Depersonalization

Depersonalization is a subjective experience in which a person feels detached from their own thoughts, feelings, or body, as if observing themselves from outside. It can occur as a brief, transient response to stress or sleep deprivation, or as part of a dissociative disorder known as depersonalization-derealization disorder when symptoms are persistent or recurrent and cause distress or impairment. Depersonalization refers to the sense of unreality or estrangement from one's self, while derealization refers to a sense of unreality about the surrounding environment.

Symptoms commonly include persistent or recurrent feelings of detachment from one’s mental processes or body, emotional numbness, time distortion, and a sense of being an observer of one’s own life. Derealization—felt unreality of the external world or surroundings—is often present. Some individuals experience perceptual alterations such as changes in sound, touch, or body image. Despite these experiences, reality testing remains intact.

Causes are not fully understood, but dissociation is thought to be a coping response to stress or trauma. Associated factors include anxiety, depression, PTSD, migraines, epilepsy, and sleep disturbance. Substance use can trigger depersonalization, including cannabis, hallucinogens, ketamine, and alcohol withdrawal. Onset typically occurs in adolescence or early adulthood, with risk factors including a history of trauma or chronic stress.

Diagnosis is clinical, lacking specific biomarkers. Differential diagnosis includes anxiety disorders, mood disorders, psychotic disorders, neurological conditions, and substance-induced states. The DSM-5-TR and ICD-11 differentiate depersonalization-derealization disorder from depersonalization as a symptom when it is persistent and impairing.

Treatment focuses on psychotherapy, especially cognitive-behavioral therapy with grounding and mindfulness techniques. Psychoeducation and support are important. Medications are used to treat comorbid conditions (e.g., anxiety or depression) but there is no medication approved specifically for depersonalization. Prognosis varies; many improve over months to years, while others experience chronic symptoms.