Depersonalization (DPDR): What It Is and How to Overcome It

Depersonalization-derealization disorder (DPDR) is a dissociative condition in which a person feels detached from their own body, thoughts, or surroundings, as if watching life from the outside. They know the feeling isn’t literally true, but it can feel overwhelming and frightening all the same.

This article is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, therapist, or other qualified health provider with any questions you may have regarding a medical or mental health condition.

Never disregard professional advice or delay in seeking it because of something you have read on this site.

What is depersonalization?

Depersonalization is a complex symptom that can be defined as ‘a state in which the sense of self and the quality of subjective first-person experience are oddly altered’ (Medford, 2012).

It can be described as feeling disconnected from the self or feeling as though you aren’t real.

It can be normal to feel depersonalization from time to time, especially in times of stress, upset, fatigue, or with drug use. Transient episodes of depersonalization have a lifetime prevalence between 26% and 74% of someone experiencing at least one episode.

What is derealization?

Derealization is also a part of the disorder, and this symptom affects how individuals relate to other people and their environment. They may feel as if their surroundings or other people are not real.

While depersonalization is defined as disconnections from the self, derealization is defined as disconnections from external reality.

Derealization is conceptualized as a sense of “unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings” (APA, 2013, p. 303).

A person who experiences derealization might feel as though they are in a fog or a dream or that the surrounding world is somehow artificial and unreal.

When does depersonalization become a disorder?

For most people who depersonalize, this feeling will usually diffuse once the stressful situation is over or once the drug has run its course (if caused by drug use).

Often, depersonalization is viewed as the mind’s defense mechanism to help cope with stressful situations.

From Symptom to Disorder

Feelings of depersonalization can become pathological in a few specific ways. This happens when a person cannot control when or where the symptoms occur, when they spread beyond the original situation, or when they persist beyond the stressor that triggered them.

In this situation, it is possible that the individual may have what was previously known as depersonalization disorder, now known as depersonalization/derealization disorder (DPDR).

The name has changed, but the experience has not.

DPDR is classified as one of three dissociative disorders, alongside dissociative amnesia and dissociative identity disorder.

Diagnosis, Onset and Course

Dissociative disorders are mental health conditions that disrupt or break down a person’s usual awareness, consciousness, and memory. For someone with DPDR, an episode can last minutes or hours, or it can stretch on for days, weeks, months, or even years.

The disorder itself is different. It is much rarer than the fleeting symptom described above.

Community surveys put the point prevalence of clinically significant DPDR at roughly 1-2%, a rate comparable to conditions like obsessive-compulsive disorder or schizophrenia (Hunter et al., 2004). Even so, it remains dramatically underdiagnosed.

Onset typically occurs in adolescence or early adulthood, around age 16 on average, and affects men and women in roughly equal numbers. Unlike many mental health conditions, DPDR tends to run a chronic, continuous course rather than an episodic one; many people live with near-constant symptoms for years or decades.

Diagnosis is often badly delayed. Michal and colleagues (2016) found that patients typically wait 7 to 12 years between the onset of symptoms and an accurate diagnosis.

Symptoms

Below are some of the key symptoms of DPDR:

Feeling disconnected from reality

People who experience depersonalization may feel as if there is a barrier between themselves and the world. They may feel as though they are living in a dream or that things around them are not real.

Feeling like you’re not real

People may feel their movements and actions do not feel like their own. They may feel as though they are watching someone else. Sometimes people will report feeling as if they are watching themselves from the outside, as if they are an onlooker.

Fear of losing one’s mind

Many people may worry that their depersonalization symptoms will become so intense that they could be insane. However, depersonalization is the brain reacting to what it perceives as danger, although it is not always accurate.

Visual symptoms

Many people who experience depersonalization report visual symptoms such as tunnel vision, distorted and blurry vision, experiencing floaters in their vision, or the distance and size of objects being altered.

