Derealization Vs. Depersonalization: Understanding the Differences

What Is Depersonalization?

Depersonalization happens when you feel disconnected or detached from your own body, thoughts, or feelings. Unlike psychosis, people experiencing depersonalization do not lose touch with reality. They recognize that their perceptions aren’t real. While brief moments of depersonalization are fairly common, frequent depersonalization can be an indicator of depersonalization disorder, which affects less than 2% of the population.²

Depersonalization Symptoms

Feeling disconnected or detached are the primary symptoms associated with depersonalization. This sensation can occur at any time and in any location, although some people may be more likely to experience it during stressful times.

Symptoms of depersonalization may include:

• Feeling cut off from reality: It may seem like you are observing your thoughts or feelings from outside of yourself
• Distorted self-image: There may be a sense that your limbs are distorted, enlarged, or shrunken. Some people also feel like their heads are wrapped in cotton³
• Feeling like you’re in a dream or dream world: Reality doesn’t seem real, and things may feel blurry or incoherent like a dream
• Feeling like you’re a robot: It can seem like you’re existing on auto-pilot without actual feelings or thoughts attached to what you do
• Anxiety over feeling that something is seriously wrong: Because you’re still grounded in a sense of reality, you may feel panicked by your own symptoms
• Feeling like you’re not in control of yourself: You may worry that you will lose control or that your speech and thoughts are not really your own
• Worrying that your memories are not your own: You may also doubt whether your memories are valid or real

What Causes Depersonalization?

Like most mental health symptoms, the exact cause of depersonalization disorder is unknown. However, it’s likely that aggravated states of anxiety and stress trigger episodes. Furthermore, a history of trauma is a significant risk factor for depersonalization.

Possible causes of depersonalization disorder include:

• Childhood trauma: Childhood trauma can profoundly affect brain structure, and it can aggravate someone’s fight-or-flight system, which may be part of the depersonalization experience. Your brain essentially shuts down (dissociates) as a way to protect itself.⁴
• Witnessing trauma: Witnessing trauma can also activate the same fight-or-flight reflexes, and the brain may detect danger even when a life-threatening situation doesn’t exist.
• Depression: Dissociation can be a symptom of depression, and depression does appear to be a risk factor for dissociation.⁵
• Anxiety: Heightened anxiety may cause the brain to dissociate as a way of coping with acute stress.
• Certain personality traits: Certain personality traits may make some people more inclined to deny or intellectualize difficult situations, which can aggravate depersonalization.
• Taking certain drugs: Stimulants, marijuana, and hallucinogens may correlate with depersonalization.

What Is Derealization?

Derealization refers to a disconnection from your surroundings and external environment. Other objects or people may seem unreal. You are aware that you’re in an altered state (so it isn’t a break from reality), but the experience can still be alarming and confusing.

Derealization may be a product of certain mental health disorders like schizophrenia, but it can also emerge from brain diseases or seizure disorders². Consistent derealization may lead to a dissociative disorder, which affects about 2% of the population (but may be as high as up to 10% in clinical settings).⁶

Derealization Symptoms

Often, derealization symptoms occur in episodes. A person may briefly experience feelings of being disconnected from reality, or as though the real world is distorted, muted, or not as it should be.

Symptoms of derealization may include: 

• Strongly feeling like you’re in a dream: It seems like you are in a dream-like state or trance, and it is markedly different from your normal reality
• Having a distorted perception of time: Time may either feel like it’s speeding up or slowing down
• Feeling like sounds are distorted: Sounds may seem too loud, too soft, or otherwise different
• Finding the outside world as lifeless, colorless, or unreal: The surroundings may look a different color, feel exaggerated, or seem fake
• Seeing other objects or people incorrectly: They may seem too large, small, or unusual in size or texture
• Feeling anxious about your consciousness: Because you aren’t fully detached from reality, you may feel panicked about your symptoms

What Causes Derealization?

Derealization can be a standalone symptom, but it may also accompany medical or mental health issues. When it happens on its own, it’s often in response to heightened stress or trauma. Like other mental health symptoms, it’s unlikely that there’s a single cause for derealization.

