depersonalizationderealization

Depersonalization-derealization refers to dissociative experiences in which a person feels detached from themselves (depersonalization) and/or perceives the surrounding environment as unreal or distorted (derealization). When these experiences are persistent or recurrent and cause significant distress or impairment, they may be diagnosed as Depersonalization-Derealization Disorder (DDD) in formal diagnostic systems. Depersonalization involves a sense of observing oneself from outside the body or a feeling of robotic or dreamlike self-awareness, while derealization involves perceptions of the external world as foggy, unreal, or fabrication.

Symptoms commonly include a persistent or recurrent feeling of being detached from one’s thoughts, emotions, or body; a sense that one’s surroundings are unreal or altered; and episodes that may last minutes to hours or become chronic. People often retain insight, recognizing that the experiences are not actually real, though this awareness can be distressing. Anxiety, mood symptoms, or a sense of detachment can fluctuate in intensity.

Causes and risk factors are not fully understood. Triggering factors frequently include severe stress or trauma, panic, sleep disruption, and substance use or withdrawal (notably psychedelics, cannabis, or ketamine). A genetic predisposition and neurobiological factors related to brain networks involved in self-perception and reality testing are areas of research. DDD can occur independently or in conjunction with other mental health conditions such as anxiety, depression, or other dissociative disorders.

Diagnosis is clinical, based on history and examination, with the goal of differentiating from medical conditions or substance effects. DSM-5 criteria emphasize persistent or recurrent depersonalization and/or derealization with intact reality testing, causing distress or impairment.

Treatment and prognosis vary. Psychotherapy, especially cognitive-behavioral or trauma-focused approaches, and stress-management or grounding techniques are commonly used. Medications may address coexisting symptoms (e.g., anxiety or depression) but there is no specific approved drug for DDD. Some individuals experience remission, while others endure symptoms for years; prognosis is highly individual and supportive care is important.