Derealization-Depersonalization disorder (DPDR), affecting approximately 2% of the population, is a dissociative condition characterized by a distortion of one’s sense of self and reality. [[1]] Often triggered by overwhelming trauma, like abuse or mistreatment [[3]], DPDR is increasingly recognized as a protective psychological response, yet remains significantly underdiagnosed. This article profiles dorian, a young man who first experienced DPDR at age 14, and explores the therapeutic approaches showing promise in treating this complex condition, offering a window into a little-understood mental health challenge.
Around 2% of the population experiences Derealization-Depersonalization Disorder (DPDR), a condition that distorts a person’s sense of self and reality. Often undiagnosed, the dissociative disorder is increasingly understood as a protective response to trauma, and is gaining attention as more individuals share their experiences.
Dorian first encountered DPDR at age 14 while at a crowded shopping mall with his family. “I’m in a mall with my family. There are crowds of people walking around and suddenly, I’m seized by this extremely bizarre feeling, like detaching from my body and falling into a dream,” he recounted in a recent podcast appearance.
The dissociation will occur when we go outside our window of tolerance
Dissociation as a Protective Mechanism
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Psychiatrist Lamyae Benzakour, at HUG and head of the TraumaCare consultation, explains that dissociation is fundamentally a defense mechanism triggered when reality becomes overwhelming.
“It will occur when we go outside our window of tolerance,” Benzakour explains, describing how the disorder disrupts the normal integration of consciousness, memory, identity, and emotions.
A Trauma-Linked Disorder
For Dorian, the onset of DPDR coincided with a difficult period in school. “During that time when I was fourteen, I was in secondary school and I was subjected to a lot of bullying,” he shared, detailing years of daily humiliation and physical violence.
This traumatic experience likely triggered the dissociative response as a way to cope with an unbearable reality.
A Three-Phase Therapeutic Approach
Benzakour advocates for a three-phase therapeutic approach to treating DPDR, a relatively understudied area that is showing promising results.
The first phase focuses on stabilization, “that is, teaching patients to dissociate less by staying within their window of tolerance.” The second step involves desensitizing the trauma. Finally, rehabilitation aims to facilitate smoother daily functioning, “to be able to cope with new ‘stressors’ and live life without dissociation,” the psychiatrist outlined.
This gradual approach provides a clear therapeutic framework and aims to help patients regain a sense of wholeness while learning to manage their symptoms.
A Complex Path to Recovery
Despite ongoing challenges, Dorian leads a seemingly normal life. “On a daily basis, I’m functional. I have a job, I have a girlfriend, I live in an apartment, I manage to do my admin every day, to have contact with people, even if it’s not always easy,” he confided.
However, he struggles to identify any positive aspects to the disorder: “I think it might help me cope with difficult moments. But at the same time, […] everything I do is completely lose touch [with reality]. So I don’t know if that makes it a superpower…”
Adrien Zerbini