A possible explanation is that when anxious, the eyes naturally become more sensitive to picking up movements by dilating the pupils to let more light in.

This can make it feel as if there is too much visual information coming in at once.

Distorted perception of time

Often, people report that time feels distorted in several ways. It might seem to go by too fast, or leave gaps that are simply forgotten. Some people feel like they jump from one moment to another, or that recent events feel old while old ones feel recent.

Anxiety is often the reason. It affects concentration, so the passing of time can feel different, and racing thoughts pull attention further away from it.

Memory loss

Occasionally, those experiencing depersonalization may have issues with their memory. They may forget what they were doing or saying, cannot remember what happened the day previously, or feel as if they are losing their short or long-term memory.

However, this is likely the anxiety affecting memory, as anxiety usually affects concentration. This can make it seem like the memories have gone blank, and one cannot focus on the task at hand.

Emotional numbness

This symptom is often described as an inability to feel happy, sad, or any emotion at all. Medford (2012) calls this ‘de-affectualisation’: the loss of the emotional colouring that normally accompanies experience, and one of the disorder’s defining features.

The emotions are still there.

Depersonalization is thought to work as a defense mechanism, keeping someone safe from an overwhelming feeling. In doing so, it can leave a person feeling distant and cut off.

Pairing this with racing thoughts and difficulty concentrating can make things feel worse. But nothing is actually wrong with a person’s emotions. These are temporary effects of anxiety, not permanent damage.

Blank mind

People who depersonalize often find that their mind is empty, their thoughts are gone, or they cannot put a thought together. Having a blank mind is often described as losing one’s inner monologue.

However, you only experience this inner monologue when not consciously thinking about it, so if individuals are constantly trying to see if this is present, they are often interrupting it.

Existential thoughts

As depersonalization is a bizarre experience, the rational brain is desperately trying to find an explanation as to what is causing this.

Often, people may attribute the bizarre feelings to having significance, such as thinking they may be in a coma, dreaming, or purgatory, for instance.

Our brains tend to want big explanations, so it often jumps to the scariest conclusions – this is known as catastrophizing.

Reality testing

Those affected by depersonalization may believe they are experiencing psychosis due to some of the symptoms mentioned earlier. However, the big distinction with depersonalization disorder is that the individuals have intact reality testing. The person is not psychotic.

This is the objective evaluation of an emotion or thought against real life. So even with the most frightening thoughts, one can always distinguish between thoughts and reality.

Some people with DPDR may experience mild, short-lived symptoms, while others have chronic symptoms that may last for years.

The symptoms may be very distressing. They can interfere with a person’s ability to function in daily life, including at work, school, or in relationships.

Are symptoms similar to other disorders?

The symptoms of depersonalization may be observed in other disorders, such as anxiety disorders such as post-traumatic stress disorder (PTSD), and panic disorder, as well as depression and schizophrenia.

Those with DPDR frequently experience cognitive symptoms of increased arousal paired with subjective deficits in attention and concentration, as seen in anxiety disorders. High levels of co-existing anxiety have been found in people with DPDR (Michal et al., 2016).

Lived experience adds another layer here. As Watson (2022) describes in a published personal account of living with DPDR, the condition can feel deeply ‘disembodied.’ It is difficult to put into words for anyone who has not experienced it themselves.

She writes about the stigma of disclosing an invisible condition to others, and about the resilience it takes to keep living well despite it.

Causes and risk factors

There is not always a clear cause for depersonalization or DPDR. Triggers can be hard to pin down.

Many people with DPDR report a history of childhood trauma, particularly emotional abuse and neglect. Dissociation is thought to begin as an adaptive defence: a way of mentally ‘switching off’ from an overwhelming experience.

It is protective, at first. Over time, though, it can become an automatic response to far more ordinary stress.

As adults, they may fall back on these dissociative tendencies under stress. Sometimes there is no obvious trigger, though it can still trace back to childhood trauma.

