Depersonalisation and derealisation: what helps when you feel unreal

Depersonalisation is feeling that you yourself are strange or unreal, or detached from your own thoughts, feelings, body or actions, as if you were an outside observer. Emotions or bodily sensations can feel numbed, or it can feel like being in a play. Derealisation is experiencing other people, objects or the world as strange or unreal, for example dreamlike, distant, foggy, lifeless or colourless (WHO, 2024). Time may seem to pass too slowly or too fast (Spiegel, 2025a). Both are forms of dissociation, and they can come separately or together (NHS, 2023).

The key point is that the ability to judge what is real stays intact during these experiences. You know that something feels strange, and there are no delusion-like beliefs, such as being controlled by someone else (WHO, 2024). This awareness is what separates it from psychosis (Spiegel, 2025a). A fear of “going crazy” can come too, and it is itself part of the symptoms (WHO, 2024).

Brief episodes are common under stress, in extreme emotional states, when exhausted or physically ill, or under the influence of substances, and they usually pass when that state changes. Depersonalisation-derealisation disorder means the experiences are persistent or recurrent and cause significant distress or get in the way of daily life; the diagnostic requirements set no minimum duration such as a number of weeks (WHO, 2024).

mind.io does not offer a depersonalisation test, and this guide is not a diagnosis. It sets out, from international diagnostic guidance and research, how common depersonalisation and derealisation are, when and why they happen, how they differ from psychosis, panic, trauma and brain conditions, what you can try now and what the treatment evidence shows. Dissociative identity disorder (multiple personality) and dissociative amnesia are different conditions and are not covered here.

Brief depersonalisation and derealisation are very common. According to a systematic review, 26 to 74% of the general population experience them at least once in their lives, and 31 to 66% at the time of a traumatic event (Hunter et al., 2004). The MSD Manual for the public says that about half of people have felt this way at one time or another (Spiegel, 2025a).

The disorder is much rarer. In a systematic review of 23 studies, its prevalence in the general population ranged from 0 to 1.9%, about 1%, rose to 5 to 20% among outpatients and was higher among teenagers and young adults (Yang et al., 2023). It was 0.95% in a UK birth cohort (Lee et al., 2012) and in a US national survey 0.9% had clinically significant depersonalisation or derealisation in the past month (Simeon & Stein, 2026). Men and women are affected about equally (WHO, 2024).

In Korea’s health-insurance records, 87 people in 2025 had depersonalisation-derealisation syndrome as their main diagnosis, about three in four of them in their teens or twenties (Health Insurance Review and Assessment Service, 2026). Compared with a population rate of about 1%, this is tiny, so it says less about how rare the condition is than about how rarely it is recorded as the main diagnosis. In German health-insurance data, too, only 0.007% received this diagnosis in a year, and the researchers concluded that it is severely underdiagnosed (Michal et al., 2010a).

Depersonalisation-derealisation disorder usually starts in mid-adolescence, with a mean age at onset of about 16, and onset after 25 is very rare. Once it has become a disorder it is typically long-lasting, and about one third of people have a course that comes and goes (WHO, 2024).

Among 117 people with the disorder in US research studies, the most common immediate triggers were severe stress, depression, panic, cannabis and hallucinogens (Simeon et al., 2003). Emotional stress, anxiety, sensory overload, lack of sleep and substances can make symptoms worse (WHO, 2024). In an experiment where healthy students were kept awake for 36 hours, dissociative symptoms increased (van Heugten-van der Kloet et al., 2015). Some cases start out of the blue, with no clear trigger (WHO, 2024).

Feeling that you or your surroundings are not real during a panic attack is one of the symptoms of a panic attack (WHO, 2024). Among 274 people with panic disorder, 24.1% had depersonalisation during their attacks, and their panic disorder was more severe (Seguí et al., 2000). If the feeling appears only during a panic attack or for a short time afterwards, no separate diagnosis of depersonalisation is made (WHO, 2024). Ways to handle panic attacks are in panic attacks: what to do.

Cannabis and hallucinogens are common triggers. But if the experiences occur only while intoxicated or in withdrawal, it is not counted as the disorder; it is diagnosed when they persist afterwards (WHO, 2024). In a survey of 196 people whose symptoms began with drug use, most had used only modestly beforehand and never used again. Their course and impairment were similar to those of people whose symptoms began without drugs, but they improved more over time (Simeon et al., 2009). Drug problems are covered in drug addiction.

