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What are depersonalization and derealization?

People generally have a coherent experience of a bodily ‘self’. Psychologists describe this as “the conscious experience of being present in the here and now”, the feeling of “being the agent of one’s own actions”, or “feeling embodied” [3]. But what happens when this experience is disrupted?

Depersonalization describes feelings of unreality and detachment from your self, your emotions, thoughts, memories, or body sensations. You might feel like you are watching yourself from behind glass, or down a tunnel. Your body may feel different, or it might feel as if you are dreaming.

Derealization describes feelings of unreality and detachment from the world around you. The world may look dreamlike and unfamiliar, or feel two-dimensional and less vivid. Your senses of sight, sound, touch, and taste might also feel distorted.

Symptoms of depersonalization and derealization include:

Can you relate to any of these experiences? When they happen to you, you might not believe that you’re literally “watching yourself from behind glass” or “in a two-dimensional world” but they describe how you feel in the moment of depersonalization or derealization. People who have these experiences know that they are subjective, and will usually describe them in a way that shows this. They would say “it’s as if I’m not real anymore” rather than “I’m not real anymore” [1]. This makes depersonalization and derealization quite different from other experiences like hallucinations (seeing or hearing things that other people can’t see or hear) or delusions (believing things that other people don’t).

Sometimes, it’s less easy to make sense of what you’re experiencing and you may worry about what is real and what is not, or about what might be causing these symptoms. This ‘not knowing’ is another part of what makes depersonalization and derealization so distressing [1,2].

What is it like to experience depersonalization and derealization?

Nora struggled with depersonalization and derealization. Her story illustrates what it can feel like.

Nora’s feeling that she wasn’t real

I first noticed feelings of depersonalization and derealization after this long period where my work and home life had both been very stressful. It felt like I was being pulled in lots of different directions. I worried about getting everything done, and I’d been putting in really long hours. One day, as I was about to leave work, everything started to feel distant and unreal. Sounds got muffled and objects in the room looked flat: almost as if I was seeing things in black-and-white. My body felt weightless and far away, and my mind felt like it wasn’t inside my body, as if I had been separated from it.

I had other similar experiences after that, and times when I would feel distant became more frequent. When it was bad, I would feel like I was going through the motions like a robot. It was difficult to cope at work, especially when I had to talk to people, and I struggled to cope in meetings. I could laugh and join in with other people, but it was purely intellectual – I didn’t feel anything, and I didn’t feel like it was ‘me’ joining in. It was even worse at home as I would have times when I was with my children and it just felt so strange and unfamiliar – even when they were just acting like being with me was the most natural thing in the world. I would have thoughts running through my head, like wondering whether I was really in control, and why I was the way I was. I could still be a Mom to them, but I didn’t feel a proper connection.

As I worried about more and more about this, I turned inwards and became quite depressed. I didn’t tell anyone for a long time because it sounded so strange, and I was sure people would think I was crazy. Eventually I spoke with a counselor, but she didn’t really seem to ‘get it’, and it didn’t help.

Do I have depersonalization and derealization?

Depersonalization and derealization should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful to have a professional assessment.

Do you ever feel strange, as if you are not real, or cut off from the world? Never Occasionally Sometimes Often When you move, does it ever feel as if you are not in charge of the movements? Never Occasionally Sometimes Often Do you ever feel like you are a ‘detached observer’ of yourself? Never Occasionally Sometimes Often Do you ever find yourself not feeling any affection towards people who are close to you? Never Occasionally Sometimes Often Do you ever feel like familiar voices, including your own, sound remote or unreal? Never Occasionally Sometimes Often Does the world ever seem ‘flat’ or ‘lifeless’, as if you are looking at a picture? Never Occasionally Sometimes Often When you cry or laugh, do you ever seem to ‘not feel’ any emotions? Never Occasionally Sometimes Often Do you ever have to touch yourself to make sure you that you really exist? Never Occasionally Sometimes Often

If you answered ‘sometimes’ or ‘often’ to most of these questions, you might be suffering with depersonalization and derealization. You might find it helpful to speak to your general practitioner, or a mental health professional, about how you’re feeling.

What causes depersonalization and derealization?

