Derealisation is the sense that the world has gone unreal: flat, distant, dreamlike, behind glass. Depersonalisation is the same detachment turned on yourself. They normally arrive together, and the first time is genuinely frightening.
The most useful thing to know at the start is that the experience is common and the persistent version is rare, and what separates them is mostly what you conclude about it.
What it actually feels like
People describe it with the same handful of images, which is a hint that it is one recognisable thing rather than many.
The room looks correct and feels wrong. Colours seem washed out. Sound arrives slightly late or slightly muffled. A street you have walked down for years feels unfamiliar. Your hands look like objects. Your voice sounds like a recording of somebody else.
The distinction from psychosis matters and it is clear. Someone experiencing this knows the world is real and reports that it feels unreal. That preserved knowledge is precisely what psychosis does not preserve, and it is the reassurance most people actually need.
Brief episodes are unremarkable, and turn up after bad sleep, alcohol, cannabis, exhaustion and prolonged stress. The persistent disorder is rare, with a population prevalence of around 1%.
Why it happens in panic
It is one of the recognised symptoms of a panic attack, and it is strongly associated with anxiety disorders generally.
The account that makes sense of it: high arousal appears to dampen the emotional colouring of experience. That colouring is the thing that makes your kitchen feel like your kitchen rather than an accurate arrangement of objects. Take it away and everything is visually correct and emotionally absent.
Our guide to panic attacks and anxiety attacks covers what else happens in an attack, and nocturnal panic attacks covers the version that wakes you.
What turns it into a lasting problem
Here is the part with a model behind it, and it is the reason this article exists.
The leading cognitive-behavioural account argues that chronic depersonalisation results from catastrophic misinterpretation of symptoms that are common and normally transient, read instead as evidence of serious mental illness or brain dysfunction, together with excessive monitoring and hyperawareness. [hunter-2003-conceptualisation]
That is a loop, and every part of it is something you are doing to try to get better:
- The sensation appears, for an ordinary reason.
- You interpret it as a sign something is seriously wrong.
- The interpretation produces anxiety.
- Anxiety makes the sensation stronger.
- You start checking whether it is still there.
- Checking directs attention at exactly the thing you want to stop noticing.
A schematic of the cognitive-behavioural model cited, which identifies catastrophic misinterpretation and symptom monitoring as maintaining factors. Not measured data.
The two right-hand bars are the whole disagreement. People treat the sensation as the problem and the checking as the solution, and the model says it is the other way round.
Searching for it online is the highest-risk version of the checking, because the results are dominated by accounts of people who have had it for years. That is the population most motivated to write about it, and it is not a sample of what usually happens.
Is the loop running?
Tick anything true. This is a reflection prompt rather than a test, and it produces no diagnosis.
0 of 8 ticked
The last item is the reassuring one: knowing the world is real while it feels unreal is exactly what separates this from psychosis. Items three to five are the maintaining loop, and they are the treatable part. The most useful single change is stopping the checking, which will feel like the opposite of taking it seriously.
Brief episodes are common and usually pass on their own. What converts them into a lasting problem is alarm plus monitoring, so the useful move now is to do less about it rather than more.
Nothing here matched. If panic rather than detachment is the difficulty, our guide to panic attacks covers what happens during one.
No screener on this site measures dissociation. The free anxiety screener uses the GAD-7, which is worth doing because this so often sits on top of anxiety rather than standing alone.
What helps
Get a first episode checked, then stop checking. Migraine, seizures, thyroid problems, anaemia and several drugs can produce this, so one appointment is worth having. After that, further investigation becomes part of the loop.
Change what it means before trying to change the feeling. “This is an ordinary response to arousal and sleep loss” and “this is a sign my brain is damaged” produce very different amounts of fear from an identical sensation.
Stop testing whether it is still there. This is the hardest instruction here and the most important. The test is what keeps attention pointed at it, and it cannot come back clear, because looking for it finds it.
Put attention outward and keep it there. Not a distraction technique so much as the correct direction. Our guide to grounding techniques covers the practical version.
Protect sleep and cut what provokes it. Sleep deprivation, cannabis and heavy alcohol are the reliable triggers.
Treat the anxiety underneath. It is frequently secondary, and cognitive behavioural therapy for panic and anxiety is well established. [nice-cg113-derealisation] Where it is the main problem, an open study of cognitive behavioural therapy targeting exactly this reported improvements in dissociation, anxiety, depression and general functioning, held at six-month follow-up. [hunter-2005-cbt-open]
The mechanism here is the same one described in our guides to safety behaviours and reassurance seeking: the thing you do for relief is the thing that keeps it going.
When to seek help
See a doctor about a first or unexplained episode, particularly alongside headaches, visual changes, blackouts or memory gaps, since several physical causes are worth excluding once.
See one again if it has become persistent, if you are checking for it through the day, if you are avoiding places because of it, or if you have concluded it means something is permanently wrong with you.
Go urgently if you have thoughts of harming yourself.
How MyFreud can help
This tracks things you are unlikely to connect from memory: how much sleep you had, how anxious the week was, what you drank. MyFreud gives you daily mood tracking that takes seconds, which is how the pattern behind an episode becomes visible instead of feeling like it comes from nowhere.
Download MyFreud and start today: App Store or Google Play.