Childhood emotional abuse is also linked. In a study of 49 people with depersonalisation disorder and a comparison group, emotional abuse was the strongest predictor (Simeon et al., 2001). The link is weaker than for other dissociative disorders, though (WHO, 2024), so having depersonalisation does not mean you were abused. In a UK birth cohort, anxiety rated by teachers in childhood strongly predicted depersonalisation in adulthood (Lee et al., 2012).

Depersonalisation and derealisation can also occur in psychoses such as schizophrenia, but then the experience may be given a delusional explanation (WHO, 2024). If you yourself know that something feels strange, it is different from psychosis. If you become convinced that someone is controlling you or that the world has really changed, get assessed promptly. Psychosis is covered in schizophrenia.

It often comes with depression and anxiety disorders. In a review of depersonalisation studies, 41 to 43% of patients had at least one anxiety disorder, and 62 to 84.8% also had depression (Dunalska et al., 2026). In a German population study, among people with depression, having depersonalisation or derealisation symptoms as well more than doubled the risk that the depression would persist or return (Michal et al., 2024). Treating co-occurring depression and anxiety alongside it is therefore important.

It is also common after trauma. In post-traumatic stress disorder, depersonalisation and derealisation are frequent, especially during re-experiencing such as flashbacks (WHO, 2024). The US diagnostic manual (DSM-5) has a separate dissociative subtype of PTSD for when these symptoms stand out, covering roughly 15 to 30% of people with PTSD (National Center for PTSD, 2025). Among 249 patients at a Korean trauma clinic, it was 32.9% (Kim et al., 2019). See also the trauma and PTSD guide.

If the symptoms are explained by temporal lobe epilepsy, a head injury, the effects of a substance or medicine, or another physical illness, it is not depersonalisation disorder (WHO, 2024). The neurological conditions most often linked with depersonalisation appear to be epilepsy and migraine (Lambert et al., 2002). An aura before a seizure can include déjà vu, the feeling that something new has been experienced before (Adamolekun, 2026). If symptoms are atypical or first begin after age 40, an MRI or EEG may be done (Spiegel, 2025b). If it first started later in life, began after a head injury, comes with seizures or blackouts, or started with a new medicine or drug, see a doctor first rather than relying on self-help.

UK researchers explain that when normally brief depersonalisation or derealisation is taken as a sign of serious mental illness or brain damage, anxiety rises, and the rising anxiety in turn feeds the symptoms in a vicious circle. Avoiding situations, using safety behaviours and constantly monitoring the symptoms keep the circle going by drawing even more attention to them (Hunter et al., 2003, 2005). In fact, many people worry about brain damage or keep checking whether what they perceive is real (Spiegel, 2025a). The checking-and-reassurance loop is also described in the health anxiety guide.

Grounding with the five senses is a coping technique that helps you feel connected to yourself and the world again. Holding a piece of ice or playing loud music are examples (Spiegel, 2025a). You can also focus in turn on three things you can see, three you can hear and three you can touch, or stand up, walk around or clap your hands. Grounding works best when it is practised regularly (Rethink Mental Illness, n.d.). It is a skill to get through the moment, not a cure.

Turning your attention to an absorbing task, rather than watching the feeling, also helps. If you can keep your mind busy and focus on other thoughts or activities, the symptoms may cause only minor problems even if they continue (Spiegel, 2025a). People with the disorder in US research studies often said that comforting contact with other people, intense emotional or physical stimulation and relaxation reduced their symptoms (Simeon et al., 2003). For physical stimulation, use ways that do not hurt you, such as exercise or holding ice.

Lack of sleep and exhaustion can make symptoms worse, so look after your sleep, and avoid drugs such as cannabis and hallucinogens (WHO, 2024). Sleep problems are covered in insomnia: what helps, and managing stress in how to relieve stress.

Talking therapies are often recommended for dissociative disorders; the aim is to cope with the underlying cause and to learn and practise techniques for managing the periods of feeling disconnected (NHS, 2023). Cognitive behavioural therapy adapted to depersonalisation has been studied; it helps people reinterpret their symptoms in a non-threatening way and reduce avoidance, safety behaviours and symptom monitoring. In an open study of 21 patients, symptoms and functioning improved, and 29% no longer met the diagnostic criteria at the end of therapy (Hunter et al., 2005).

