Have you ever found yourself driving home on “autopilot,” feeling disconnected from reality, as if you were watching your own life from the outside? This experience, while sometimes normal, can indicate something more if it becomes frequent and intense. You may then be experiencing derealization or depersonalization.
The feeling that the world around you is like out of a dream, and that you yourself feel unreal, can be frightening. Many people then fear that they are “going crazy” or losing touch with reality. But know that you’re not alone – these experiences are more common than you might think, and modern psychotherapy offers effective ways to help.
In this article, you’ll learn what depersonalization and derealization are, what triggers them, and how cognitive behavioral therapy can help you regain a sense of reality and connection to yourself.
What is derealization and depersonalization
Depersonalization and derealization are two distinct but often co-occurring types of dissociative symptoms. Dissociation is a general term describing the disruption of the normal integration of consciousness, memory, identity and perception.
Depersonalization is a sense of detachment from your own experiences. You may feel unreal, as if you are in a dream-like state, numb or disconnected from your own emotions, thoughts and your own body. It’s as if you’ve become an outside observer of your own life – you see yourself, but don’t feel a real connection to what you’re doing or thinking.
Derealization is a sense of unreality about the world around you. People experiencing this condition describe that their surroundings seem hazy, as if from a movie or dream. People and objects may appear distorted, two-dimensional or even cartoonish. There may also be distortion of time perception – minutes may seem like hours or vice versa.
Both of these states can last for days, weeks or even months. People experiencing them often describe them as some of the most disturbing mental states one can experience.
What is depersonalization-derealization syndrome?
Depersonalization-derealization (DD) syndrome is a dissociative disorder characterized by persistent or recurrent feelings of separation from the self (depersonalization) and a sense of unreality surrounding reality (derealization state). People suffering from the disorder often have difficulty describing their experiences, which can lead to feelings of isolation and anxiety.
Who experiences these states and why?
Symptoms of depersonalization and derealization are surprisingly common. It is estimated that between 26% and 74% of people in the general population have experienced transient symptoms of depersonalization during their lifetime. However, for some, they become chronic, causing significant difficulties in daily functioning.
Among people with mental disorders such as anxiety, depression or psychosis, the prevalence rate is much higher, and can be as high as 82.6%.
Causes of derealization – what can cause feelings of unreality?
Derealization most often does not occur without a reason. It is your mind and body trying to cope with difficult experiences or overload. Understanding what can trigger this condition is the first step to regaining a sense of security and control.
The most common triggers of derealization:
- Severe or chronic stress
When you’ve been struggling with tension, responsibilities or pressure for an extended period of time, your nervous system may begin to “shut down” to protect you from overload. - Traumatic events
Experiences such as violence, an accident, the loss of a loved one or other difficult situations can cause your mind to activate a defense mechanism – distancing you from painful emotions and the world around you. - Mental disorders
Derealization often accompanies anxiety disorder, depressive episode, post-traumatic stress disorder (PTSD), as well as other mental problems. It is the body’s way of trying to cope with severe tension or anxiety. - Neurological and health factors
Some neurological diseases (such as epilepsy), sleep disorders or chronic fatigue can affect your sense of reality. - Psychoactive substances
The use of drugs, alcohol or certain medications can lead to temporary states of derealization. Sometimes symptoms also appear after withdrawal from these substances. - Social isolation and lack of support
Long-term loneliness, lack of a sense of understanding or support from loved ones can make the world begin to seem alien and distant.
How does this mechanism work?
Derealization is not a “fad” or “weakness.” It’s a signal that your body is looking for a way to cope with the overload. Sometimes, when the level of stress or tension exceeds your ability to cope, there are changes in neurotransmitters in your brain (e.g. dopamine levels drop, adrenaline rises). This can lead to a feeling of detachment from reality – as if you were looking at the world through a glass window.
Differentiating from psychoactive substances
Derealization differs from drug- or alcohol-induced states primarily in the context and nature of the symptoms. In derealization, the sensation of the unreality of the world occurs spontaneously, often as a result of stress or anxiety, and can last for a long time, with the retained awareness that it is a subjective experience. After drugs and alcohol, symptoms are directly related to their use, often include hallucinations, euphoria or disorientation, and subside after the substance is metabolized. Derealization lacks the loss of behavioral control that can occur with alcohol or drugs.
How do you recognize the symptoms?
