Many people have felt disconnected from themselves and their surroundings. But if these feelings arise regularly, you might have depersonalization-derealization disorder.

At one time or another, all of us have found ourselves lost in our daydreams, thinking pleasant thoughts about our lives and our futures.

Maybe you’ve gotten lost in a book or become hyper-focused on a fascinating project.

Occasionally, maybe you’ve even felt disconnected from yourself, having an out-of-body experience during a stressful time in your life.

If these feelings are happening more frequently, you may have depersonalization-derealization disorder. Feeling disconnected from reality or yourself are two of the main symptoms of this condition.

Depersonalization-derealization disorder is classified as a dissociative disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In depersonalization-derealization disorder, people experience one or both of these states:

  • Depersonalization: feeling detached from your own body, thoughts, or feelings
  • Derealization: feeling detached from your surroundings

Unlike psychotic disorders, people with depersonalization-derealization disorder know that their experience isn’t reality. People with the condition realize that something is off, which usually causes them to feel distressed.

It’s estimated that depersonalization-derealization disorder affects 1-2% of the population.

According to the DSM-5, some people with depersonalization-derealization disorder have discrete episodes, while others have continuous symptoms. Or, some individuals may start out experiencing episodes that eventually become continuous symptoms.

People with depersonalization-derealization disorder may have a tough time describing their symptoms. They might also think they’re odd or unusual or fear they have irreversible brain damage, according to the DSM-5.

Understandably, experiencing depersonalization-derealization symptoms can feel unnerving. Some common symptoms include:

Depersonalization symptoms
  • feeling like you’re completely detached from yourself, even believing that you have no self
  • feeling detached from parts of yourself such as your thoughts, as in, “My thoughts don’t feel like my own,” or “My head is filled with cotton”
  • feeling like you’re outside of your body, watching yourself in a movie or from above
  • having a distorted sense of time – time is either too fast or too slow
  • feeling mentally, emotionally, or physically numb
  • feeling like you have no control over your body, including your movements or speech
  • feeling like you’re a robot
Derealization symptoms
  • feeling detached from reality
  • experiencing others or objects as foggy, artificial, cartoonish, or dreamlike
  • experiencing sounds or voices as muted or heightened
  • experiencing objects as flat or two-dimensional
  • seeing objects as distorted in size or distance
  • feeling like you’re trapped in a glass bell or like there’s a veil between you and the world

In some cases, depersonalization-derealization symptoms go away on their own. But for others, symptoms are persistent and can develop into depersonalization-derealization disorder.

Treatment may include psychotherapy, medication, or a combination of both.


Research on treatment for depersonalization-derealization disorder is limited. Still, existing research stresses the importance of psychotherapy.

According to this older study, strengthening coping skills is helpful when individuals are experiencing intense or acute symptoms, such as frequent dissociation or severe anxiety or depression.

When symptoms are milder or relatively stable, therapy may help delve into – and over time resolving – why individuals become disconnected from reality or themselves.

Other helpful therapies include:

Grounding techniques that can help you reconnect to reality and yourself may also be addressed in therapy. These in-the-moment strategies may include practicing deep breathing exercises or holding an ice cube.

Overall, a range of approaches may be used, depending on your needs, specific symptoms, and if you have another mental health condition.


The Food and Drug Administration (FDA) hasn’t approved any medication to treat depersonalization-derealization disorder.

A 2019 review that looked at medication for dissociative disorders found that paroxetine (Paxil) and naloxone (Narcan) may be effective for depersonalization and dissociative symptoms that co-occur with post-traumatic stress disorder (PTSD) and borderline personality disorder.

However, researchers noted that these findings were modest and “should be interpreted with caution” because of limited data.

In some cases, doctors might prescribe medication to reduce accompanying symptoms of anxiety or depression.

If your doctor suggests taking medication, consider asking these questions at your next appointment:

  • What specific symptoms should this medication reduce or relieve?
  • When can I expect to experience these improvements? Weeks or months from now?
  • What are common and less common side effects?
  • How can I reduce or prevent possible side effects?
  • When is my follow-up appointment?
  • How long should I take this medication?
  • Is it OK to stop abruptly, or will I need to slowly and gradually take a reduced dose to avoid withdrawal syndrome?

If your symptoms are stressing you out or interfering with an area of your life – like your work or relationships – consider talking with a mental health professional.

It’s common for depersonalization-derealization disorder to co-occur with depression and anxiety disorders. So, it’s important to let your doctor know if you’re also experiencing these symptoms.

Remember that you don’t have to wait until your symptoms worsen or experience a crisis before you consider reaching out to someone for help.

Therapy, if it’s available to you, can be helpful. A therapist can help you:

  • address specific symptoms or situations that are bothering you
  • learn to cope with stress
  • build a healthier lifestyle

Experiencing symptoms of depersonalization or derealization can lead you to feel alone – even if intellectually you know that others also have similar experiences.

Connecting with others to share your story, asking questions about possible treatments, or reminding yourself that you’re not alone can be helpful.

These online communities may be helpful:

Understandably, dealing with symptoms of depersonalization or derealization can bring up a range of emotions – from fear and frustration to confusion.

If possible, consider working with a mental health professional and connecting with others. With treatment and support, you can reduce your symptoms of depersonalization or derealization and feel better.