The link is not always obvious. Some people may find that they depersonalize after experiencing trauma or intense stress that did not occur in childhood. This may occur after the following:

• Witnessing or experiencing abuse
• An accident
• Encountering a life-threatening danger
• Natural disasters
• The death of a loved one
• Violence or war

Hunter and colleagues (2003) proposed a more detailed explanation for how the disorder takes hold and persists. Depersonalization symptoms, which almost everyone experiences briefly at some point, can become chronic when a person catastrophically misinterprets them: thinking ‘I am going mad,’ or ‘I am permanently losing myself.’

The emotions are still there. That interpretation creates anxiety. The anxiety then intensifies the dissociative symptoms, producing a self-perpetuating cycle.

Avoidance makes it worse. So do safety behaviours, like constantly checking whether things still feel real.

Both keep attention locked on the symptoms and stop the catastrophic beliefs from ever being disproven. On this account, DPDR is maintained less by the original symptoms than by how a person responds to them, which is exactly what cognitive behavioral therapy for the disorder targets.

Some other causes of depersonalization include:

• Certain drugs, such as hallucinogens
• Extreme fatigue and sleep deprivation
• Physical conditions such as seizure disorder
• Living with a parent who has a severe mental illness
• A co-existing mental health condition

Treatment options

In terms of treatment, this depends on the severity of the depersonalization symptoms being experienced and whether DPDR is diagnosed.

During periods of acute stress or some episodes of depersonalization, supportive interventions such as coping skills and strategies may be a good fit.

Whereas, during periods of mild to more severe symptoms and a diagnosis of DPDR, other approaches may be required.

Medication

Medication use in Depersonalization-Derealization Disorder (DPDR) typically targets associated symptoms like anxiety, depression, or severe distress rather than DPDR itself. Here’s a concise summary to clarify when medication might help and when it could exacerbate symptoms:

Medication Type	When It Might Help	When It May Worsen Symptoms
SSRIs (Selective Serotonin Reuptake Inhibitors)	Helpful if anxiety or depression co-exists; can reduce emotional distress.	May initially increase feelings of detachment or emotional numbness in some people, particularly at the start of treatment.
Atypical Antipsychotics	Useful in cases with severe anxiety, agitation, or mild psychotic symptoms.	Not typically beneficial for DPDR alone; side effects can include increased emotional numbness, sedation, or cognitive dulling.
Benzodiazepines (short-term use)	Effective for immediate, short-term relief of severe anxiety or panic episodes.	May exacerbate dissociative symptoms with prolonged use; risk of dependence and withdrawal symptoms.

Note: Medication responses are individual, and careful monitoring by a mental health professional is essential. Always discuss potential benefits and risks with your provider before beginning or adjusting medication treatment.

Psychotherapies

Psychotherapies such as psychodynamic therapy or cognitive behavioral therapy (CBT) may help manage DPDR symptoms. CBT has the strongest evidence so far.

In the field’s main treatment trial, Hunter and colleagues (2005) gave 21 patients with DPDR a course of individual CBT, targeting the catastrophic misinterpretations, avoidance and safety behaviours described earlier. The results were encouraging.

Patients showed significant improvements in DPDR severity, along with reductions in dissociation, depression, and anxiety, and the gains held at six-month follow-up. By the end of treatment, 29% of participants no longer met the criteria for the disorder.

Even so, the study had no control group. So the improvement cannot be firmly credited to CBT itself, rather than to attention, expectancy, or natural fluctuation.

CBT is focused on identifying and adjusting unhelpful thinking patterns, feelings, and behaviors with a therapist. Psychodynamic therapy works differently.

Psychodynamic psychotherapy uses self-reflection and self-evaluation achieved through cooperation and interrelationship with a psychiatrist. The expectation is that the individual will explore effective coping strategies and relationship patterns.