The evidence is still limited, though. A clinical audit of the outcomes of 36 patients at a specialist UK clinic showed medium-sized improvements, but treatment was not randomly assigned (Hunter et al., 2023), and a trial that randomised 30 people was a first step showing that a larger trial is feasible (Hunter et al., 2025). A 2024 systematic review of 41 studies and 300 participants concluded that the quality and quantity of the research were generally low (Wang et al., 2024).

No medicine has yet been proven to work for depersonalisation itself (Spiegel, 2025a). In small randomised trials, one anticonvulsant (9 people) and one antidepressant (50 people) did no better than placebo (Sierra et al., 2003; Simeon et al., 2004). Medicines for co-occurring depression, anxiety or panic can still be prescribed (NHS, 2023), and in one trial depersonalisation was more likely to improve when co-occurring anxiety improved (Simeon et al., 2004). Decide on medicines with your doctor, and do not stop a medicine on your own.

When depersonalisation or derealisation comes with PTSD, there is preliminary evidence that people respond better to treatment that adds work on changing thoughts and training in emotional and interpersonal regulation skills, rather than exposure therapy alone (National Center for PTSD, 2025). Complete recovery is possible for many people, especially when the symptoms stem from stresses that can be dealt with (Spiegel, 2025a).

If dissociation is frequent or distressing, it is important to seek professional advice (Rethink Mental Illness, 2026). If it persists or keeps coming back and gets in the way of daily life, see a doctor (WHO, 2024). A doctor may examine you and do some tests to check whether another illness is the cause (NHS, 2023).

In Korea, help is available from psychiatry clinics and city, county or district community mental health welfare centres, and the mental health crisis line 1577-0199 (24 hours) connects you to the nearest centre (Ministry of Health and Welfare, 2025). What happens at a first visit is described in Seeing a psychiatrist for the first time. Elsewhere, start with your family doctor or local mental health service.

A German population survey found that people with depersonalisation more often had suicidal thoughts (Michal et al., 2010b). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services. In Korea, call 109 (24 hours, free).

Q. Does depersonalisation mean I am going mad? Will I get schizophrenia? A. If you yourself know that something feels strange, it is different from psychosis. Reality testing stays intact during depersonalisation, and the fear of going crazy is itself part of the symptoms (WHO, 2024). If you become convinced that someone is controlling you or that the world has really changed, get assessed straight away.

Q. I only feel unreal during panic attacks. Is it depersonalisation? A. If it appears only during a panic attack or briefly afterwards, it is treated as a symptom of the panic attack, with no separate diagnosis of depersonalisation (WHO, 2024). If it continues between attacks, see a doctor.

Q. It has gone on ever since I used cannabis. A. Cannabis and hallucinogens are common triggers (WHO, 2024). One survey found that people whose symptoms began with drug use improved more over time than those whose symptoms began without drugs (Simeon et al., 2009), but do not use again, and see a doctor.

Q. Is there a depersonalisation self-test? A. mind.io does not offer a depersonalisation test. Research uses questionnaires such as the Cambridge Depersonalisation Scale (Michal et al., 2011), but a questionnaire score alone is not a diagnosis. You can check anxiety, which often comes with it, with the anxiety check-in (GAD-7), but that check-in cannot measure depersonalisation.

Q. Will I have to live like this forever? A. Once it has become a disorder it often lasts a long time (WHO, 2024), but complete recovery is possible for many people (Spiegel, 2025a). The more you can focus on other thoughts or activities rather than on the symptoms, the smaller the problems they may cause (Spiegel, 2025a). Cognitive behavioural therapy adapted to depersonalisation has helped in small studies (Hunter et al., 2005, 2023).

Q. Will medicine cure it? A. No medicine has yet been proven to work for depersonalisation itself (Spiegel, 2025a). Medicines for co-occurring depression or anxiety can be prescribed (NHS, 2023), so talk to your doctor.

Q. This feeling came on while I was meditating. A. Depersonalisation or derealisation deliberately brought on in meditation or spiritual practice is not a diagnosis (WHO, 2024). Such states during meditation were often felt as more welcome and meaningful than those triggered by trauma, stress or cannabis, though distress was not uncommon (Pons et al., 2026). If it is distressing or continues after meditating, see a doctor. Other difficult experiences that meditation can bring, and who should be careful, are covered in meditation and mindfulness.

Q. Things are so hard that I want to disappear. A. Please do not carry this alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services. In Korea, call 109 (24 hours, free).

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