Depersonalisation and derealisation are dissociative conditions. Individuals who experience these conditions persistently may have depersonalisation-derealisation disorder. It is estimated that 1-2% of the worldwide population have this disorder.¹

Depersonalisation is a state where you feel as though you are disconnected from your body, and that you are observing your actions with little control over what you say or do. Derealisation is where you feel like the world is unreal and you have a distorted perception of the external world. These two states both cause high levels of distress. They are generally considered to not exist independently of each other - so an individual who experiences persistent, recurring experiences of either condition (or both conditions) might be considered to have depersonalisation-derealisation disorder.

Depersonalisation and derealisation may seem quite similar, but there are key differences in the feelings experienced with each condition.

Depersonalisation

Depersonalisation is where you feel disconnected from yourself, and like you’re observing your actions, feelings or thoughts from a distance. It’s almost like you’re outside your body watching your life – as if you were watching a character on a TV show. Depersonalisation is categorised by a disruption in self-awareness and emotional numbness where individuals feel disconnected from themselves. A lot of people experience depersonalisation at the highest point of anxiety during a panic attack. It is thought that this phenomenon is a strategy used by the mind to cope with high amounts of stress. 

Depersonalisation symptoms

Depersonalisation can cause many feelings which can be distressing for individuals. Examples of feelings an individual might experience with depersonalisation are:

• Feeling disconnected from your thoughts, feelings, and body
• Feeling robot-like
• Feeling emotionally numb
• Feeling like you’re observing yourself from outside your body
• Feeling sad or anxious
• Feeling like you have no control over what you do or say

Derealisation

Derealisation is categorised as experiences where you feel that the world is unreal. It has been described as feeling as though the environment is ‘dreamlike, empty, lifeless, or visually distorted’.² When experiencing derealisation, individuals’ perception of the external world is altered. 

Derealisation symptoms 

Derealisation can cause many distressing feelings, such as:

• Feeling disconnected from your surroundings or environment
• Feeling emotionally numb
• Feeling sad or anxious
• Feeling like you’re living in a dream world
• Feeling that the world is distorted or lifeless, colourless and artificial
• Feeling that sounds are louder or softer than they really are
• Feeling that time may seem to be going too slow or too fast

Why someone might experience depersonalisation or derealisation

It is common to have temporary experiences of depersonalisation or derealisation. There are particular situations where these feelings occur: 

• When individuals experience life-threatening danger
• When individuals become very tired
• When individuals are deprived of sensory stimulation (such as within an intensive care unit)
• When certain drugs are taken (including marijuana, ketamine, ecstasy or hallucinogens)

Depersonalisation/ derealisation can occur as a secondary symptom of psychiatric conditions. Examples of these conditions are:⁴ 

• Borderline personality disorder (BPD)
• Obsessive-compulsive disorder (OCD) 
• Major depressive disorder (MDD) 
• Or as a dissociative qualifier of posttraumatic stress disorder (PTSD + DS)

Additionally, it can be a secondary symptom of general medical disorders such as seizure disorders. 

Depersonalisation-derealisation disorder (DPDR)

Depersonalisation-derealisation disorder is a dissociative disorder characterised by ongoing experiences of either depersonalisation, derealisation, or both. They must be persistent or recurrent.³ The two states tend to co-occur, there is little evidence they exist independently of one another, so individuals who experience either will be identified as having DPDR.⁴

Individuals with DPDR are aware that it is occurring and that it is not a typical state.⁵ Studies have shown that there is equal occurrence between people assigned female at birth and people assigned male at birth. It was also found that the average age of onset was in adolescence, and cases with onset over the age of 25 are rare.⁶

Individuals are diagnosed with DPDR when it is not considered a symptom of a different disorder. The symptoms are very distressing and they significantly impact daily life. 