The psychiatrist will attempt to reveal the unconscious components of the individual’s maladaptive functioning to tackle the symptoms being experienced. Results vary from person to person.

Aside from psychodynamic therapy and CBT, people may opt for one of the following:

• Dialectical behavior therapy (DBT): this is a type of CBT that may help individuals with tolerating difficult emotions, including dissociative symptoms. It may also be useful for those who have experienced abuse or trauma.
• Family therapy: working together, the individual’s family can learn about depersonalization. The group can learn how to recognize signs of when this occurs and offer their support when it does.
• Creative therapies: art or music therapy can help individuals to explore and express their thoughts and feelings in a safe and creative environment.

Managing DPDR

When experiencing episodes of depersonalization, some techniques can be used to help make the symptoms more manageable.

Acknowledge your feelings

Often, acknowledging what you are feeling and the emotions being experienced can help to lessen these feelings.

It may be helpful to name the emotion you are experiencing to bring awareness and understanding to your feelings.

Breathing exercises

When moments of stress and anxiety arise, the body’s sympathetic nervous system fires up, which can lead to feelings of depersonalization.

Breathing exercises, especially deep breathing, may help reset the nervous system, calming it down. Guided meditation and mindfulness training usually include deep breathing and can also calm the body down.

Listen to music

Feelings of depersonalization can become more intense when the brain focuses on them. A grounding technique can help. Listening to music, for instance, may make the experience feel less frightening.

Music is also known to lower cortisol, the body’s main stress hormone. Keeping a playlist of favorite songs on hand can make it easy to use this in the moment.

Read a book

Reading a book may be another way to help with the anxious thoughts that often occur alongside depersonalization. This may help to focus the mind on something else, interrupting the intrusive thoughts.

Concentrating on the words and being immersed in a story could help ease negative thoughts.

Challenge intrusive thoughts

Some people who experience depersonalization have few intrusive thoughts. For others, especially those with anxiety disorders or PTSD, intrusive thoughts can be a real challenge.

One helpful tool is called psychological distancing. It can help quiet intrusive thoughts.

Psychological distancing means finding space between upsetting thoughts and painful emotions. Ask yourself what evidence there actually is that an intrusive thought is real.

Usually, there is little to no evidence that the thought is true. That alone can help. Recognizing it makes room for a more realistic, rational response instead.

Talk to a trusted friend

Often, when experiencing depersonalization, it is tempting to isolate yourself from others. But at these times, talking to a trusted friend or family member may help.

Sharing these struggles with others can help you feel better. As well as this, others may provide some useful advice or insight that can further help you.

Getting enough sleep

Although this is more of a longer-term method, going to sleep when the body feels tired can help with managing stress and decreasing anxiety.

Some people may experience depersonalization due to being fatigued, so keeping a regular sleeping schedule can be really beneficial to mental health.

Also, keeping bedtime as relaxing as possible can aid in better sleep, such as ensuring that phones or other screens are not used in bed or before trying to sleep.

Exercise

Engaging in exercise is often proven to help with managing stress and can be beneficial to mental health. Aerobic exercise, for instance, could help decrease burnout as a result of depersonalization.

Engaging your senses

If you find yourself in a situation where you feel the symptoms of depersonalization starting to creep up on you, it can be useful to try engaging all your senses.

Being able to engage the senses can help with checking that you are real and can also help in grounding yourself in your body and surroundings.

Engaging the senses can include holding ice cubes, eating sour candy, smelling spices, strong coffee, or essential oils.

Related Articles

Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress: Etiology and treatment. Zeitschrift für Psychologie / Journal of Psychology, 218(2), 109-127.

Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., & Spiegel, D. (2012). Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. Journal of Trauma & Dissociation, 13(1), 9-31.

Neuroscience of Depersonalization

Depersonalization is increasingly understood as a disorder of emotional and interoceptive processing. The brain’s thinking systems stay switched on but disconnect from the signals that make experience feel real.

