Depersonalization Disorder

Written by Matt McMillen
Medically Reviewed by Jabeen Begum, MD on November 06, 2024
11 min read

Depersonalization disorder, often referred to as depersonalization-derealization disorder, is marked by periods of feeling disconnected or detached from one's body and thoughts (depersonalization). The disorder is sometimes described as feeling like you are observing yourself from outside your body or like being in a dream. 

However, people with this disorder don't lose contact with reality; they realize that things are not as they appear. An episode of depersonalization can last anywhere from a few minutes to (rarely) many years. Depersonalization also might be a symptom of other disorders, including some forms of substance abuse, certain personality disorders, seizure disorders, and certain other brain diseases.

Depersonalization-derealization disorder is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, consciousness, awareness, identity, and/or perception. When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with your general ability to function, including social and work activities and relationships.

Depersonalization vs. derealization

Depersonalization leads you to believe that your thoughts, feelings, and body are not your own. Derealization impacts how you view the world around you.

Derealization causes you to believe that the people and things around you are not real, like you exist in a dream or a movie. You may feel disconnected emotionally from loved ones and others you care about, as if an invisible barrier existed between you and them. Your surroundings may appear out of whack: blurry, two-dimensional, or lacking color, or you may feel you see your environment more clearly than you’re used to and your awareness of your surroundings may be heightened. Your sense of time may be altered as well as your ability to judge distances and the shape and size of things around you.

The primary symptom of depersonalization-derealization disorder is a distorted perception of the body. The person might feel like they are a robot or in a dream. Some people might fear they are going crazy and might become depressed, anxious, or panicky. For some people, the symptoms are mild and last for just a short time. For others, however, symptoms can be chronic (ongoing) and last or recur for many years, leading to problems with daily functioning or even disability.

Little is known about the causes of depersonalization-derealization disorder, but biological, psychological, and environmental factors might play a role. Like other dissociative disorders, depersonalization-derealization disorder often is triggered by intense stress or a traumatic event — such as war, abuse, accidents, disasters, or extreme violence — that the person has experienced or witnessed.

Depersonalization-derealization disorder risk factors

While the causes are not clear, experts have identified risk factors that make the disorder more likely. These include:

  • Emotional abuse or neglect as a child
  • Witnessing domestic violence
  • Physical abuse
  • Being raised by a parent with severe mental illness and impairment
  • Suicide or other unexpected death of a loved one
  • Less commonly, sexual abuse
  • Having a personality that leads you to avoid stressful situations and makes it difficult for you to express how you experience things emotionally
  • Depression, particularly if it’s serious depression
  • Anxiety, particularly if accompanied by panic attacks
  • Illicit drug use

How common is depersonalization-derealization disorder?

An estimated 1%-2% of people have this disorder. It mostly affects adolescents and young adults. Just 5% of people who have the disorder are over the age of 25. Women and men are equally likely to develop it.

If symptoms of depersonalization-derealization disorder are present, the doctor will start examining by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests, such as imaging studies and blood tests, to rule out physical illness or medication side effects as the cause of the symptoms.

To be diagnosed with this disorder, you must meet the following criteria:

  • You have persistent or recurrent episodes of depersonalization, derealization, or both.
  • You remain able to distinguish reality from what you experience during your episodes.
  • Your symptoms cause significant stress or difficulties in your daily life, such as at work and in your relationships with others
  • Your episodes can’t be explained by other causes, such as another medical condition or the effects of drugs.
  • Your episodes can’t be attributed to a different mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder

Depersonalization-derealization disorder tests

If no physical illness is found, you may be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interviews and assessment tools to assess a person for a dissociative disorder. These include:

  • Dissociative Experiences Scale, which includes questions about experiences you may be having that indicate a dissociation from reality typical of depersonalization-derealization disorder.
  • Cambridge Depersonalization Scale, which includes 29 questions that ask how often and for how long you experience depersonalization and/or derealization.

Most people with depersonalization-derealization disorder who seek treatment are concerned about symptoms such as depression or anxiety, rather than the disorder itself. In many cases, the symptoms will go away over time. Treatment is usually only needed when the disorder lasts a long time, keeps coming back, or if the symptoms are particularly distressing to the person.

The goal of treatment is to address all stresses associated with the onset of the disorder. The best treatment approach depends on the individual and the severity of their symptoms. Psychotherapy, or talk therapy, is usually the treatment of choice for depersonalization-derealization disorder. Treatment approaches for the disorder may include the following:

Clinical hypnosis

This is a treatment technique that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness or awareness, allowing people to explore thoughts, feelings, and memories they might have hidden from their conscious minds.

Therapy

Talk therapy, also called counseling or psychotherapy, effectively treats this disorder. Its goals are:

  • To help you understand your condition and what caused it
  • To enable you to feel a better connection with the world around you and be more in touch with your feelings
  • To teach you ways to handle your symptoms when they occur
  • To deal with any mental health conditions related to your disorder and address how you feel about traumas in your past

Therapy used to treat depersonalization-derealization disorder may involve:

Cognitive behavioral therapy (CBT). This therapy helps you recognize and manage inaccurate and negative thoughts.

Grounding techniques. These skills involve using your five senses to help you and your surroundings feel more rooted in reality and the present moment. You can do this by touching things, moving your body, or focusing on your breathing, for example. You also can use your mind to imagine calming scenarios, such as being at the beach or thinking of things you find funny.

Psychodynamic therapy. You will explore the psychological roots of your disorder through self-examination and self-reflection. This helps you to get in better touch with your emotions and learn to deal with unprocessed feelings.

Family therapy. This kind of therapy helps to educate the family about the disorder and its causes, as well as to help your family members recognize symptoms of a recurrence.

