Lifestyle
Defining Depersonalization Derealization Disorder
Barrie Miskin was newly pregnant when she noticed her appearance was changing. Dark patches bloomed on her skin like watercolor ink. A “thicket” of hairs sprouted on her upper lip and chin.
The outside world was changing, too: In her neighborhood of Astoria, Queens, bright lights enveloped objects in a halo, blurring her vision. Co-workers and even her doctors started to seem like “alien proxies” of themselves, Ms. Miskin, 46, said.
“I felt like I was viewing the world through a pane of dirty glass,” she added. Yet Ms. Miskin knew it was all an illusion, so she sought help.
It took more than a year of consulting with mental health specialists before Ms. Miskin finally found an explanation for her symptoms: She was diagnosed with a dissociative condition called depersonalization/derealization disorder, or D.D.D. Before her pregnancy, Ms. Miskin had stopped taking antidepressants. Her new psychiatrist said the symptoms could have been triggered by months of untreated depression that followed.
While Ms. Miskin felt alone in her mystery illness, she wasn’t. Tens of thousands of posts on social media reference depersonalization or derealization, with some likening the condition to “living in a movie or a dream” or “observing the world through a fog.”
People who experience depersonalization can feel as though they are detached from their mind or body. Derealization, on the other hand, refers to feeling detached from the environment, as though the people and things in the world are unreal.
Those who are living with D.D.D. are “painfully aware” that something is amiss, said Elena Bezzubova, a psychoanalyst who specializes in treating the condition. It’s akin to seeing an apple and feeling that it is so strange it doesn’t seem real, even though you know that it is, she added.
The disorder is thought to occur in about 1 to 2 percent of the population, but it’s possible for anyone to experience fleeting symptoms.
Mental health providers have sometimes dismissed D.D.D. as its own diagnosis not only because of a lack of familiarity with the disorder, but also because its symptoms overlap with conditions like depression, anxiety or panic disorder.
As new research has emerged, it has become more widely acknowledged and discussed. The second edition of “Feeling Unreal,” a primer on D.D.D. originally published in 2006, was released in 2023. And Ms. Miskin published a memoir on the subject titled “Hell Gate Bridge” last June. The same month, the novel “Please Stop Trying to Leave Me” came out, featuring a protagonist with D.D.D. The author, Alana Saab, knows the disorder well: She was diagnosed several years ago.
“It’s kind of what I would imagine a drug trip would be,” she said of her experience with the disorder. “But it’s 2 in the afternoon and I’m completely sober.”
The Cambridge Depersonalization Scale is widely considered the most reliable measure of the disorder. Patients are asked to rate how often and how long 29 different experiences occur. Examples include feeling like “a robot,” losing bodily sensations like hunger or thirst and seeing a world that now looks “flat” or “lifeless,” like a picture.
People with D.D.D. may feel disconnected from themselves and their surroundings for months or even years at a time. Less commonly, they may also experience auditory distortions — like muffled or louder sounds.
D.D.D. is often associated with a history of emotional abuse or neglect. The symptoms can be brought on by anxiety, depression, the resurfacing of early trauma, major life stressors, cannabis and hallucinogens like LSD, said Dr. Daphne Simeon, an expert on the disorder and the co-author of “Feeling Unreal.”
In some people, there can be multiple triggers, particularly if there is an underlying propensity to dissociate.
“You can meet a person whose first episode was triggered by panic and then it happened again when they got depressed and then it happened a third time when they had a terrible divorce,” Dr. Simeon said.
Researchers have hypothesized that depersonalization/derealization might be part of the mind’s defense system.
“Your body and your mind are telling you something,” Dr. Simeon added. “You’re having an intolerable experience, essentially, from which you then have to detach.”
Jeffrey Abugel, Dr. Simeon’s co-author on “Feeling Unreal,” dealt with D.D.D. for more than a decade before finally getting a diagnosis. He knows exactly where it stemmed from: “Pot, plain and simple,” he said. The drug pushed him “over the edge,” he added, creating a “massive panic attack.”
Mr. Abugel, who is a health and wellness coach, eventually found help. He now offers private consultations and virtual support groups for people with the disorder.
Ms. Miskin’s symptoms improved with a combination of psychotherapy and medication. She restarted her antidepressant and also began taking lamotrigine, or Lamictal, a medicine best known for treating seizures and bipolar disorder.
Recovery was a painful process.
“You have to relearn how to be in the world,” she said, even though “you just want to lay in bed and pull the covers over your head and never come out.”
Karen McNenny is a certified divorce coach, certified co-parenting specialist and author of the book The Good Divorce: How to End Your Marriage Without Ending Your Family.
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When Karen McNenny was facing divorce about 15 years ago, she was afraid of what it would mean for her future: despair, debt and a lifetime of resentment, she says.
