Highlights
- Depersonalization-derealization disorder (DPDR) is a serious mental health condition that affects up to 2% of the population.
- Brief episodes of depersonalization and derealization are common, but persistent symptoms that affect daily life may point to DPDR.
- DPDR treatment often combines talk therapy, lifestyle changes, and sometimes medication. CBT (cognitive-behavioral therapy) and DBT (dialectical behavior therapy) are especially effective approaches.
It’s not uncommon to have brief moments where you feel a bit disconnected from reality. For example, you might be walking somewhere when you notice you made a wrong turn without realizing it. Or you might suddenly feel like time skipped ahead, as if you zoned out for a moment and “missed” part of your experience.
But for some people, this sense of disconnection doesn’t go away. They may frequently feel like they’re detached from themselves or the world around them, to the point where it starts to impact their day-to-day functioning.
If this describes your experience, you may live with depersonalization-derealization disorder. This is a serious mental health condition, but with treatment, you can manage DPDR symptoms and feel more grounded.
Here’s what to know about this relatively rare condition and how to cope with it.
What Is Depersonalization-Derealization Disorder (DPDR)?
Depersonalization-derealization disorder (DPDR) is a mental health condition characterized by persistent feelings of detachment from yourself or your surroundings. Typically, you feel that you’re outside your body or that the environment around you isn’t real. It’s listed as a type of dissociative disorder in the Diagnostic Statistical Manual of Mental Disorders (DSM).
Unlike individuals with psychotic disorders, people with DPDR have insight. This means that they have a better understanding that their symptoms aren’t objectively “real.” But that doesn’t mean that the experience is any less frightening or uncomfortable.
What Is Depersonalization?
Depersonalization is when you feel detached from yourself, your thoughts, or your body. For example, you might feel like you’re observing yourself from outside of your body. It might feel like certain body parts don’t belong to you. You might even be numb to sensations like pain.
What Is Derealization?
Derealization can feel similar, but it’s more about feeling disconnected from the world and the environment around you. You might feel like you’re living in a dream and that your surroundings aren’t quite “real.” You might feel like sounds and sights are distorted or that everything around you is “fake.”
Depersonalization | Derealization |
Detachment from self | Detachment from surroundings |
Feeling like you’re observing yourself | Feeling like the world is dreamlike or unreal |
Sense that your body parts don’t belong to you | Distorted sense of space, objects, or time |
Numbness to sensations or emotions | Sounds or sights feel altered or “fake” |
Feeling like you’re moving automatically, without control | Feeling cut off from familiar places or people |
How Common Is Depersonalization Disorder?
Many people experience brief moments of depersonalization or derealization at some point in their lives. In fact, research suggests that
For most people, the feeling passes. But for about
Symptoms of Depersonalization-Derealization Disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), DPDR is diagnosed when:
- You experience persistent or recurrent depersonalization, derealization, or both.
- You have intact reality testing (you know your experiences aren’t objectively real).
- Your symptoms cause significant distress or impairment.
- Your symptoms aren’t caused by substances, another medical condition, or another mental disorder.
Although they’re not listed in the DSM, some other signs and symptoms that you’re experiencing depersonalization or derealization include:
- Feeling cut off from your thoughts, body, or emotions, like you’re not fully “in” yourself.
- Moving or speaking automatically, almost like you’re on autopilot.
- Feeling as though the world around you isn’t real or that you’re separated from it.
- Struggling to put words to your emotions or describe what you’re going through.
- Feeling numb to physical sensations, like pain or touch.
- Noticing that objects look distorted — too big, too small, or blurry.
- Becoming hyper-aware of your surroundings, but in an uncomfortable way.
- Feeling terrified that you’re “going crazy.”
These depersonalization and derealization symptoms can be:
- transient, lasting hours to a few days, or
- chronic, lasting several weeks to months.
It’s relatively common to experience transient depersonalization and derealization symptoms, especially after a traumatic event. But if they don’t go away, or if they’re so severe that they get in the way of functioning, then you may be diagnosed with DPDR.
Causes and Risk Factors
Like most other mental health conditions, there is no singular cause of DPDR. But research has found that there are
One of the biggest triggers of DPDR is trauma. People with a history of trauma, especially during childhood, are more likely to develop DPDR symptoms. It’s possible that dissociative symptoms, like depersonalization and derealization, may be
Examples of traumatic events that can become causes of depersonalization-derealization disorder include:
- Abuse or neglect.
- Witnessing domestic violence.
- Experiencing a sudden loss of a loved one.
- Being a victim of physical or sexual assault.
