Have you ever felt like you’re observing yourself from outside your body or that things around you aren’t real? Maybe you’ve experienced a combination of both.
While this can be jarring, passing experiences with these feelings are common. However, when these feelings keep coming back or don’t go away, depersonalization-derealization disorder — also referred to as dissociation — might be the cause, as it is for about 1% of the general population.
The good news: Even if you have depersonalization-derealization disorder, you’re not losing your grip on reality. And there are treatments that can help you deal with — or even get rid of — these feelings.
About depersonalization-derealization disorder
Depersonalization and derealization are distinct experiences but are often grouped together into a single disorder. You might experience one or both conditions. Depersonalization-derealization disorder refers to an altered perception or experience of yourself and the environment. It can interfere with many parts of life. Persistent and repeated feelings of either depersonalization or derealization can impact your performance at school or work, relationships, and your daily activities.
The difference between depersonalization and derealization
Shweta Kapoor, M.D., Ph.D., a Mayo Clinic psychiatrist, provides distinction between depersonalization and derealization. Dr. Kapoor says “(Derealization is) feeling like the people and world around you are unreal, foggy or dreamlike. (Depersonalization is) feeling that your actions and thoughts are happening outside of your body or like you’re watching yourself like an observer from a distance.”
Symptoms of depersonalization and derealization
Although somewhat similar, the symptoms associated with derealization and depersonalization have unique features. Here are some examples of what a person with depersonalization-derealization disorder might experience:
- Perceived distortion of yourself. You might sense that your limbs are enlarged or shrunken, distorted or taking on another shape or form, or that your head is wrapped in cotton.
- Emotional or physical numbness. You may have dulled responses to your surroundings.
- Uncertainty about memories. This could be a sense that memories lack emotion, or perhaps aren’t your own.
- Perceived distortion of your surroundings. You might see things as blurry, colorless, two-dimensional or artificial.
- Perceived distortion of time. Time may seem slowed down or sped up. For example, this may involve the perception that things and time are changing in slow motion like we see in movies. Or it may present as an acute and overwhelming awareness of your surroundings.
- Perceived distortion of distance, size and shape. Objects might appear closer and bigger than they are.
How it feels to experience depersonalization or derealization
Episodes of depersonalization-derealization disorder can be disturbing, scary and disabling. However, during an episode, you’re aware it’s a feeling and not reality, compared to people with other psychotic disorders who might believe they are actually outside of their body or are trapped inside a dream.
How long it lasts can vary. Feelings associated with depersonalization-derealization disorder can pass within hours or persist for months. This disorder has been shown to negatively impact the individual’s quality of life.
When experiencing depersonalization, you might feel:
- As if you’re floating in the air and watching yourself from above.
- Like a robot that isn’t in control of their speech or movements.
During a derealization episode, you might feel:
- Like you’re living in a dream.
- As if an unseen barrier separates you from people that you care about.
Dissociation vs. depersonalization and derealization
The American Psychiatric Association classifies depersonalization-derealization disorder as a type of dissociative disorder. Dissociation involves a disconnect between thoughts, memories, feelings, actions or sense of self.
Dissociation can be mild and part of everyday life — for example, daydreaming or getting lost in a book. On the other hand, people with severe dissociation or dissociative disorders escape reality in ways that are involuntary and unhealthy.
Other major dissociative disorders include:
- Dissociative amnesia or fugue. This refers to a more severe memory loss than typical forgetfulness.
- Dissociative identity disorder. This involves “switching” between alternate identities (previously known as multiple personality disorder).
Dissociative disorders often develop as a reaction to complex trauma. As many as 50% of people who have experienced trauma develop symptoms of depersonalization or derealization. The symptoms of depersonalization and derealization can be the brain’s way of blocking overwhelming emotion and instead focusing on surviving a traumatic event. For some, these symptoms clear within a short time. It’s more common for people who experience ongoing trauma — especially during childhood — to develop depersonalization-derealization disorder.
Derealization and depersonalization, anxiety and depression
Anxiety and depersonalization-derealization disorder often go hand in hand. Between 3.3% and 20% of people with anxiety disorders and approximately half of those who experience depression also experience symptoms of depersonalization and derealization.
People who experience panic attacks are at an increased risk for developing depersonalization-derealization disorder, and might experience symptoms of depersonalization or derealization during a panic attack.
When experiencing symptoms of depersonalization-derealization disorder, some people worry about “going crazy,” or spend a significant amount of effort concerned about and checking their existence and reality. These fears often arise because the symptoms can seem so unfamiliar and strange that they are hard to put into words.
It might help put your mind at ease to know that depersonalization-derealization disorder will not evolve into a psychotic disorder, and there’s no evidence it will contribute to permanent brain damage.
For some people, episodes of depersonalization or derealization can be a side effect of using marijuana. Although most marijuana-induced symptoms of depersonalization or derealization happen during the time a person is intoxicated, some people might experience symptoms long after they stop using marijuana.
The people who experience symptoms for weeks, months or even years after they stop using marijuana might develop depersonalization-derealization disorder. Although several risk factors can contribute to marijuana-induced depersonalization-derealization disorder, most people also have a prior history of anxiety disorder.
Depersonalization-derealization disorder test
Although some sources might claim to offer a “test” or “quiz” online for depersonalization-derealization disorder, diagnosis isn’t that easy. You should visit a health care provider if you experience ongoing or severe feelings of detachment and distortion of your surroundings, or are otherwise concerned about your mental health.
Clinical methods used to diagnose depersonalization-derealization disorder can include:
- Psychiatric evaluation of your symptoms, thoughts, feelings and behaviors against criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association.
- Physical exam and lab testing to uncover physical issues related to medication or recreational drug use.
Depersonalization-derealization disorder treatment
Depersonalization-derealization disorder is treatable with psychotherapy, also called counseling or talk therapy. Cognitive behavioral therapy is a common type of talk therapy that focuses on helping you become aware of inaccurate or negative thinking and respond to it more effectively.
The benefits of psychotherapy include:
- Understanding the condition and its causes.
- Learning ways to feel more connected to your world and feelings.
- Gaining strategies to cope with symptoms.
- Addressing related mental health conditions, as well as emotions related to past trauma.
There aren’t specific medications approved for treating depersonalization-derealization disorder. However, medications are commonly used along with psychotherapy to treat specific symptoms or associated anxiety or depression.
Learn how to stop depersonalization-derealization disorder
Immediately stopping depersonalization-derealization disorder might not be realistic, but there are ways to cope with the associated symptoms. A key thing to remember is that no matter how symptoms might feel, they are mental and not physical.
If you or someone you care about is hoping to take proactive steps toward recovery, follow or encourage these three steps:
- Seek treatment and follow the recommended treatment plan.
- Be informed and learn about the condition.
- Connect with supportive people, including family, friends and others experiencing depersonalization-derealization disorder.
As unsettling as the symptoms of depersonalization or derealization can be at times, there is hope for the future. It is largely treatable. Working together with a health care provider, it’s possible to alleviate symptoms in the short term, and improve your overall life experience as time goes on.