Depersonalisation and derealisation explained

What depersonalisation and derealisation are

Depersonalisation is feeling detached from yourself. You might feel as if you are watching yourself from the outside, as if your body, hands or voice do not quite belong to you, or as if your feelings have been switched off. Some people say they feel like a robot, or like an actor going through the motions.

Derealisation is feeling detached from the world around you. Places and people can seem dreamlike, foggy, flat or far away, as if you are looking at them through glass or on a screen. Colours and sounds can seem dull or odd, and time can feel strange.

Many people have both together. The feelings can come and go, or they can be there most of the time. They are often hard to put into words, and people often say things are 'as if' unreal rather than actually unreal.

Reading this does not mean you have a disorder. Only a qualified professional can assess that, together with you.

Brief episodes are common

Short spells of feeling unreal are very common. In surveys, somewhere between a quarter and three quarters of people say they have had them at some point. They often happen when you are very tired, stressed or jet-lagged, during or after a panic attack, after a frightening event, or after using cannabis or other drugs. For most people they pass on their own.

For some people the feelings last, or keep coming back, and become upsetting and hard to live with. When that happens, and nothing else explains it, professionals call it depersonalisation-derealisation disorder. Around one or two people in every hundred live with this. It is a recognised problem, it is not your fault, and it can be worked on.

How to recognise it

People describe these experiences in many different ways. Tick any that feel familiar to you. There are no right or wrong answers, and ticking some of them is not a diagnosis.

Knowing it is a feeling

One of the most frightening parts of these feelings is the worry that you are going mad, losing control or that something is badly wrong with your brain. This worry is very common, and it is understandable, because the feelings are so strange.

But there is an important sign that you are still in touch with reality: you know that it is a feeling. You can tell that the world is still real, even though it does not feel real, and that you are still you, even though you feel cut off. That ability to stand back and notice the strangeness stays in place during depersonalisation and derealisation.

The feelings are unpleasant, but in themselves they are not dangerous, and they are not a sign that you are about to lose your mind.

What can set it off

There is often no single cause. Things that commonly set off or worsen the feelings include stress, anxiety and panic, low mood, not sleeping well, using cannabis or other drugs, and going through something overwhelming or frightening. Some people notice it more in bright artificial light, busy places or when they are alone with their thoughts.

Anxiety and these feelings often feed each other. The feelings are frightening, the fear adds to them, and paying close attention to them makes them stand out even more. Your therapist can share a sheet on how depersonalisation keeps itself going, which looks at this cycle in detail.

If your feelings of being cut off come with frightening memories of past events, or with losing chunks of time, tell your therapist. They can share a sheet on dissociation and grounding that may fit you better.

Now and then, feelings like these have a physical cause, such as some types of epilepsy, a head injury, or a medicine or drug, or coming off one. If you think a prescribed medicine plays a part, talk to your prescriber before you change it.

If you haven't had these feelings checked by a doctor, or they change or feel different from usual, see your GP. If you think something is medically wrong right now, get urgent help.

What can help

Understanding what is happening is a first step. Many people feel some relief when they learn that these are known, common experiences, and that the fear of going mad is part of the pattern rather than a sign of it.

Cognitive behavioural therapy (CBT) can help. With your therapist, you look at what the feelings mean to you, how you react to them, and what you do to cope. Together you might work on:

Noticing the frightening meanings you give the feelings, and testing them out.

Cutting down checking, such as testing how real you feel, looking in the mirror or searching online.

Stepping back into places and activities you have started to avoid.

Turning your attention outwards, onto what you are doing and the people around you, rather than inwards onto how you feel.

Looking after sleep, and cutting down cannabis, alcohol and other drugs.

Some things tend to make the feelings stand out more, even though they seem sensible at the time: watching yourself closely for changes, trying hard to force yourself to feel real, staying in or avoiding people, and reading about the worst cases. Some people find that relaxation exercises make them more aware of the feelings. Your therapist can help you find out what works for you.

Questions for my therapist

Write down anything you are unsure about, or anything you would like to understand better.