Interestingly, emotional neglect, rather than physical abuse, may be
Many people who go through a traumatic event may experience temporary symptoms of depersonalization or derealization without developing the full disorder.
Other triggers of derealization symptoms include:
- Severe emotional stress.
- History of anxiety disorders.
- Interpersonal relationship difficulties.
- Certain substances, especially cocaine, amphetamines, ecstasy, and cannabis.
Studies have found that
How Is DPDR Diagnosed?
There’s no single test that can diagnose DPDR. Healthcare professionals may use a combination of different methods, including:
- A clinical interview to understand your symptoms and history.
- Questionnaires or assessment tools for dissociation.
- A physical exam or lab tests to rule out neurological conditions.
- A medication or substance use history to rule out drug-related causes.
Unfortunately, research shows that getting a correct diagnosis for DPDR can take between
DPDR also co-occurs with many other mental health conditions, including post-traumatic stress disorder, anxiety, depression, and more. So it’s essential to find a provider who can untangle all of your symptoms and make the correct diagnoses.
Before diagnosing depersonalization-derealization disorder, the provider must rule out all conditions (such as anxiety, depression, post-traumatic stress disorder, seizure disorders, schizophrenia, and borderline personality disorder). These conditions also often come with feelings of depersonalization and derealization, so if your symptoms are caused by any of these, it’s important to receive an accurate diagnosis.
Depersonalization-Derealization Disorder Treatment
Treating DPDR requires a multifaceted approach. This is a complex condition, and the best treatment is typically a combination of therapy, medication, and lifestyle changes.
Psychotherapy
Psychotherapy is considered the most effective way to treat DPDR.
Many people with DPDR become stuck in cycles of rumination — focusing on whether they’re “real,” worrying about their sense of self, or checking how they feel over and over. CBT can give you tools to step out of these loops and reduce the anxiety that keeps the symptoms alive. It also helps you notice and challenge the thought patterns that make symptoms worse. You can focus on behavioral changes, like re-engaging in daily activities so that your life doesn’t revolve around your condition.
DBT was originally developed for people with intense emotions and trauma backgrounds, which is why it can be helpful for DPDR. DBT skills can give you concrete ways to ground yourself, regulate overwhelming emotions, and tolerate distress without shutting down.
Medications
Antidepressants, including SSRIs and SNRIs, are usually the
Lifestyle Modifications
Making lifestyle changes can also go a long way in helping you manage the symptoms of DPDR. Physical exercise has been shown to
Grounding and Immediate Coping Strategies
Grounding techniques can also be especially helpful right during the episodes to help ease them. These involve:
- Using your five senses to re-anchor yourself in the present moment. For example, holding an ice cube can remind you of your body’s physical presence when you feel detached. Physical activity, like walking briskly or engaging in other kinds of exercise, can be helpful. You may also try keeping sensory anchors, such as things with a strong smell you like or objects with unusual textures.
- A 5-4-3-2-1 technique, which means you should name 5 things you can see at the moment, 4 things you can touch, 3 sounds, 2 smells, and 1 taste. Focus on each of these to feel more present.
- Focused breathing, which can range from an overall deeper awareness of your breath to
box breathing[8] and 4-4-6 breathing.
Prognosis and Living With DPDR
DPDR is a chronic condition, which means there’s no cure for it. But that doesn’t mean that you need to live with severe symptoms forever. Many people are able to manage their symptoms to the point where they can function well in daily life.
The prognosis of DPDR varies for each person. When left untreated, it can last for years and get worse over time. But
When to Seek Help
Getting treatment early on is linked to a better prognosis for DPDR. Even though some fleeting moments of depersonalization and derealization symptoms are normal, it can still be helpful to see a mental health provider. It’s especially important to get help if these symptoms have come on after a traumatic experience, or if they’re severe enough to be getting in the way of your daily life.
It’s never too early to seek support. You don’t need to wait until symptoms feel unbearable. The earlier you get help, the better the outcome.
Conclusion
Depersonalization-derealization disorder is a dissociative condition marked by ongoing feelings of detachment from yourself or your environment. Trauma, stress, and certain substances are common triggers, and symptoms can feel overwhelming — but they aren’t a sign that you’re “crazy.”
If these symptoms are part of your daily life, reaching out to a mental health professional can make a difference. Treatment can help you feel more present, more grounded, and more connected again.
Frequently Asked Questions
What are the 4 stages of DPDR?
How to tell if someone has depersonalization?
What can mimic DPDR?
Can derealization lead to psychosis?
Can DPDR turn into schizophrenia?
Is derealization normal?
How long does derealization last?
Does derealization go away?
What age does DPDR start?
DPDR most often begins in adolescence or early adulthood (