Possible causes of derealization include:

• Schizophrenia: Derealization is a common symptom with schizophrenia and other related psychotic disorders
• Panic attacks: A panic attack may trigger derealization
• Post-traumatic stress disorder (PTSD): Derealization can coincide with PTSD, and people may experience this symptom when they are having a trauma flashback or feeling currently triggered
• Childhood trauma: Childhood trauma impacts the fight-or-flight response, and derealization can act as a way to cut off the brain from feeling overwhelmed
• Sexual abuse: Sexual abuse can also dysregulate the fight-or-flight response, and people who have experienced such trauma may also experience derealization
• Substance use: Certain substances like hallucinogens, marijuana, stimulants, or alcohol (especially when intoxicated) can cause episodes of derealization

Depersonalization-Derealization Disorder (DPDR)

Both depersonalization and derealization can occur at the same time. When this happens over an extended period, this may indicate that someone has depersonalization-derealization disorder (DPDR). DPDR is a dissociative disorder that affects someone’s quality of life and impacts their ability to function in everyday tasks. This condition is relatively equal among both men and women, and it usually starts in either adolescence or early adulthood. The average age of onset is around 16 years old.

Differences Between Depersonalization & Derealization

Symptoms may overlap between depersonalization and derealization. The main difference comes down to internal vs. external awareness. Someone experiencing depersonalization feels disconnected from themselves (their bodies, thoughts, feelings, sensations). Someone experiencing derealization feels disconnected from the outside world (other people, objects, time, and location). When someone has both symptoms simultaneously, they tend to feel completely detached.

The lifetime prevalence of depersonalization tends to be around 19%, and 14% for derealization. However, nearly 1 in 4 people report having any dissociative experience. Women are slightly more likely to experience dissociation than men. One randomized study of more than 1000 adults found that employed people who attended church regularly were more likely to experience depersonalization, and ethnic minorities were more likely to experience derealization.⁷

How Are Depersonalization & Derealization Diagnosed?

There are no specific tests for diagnosing either condition. However, a trained healthcare professional may administer various physical and mental health exams to rule out other mental or physical conditions, like traumatic brain injuries or PTSD. They may also request lab tests to rule out other medical issues.

Depersonalization & Derealization Treatment

Brief episodes of depersonalization or derealization do not necessarily warrant treatment. This is especially true if the episodes are rare and do not affect your everyday functioning. But if symptoms persist, occur frequently, and cause significant distress, it’s important to consider treatment. If you can’t stay present in your relationships, perform at work, or adequately take care of yourself, these red flags indicate the need for professional support.

Therapy Options

Psychotherapy can be an integral part of understanding your symptoms and feeling better. When it comes to depersonalization and derealization, working with a therapist should help reduce or eliminate your symptoms.

Cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing therapy (EMDR), and psychodynamic therapies are common treatment options. You can find a therapist by looking for a professional specializing in dissociative disorders and trauma (as they often go hand-in-hand). Some people prefer online therapy options for convenience and accessibility, but in-person therapy can be beneficial when working with a therapist who does more body-focused work.

Medications

Medication may also be prescribed to someone experiencing depersonalization, derealization, or both conditions. This is especially true when the symptoms are part of other associated disorders like schizophrenia or PTSD. While no specific medications for dissociative disorders exist, people may benefit from anti-anxiety medications, antipsychotic drugs, or antidepressants. A qualified primary care provider or online psychiatrist options can evaluate your symptoms and review the best medication options with you.

Self-Coping Methods

Practicing routine stress management is important because stress often exacerbates disassociation symptoms. Stress management includes self-care strategies like meditation, exercise, mindfulness, journaling, and building a positive support system. Remember that these skills may not necessarily make you feel better right away, but practicing them routinely can benefit your overall emotional well-being.

Final Thoughts

Depersonalization and derealization can be uncomfortable experiences, but they are not inherently dangerous. Likewise, they don’t mean anything is wrong with you. However, if they cause you significant concern – or affect other areas of your life –  it’s important to seek treatment to get the relief you deserve.