Seeking therapist recommendation for "depersonalization disorder"

Following a panic attack at college, my teenage son now seems as though he may be suffering from "depersonalization disorder," which is characterized by a strange feeling that everything around him is artificial (all while still lucidly knowing that it is not actually artificial). He does not have anything like psychotic delusions, just a very disturbing feeling that the world around him "looks flat" and "doesn't feel real." This feeling is not constant, but comes on in times of stress; it also gets worse as evening falls and sometimes with strenuous exercise (where labored breathing may remind him of the panic attack). He also reports changes in his vision - sort of a delay in processing visual information - when this is going on. This is generally a very anxious child, but these "depersonalization" feelings, seemingly triggered by anxiety, are causing a vicious cycle of additional extreme anxiety. (My son also has periodically suffered from something that sounds like "existential OCD" - compulsive intrusive thoughts about "the meaning, purpose, or reality of life" - which seems as though it could be related to this.)

Clearly my son needs help, but we aren't sure where to turn. We have Kaiser insurance, but the therapist they assigned him was not helpful - did not seem to understand what my son was describing, and made suggestions that were more counterproductive than helpful. Can anyone recommend a psychiatrist or psychologist, whether or not in Kaiser, who has specific expertise in the field of depersonalization disorder (and/or existential OCD or related syndromes)? I think my son would also benefit from just garden-variety talk therapy and anxiety management - but our first priority is to get expert advice about the depersonalization issue.

Although I am asking for therapy recommendations, I would also be interested to hear if others on this site have experienced this issue and what you have done to combat it (therapy, specific medications, etc.) or to learn to live with it. Thank you!

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I would try an experienced psychologist (PhD) rather than a LSCW or MFT etc.  You should leave any therapist who hasn't heard of it or isn't helpful.  I have seen foliage as looking as flat sharp leave cut with tin slips, feeling in a fog at gatherings, etc.  My psychologist sent me to a neurologist, and the neurologist tried, off-label, Lamotrigine that helped.  This may be TMI but I wanted to help.  I also have been seeing a psychodynamic therapist for a few years, because the whole thing is stressful and I also think stress is definitely related.
 

I am of course not a professional but is it possible he is dissociating at these times? It can be common for folks with severe anxiety or trauma. The description you provided sounds like that could be. I have never heard of “depersonalization disorder” but honestly teens are so often misdiagnosed. I would find a therapist with a good knowledge of anxiety and trauma and who your teen feels comfortable with and go from there. 

First of all, I’m sorry to hear that your son is experiencing such distress and disturbing symptoms. Second, don’t let Kauser off the hook. He should be evaluated by a psychiatrist (MD) (they have training in neurology as well and are diagnosticians) and you should insist upon it. Be squeaky. Since an evaluation may be done virtually (online), your son could “see” any psychiatrist in the Northern CA Region. You and your son deserve a diagnosis and a medical opinion of what is going on his brain. Ask to speak to the psychiatric nurse at the Medical Center you call for a recommendation. Read the MD bios online. One good psychiatrist at Kaiser Oakland is Lucas Van Dyke. Kaiser is known for making it difficult for members to psychiatrists as well as the more experienced practitioners and for assigning patients to therapists who are out of their league. File a grievance if you don’t get an appointment with an experienced psychiatrist and then move forward with getting help outside KP. (I know all of this from personal experience) Bay Psychiatric Associates has a large practice in Berkeley with very experienced psychiatrists. You might call and explain and ask  whom your son might best see. I’m familiar with Eric Arnold MD but I don’t think he’s seeing outpatients at this time. It’s a solid practice. If KP fails you, file a grievance. Your son is legally entitled to the same level of mental health care as physical health care. Submit you out if network costs for reimbursement and if denied, file a complaint with the State. Only way to make KP take its mentally ill patients seriously.  Wishing you the best. 

Hello Dear Parent.  So I have had a lifetime of anxiety/depression that was not really treated until my 20's.  I don't have a "depersonalization disorder" diagnosis but it sounds very much like something I experienced.  Getting on antidepressant medication, first Prozac, later Zoloft helped immensely.  The best way to describe it is I felt consistently "connected" for the first time in my life after medication.  I just saw a regular psychiatrist at Kaiser to get started on medication.  I've been on meds for many years now and have no intention to get off.  Hope this helps.  