At the same time, she was thinking of her two children, she says. She didn’t want their father to become her enemy.
So she and her former husband chose to approach divorce differently as a couple. “We’re going to renovate and transform this family. We’re not going to destroy it,” she says. “The marriage is ending, not your relationship.”
For McNenny, a mediator, certified divorce coach and certified co-parenting specialist, divorce is a tool, not a weapon. She expands on this concept in The Good Divorce: How to End Your Marriage Without Ending Your Family, which came out this spring. The book offers guidance on how to maintain compassionate and respectful ties with a former spouse while also healing and moving forward.
According to Pew Research Center, a third of Americans who have ever been married had a first marriage that ended in divorce. For that reason, McNenny hopes her book becomes a must-read for couples before they get married. “The best time to talk about divorce is before you need to talk about it,” she says.
She shared insights from her book in a conversation with Life Kit. This interview has been edited for length and clarity.
The book is called The Good Divorce. What does that mean?
[For those with kids,] the good divorce is about protecting the future of the family while we dissolve the marriage.
After the paperwork is done and the assets have been divided, can you and your co-parent sit on the same side of the bleachers during the basketball game? Can you still see yourselves as a partnership, with the ability to have thoughtful conversations about your kids?
For those who don’t have kids, [the good divorce is] about protecting your health — your mental health and your physical health. If we are doubling down with resentment and bitterness, all of that gets stored in the body and shows up in different ways. You deserve a pathway that’s less destructive.
Let me also be clear: There are times when an amicable, collaborative process is not possible and maybe even inappropriate. For instance, where there’s active addiction, abuse, domestic violence, coercion or unmanaged mental health issues.
How do you get to a place where you don’t feel triggered by your partner, so you both can work together toward a good divorce?
That, my dear, does not happen overnight. That is more like a dimmer switch going up and down and up and down, and the gift of time helps to get there.
It’s a complex emotional journey because we do feel relief in walking away from our spouse and the challenges. But with it, there is extraordinary grief that comes with divorce that I think is often underestimated and undersupported.
If my spouse had died, people would’ve been checking in with me regularly. I never would’ve spent a holiday alone in that first year. There probably would’ve been a meal train.
But he didn’t die. My marriage died, my family structure died, my identity as a wife and a partner died. There’s so much grief through these transformations that come with divorce that we don’t see.
So supporting friends in all those ways that you would as if there had been an actual death is doing a lot for your friends who are going through divorce.
How do you let your friends, family and community know that you’re getting a divorce and that you might need support?
Put a communication strategy together. It’s not just for how we tell the kids. It’s also a communication strategy for the grandparents; to the circle of support around the kids, like teachers, coaches and mentors; and our shared community.
It’s extraordinary when a couple can write that message together, not unlike a marriage announcement. [You might say:] We’ve made a really difficult decision. We wanted to let you know. We’re not going to court. Don’t expect a battle. Please don’t ask us why. Just ask us how we’re doing. We’re on the same side as the kids. You don’t need to pick sides.
In doing so, we’ve given everyone the same information at once. It’s a unified message that comes from the parent team, and it allows your community to know how best to support you. And it takes out all the gossip and wonder about what is going on.
If you have kids and they’re splitting time between two homes, what are some ways to make that change easier for them?
Our kids were 5 and 7 when we divorced, so it was three or four nights at a time in each home. By the time they got to be about 8 or 10, it made sense to go a week in each residence. After COVID, the kids came to us and said, “Can we just have two weeks in a house? We wanna be able to settle in more.” [So we said] OK.
A lot of parents are so rigid about the schedule. There’s no flexibility. That doesn’t serve anyone. So I recommend liberating yourselves from the calendar and letting it grow and bend with your kids appropriately.
Knowing what you know now about divorce, what questions do you think couples should ask themselves before they get married?
So often when people arrive at the threshold of divorce, couples are like, “We don’t know what we’re doing.” Get educated about the business part of it.
There is no harm in having a prenuptial agreement. Even if you decided not to file it, have the conversation about the implications. What does it mean if we buy this house together? What does it mean if one of us works more and one of us works less?
We also underestimate what it means to be roommates. What are your value systems around cooking and cleaning? How much alone time do you need? It’s easy to fall in love and not know if you’re compatible.
Do you think you’d get married again?
I absolutely hope that I get to say yes to a lifelong commitment with a partner, as I believe we often are given the opportunity to become a better version of ourself through partnership.
The story was edited by Meghan Keane. The visual editor is CJ Riculan. We’d love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.
Listen to Life Kit on Apple Podcasts and Spotify, and sign up for our newsletter. Follow us on Instagram: @nprlifekit.
In Alice and Steve, Jemaine Clement and Nicola Walker play long-time friends who turn on each other after he gets involved with her 26-year-old daughter.