Two mechanisms keep recurring in this research: prefrontal over-suppression of emotion, and a dysregulated stress-hormone system.

Prefrontal Control and Emotional Numbing

Why does depersonalization feel so emotionally flat? Phillips and colleagues (2001) scanned six patients with depersonalization disorder, ten with obsessive-compulsive disorder as a comparison group, and six healthy volunteers while they viewed aversive and neutral pictures.

Both comparison groups rated the aversive pictures as strongly emotional. They also showed strong activity in the insula and other emotion-processing regions while viewing them.

The depersonalization patients were different. Their aversive images instead activated the right ventral prefrontal cortex, a region tied to regulating and suppressing emotion, while their insula responded only to neutral pictures.

This gave rise to the influential ‘thinking without feeling’ model: heightened prefrontal control appears to actively dampen limbic emotional responses, stripping experience of its normal emotional colour.

The study is small, a common limitation in this field. Even so, its pattern has been widely cited and repeatedly revisited.

The Insula and Interoception

The insula, a region tucked deep in the brain, plays a key role too. It integrates interoceptive signals from inside the body, like heartbeat and breathing, with signals from the outside world.

This blending is thought to generate the ordinary, usually unnoticed feeling of being a real, embodied self.

That integration can fail. When it does, bodily and emotional signals no longer bind into the normal sense of ‘being’ one’s body, and the self can start to feel unreal.

Researchers link this to work on phantom limbs and body image, which shows the whole sense of inhabiting a body is something the brain actively builds.

It is something that can be disrupted, like any other perception. This remains an active, and still incomplete, area of research.

Stress Hormones and the Body

The body’s stress-response system appears to be involved too. Simeon and colleagues (2001) compared nine patients with depersonalization disorder against nine matched healthy controls, using a low-dose dexamethasone suppression test alongside cortisol measures from blood and urine.

The depersonalization group showed a blunted response to dexamethasone and higher morning cortisol, even after accounting for depression.

Dissociation scores, not depression scores, predicted this abnormal pattern. This points to a distinctive kind of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, different from the pattern typically seen in PTSD.

It was a small, preliminary study. Even so, it showed that depersonalization has a measurable biological signature, not a ‘purely psychological’ one.

Taken together, the prefrontal, insula and stress-hormone findings point to the same picture. A heightened mental ‘brake’ sits on top of emotional and bodily processing, layered onto an already-dysregulated stress system.

Critical Evaluation

Depersonalization-derealization disorder has a well-documented phenomenology and a growing evidence base, but it also faces real limits as a diagnosis and as a field of research:

1. The Subjectivity Problem: Depersonalization is a private, first-person experience, which makes it inherently hard to verify, measure, or communicate to others.
2. A Small Evidence Base: Much of the neuroscience, and the leading CBT treatment study, rest on very small and often uncontrolled samples.
3. Diagnostic Heterogeneity: DPDR can look different from person to person, and researchers still debate whether it is one disorder or several related subtypes.

The Subjectivity Problem

Depersonalization is defined by a private experience that is genuinely hard to put into words. Even well-validated tools, such as the Cambridge Depersonalisation Scale, rely entirely on self-report.

There is no external test for it. Patients often struggle to describe a state that has no everyday vocabulary, and many fear that trying to explain it will make them sound ‘mad.’

This creates real limits for research. Findings that link the experience to particular brain states are often correlational rather than explanatory.

Researchers cannot directly observe what a patient is feeling. They can only measure indirect signals, like brain activity or hormone levels, and infer the rest. The core phenomenon itself stays difficult to pin down precisely, which is part of why the disorder was so poorly understood for so long.

A Small Evidence Base

Several of the field’s key findings come from very small studies. The brain-imaging work on emotional numbing involved just six patients, and the stress-hormone study compared only nine patients with nine controls.

