What Is Depersonalization?

<p>Oliver Rossi / Getty images</p>

Oliver Rossi / Getty images

Medically reviewed by Michael MacIntyre, MD

Depersonalization refers to a feeling of being detached from yourself, including your thoughts, feelings, or body. Some people refer to depersonalization as an out-of-body experience.

Many people experience episodes of depersonalization that last minutes, hours, or days. For others, the feeling of not being real is ongoing. Depersonalization can stem from a variety of mental and physical conditions, as well as trauma, drug use, and sleep deprivation.

Talk to your healthcare provider if you think you are experiencing depersonalization. There are several treatment options that can help, as well as a few practices to possibly prevent new episodes.

Depersonalization is one type of dissociation, or a feeling of unreality. Dissociation isn’t the same as psychosis – a complete break from reality, which can include hallucinations or delusions. People who experience depersonalization are typically aware of their surroundings, but they feel disconnected from them.

Depersonalization Symptoms

Depersonalization is a feeling of being separate from or outside of yourself. During an episode of depersonalization, people may feel:

  • Detached and distant

  • Unreal

  • Like they are watching themselves from above or observing their own body, thoughts, and emotions

  • Apathetic (feeling indifferent)

  • Emotionally numb

  • Robot-like or automated

  • Like they are dreaming

  • As if they are viewing the world through a veil, glass, or fog

  • Disconnected from their own memories

What Causes Depersonalization?

There are many different possible causes of depersonalization, including:

  • Depersonalization/derealization disorder: This type of dissociative disorder involves persistent episodes of either depersonalization, derealization (a sense of disconnection from one’s surroundings or a feeling that the outer world is not real), or both. People with this disorder typically first develop symptoms during childhood or adolescence.

  • Other mental health conditions: Many other mental illnesses can cause dissociative symptoms like depersonalization. Research suggests about 50% of people with depression, 17% of people with borderline personality disorder (BPD), and 16.3% of people with schizophrenia frequently experience depersonalization, compared to just 1% of people in the general population.

  • Trauma: Trauma—including grief, loss, accidents, injuries, danger, or experiencing or witnessing any kind of abuse—may trigger episodes of depersonalization for some people.

  • Drug use: Using psychotropic (mind-altering) drugs, such as marijuana or hallucinogens, can lead to a sense of detachment from oneself.

  • Panic attacks: Some people with panic disorder have temporary out-of-body experiences during panic attacks.

  • Sleep deprivation: Chronic or severe sleep deprivation can blur the line between reality and unreality, leading to symptoms of dissociation. Research has shown just one night of sleep loss can cause feelings of depersonalization. Typically, these resolve after getting sleep.

  • Neurological conditions: Disorders involving physical or electrical changes in the brain sometimes cause depersonalization. Examples include seizure disorders, such as temporal lobe epilepsy and frontal lobe epilepsy, as well as traumatic brain injuries (TBIs).

Risk Factors

Anyone can experience episodes of depersonalization. However, certain factors may increase your chance of experiencing depersonalization and other kinds of dissociation. These include:

  • Age: Depersonalization is especially common among teens and young adults.

  • Abuse: A history of abuse, whether as a child or in your relationships as an adult, increases your risk of having ongoing episodes of depersonalization.

  • Stress: Both acute and chronic stress can contribute to depersonalization. A dangerous incident or stressful environment (such as a high-pressure job or a family situation that involves domestic violence) can trigger your fight-or-flight response, which can lead your mind to try to escape through dissociation.

  • Mental health conditions: Having a mental health condition such as depression, anxiety, or a personality disorder increases your likelihood of feeling separate from your own body and mind.

  • Insomnia: Sleep disorders, including insomnia, have been linked to a higher risk of depersonalization.

How Is Depersonalization Diagnosed?

If you think you may be experiencing depersonalization, your healthcare provider can refer you to a mental health professional, such as a psychiatrist, to make a diagnosis.

During your appointment, the mental health professional will gather information about your medical and family history, symptoms, and previously diagnosed conditions. They will also refer to the most recent criteria in the Diagnostic and Statistical Manual of Mental Disorders, which provides medical information to help healthcare professionals give accurate diagnoses and treatments.

To rule out other potential diagnoses, such as epilepsy or a brain injury, your healthcare provider may run other tests. These could include magnetic resonance imaging (MRI) scans, an electroencephalogram (EEG), or both.

Treatments for Depersonalization

The first line of treatment for depersonalization is typically psychotherapy, or talk therapy. A mental health provider will use one or several methods of psychotherapy to help you address certain emotions, thoughts, or behaviors.

Types of therapy that can help treat depersonalization include:

  • Cognitive behavioral therapy (CBT): CBT can help you improve your coping skills, identify negative patterns of thinking and behavior, and find healthy ways to distract yourself.

  • Mindfulness-based therapy: Mindfulness therapy can help you learn to feel more aware in the present moment, which can relieve symptoms of dissociation.

  • Psychodynamic therapy: Psychodynamic therapy addresses conscious and unconscious thoughts to bring underlying negative feelings and unresolved trauma to the surface. The goal is to improve self-awareness and understand the reason for your depersonalization.

  • Family therapy: Family therapy may effectively treat depersonalization if your dissociative symptoms are related to a history of relationship conflicts or family trauma. This may include abuse, grief, or loss.

  • Eye movement desensitization and reprocessing (EMDR) therapy: EMDR therapy is useful in treating symptoms of post-traumatic stress, including depersonalization.

In some cases, your healthcare provider may also prescribe medication, such as selective serotonin reuptake inhibitors (SSRIs), opioid agonists, or antipsychotics. However, research about the effectiveness of psychiatric medications in treating dissociative symptoms is currently limited.

If your symptoms are related to an underlying neurological or physical condition, such as epilepsy, treating that condition may prevent further episodes of depersonalization.

How to Prevent Depersonalization Episodes

There’s no known way to prevent depersonalization entirely. However, because depersonalization is often related to stress and anxiety, you may be able to prevent certain dissociative episodes by managing your stress effectively.

For example, you can try:

  • Doing deep breathing exercises

  • Practicing mindfulness meditation

  • Using grounding techniques to help you stay in the present, such as counting the items in a room

  • Getting gentle physical exercise, such as walking

  • Identifying your triggers and making a plan to manage or avoid them

  • Connecting with friends and family

  • Joining a peer support group

Related Conditions

People who experience depersonalization on an ongoing basis often have comorbid mental health conditions. In fact, studies suggest around 72% of people with depersonalization/derealization disorder have at least one other mental disorder.

Common comorbid conditions include:

If you or someone you know is experiencing thoughts of self-harm or suicide as a result of depersonalization or any other mental health condition, seek emergency help right away. Go to the hospital, call 911, or contact the National Suicide Prevention Lifeline at 988.

Living With Depersonalization

In many cases, symptoms of depersonalization resolve on their own. Sometimes, they become worse or more persistent over time. Rarely, these symptoms can interfere with major aspects of daily functioning, such as work, school, and relationships. People who experience depersonalization frequently may feel increasingly out of control or disoriented.

Many people don’t seek treatment for depersonalization, possibly because it can be distressing and difficult to describe. If you're experiencing depersonalization, you're not alone. An estimated 50% of people have had at least one episode of depersonalization at some point during their lifetime.

Remember, there are effective treatments for depersonalization and mental health professionals that can help. If your dissociative symptoms are affecting your daily life, reach out to a healthcare provider to talk about your options.

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