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I grew up watching episodic shows on network TV, nearly all of them formulaic but some indelibly great. Then, like everyone else, I moved into the days of what my colleague David Bianculli dubbed Platinum TV, where series like The Sopranos and The Wire and Fleabag aspired to something higher. What both these eras had in common was that their shows were carefully crafted — they had an internal logic, and a tone, that held them together.
In recent years, though, there’s been a proliferation of shows that, possibly obeying some algorithm, care less for coherence than sensation. They lurch among tones, from cuteness to sentimentality to meanness, stirring in random plot twists along the way. Bouncing all over the emotional map, these shows depend on compelling actors and a few memorable scenes to make us overlook their loose construction.
A great example is Alice and Steve, an entertaining but sometimes exasperating six-part British comedy on Hulu about two 50-something best friends who turn on each other after he gets involved with her 26-year-old daughter.
While the premise is juicy, it’s also a tad yucky, and I mainly tuned in because its title characters are played by performers Jemaine Clement from Flight of the Conchords and Nicola Walker, whom I’ve raved up on this show more than once.
The series starts poorly with Steve and Alice going on a cutesy bender after a friend’s funeral. Now, I always hate drunk scenes, which are an invitation to overact. As Clement and Walker bray their lines, we learn that Steve’s a divorced celebrity hair stylist who can’t find a girlfriend while Alice is a clothes designer with a doting younger husband, nicely played by Joel Fry, a sweetie-pie of a teenage son — that’s Tyrese Eaton-Dyce — and, of course, that 26-year-old daughter, Izzy, who has inherited her mother’s willfulness. Played by Yali Topol Margalith, Izzy kickstarts the plot by flirting with Steve. Predictably, he succumbs.
Almost immediately, they think they’re in love. While the weak-willed Steve wants to hide their romance — he knows it’s inappropriate — Izzy just blurts out the facts to her mom. Alice flips. And from hereon out in this series where the women are as alpha as the men are hangdog, Alice drives the action. Betrayed and violently angry, she’ll do whatever it takes to break them up — no matter who gets hurt. Her antics unleash Steve’s own malice. We’re in Beef territory.
At its core, Alice and Steve hinges on the way that platonic friendships are often richer and more powerful than romantic ones. It’s a fascinating subject, which may be why I found the script by Sophie Goodhart so frustrating. I wanted her to dig deeper. While the show’s got some very funny bits — Alice’s sharp-tongued mother is a blast — it’s often annoyingly lax.
If Steve really does the hair of Charli XCX, how come he’s a clueless older guy whose pop culture references are Willie Nelson and Woody Allen? If Izzy truly adores her mother as she claims, why does she keep rubbing her relationship with Steve in her mom’s face? Halfway through, one character nukes the other’s career, but this life-shattering event has no real weight: It’s barely even mentioned for the rest of the series.
That said, Alice and Steve is worth seeing for scenes like the one in which Steve spinelessly sells Izzy out or the lacerating discussion between Alice and her husband when he fully grasps that he adores a woman who views him as a reliable but dull concierge, not a man she likes hanging with. Most touching of all may be the lovely sequence when Alice, wise for once, smooths a romantic crisis between her son and his would-be girlfriend, a pair who are the show’s emblem of hope. For once, we understand why people love her.
While most viewers will find Steve more likable than Alice — the show takes pains not to make him appear predatory or creepy — the role doesn’t give Clement a whole lot to do except play variations on shambolic dread and discomfort. The show gets its galvanizing zing from Walker, a beloved star in England with amazing, luminous eyes. Her Alice is the kind of complicated, volcanic heroine that you don’t see in movies and rarely see on TV, one who shows her apocalyptic rage freely and in many different forms.
At least once in every episode, something would lead me to say, “Man, is this show a mess.” But that wasn’t a deal breaker. I kept watching. After all, life is messy, too.
How to enter your Sporty Spice era.
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Reality dating and professional sports are not as different as you’d think.
Brittany is in her Sporty Spice era – she watched the NBA playoffs, she’s following World Cup games, and she’s watching the New York Liberty play their WNBA season. These games are daily – and so is the reality dating show Love Island. And she noticed that the two formats are not very different at all. Defector.com staff writer and co-owner Kelsey McKinney came to the same conclusion – so the two of them discuss why these games of athleticism and love can bring us together… and why they get valued differently in our culture.
For more episodes on sports and reality TV, check out:
Get rich or die trying: how sports betting is changing our love of the game
Is this the end of reality TV?
The ugly truth of America’s expensive homes
Support Public Media. Join NPR Plus.
Follow Brittany on Instagram: @bmluse
This episode was produced by Liam McBain. It was edited by Neena Pathak. Our Supervising Producer is Cher Vincent. Our Executive Producer is Barton Girdwood. Our VP of Programming is Yolanda Sangweni.
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