What causes depersonalisation-derealisation disorder 

The underlying mechanisms of DPDR are currently not completely understood but there are several theories looking at neural circuitry. It is thought that DPDR is a behavioural response to psychological trauma.⁴ The disorder can be triggered by severe stress – this can be emotional abuse or neglect during childhood, or experiencing or witnessing physical abuse amongst other stressful events. 

Treating DPDR

Currently there isn’t clear evidence from research as to which form of treatment is most effective for DPDR. Healthcare professionals will discuss with patients different treatment options and find the best-suited treatment. They can do this by discussing medical history, symptoms and treatment goals. 

One method of treatment for DPDR is psychotherapy.⁷ This is also known as talk therapy and aims to identify and change unhealthy emotions, thoughts and behaviours. Mental health professionals will discuss emotions, thoughts and behaviours with the patient and attempt to change their perspective to encourage healthy emotions and behaviours. 

Cognitive behavioural therapy (CBT) is another commonly used treatment for DPDR. CBT is a type of talk therapy which focuses on meeting goals. During CBT, a mental health professional will talk about emotions and thoughts and discuss how thoughts affect actions. CBT works on unlearning negative thoughts and behaviour to adopt healthier thinking. 

Eye movement desensitisation and reprocessing (EMDR) therapy is another approach used to treat DPDR. EMDR focuses on healing from trauma or other distressing life experiences. It involves moving your eyes in a specific way whilst processing traumatic memories. EMDR is a treatment option which doesn’t involve talking about a traumatic situation, or something that causes distress.

During the treatment, the traumatic events are reprocessed whilst being guided which helps to “repair” the mental injury caused by the memory. This means that when the memories are remembered, it will no longer feel as though they are being relived. DPDR is often caused by stress or experiencing traumatic events so repairing this trauma can help to ease stress and symptoms of DPDR. 

Talking therapies are generally considered to be the most effective treatments, however, healthcare providers may recommend medication as part of treatment for DPDR. These medications (or combination of medications) can be:

• Anti-anxiety medications
• Selective serotonin reuptake inhibitors (SSRIs)
• Mood-stabilising medications
• Antipsychotic medications

These medications can cause various side effects so it is best to discuss suitability with a healthcare provider. 

FAQs

What causes a depersonalisation episode?

Great levels of stress, such as major financial, work-related or relationship issues can cause depersonalisation to occur. It can also be caused by high levels of anxiety, for example during a panic attack. Taking certain drugs can trigger an episode of depersonalisation.

Can derealisation or depersonalisation lead to psychosis?

There are studies which have found that depersonalisation/derealisation has been associated with the initial phases of psychosis.⁸ However, many individuals experience temporary episodes of depersonalisation or derealisation and do not develop psychosis. Experiencing these conditions does not mean that you will develop psychosis. Depersonalisation/derealisation can be a symptom of other medical disorders such as OCD, BPD and seizure disorders. 

Summary

Depersonalisation and derealisation are dissociative conditions that often occur together.

Depersonalisation is categorised as feeling disconnected from yourself and observing your actions from an outside perspective. This can cause individuals to feel emotionally numb, robot-like, anxious and like they have no control over their actions. Derealisation is categorised as feeling like the world is unreal and having a distorted perception of the external world. This can cause individuals to feel sad or anxious, like the world is lifeless, and like they’re living in a dream world. Both depersonalisation and derealisation can cause high levels of distress. 

People can experience these conditions temporarily when they experience a life-threatening situation, take certain drugs, are sleep-deprived, or lack sensory stimulation. It can occur as a secondary symptom of many psychiatric and general medical conditions. 

It is considered that the states of depersonalisation and derealisation don’t exist independently of each other, so individuals who experience depersonalisation, derealisation, or both persistently may be diagnosed with depersonalisation-derealisation disorder (DPDR). This is diagnosed when the conditions are not a symptom of a different disorder.

The cause of this disorder isn’t fully understood but it is thought to be due to stress or trauma. Treatments of DPDR haven’t been extensively researched but talking therapies are most commonly used. These include psychotherapy, CBT and EMDR. Medications can also be taken to ease symptoms.