Withdrawal from benzodiazepines often precipitates a host of physical and psychological challenges. Depersonalization and Derealization (DPDR) represent some of the most perplexing and distressing experiences. DPDR during benzodiazepine withdrawal can make you feel detached from your sense of self (depersonalization) and/or detached from the world around you (derealization). Let’s explore the causes of DPDR and learn coping strategies to navigate through these experiences.

What is DPDR?

Depersonalization-Derealization Disorder (DPDR) is a dissociative disorder characterized by persistent or recurrent feelings of detachment from one’s own thoughts, feelings, body (depersonalization), and/or a sense of unreality or detachment from one’s surroundings (derealization). Individuals experiencing DPDR often report feeling as though they are an outside observer of their own lives or that the world around them is unreal, dreamlike, foggy, or lifeless. Despite the profound alterations in perception and experience, people with DPDR remain aware that this altered state is not congruent with reality, which distinguishes it from psychotic disorders where such insight is typically absent. The symptoms can cause significant distress and impairments in social, occupational, or other important areas of functioning. The onset of DPDR can be triggered by severe stress, trauma, the use of substances, psych med withdrawal, or no identifiable cause at all. 

Symptoms of Depersonalization

External Perspective on Self: Experiencing the sensation of observing your thoughts, emotions, or body parts from an outside viewpoint, such as feeling like you’re floating above your own body.
Feeling Mechanistic: Having the sensation of being robotic or not in control of your speech or movements.
Distorted Body Perception: Observing your body, limbs, or head as being misshapen, twisted, disproportionately large or small, or feeling as though your head is encased in cotton.
Numbness: Experiencing emotional or physical numbness, leading to a diminished sensory response or connection to the environment.
Detached Memories: Perceiving memories as emotionally flat or questioning their ownership, as if they might not belong to you.

Symptoms of Derealization:

Perception of Unreality: Feeling as though people and the environment are unreal, akin to being in a movie or dream.
Emotional Detachment: Experiencing a sense of emotional disconnect from loved ones, as if a glass wall separates you.
Visual Distortions: Observing surroundings that seem altered in shape, appear blurry or colorless, lack depth (appearing two-dimensional), or, conversely, seem unusually sharp and clear.
Distorted Perception of Time: Having unrealistic perceptions of time, where recent events feel like they occurred in the distant past.
Altered Sense of Space: Experiencing distortions in the perception of distance, size, and shape of objects.

Understanding DPDR in Benzodiazepine Withdrawal

The onset of DPDR can be a bewildering experience. Mine occurred after my doctor advised me to cut my dose in half  in a week (one should slowly taper off their benzo and not make significant cuts). The sensations I felt could only be described as surreal, as if I was living in a dream, watching myself watch myself. Time and space felt distorted. I was sure I had gone mad, trapped in some nightmare that would never end. I often shook my head, hoping to clear the weird perceptions.

Depersonalization manifests as a sensation of detachment from oneself, where you might feel like an observer of your life, thoughts, and feelings. You may see your reflection in a mirror and not recognize yourself. Derealization, on the other hand, involves a sense of detachment from the environment, making the world seem unreal or distant— as if you are trapped in a movie. During benzodiazepine withdrawal, these experiences can be particularly intense and distressing, often exacerbating the difficulty of the withdrawal process.

What Causes DPDR During Benzodiazepine Withdrawal?

The exact mechanisms by which benzodiazepine withdrawal leads to DPDR are complex and multifaceted. Benzodiazepines act on the central nervous system by enhancing the effect of the neurotransmitter GABA, which is involved in reducing neuronal excitability throughout the nervous system. GABA is the inhibitory neurotransmitter, and glutamate is the excitatory neurotransmitter. The brain doesn’t like the increased inhibition and makes changes to keep a balance (homeostasis) between excitatory (glutamate) and inhibition (GABA). These changes are called neuroadaption: the brain downregulates GABA receptors, so fewer are available to inhibit the neurons. 

The lack of functioning GABA receptors leads to an overexcited state in the brain, causing the nervous system to often be in fight, flight, or freeze,  a response called the protect state. The stress hormones that accompany the protect state contribute to the development of DPDR symptoms. Fear of benzo withdrawal symptoms can exacerbate DPDR symptoms. Environmentally, isolation or lack of understanding from others can increase DPDR symptoms, making one feel even more detached from their surroundings. Certain stressful activities such as driving can increase your DPDR symptoms (Driving was a big trigger for my DPDR).

Coping with DPDR During Benzodiazepine Withdrawal

Here are several strategies to help manage DPDR symptoms:

  • Grounding Techniques: Grounding techniques can help reconnect you with the present moment and reduce feelings of unreality. Simple activities like walking barefoot on grass, holding a piece of ice, or engaging in mindful breathing can help diminish the intensity of DPDR symptoms.
  • Routine and Structure: Establishing a daily routine can provide a sense of normalcy and predictability, which can be comforting during withdrawal. Try to maintain regular sleeping patterns (Insomnia is a common benzo withdrawal symptom. but do try to keep a set time of going to bed) eat nutritious meals, and schedule activities that you enjoy and find meaningful (or used to).
  • Mindfulness and Meditation: Mindfulness practices can enhance your awareness of the present moment and reduce feelings of detachment. Meditation, in particular, can help foster a state of calmness and connection to oneself and the environment.
  • Support Networks: Connecting with others who understand what you’re going through can be incredibly validating and reassuring. Consider joining my support group to connect with others and learn more about your brain and nervous system and how to best help your recovery.
  • Engage in  Gentle Physical Activity: Gentle physical activity can help regulate mood, reduce stress, and improve overall well-being. Activities like yoga and tai chi are particularly beneficial, as they also incorporate mindfulness and breathing techniques.
  • Creative Expression: Engaging in creative activities such as painting, writing, or playing music can be therapeutic. It provides an outlet for expressing feelings and thoughts that might be difficult to articulate otherwise.
  • Sensory Engagement: Engaging your senses can help ground you in reality and reduce feelings of derealization. This could involve activities like cooking and focusing on the smells and tastes, listening to music, or touching different textures.
  • Observe Don’t Judge or Believe: Observe your DPDR symptoms. Do not judge them or believe any negative thoughts. Know that they are from your hyperexcited nervous system and they will pass.
  • Nature and Green Spaces: Spending time in nature can have a grounding effect, reducing stress and promoting feelings of well-being. Try to spend time outdoors daily, even if it’s just a short walk in a park.
  • Avoid Stimulant Intake: Caffeine and other stimulants can exacerbate anxiety and feelings of unreality. avoiding these substances can help manage DPDR symptoms.
  • Learn the four cornerstones of well-being: Put the four cornerstones of well-being— eat right, move enough, stress less and connect well into practice. The cornerstones work together to create health and happiness.

DPDR during benzodiazepine withdrawal can be a challenging and disorienting experience. However, by employing a combination of grounding techniques, establishing routine, engaging in mindfulness and physical activity, living the four cornerstones, and seeking support, it is possible to navigate through these experiences. As your GABA receptors upregulate and your brain can once again maintain homeostasis, the delicate balance between glutamate and GABA, DPDR symptoms fade away.