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Depersonalization and Derealization with Vestibular Disorders

By Cheryl Wylie, MSc (PT)

Vestibular disorders, conditions that affect the inner ear and brain's balance systems, are often associated with symptoms like dizziness, vertigo, and imbalance. However, less commonly discussed are the profound psychological impacts these disorders can have, such as depersonalization and derealization. These are distressing experiences where individuals feel disconnected from themselves (depersonalization) or their surroundings (derealization). Understanding these phenomena and their relationship to vestibular disorders is crucial for effective management and improved quality of life.


What is Depersonalization and Derealization?

Depersonalization

Depersonalization is a feeling of being detached from one's body, thoughts, or emotions. People experiencing depersonalization may feel like they are observing themselves from outside their body or feel as though they are in a dream.

Key features of depersonalization include:

  • Feeling Detached: Individuals may describe a sense of detachment from their own body, emotions, or thoughts. It can feel as if they are an outside observer of their own life.

  • Emotional Numbness: A diminished or altered emotional experience is common, with individuals reporting feeling emotionally numb or disconnected from their usual range of emotions.

  • Altered Perception of Reality: The perception of the external world may be distorted or feel unreal. Colors, shapes, and distances might appear different than usual.

  • Time Distortion: Some individuals with depersonalization may have a distorted perception of time, feeling as though time is passing too quickly or too slowly.

  • Memory Impairment: There may be difficulty forming or recalling memories during episodes of depersonalization.

  • Anxiety: Depersonalization is often associated with anxiety, and episodes may be triggered or exacerbated by stress.

Derealization

Derealization involves a sense of unreality or detachment from the environment. It can make the world feel foggy, distant, or artificial. Individuals may perceive their surroundings as lacking in color or depth.

Key features of derealization include:

  • Distorted Perception of the Environment: Individuals with derealization may describe a sense that the external world is distorted, unfamiliar, or artificial.

  • Feeling Detached from the Environment: There is a prevailing sense of detachment or disconnection from the environment, as if one is observing the world from a distance.

  • Loss of Emotional Resonance: The emotional significance of the environment may be diminished, and individuals may feel emotionally numb or disconnected from their surroundings.

  • Impaired Concentration: Derealization can interfere with concentration and cognitive functioning, making it challenging to focus on tasks or engage with the environment.

  • Altered Perception of Time: Time may seem distorted, with individuals experiencing a sense that time is passing either too quickly or too slowly.


The Link Between Vestibular Disorders and Depersonalization and Derealization

Vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, and labyrinthitis, disrupt the body’s balance system. This disruption can lead to persistent dizziness and vertigo, which can, in turn, trigger or exacerbate feelings of depersonalization and derealization.

Mechanisms Behind the Link
  1. Sensory Mismatch: Vestibular disorders create a mismatch between visual, proprioceptive, and vestibular inputs, most importantly our otolith organs which provide our sense of gravity. The brain struggles to reconcile these conflicting signals, potentially leading to feelings of unreality.

  2. Chronic Stress and Anxiety: The constant discomfort and unpredictability of vestibular symptoms can cause significant stress and anxiety, which are known to trigger depersonalization and derealization episodes.

  3. Hypervilagence: People with vestibular disorders often become hypervigilant to their symptoms, heightening their awareness and potentially leading to dissociative experiences as a coping mechanism.


Managing Depersonalization and Derealization in Vestibular Disorders

Vestibular Rehabilitation Therapy (VRT)

VRT is a specialized form of physiotherapy aimed at improving balance and reducing dizziness through exercises that retrain the brain to process signals from the vestibular system correctly. By reducing dizziness, VRT can help alleviate the sensory mismatch that contributes to depersonalization and derealization.

Cognitive Behavioral Therapy (CBT)

CBT is an effective treatment for anxiety and can be particularly beneficial for those experiencing depersonalization and derealization. It helps individuals develop healthier thought patterns and coping strategies to manage anxiety and stress associated with vestibular disorders.

Mindfulness and Grounding Techniques

Mindfulness practices can help individuals stay connected to the present moment, reducing the intensity of depersonalization and derealization. Grounding techniques, such as focusing on physical sensations or engaging with the environment through the senses, can also help re-anchor individuals experiencing these symptoms.

Medication

In some cases, medication may be necessary to manage the anxiety and depression associated with vestibular disorders. Antidepressants or anti-anxiety medications can help reduce the frequency and intensity of depersonalization and derealization episodes.


Depersonalization and derealization are challenging symptoms that can significantly impact individuals with vestibular disorders. Recognizing the connection between these psychological symptoms and vestibular dysfunction is crucial for effective treatment and management. By combining vestibular rehabilitation, cognitive-behavioral therapy, mindfulness practices, and, when necessary, medication, individuals can find relief from these distressing experiences and improve their overall quality of life.

If you or someone you know is struggling with these symptoms, please reach out to us here at Healing Vertigo as we can provide the support and guidance needed to navigate this complex condition. You can contact us if you have any questions, or book directly online

About the Author

Cheryl Wylie, is a vestibular physiotherapist and owner of Healing Vertigo. She is also the creator of our Vertigo Treatment App, and instructs vestibular courses to other healthcare professionals.
She offers vestibular therapy for all Ontario Residents. If you're interested in working with Cheryl, connect below!


Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.