Even the main CBT trial, the field’s best-evidenced treatment, followed just 21 patients with no control group at all. That is a small base to build on.

A 2024 systematic review illustrates just how thin this evidence base still is. Wang and colleagues screened over 17,500 records but found only 41 studies worldwide testing any DPDR treatment.

That covers seven decades and roughly 300 participants combined. Just four were randomised controlled trials; the rest were case series and case reports.

The reviewers called the overall quality and quantity of evidence low, and issued what they termed an urgent call for more high-quality research. The gap is striking, given how common the condition is.

Diagnostic Heterogeneity

Depersonalization symptoms turn up across many other conditions, including anxiety, depression, PTSD, panic attacks, drug intoxication, and epilepsy.

This overlap makes DPDR partly a diagnosis of exclusion, confirmed only once these other explanations, such as anxiety, depression, PTSD, or drug use, have been ruled out.

Researchers also debate whether DPDR is really one disorder. A 2021 study by Millman and colleagues used statistical clustering methods on over 300 DPDR patients.

They identified five distinct subgroups, ranging in severity and split between different profiles of detachment and compartmentalisation symptoms, each with a somewhat different treatment need.

Some even question whether depersonalization belongs in the same diagnostic family as conditions like dissociative amnesia, arguing the two involve genuinely different mechanisms. The debate remains unresolved.

Contemporary Research

Recent studies have begun to close some of these gaps. Small samples and a shortage of controlled trials remain the field’s central weakness, though.

One influential recent contribution reframes dissociation as a maladaptive way of regulating emotion. Cavicchioli and colleagues (2021) pooled 57 studies covering over 11,500 participants.

The finding was consistent. They found dissociation was moderately linked to avoidance, suppression, and rumination, but not to healthier coping strategies.

The parallel is striking. This fits neatly with the prefrontal ‘thinking without feeling’ pattern described above, seen from an entirely different angle.

A 2023 systematic review by Yang and colleagues confirmed that DPDR affects around 1% of the general population.

The number is small. It rises sharply, though, in clinical settings: 17.5-41.9% of psychiatric inpatients, and as high as 25-53.8% of survivors of interpersonal abuse.

Treatment research remains the field’s weakest spot, as the 2024 review above shows. One active area is neuromodulation.

Zheng and colleagues (2022) combined brain-imaging data to identify candidate targets, including the prefrontal cortex, for future non-invasive brain stimulation trials.

This work is still at an early, target-identification stage. Finally, a 2026 review by Michal reconsiders the popular idea that drugs like cannabis and psychedelics cause a lasting disorder.

That idea may be wrong. Instead, intoxication may act as a catalyst that speeds up onset in people who are already vulnerable, by stirring up anxiety-laden emotional conflict.

References

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Cavicchioli, M., Scalabrini, A., Northoff, G., Mucci, C., Ogliari, A., & Maffei, C. (2021). Dissociation and emotion regulation strategies: A meta-analytic review. Journal of Psychiatric Research, 143, 370-387. https://doi.org/10.1016/j.jpsychires.2021.09.011

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Simeon, D., Guralnik, O., Knutelska, M., Hollander, E., & Schmeidler, J. (2001). Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder. Neuropsychopharmacology, 25(5), 793-795. https://doi.org/10.1016/S0893-133X(01)00288-3

Wang, S., Zheng, S., Zhang, X., Ma, R., Feng, S., Song, M., Zhu, H., & Jia, H. (2024). The treatment of depersonalization-derealization disorder: A systematic review. Journal of Trauma & Dissociation, 25(1), 6-29. https://doi.org/10.1080/15299732.2023.2231920

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Zheng, S., Song, N., Wang, S., Ning, Y., Zhu, H., Song, M., Jia, Y., & Jia, H. (2022). Potential targets for noninvasive brain stimulation on depersonalization-derealization disorder. Brain Sciences, 12(8), 1112. https://doi.org/10.3390/brainsci12081112