Depersonalization and derealization are psychological states that come and go, says Dr. Sand. Any form of distress severe enough could trigger a DDD episode.
This may be because dissociation is a way to cope with feelings of being overwhelmed, Dr. Hunter adds. “It seems to be an innate psychological mechanism, which can kick in at a certain time. Anyone could experience this under the right circumstances, as it is something we are all capable of. The problem is when the dissociation becomes chronic enough to constitute a disorder.
According to a 2021 article in the Trauma and Dissociation Journal who examined the prevalence of DDD among different populations, “the prevalence rate of DDD is approximately 1% in the general population”.
To justify a diagnosis, Dr. Sand looks for people who do not seem present in reality and often experience this sensation. For her, a diagnosis is usually made “when it occurs frequently and interferes with a person’s ability to function”.
Here are four common causes or risk factors for DDD that the two experts have noticed over many years of combined studies:
“Most child victims [abuse] or the sexual abuse will report going somewhere else in their mind – like, ‘I’m not here, it’s not happening,’” says Dr. Sand, who adds that she has mostly seen DDD in people with trauma. DDD can also develop in adults who experience traumatic events, such as health emergencies.
According to Trauma and Dissociation Journal paper, the highest rates were found in people who experienced interpersonal violence. “DDD is more prevalent in adolescents and young adults as well as patients with mental disorders,” the researchers write, adding that “there is also a possible relationship between interpersonal violence and DDD.”
“When people are severely depressed, they disconnect from themselves because it’s too difficult to be an embodied self,” says Dr. Sand. In other words, when life seems painful, there can be an urge to escape reality. The prevalence of DDD in people with depression was 50%, notes the Journal of Trauma and Dissociation.
History of anxiety
“Many people experience depersonalization and derealization when they have panic attacks,” says Dr. Hunter, adding that diagnostic criteria for a panic attack include both depersonalization and derealization. “Some people who have a panic attack may worry that they are having a heart attack. But others feel like things aren’t real. Social anxiety may accompany DDD. By the Trauma and Dissociation Journal research, DDD has been found between 3% and 20% of people with anxiety.
Recreational drug use (with panic attacks)
Recreational drug use alone can trigger or prolong symptoms of DDD. According to a research article in the Journal of Addiction Research and Therapy, “nearly 25% of non-drug addicts (ex-addicts) have or have had severe depersonalization disorder.”
DDD prevalence rates among people who use drugs were between 2% and 6%, according to the review’s findings. When people react negatively to medications and have a panic attack, they sometimes experience depersonalization, Dr. Hunter adds.
Other mental health issues
Symptoms of DDD can overlap with symptoms of other mental health disorders. The Journal of Addiction Research and Therapy The article noted the prevalence of DDD between 4% and 20% in people with other dissociative disorders such as dissociative amnesia, dissociative fugue and dissociative identity disorder, 16% in people with schizophrenia and 17% in those with borderline personality disorder (BPD).