the person may experience a “split self” in which one part of the person feels as if they are observing and the other part participating in the world.1 The symptoms of derealization disorder include a sense of unreality or detachment from one’s surroundings. People or objects may seem unreal, dreamy, or lifeless.1

The person may feel as if they are in a fog or bubble. Their environment may seem artificial. Often, people with this condition experience visual disturbances such as blurriness, a widened or narrowed visual field, or distortions in the size or distance of objects. Sounds can also be muted or amplified.1

The symptoms of depersonalization/derealization disorder usually cause great distress and make normal life—going to work or school and interacting socially—extremely difficult. It’s not uncommon for those with the disorder to believe that they don’t actually exist or even to believe that what they are experiencing is caused by irreversible brain damage.1,2

What Causes It?

The causes of depersonalization/derealization disorder are often related to extreme stress and include:2

  • Emotional or physical abuse.
  • Seeing domestic violence.
  • Growing up with a severely impaired or mentally ill parent.
  • Suddenly losing a loved one.

Symptoms of the disorder can also be triggered by stressful events (relationships, finances, work), depression, anxiety, or use of illegal drugs.2

Substance Abuse and Depersonalization Disorder

Substance use can be a potential trigger for depersonalization/derealization. The use of alcohol and certain drugs, especially cannabis, can contribute to the emergence of the disorder.3

Most commonly with cannabis, any drug-induced depersonalization effects are generally only felt while the drug is active in the system, appearing within about 30 minutes of ingestion and dissipating within 2 hours. For some, however, the drug may trigger symptoms of depersonalization that persist for weeks, months, or even years. Studies have termed this condition cannabis-induced depersonalization-derealization disorder.3

The use of alcohol and certain drugs, especially cannabis, can contribute to the emergence of depersonalization disorder.

The disorder is characterized by an episode of depersonalization/derealization that fades but returns and eventually become chronic. In others, onset is sometimes more abrupt, with symptoms beginning during an instance of cannabis intoxication and continuing for months or years after. In other cases, symptoms may not present themselves until hours or days after cannabis use.3

Most of those who experience cannabis-induced depersonalization/derealization disorder have a history of anxiety disorder, such as panic disorder and social phobia. Using cannabis during periods of significant stress or following exposure to trauma may increase the risk of cannabis-induced symptoms.3

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), other substances, including hallucinogens (LSD, psilocybin mushrooms), ketamine, Ecstasy (MDMA), and salvia may trigger derealization/depersonalization episodes. However, the DSM states that symptoms triggered by substances do not meet the criteria for a diagnosis of the disorder unless they persist for a period of time after the person has stopped using the substance.1

There is not much evidence on whether people use drugs or alcohol to cope with derealization/depersonalization. Still, it’s possible that people with the disorder could also be abusing substances. It is common for people with mental health disorders to self-medicate with drugs or alcohol, which can make the symptoms of the disorder worse.4 And since drug use can trigger the disorder, people who have been abusing drugs could develop derealization/depersonalization.

Treatment for Co-Occurring Disorders

When a person has both a mental health and a substance abuse condition, it’s known as a dual diagnosis. It’s vital that both conditions be treated simultaneously. If only the substance abuse disorder is treated, the persisting symptoms of the mental health issue could complicate recovery, making relapse more likely. Conversely, if only the mental health disorder is treated, the person may continue to use substances as a coping mechanism with other issues, such as stress.

The primary method of treatment for derealization/depersonalization is therapy. Some of the therapies that may be used to help someone deal with the disorder include the following:2

  • Cognitive behavioral therapy (CBT) can help people to manage obsessive thoughts about their detachment from reality. CBT is also used to help people change unhealthy thoughts and behaviors around drug use.2,4
  • Grounding techniques use the person’s senses to help them feel a greater sense of connection. For example, exposing the person to something very cold or to loud noises (things that are hard to ignore) can help to ground the person in the present moment.2
  • Psychodynamic therapy is sometimes used because it helps people to work through traumatic experiences or negative feelings that are often the source of detachment.2
  • Identifying and tracking emotions and thoughts can sometimes help those with depersonalization/derealization disorder to better recognize their sense of dissociation and, like grounding techniques, realign them with what is happening in the present moment.2

A range of medications have been used to treat depersonalization disorder, but so far none have proved to be effective. For some people, anti-anxiety drugs and antidepressants help relieve the symptoms of anxiety or depression that often accompany the disorder. However, anti-anxiety drugs can, in rare instances, exacerbate feelings of depersonalization, so careful monitoring of these drugs by medical professionals is required.2

Other therapies that are used in dual diagnosis treatment include:4

  • Dialectical behavior therapy—helps to reduce drug use and suicidal behaviors
  • Contingency management—rewards people for healthy behaviors such as abstaining from drugs
  • Assertive community treatment—consists of outreach to people with mental illness in the community, a wide range of services (psychiatric, vocational, housing), and treatment that’s tailored to the individual

Future Outlook

Research continues into the causes of and most effective treatments for depersonalization/derealization disorder. When the disorder is accompanied by substance abuse—whether that abuse arises out of the disorder or was present before it—it’s important that individuals be treated in an integrated fashion in order to address all their symptoms and achieve an effective and long-lasting recovery.

Increasingly, more rehab centers are offering dual diagnosis treatment. If you believe you need help for a mental health and/or substance use disorder, explore your options today. It’s likely that a program near you will be able to help.

Sources

[1]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[2]. Spiegel, D. (2017). Depersonalization/Derealization Disorder. Merck Manual.

[3]. Madden, S. and Einhorn, P. (2018). Cannabis-Induced Depersonalization-Derealization Disorder. The American Journal of Psychiatry, 13(2), 3-6.

[4]. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.

 

Last Updated on December 16, 2019
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