It’s not clear exactly what causes depersonalization and derealization. For some people the symptoms start very suddenly. For others, they appear gradually over weeks or months. The most common time for symptoms to begin is in a person’s teenage years, and people who struggle with depersonalization and derealization often live with their symptoms for many years before a diagnosis is made [3]. Psychologists think that the ability to dissociate may explain some experiences of depersonalization and derealization.Brief experiences of dissociation, including depersonalization and derealization are common. Some things that make you more likely to have these experiences include:

High levels of stress, such as a traumatic event or a prolonged period of severe anxiety [4].
Recreational drug use, especially drugs like marijuana and LSD.
A previous mental health problem, such as depression or anxiety [5].
A history of emotional abuse or emotional neglect during childhood. One study of 49 people with experiences of depersonalization and derealization found that 44 reported having experienced emotional abuse [6].

What keeps depersonalization and derealization going?

Cognitive behavioral therapy (CBT) is a popular evidence-based psychological therapy. CBT therapists work a bit like firefighters: while the fire is burning, they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by interrupting this maintaining cycle. In 2003, Elaine Hunter and her colleagues at the Institute of Psychiatry in London published a model of depersonalization and derealization, which explains the ‘parts’ that make its symptoms more prolonged and distressing for some people [1,7]. These are:

Treatments for depersonalization and derealization

Psychological treatments for depersonalization and derealization

The psychological treatment for depersonalization and derealization that has the strongest research support is cognitive behavioral therapy. CBT therapists understand that what we think and do affects the way we feel. Unlike some other therapies, it’s often quite structured. After talking with your therapist so that they understand your problem, you can expect the therapist to set goals with you so that you both know what you are working towards. At the start of most sessions, you will set an agenda together so that you have agreed what that session will concentrate on. ‘Ingredients’ of CBT treatment that are believed to be effective for depersonalization and derealization include [7,8,9]:

Developing a personalized model of your symptoms.
Self-monitoring to track changes in your symptoms.
Grounding strategies to bring you back to here-and-now awareness.
Learning about depersonalization, derealization, and how the brain and body respond to stress.
Experimenting with how you pay attention to your symptoms.
Challenging unhelpful or catastrophic thinking.
Using behavioral experiments to test your specific negative beliefs and assumptions.
Developing a therapy blueprint.

Medical treatments for depersonalization and derealization

No specific medications are recommended for the treatment of depersonalization and derealization by bodies such as the UK National Institute of Health and Care Excellence (NICE) or the US Food and Drug Administration (FDA). There has been small-scale research on various medications in the treatment of depersonalization and derealization, including lamotrigine and naltrexone [10], but psychologists emphasize that results are tentative and neither drug has been licensed for the treatment of depersonalization and derealization [3].

References

Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behaviour Research and Therapy, 41(12), 1451-1467.
Medford, N., Sierra, M., Baker, D., & David, A. S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11(2), 92-100.
Simeon, D. & Abugel, J. (2006) Feeling Unreal: Depersonalization Disorder and the Loss of the Self. Oxford University Press, UK.
Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. Biological Psychiatry, 44(9), 898-908.
Baker et al (2003) Depersonalisation disorder: clinical features of 204 cases. British Journal of Psychiatry, 182, p428-433.
Simeon, D., Guralnik, O., Schmeidler, J., Sirof, B., & Knutelska, M. (2001). The role of childhood interpersonal trauma in depersonalization disorder. American Journal of Psychiatry, 158(7), 1027-1033.
Hunter, E.C.M., Salkovskis, P.M. & David, A.S. (2014) Attributions, appraisals and attention for symptoms in depersonalisation disorder. Behaviour Research and Therapy, 53, 20-29.
Hunter, E. C., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour Research and Therapy, 43(9), 1121-1130.
Hunter, E. C. (2013). Understanding and treating depersonalisation disorder. In: Cognitive behavioural approaches to the understanding and treatment of dissociation (pp. 160-72). Routledge Press.
Sierra, M. (2008). Depersonalization disorder: pharmacological approaches. Expert Review of Neurotherapeutics, 8(1), 19-26.

About this article

This article was written by Dr Lotte Meteyard and reviewed by Dr Matthew Whalley. It was last reviewed on 2022/03/18.