Do you wonder if what you are experiencing could be depersonalization or derealization? In addition to a general sense of disconnection, you may notice:
Emotional numbness – difficulty feeling emotions and connecting with other people. You may feel like you are behind a glass wall, seeing life but not really participating in it.
Altered perceptions – hazy vision, dizziness, distorted sounds and colors. The world may seem flat or lack depth.
Lack of motivation and anhedonia – a loss of pleasure in things you previously enjoyed. You may feel emptiness and a lack of meaning.
“Freezing” – a physiological reaction to extreme stress, leading to feelings of sadness, fatigue, hopelessness and inability to act.
Diagnosis of derealization and depersonalization-derealization syndrome
If you notice a persistent sense of unreality in the world or disconnection from yourself, you may be wondering what the process is for diagnosing these experiences and where to seek help. A diagnosis of derealization and depersonalization-derealization (DD) syndrome is an important step on the road to regaining a sense of security and balance. Here’s what you can expect and what to look out for:
When is it a good idea to see a specialist?
If the feeling of being unreal or “out of yourself” persists for an extended period of time, recurs or begins to impede daily functioning, it is worth consulting a psychologist psychotherapist or psychiatrist. A supportive and professional approach will allow you to safely talk about your experience and get an honest assessment of the situation.
What does the diagnostic process look like?
- Detailed clinical interview
During the first meeting, the specialist will ask you about your symptoms, their duration, the circumstances under which they appeared and how they affect your daily life. It is also important to discuss your mental health history, past traumas, stressful events or use of psychoactive substances. - Differentiating symptoms
Symptoms of derealization and depersonalization can resemble other conditions – for example, side effects of medications, neurological diseases (such as epilepsy), sleep disorders or the effects of psychoactive substance use. In the process of diagnosis, the specialist may suggest additional tests (such as laboratory or imaging) to rule out other causes. - Assessment of mental status
Standardized diagnostic tools, such as questionnaires or symptom assessment scales, are often used to help accurately determine the severity and impact of the disorder on your life. Diagnosis is based on current criteria (e.g., DSM-5 classification) that take into account the duration, intensity and nature of symptoms. - Individualized approach and support
Everyone experiences derealization and depersonalization slightly differently, so the diagnostic process should be flexible and tailored to your needs. It is important to have a partnership with the diagnosing person, to trust and feel safe in the conversation.
Diagnostic tools for studying derealization and depersonalization
The Dissociative Experiences Scale (DES-R PL) is the primary screening tool for assessing dissociative symptoms in Poland. It was developed as a revision of the original DES scale from the 1980s, with a revised response system.
The Cambridge Depersonalization Scale was adapted into Polish by Igor Pietkiewicz and Radoslaw Tomalski of the Trauma and Dissociation Research Center. It assesses the frequency and duration of depersonalization and derealization symptoms in the past 6 months.
Somatoform Dissociation Questionnaire (SDQ-20). SDQ-20 is used to assess somatoform dissociation – dissociative symptoms manifested through the body and sensory organs. Particularly effective in detecting pathological dissociation, it is useful in the diagnosis of post-traumatic disorders.
Treatment of derealization – CBT psychotherapy
Do you feel lost and unsure how to cope with these frightening experiences? Although depersonalization-derealization disorder can sometimes be difficult to treat pharmacologically, cognitive-behavioral therapy (CBT) offers real help.
CBT is a form of psychotherapy that focuses on identifying and modifying negative thought patterns and behaviors. Research shows that it is a promising approach for treating symptoms of depersonalization and derealization.
Effectiveness proven by research
In a 2023 study, 36 participants with chronic depersonalization-derealization disorder (average 15 years of symptoms) experienced significant symptom reduction after an average of 18 sessions of CBT therapy. Importantly, the improvement occurred only during the active therapy period, confirming the effectiveness of this method.
Even shorter interventions can have an effect. A 2016 study found that as few as six sessions of CBT can significantly reduce symptoms in people experiencing depersonalization and derealization.
Cognitive model
The cognitive model explains that catastrophic interpretations of transient depersonalization experiences (e.g., “I’ve damaged my brain” or “I’m going crazy”) create a vicious cycle. These distressing beliefs, along with excessive symptom monitoring and avoidant behavior, sustain and exacerbate the problem.