Hi! I have experienced similar feelings when I have panic attacks. I saw Emily Berner at the San Francisco Bay Area Center for Cognitive Therapy for OCD and panic attacks and had life-changing results with exposure-response therapy. I highly recommend her or any one else at this clinic.

Talk to your son's therapist and let them know that the treatment provided isn't enough. They typically allow one-on-one therapy that's infrequent and for a short period of time, but they can refer you out to a private therapist contracting with Kaiser (it used to be to a 3rd party service like Magellan or Beacon but they have their own contracting service now).  My son is seeing a therapist once every two weeks this way, and could see him more often if that was needed.  My guess is that it would still be not easy to find someone as there are only so many therapists who contract their services out this way, but it is possible and is worth trying if cost is a factor.  My son's therapist provides what you called a "garden variety talk therapy", and I assume there are others that do other types.
Kaiser also has a DBT program in Richmond, at least they did last year.  It's worth checking it out. There's also a private DBT clinic called Clearwater which has group classes and one on one therapy; they work with teens with all kinds of mental health issues a lot and from my experience they know what they are doing and are helpful.

How terrifying for him (& for you!) to be having this experience. Since you mention he’s seen a therapist at Kaiser, I’m assuming he’s seen his primary care doctor who has done a neurological screening? And, is there any chance he used pot or any other drugs prior to this onset? He definitely needs to be seen by a psychiatrist because these symptoms do sound like they may be pre-psychotic and these disorders often first present in this age group. It’s great you’re looking for someone because early intervention helps. I don’t know anyone who I know for sure has openings but I would look at the website for referrals: 1.NCSPP: Northern California’s Society for psychoanalytic psychotherapy or 2. PINC: Psychoanalytic Institute of Northern California or 3. SFCP San Francisco Center for Psychoanalysis

We have not found the Kaiser psychiatrists to be very helpful. We decided to pay out of pocket but were delighted to find the Berkeley Therapy Institute accepts Kaiser insurance.

I am in no way a medical doctor or therapist but based on what you are describing I would agree that you ditch the previous therapist, and engage an experienced psychologist or psychiatrist to consider whether your son may be experiencing schizophrenia. It presents (for males) in late adolescence early 20's and affects perception and vision as well. It can be triggered by anxiety-producing events. There has been tremendous progress in studying and treating this disease in the last 20 years. 

Hi! I'm sorry that your teen  is going through this, and although I don't have recommendations, I fully sympathize with you. My highly anxious teenage daughter started experiencing many DP episodes at the beginning of the COVID pandemic. And just like your son, night time and strenuous exercise made it worse. She also tends to be an OCD-ish type, with a very rigid mind. Unfortunately, she also has high social anxiety, so she has adamantly refused any treatment. After reading a lot about DP, what helped during those times (not a whole lot, but I kept trying) was reminding her that a) nothing bad or serious was happening to her, although it felt that way, b) DP was actually her mind's protective mechanism against stress, c) it would get better. The vicious cycle of the anxiety making it worse is hard, because although I would try to calm her down by reminding her that getting anxious about it only makes it worse, it's easier said than done, and really hard for a teenage mind to calm down. https://acoachcalledlife.com/beliefs-recover-from-anxiety-dpdr/

The good news is that it did get better when the outside stressors were reduced (in her case, when the school year ended and Summer started), so since your son is open to therapy, I hope that he can find someone to manage his anxiety, even if they don`t fully understand DP. I'm looking forward to read what others suggest. Best of lucks. 

I responded already.  I wanted to add, just in case it resonates with your son, and just in case they have some comorbidity, I have weird visual effects ("visual snow")  that get worse in the evening, and I also have depersonalization disorder.  Visual snow has only been recognized in the past 10 years; there have started to be some academic papers about it in the last few years.  My visual snow also gets worse in low light, under fluorescent light ,under stress etc.  An experienced (10 years or more?) psychologist, psychiatrist, or neurologist(?) might be able to help.  For the visual snow, my neurologist had only had one other case in his career, and my psychologist had never heard of it, but he sent me to the neurologist because of the unusual vision problems.  Depersonalization, both the psychologist and neurologist were familiar with.  Best of luck to you and your son.