Understanding Depersonalization-Derealization Disorder

Have you ever felt like you were watching yourself from the outside as if life were a movie and you were just observing it? For some people, that feeling isn’t fleeting. It’s persistent, distressing, and deeply unsettling.

Depersonalization-derealization disorder (DPDR) is a dissociative disorder that causes ongoing or recurring episodes of feeling detached from your body, thoughts, or surroundings. While the experience can feel frightening, people with DPDR remain aware that what they’re feeling isn’t reality.

Here’s what you need to know about depersonalization-derealization disorder, including symptoms, causes, and treatment options.

What Is Depersonalization Derealization Disorder?

DPDR is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a dissociative disorder. It affects up to 2% of the general population, often beginning in adolescence. The average age of onset is around 16, and most cases are diagnosed before age 20.

There are two core components:

• Depersonalization: Feeling detached from your own body, thoughts, or emotions

• Derealization: Feeling detached from your environment, as though the world around you is unreal or distorted

Most people with DPDR experience both, although one may feel more dominant.

Importantly, people with DPDR maintain contact with reality. They know their experiences are unusual which distinguishes the condition from psychotic disorders.

What Does Depersonalization Feel Like?

Depersonalization can feel like being outside of yourself.

Common depersonalization symptoms include:

• Feeling disconnected from your body or emotions

• Sensing that you are observing yourself from outside

• Emotional numbness

• Feeling robotic or on autopilot

• Difficulty describing feelings

• Feeling unable to control speech or movement

• Memory lapses

Some describe it as an “out-of-body experience,” though it is psychological rather than physical.

What Does Derealization Feel Like?

Derealization affects how you perceive the world around you.

Common derealization symptoms include:

• Feeling like the world isn’t real

• A sense of being separated from others by a “glass wall”

• Visual distortions (objects appearing blurry, unusually large or small, or colorless)

• A dream-like or surreal quality to surroundings

Episodes may last minutes, hours, or even days. For some, symptoms recur intermittently over years.

What Triggers Depersonalization?

DPDR is often triggered by intense stress.

Common triggers include:

• Severe anxiety or panic attacks

• Major depressive episodes

• Sleep deprivation

• Overstimulation

• Traumatic experiences

Up to half of individuals with DPDR report a history of abuse, including childhood abuse or domestic violence. Trauma is one of the strongest known risk factors.

How Is DPDR Different From Schizophrenia?

Because DPDR involves feelings of unreality, it’s sometimes confused with psychotic disorders like schizophrenia.

The key difference:

People with DPDR know their experiences aren’t real.

In psychotic disorders, a person may have hallucinations or delusions that they believe are real. In DPDR, insight remains intact.

How Is Depersonalization Derealization Disorder Diagnosed?

To receive a diagnosis, a person must experience:

• Persistent or recurring depersonalization, derealization, or both

• Intact reality testing during episodes

• Significant distress or impairment in daily life

Healthcare providers will first rule out medical causes that can mimic symptoms, such as:

• Brain injury or stroke

• Seizure disorders

• Infections

• Neurodegenerative conditions

Tests may include bloodwork, imaging scans (MRI or CT), or an EEG.

Because about 72% of people with DPDR also have another mental health condition, commonly anxiety or depression, providers assess for co-occurring disorders as well.

What Causes Depersonalization Derealization Disorder?

The exact cause isn’t fully understood, but DPDR is believed to be a protective response to overwhelming stress or trauma.

In highly distressing situations, the brain may “mute” emotional perception as a defense mechanism. Over time, this coping response can become persistent.

Risk factors include:

• Post-traumatic stress disorder (PTSD)

• Physical or sexual abuse

• War or violent assault

• Sudden loss of a loved one

• Severe accidents

• Substance use (especially hallucinogens)

• Certain types of epilepsy

• Chronic sleep deprivation

Neurobiological research suggests altered functioning in the prefrontal cortex the brain region involved in emotional processing may play a role.

Can DPDR Be Treated?

Yes. Many people recover fully, either spontaneously or with treatment.

Medications

There is no medication specifically approved for depersonalization-derealization disorder. However, doctors may prescribe medications to treat related symptoms, such as:

• Antidepressants (like sertraline or fluoxetine)

• Anti-anxiety medications

• Anti-seizure medications like lamotrigine

Treating underlying anxiety or depression often reduces DPDR symptoms.

Psychotherapy

Talk therapy is considered the cornerstone of treatment.

Common approaches include:

• Cognitive behavioral therapy (CBT): Helps identify and change unhelpful thought patterns

• Psychodynamic therapy: Explores unconscious emotional processes

• Eye movement desensitization and reprocessing (EMDR): Often used for trauma

• Dialectical behavior therapy (DBT): Teaches emotional regulation skills

The goal is to reduce stress triggers and help individuals feel grounded in the present moment.

Coping Strategies for Depersonalization

Grounding techniques can help during episodes.

Try:

• Gently pinching your skin to reconnect with physical sensation

• Slow, deep breathing focused on chest movement

• Calling a friend to engage in conversation

• Moving your eyes around the room and naming objects aloud

• Counting objects and describing their colors

• Practicing mindfulness meditation

These strategies help redirect attention to the present and strengthen sensory awareness.

The Bottom Line

Depersonalization-derealization disorder can feel frightening and isolating, but it is treatable. You are not “losing your mind,” and you are not alone.

With proper support, therapy, and stress management, many people regain a stable sense of connection to themselves and their surroundings.

If you’re experiencing persistent feelings of detachment, seeking professional help is a strong and important first step.

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