What are Derealization and Depersonalization?

About 50% of the general population has felt that they are outside themselves, watching what is happening once in their lifetimes. Perhaps they were going under or coming out of anesthesia and felt eerily like they were not real or that they can see themselves lying in their hospital bed.

However, about 2% of the population have derealization and/or depersonalization and have those sensations often, and they feel unreal or literally not themselves. Depersonalization and derealization both occur equally among men and women and the disorders often begin in early to middle childhood, with only 5% starting after the age of 25. Often found together, this disorder is given the name depersonalization/derealization disorder (DDD)

This piece will examine derealization and depersonalization and how they affect lives.

What is Derealization?

Derealization is a sign that there are other mental health issues present and is poorly understood by doctors. It often accompanies chronic depression, social anxiety disorder, and dissociative disorders (Lemche et al., 2013).

Derealization comes and goes and has many signs that someone may be experiencing it. They include:

  • Having a foggy feeling in their head
  • Audibly the sounds seem distorted
  • They feel the world around them is unreal or dull
  • They experience time not moving at its usual pace

Derealization makes a person feel like they aren’t there and are living in a dream state. For instance, one might feel that the world in a television program is more real than their world.  

What is Depersonalization?

Depersonalization disorder makes one feel they are not real and are outside their body watching themselves live.

Depersonalization almost always accompanies derealization and includes the following symptoms:

  • Feeling detached from oneself as if you are not yourself
  • Feeling like one is outside their body as if looking down upon oneself from above
  • Feeling numbness in their mind or body
  • Feeling as though they cannot control what they say or do
  • Having difficulty attaching emotions to memories

Both depersonalization and derealization are challenging to diagnose because it is a subject experience. However, the Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM 5) criteria can help.

Depersonalization/Derealization Disorder in the DSM 5

Released in 2013, the DSM 5 is the bible used by mental health professionals to diagnose mental illness. One can find the criteria of depersonalization/derealization disorder under Code 300.6. The criteria for this disorder are as follows:

“A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

Depersonalization: Experiences of unreality, detachment, or being an outside observer concerning one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

Derealization: “Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted.”

B. During the depersonalization or derealization experiences, reality testing remains intact.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical conditions (e.g., seizures).

E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.” (DSM 5 2013)

As one can see by criteria C, depersonalization and derealization alter a person’s ability to conduct their lives.

There is testing that can be used side-by-side with an evaluation and clinical interviews. Depersonalization and derealization can also be diagnosed using tests such as the Structured Clinical Interview for Dissociative Disorders (SCID-D) or the Dissociative Experience Scale.

The Brain and Depersonalization/Derealization Disorder (DDD)

In 2018 researchers did a study that included 23 individuals with DDD and 23 matched healthy controls. They applied graph theory to diffusion tensor imaging data, an MRI technique using anisotropic diffusion (a computer process) to measure the white matter of the brain to measure the FA, a measurement of the myelination and azonal diameter, and fiber density in the brain.

Their main finding was that there were lower FA values within the left temporal and right temporoparietal regions in the brains of their subjects who lived with depersonalization/derealization disorder.

In people with DDD, the structural connectiveness between brain regions responsible for integration and emotional regulation may be altered, and fiber communication changes are a secondary effect of local grey matter volume loss.

To put this jargon into English, something has happened in the brains of those living with DDD that did not occur in the lives of those without it. This trauma altered some brain region’s ability to communicate, causing the feelings associated  with depersonalization/derealization disorder (Lotfinia et al. 2020).

Treatments for Depersonalization/Derealization Disorder

Treatment involves psychotherapy that addresses all the stresses associated with the disorder’s onset, including early childhood abuse or neglect.

There are various psychotherapies used in the treatment of DDD, including;

Behavioral techniques that help people with DDD to engage in tasks that will distract them from the disorder

Grounding techniques using the five senses to help people with DDD feel more connected to themselves and their world.

Cognitive techniques that help block obsessive thinking about how they feel unreal.

Psychodynamic therapy helps people with DDD deal with underlying conflicts and negative feelings that make them feel their lives are intolerable and create dissociation.

Some medications have been used to treat depersonalization/derealization disorder, but none have clearly demonstrated that they work well. Some are helped with selective serotonin reuptake inhibitors (SSRIs), while others are helped with Lamotrigine and other drugs.

It is thought that these drugs do not directly treat DDD but instead treat the underlying mental health conditions.

Pulling it All Together

DDD is a very uncomfortable and sometimes frightening disorder that accompanies mental health disorders, especially those associated with dissociation. However, dwelling or ruminating on the disorder only makes matters worse.

There have been MRI studies looking for the root causes of DDD, and they have found connectivity problems within the brain and a loss of volume to the grey matter itself.

There are no quick fixes for DDD. All one can do is learn to live with it by learning grounding and other techniques that will make life easier.

“I realised a long time ago that a warrior in search of his dream must take his inspiration from what he actually does & not from what he imagines himself doing.” ~ Paulo Coelho


Lemche, E., Surguladze, S. A., Brammer, M. J., Phillips, M. L., Sierra, M., David, A. S., … & Giampietro, V. P. (2016). Dissociable brain correlates for depression, anxiety, dissociation, and somatization in depersonalization-derealization disorder. CNS spectrums21(1), 35-42.

Lotfinia, S., Soorgi, Z., Mertens, Y., & Daniels, J. (2020). Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. Journal of psychiatric research.

Sierk, A., Daniels, J. K., Manthey, A., Kok, J. G., Leemans, A., Gaebler, M., … & Walter, H. (2018). White matter network alterations in patients with depersonalization/derealization disorder. Journal of psychiatry & neuroscience: JPN43(5), 347.

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