Creative therapies (art therapy, music therapy). These therapies allow the patient to explore and express their thoughts and feelings in a safe and creative way.

Medication

Medications have not proved effective for depersonalization-derealization disorder. However, the disorder often is accompanied by either anxiety or depression. If you have either or both, an anti-anxiety medication or an antidepressant may help. Unfortunately, anti-anxiety medications sometimes increase feelings of depersonalization or derealization. Your doctor will need to monitor you for this if you take medication for anxiety. 

Some people with this disorder may benefit from mood stabilizer medications, which are used to treat conditions such as bipolar disorder, or antipsychotic drugs. Antipsychotic medications are also sometimes used to help with disordered thinking and perception related to depersonalization.

First, stay hopeful. With treatment, the disorder often eases its grip after a few months. It can go on for years, though, if you don’t address it. Here are some things that you can do to help yourself:

Get personalized help

Talk therapy with a mental health professional can address your unique experience of the disorder — what triggers your symptoms and any past traumas that may play a role. With your therapist, you can develop coping strategies tailored to your specific needs.

Avoid drugs and alcohol

Recreational drinking and drugs affect your brain chemistry and your perception of reality. That contributes to your feelings of depersonalization and detachment. If you struggle to quit, ask for help. Lots of resources and treatments exist to make it possible. Your doctor can direct you to programs right for you.

Practice staying grounded

Engaging your senses can help you feel connected to the world around you and to the present moment. Try the following:

  • Listen to music or the sounds around you.
  • Hold something -- a rock, a book, a bagel, or anything else -- in your hands and interact with it.
  • Touch the ground.
  • Focus on a pleasing smell nearby.
  • Sing or hum to yourself when you need a distraction.
  • Wrap a blanket around yourself.

Perform breathing exercises

Such exercises can help ease stress, which is a common trigger of depersonalization-derealization disorder symptoms. Try a calming technique called box breathing (sometimes called square breathing or 4x4 breathing):

  1. Slowly exhale all the air from your lungs.
  2. Focusing on your breath, breathe in through your nose as you slowly count to four.
  3. Hold your breath for four seconds.
  4. Exhale for four seconds.
  5. Hold your breath for four seconds.
  6. Repeat steps 2 to 5 for three or four rounds.

Cultivate mindfulness

This is a calming meditation practice that helps you stay in the present moment and focus on what you sense around you. It can ease anxiety. Instead of dwelling on stressful thoughts, you direct your mind to your breathing, the taste of the food you are eating, or other sensory experiences in your immediate environment in a nonjudgmental way.

Seek support

You don’t have to face the disorder alone. Talk with close friends and family about what you’re going through. This can help you stay grounded and improve your mental health. Remember, they may not grasp what you’re going through, but they still care about you. Letting them know what you need will better allow them to help you.

If you have a loved one with the disorder, you can help. Here’s how:

Follow their lead

Be prepared for the disorder to cause them to behave in ways you don’t anticipate. Be patient and understanding. Ask them what they want or need, though they may not always know. Listen to them when they’re ready to share their experiences. The disorder may make physical contact and intimacy difficult for them, so ask before you touch them.

Help them get the support they need

Find therapists and other resources that could benefit them. Offer to be with them before and after therapy sessions in case they need that extra help. Help them craft a plan for what to do if they have a mental health crisis, such as who to contact, especially if you’re not there.

Understand their disorder and how to help manage it

Your loved one’s symptoms may have specific triggers. If you know about those, you may help them avoid those triggers or at least anticipate what will happen when an episode occurs. Encourage them to practice grounding and other helpful techniques. Ask them what you can do at times when they need extra support. And if you’re worried about them having suicidal thoughts, urge them to get help immediately by reaching out to the 988 Suicide and Crisis Lifeline or Lifeline Chat. If they are injuring themselves, urge them to get help or reach out to their counselor yourself. In an emergency, call 911.

Complete recovery from depersonalization-derealization disorder is possible for many patients. The symptoms associated with this disorder often go away on their own or after treatment that help the person deal with the stress or trauma that triggered the symptoms. However, without treatment, additional episodes of depersonalization can occur.

The disorder can lead to numerous complications that make life difficult, including:

  • Limiting your ability to focus on what you’re doing
  • Impairing your memory
  • Interfering with your work and other aspects of your daily life
  • Putting strain on your relationships with loved ones
  • Increasing your risk of depression and anxiety

Although it might not be possible to prevent depersonalization-derealization disorder, it might be helpful to begin treatment in people as soon as they begin to show symptoms. Also, quick intervention following a traumatic event or emotionally distressing experience might help reduce the risk of developing dissociative disorders.

Depersonalization-derealization disorder can make you feel disconnected from yourself, other people, and the world around you. This mental health condition can make many aspects of your daily life difficult and stressful. Though its causes remain unknown, past experiences, such as traumatic events, can contribute to its development. Fortunately, treatment — particularly talk therapy — can help you recover.

Is depersonalization-derealizationdisorder a mental health issue?

Yes. It’s one of a number of dissociative disorders recognized by the American Psychiatric Association.

Can overthinking lead to depersonalization?

Experts say that the disorder is often rooted in past traumas, such as physical abuse, domestic violence, and life-threatening dangers. But overthinking may contribute to the feelings of detachment that occur in episodes of the disorder. Such overthinking may also result from the disorder itself.

How do I stop feeling depersonalized?

Effective treatment (particularly talk therapy) can help you recover from depersonalization-derealization disorder.

Why does my brain feel disconnected from my body?

This feeling can happen to anyone from time to time. But if such feelings persist for long periods, you may have depersonalization-derealization disorder. Talk to your doctor, who can refer you to a mental health specialist.

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