Imagine going through your day feeling as if you’re not connected to your own body or surroundings. You feel as if you’re just watching your life play out in front of you in a dream-like state, rather than experiencing things in the moment. Nothing feels real, and it’s as if you’re watching yourself go through the motions while you observe from the air above.

People with depersonalization-derealization disorder experience this frequently or, in more severe cases, constantly. Depersonalization-derealization disorder is a type of dissociative disorder that involves persistent, recurring feelings of being detached from one’s body or surroundings. People with depersonalization feel detached from their bodies, as if they are an outside observer of their life. Those with derealization feel detached from their surroundings.

The two types of dissociation go hand in hand, and people with this disorder will often experience both types (one more strongly than the other). Over half of people may experience this kind of dissociation at least once in their lifetime.  About 2% of people experience it frequently enough for it to be classified as depersonalization-derealization disorder.

Depersonalization-derealization can often be confused with brain fog, which is not considered a medical condition. It has similar symptoms, such as feeling confused and disorganized. However, it is not as severe or frequent as depersonalization-derealization.

There are several causes that are linked to this disorder, but the most common causes are stress and unresolved trauma. These consist of but are not limited to emotional abuse, neglect during childhood, physical abuse, witnessing domestic violence, having a severely impaired/mentally ill parent, or unexpected death of a loved one.

Depersonalization-derealization is categorized as an episodic disorder, with episodes varying in length and intensity. Episodes can be triggered by different personal, financial, or occupational stresses and can be connected to depression, anxiety, and drug use.

Symptoms of depersonalization include feeling detached from your thoughts, feelings, or body — as if you are watching yourself on a TV screen. People who suffer from depersonalization-derealization may also feel like a robot or a puppet, as if they are not in control of their own speech or movements. Body parts may feel distorted, enlarged, or shrunken. Emotional or physical numbness of the senses is another common symptom, which can affect responses to the world around you. It may feel as if your memories lack emotion, like they aren’t even your own real memories.

Likewise, people who experience frequent derealization feel disconnected from their real life. Surroundings may seem unfamiliar, causing you to feel alienated. This may cause you to feel like you’re living in a movie or a dream. You may also feel emotionally disconnected from the people around you, as if you’re separated by a glass wall. Surroundings may even appear distorted, blurry, colorless, two-dimensional, or artificial. Some people may experience a heightened awareness of their surroundings instead, causing an increase in the clarity of the objects around them. These symptoms can lead to the distortion of distance, along with the shape and size of objects. Similarly, time may feel distorted, causing recent events to feel like the distant past.

There are a variety of different treatment options for depersonalization-derealization disorder. Treatment of depersonalization-derealization disorder must tackle all of the factors associated with onset of the disorder, such as current-day stresses as well as earlier problems that may have predisposed people to the disorder. 

While medications can be used, the main kind of treatment is talk therapy, also known as psychotherapy. Psychotherapy is the treatment of mental health problems through discussions with a psychiatrist or psychologist. It involves using psychological methods to help change a person’s behavior in order to overcome their mental health challenges. This can help people learn about their condition, feelings, and behaviors. Psychotherapy can help people find ways to cope and treat their mental health conditions.

Cognitive techniques block obsessive thoughts about an unreal state of being and disconnection from the world around them. Behavioral techniques allow people to engage in tasks that will distract them from their challenges with depersonalization-derealization. Psychodynamic therapy helps patients deal with their negative thoughts and feelings while dealing with underlying experiences that can cause frequent dissociation.

A very common, simple treatment option is the use of grounding techniques. These are especially helpful because someone who has the disorder can do them by themselves during an episode. Grounding techniques can include holding an ice cube in your hand, playing loud music, focusing on colors around you, and paying attention to different textures you can feel.

Various medications have been used to combat depersonalization-derealization, but none have proven to be very effective. Some patients have seen improvements through the use of selective serotonin reuptake inhibitors (SSRIs), lamotrigine, opioid antagonists, anxiolytics, or stimulants. However, these medications may work because they specifically target other mental disorders that are linked to depersonalization-derealization, such as anxiety and depression. They do not directly target depersonalization-derealization itself.

If you or someone you know is suffering from depersonalization-derealization disorder, you can contact the National Alliance on Mental Illness (NAMI) HelpLine for more information and guidance.