Key elements of CBT therapy
Psychoeducation helps you understand that depersonalization and derealization are psychological mechanisms that help you cope with overwhelming experiences. It doesn’t mean that you are “going crazy” – It’s your mind’s way of trying to protect you.
Cognitive restructuring involves identifying and challenging catastrophic thoughts about symptoms. Instead of thinking “I’m crazy,” you learn more factual interpretations: “I’m experiencing stress symptoms that can be treated.”
Modifying your thought processes focuses on reducing excessive symptom monitoring and ruminations. Instead of constantly checking to see if your symptoms are getting worse, you learn to direct your attention to other aspects of your life.
Behavioral strategies help you gradually reduce avoidance behaviors and test the effects of various activities on symptoms.
Pharmacotherapy – support for more difficult cases
In some situations, especially when derealization co-occurs with severe anxiety, depression or other disorders, a specialist may suggest consulting a psychiatrist. Medications (such as SSRIs or anti-anxiety medications) can alleviate the most troublesome symptoms and facilitate the use of psychotherapy. It is worth remembering that pharmacotherapy is always selected individually, and the decision to implement it is made by a psychiatrist after a thorough assessment of your situation. Medication does not replace psychotherapy, but can be a valuable supplement to it.
Support of loved ones and education of the environment
Dealing with derealization is sometimes easier when you are not alone with it. It’s a good idea to talk openly with people you trust and share your experiences. You can also ask your loved ones to learn some basic information about derealization – this will help them understand you better and support you in more difficult moments. Remember that asking for help is an expression of self-care, not weakness.
Techniques to help you on a daily basis
Grounding techniques (grounding) can help you reconnect with the here and now. Try the “5 senses” exercise: focus on five things you see, four you hear, three you touch, two you smell, and one you taste.
Regulating emotions through relaxation techniques such as deep breathing, yoga or meditation can significantly reduce dissociative symptoms.
Polyvagal exercises help activate the vagus nerve, promoting a sense of security. Deep breathing, chanting or gentle neck stretching can provide relief.
Somatic experience focuses on bodily sensations, helping to release accumulated tension from unprocessed traumas.
Frequently asked questions
Are depersonalization and derealization dangerous?
Although the symptoms can be very disturbing, they are not dangerous in themselves. They are defense mechanisms of the mind that can be effectively treated with appropriate therapy.
Can any of us experience this?
Yes. Even if you are doing great on a daily basis, the accumulation of difficult experiences, exhaustion or sudden stress can trigger this condition. Often, derealization occurs temporarily and passes when you return to balance. However, if it persists longer or makes your daily life difficult, it is worth seeking support.
How long does treatment last?
The length of therapy is individual. Some people experience improvement after just a few sessions, while others need longer support. It is important to note that the benefits of CBT often persist or even deepen after therapy ends.
Can I help myself?
Self-help techniques such as grounding or emotion regulation can provide relief, but professional psychological support is usually necessary for lasting improvement.
You are not alone – seek support
Feeling disconnected from yourself and the world can be very isolating. Talking about your experiences with a licensed psychologist is the first step to regaining a sense of reality.
If you are experiencing symptoms of depersonalization or derealization, know that there is hope for improvement. Modern psychotherapy, particularly cognitive-behavioral therapy, offers effective tools to break the vicious cycle of dissociation. Understanding the underlying mechanisms of these conditions and appropriate interventions can help you regain a full and grounded life.
Bibliography:
Tomalski R., Pietkiewicz I.J. (2022). Depersonalization – the key to understanding the complexity of dissociative phenomena. “Psychiatry. Psychology. Clinical,” 22(3), pp. 166-174.
Sterna W., Banach M., Brylska A., Sienkiewicz-Jarosz H. (2018). Depersonalization/derealization – a syndrome of symptoms or a separate disorder? “Psychiatry,” 15(1), pp. 26-34.
Wciórka J. (ed.). (2011). Psychopathology. Warsaw: Wydawnictwo Lekarskie PZWL.
Kępiński A. (2002). Psychopathology of neuroses. Warsaw: Wydawnictwo Literackie.
Collective study (2021). Dehumanization and depersonalization in medicine and the modern world and the life of St. John of Dukla. Warsaw: Wydawnictwo Naukowe PWN
https://pmc.ncbi.nlm.nih.gov/articles/PMC5154060/
https://traumaidysocjacja.pl/wp-content/igor/testy/SDQ-20_PL.pdf