Depersonalization and derealization: is it dangerous and how is it treated?

What are depersonalization and derealization, and what do they feel like?

Depersonalization is an unsettling sense of being detached from yourself: as if you were watching your own thoughts, body and actions from a distance, or as if you were "not you". It can come with derealization (also described as feeling unreal or detached from your surroundings), where the world around you seems like a dream, a fog or a scene behind glass. The reassuring news is that this is not madness: Cleveland Clinic notes that people with depersonalization-derealization symptoms have not lost touch with reality; they know that what they are feeling is not real.

Many people have this feeling for a few seconds or minutes, and then it passes. When it lasts or keeps coming back, and causes distress or gets in the way of your life, doctors call it depersonalization-derealization disorder, one of the dissociative disorders.

How do people describe depersonalization?

• "I don't feel like myself", or as if you were watching your life like a film from the outside
• Feeling like a robot that isn't in control of what you do or say, or feeling cut off from your body
• Numbed emotions: you know you love your family, but you don't feel it the way you used to
• Feeling detached from your own thoughts and feelings, as if they belonged to someone else

And what does derealization feel like?

• The world seems like a dream or a fog, or as if there were a pane of glass between you and it
• Things look dull, flat, blurry or distorted
• Your sense of time or of sounds changes
• The people around you seem lifeless or robotic

Why does derealization happen? Anxiety, panic and exhaustion

The UK's National Health Service (NHS) describes dissociation as a way the mind copes with more stress than it can handle. A scientific review published in 2005 notes that people exposed to life-threatening danger usually report some of its features, and it presents an older view of it as a natural response to threat that, in some people, can get "stuck" and carry on after the danger has passed. Common triggers include:

• Severe anxiety and panic attacks: the NHS lists feeling disconnected from your body among the symptoms of a panic attack.
• Exhaustion and lack of sleep: the MSD Manual notes that brief episodes can follow extreme tiredness or sleep deprivation.
• Current stress: in relationships, work or money, along with depression and anxiety.
• Using cannabis (hashish) and some other substances, which we explain below.

It is more common than you might think: in its 2025 review, the MSD Manual states that about half of people have felt detached from themselves or from their surroundings at some point. A systematic review published in 2004 found that, depending on the study, between 26% and 74% of people in the general population had had brief episodes at some time in their lives, and that it is also very common among people with panic disorder or depression.

The trouble is that the feeling itself is frightening, which raises anxiety, and anxiety in turn makes the feeling stronger. The 2005 review describes this vicious circle and reports that, in one case series, 43% of patients had a past history of anxiety or panic attacks. Read more about panic attacks and their symptoms.

Is depersonalization dangerous? Does it mean I am losing my mind?

The biggest fear for many people with depersonalization is that it is the start of "going crazy". The MSD Manual notes that many people fear they are losing their minds or that their brain has been permanently damaged. But there is a key difference:

• In depersonalization: you know that what you feel is not real, so you say "it is as if the world were a dream". Your grasp of reality is intact.
• In psychosis, such as schizophrenia: a person may firmly believe ideas that do not match reality, and often does not realize that they are not real.

The 2005 review stresses that these "as if" statements are not psychotic delusions, because insight is preserved. But it also notes that depersonalization can appear as part of other conditions, including schizophrenia, so knowing that the feeling is strange is not enough on its own to rule them out. A psychiatrist tells the two apart by talking with you and assessing the whole picture. If your fear is linked to using cannabis, read about cannabis-induced psychosis.

So where is the danger? In the distress it causes and in what may come with it, not in leading you toward madness. Cleveland Clinic notes that, left untreated, the condition can last for years and affect relationships and work, and in its 2023 review it estimates that the persistent disorder affects about 1% to 2% of people and is more common among teenagers and young adults.

Cannabis, other substances and trauma: causes worth noticing

Cannabis and some other drugs

The MSD Manual notes that using cannabis (bango or hashish), hallucinogens, ketamine or ecstasy can trigger symptoms of depersonalization, and the 2005 review reports that some patients link the start of their condition to drug use, especially cannabis. In a case series published in 2012, doctors described six teenagers who developed persistent depersonalization disorder after using cannabis, and warned that this link gets too little attention in research on cannabis and mental health. Read also: Is hashish addictive?

Trauma and severe stress

Cleveland Clinic says this disorder is often linked to intense stress or trauma, such as physical abuse, domestic violence, accidents, life-threatening danger or the sudden death of a loved one. The MSD Manual adds emotional abuse or neglect in childhood, and notes that sometimes the cause cannot be identified.

Grounding exercises: how can you ease a depersonalization episode right now?

"Grounding" means bringing your attention back to the present moment through your senses. The MSD Manual lists it among the techniques therapists use, and a 2020 guide from the Tavistock and Portman NHS Foundation Trust in the UK suggests practical ideas, including these:

1. Name what is happening: tell yourself, "This is depersonalization. It's unpleasant, but it will settle." Noticing and labeling the feeling is one of the techniques the MSD Manual mentions, and understanding what you are going through takes some of the fear out of it.
2. Breathe slowly, making your out-breath longer than your in-breath, as Cleveland Clinic suggests.
3. Use your senses: say out loud one thing you can see, one thing you can hear and one thing you can touch, then repeat with other things.
4. Wake up your body: hold something cold such as an ice cube, smell something strong, or eat something with a strong taste or a crunchy texture.
5. Press your feet into the ground and walk a little, noticing how each step feels.
6. Talk to someone you trust, or hold an object that has a positive meaning for you.
7. Get absorbed in a task that takes your attention: the MSD Manual notes that keeping busy with other activities lessens the impact of the symptoms.

Depersonalization and derealization treatment: how does therapy tackle the anxiety behind it?

The MSD Manual states that psychotherapy is the mainstay of treatment and that cognitive behavioral therapy (CBT) is often helpful. Cleveland Clinic names talk therapy as a first option, including CBT and eye movement desensitization and reprocessing (EMDR).

CBT here rests on a simple idea: it is not the feeling alone that keeps the problem going, but interpreting it catastrophically ("I'm going mad", "I'll never be myself again"), constant self-monitoring and avoidance, as the 2005 review explains. According to a CBT program designed for this disorder and tested in a UK study published in 2025, the things a therapist works on with you include:

• Understanding the condition: explaining what happens in the mind during dissociation, because putting a name to what you are going through relieves a great deal of fear.
• Mapping the vicious circle: how a situation or a thought leads to anxiety, then to detachment, then to even greater fear.
• Reviewing frightening thoughts about the condition and correcting thinking errors.
• Reducing rumination, worry and hypervigilance.
• Behavioral experiments and gradual exposure to the places and situations you have started avoiding.
• Grounding and managing emotions.

In that early study of 30 participants, some of the people the researchers interviewed after receiving this treatment said their condition had become less frightening and easier to control. But the researchers cautioned that it was a small trial not designed to prove effectiveness and that a larger study is still needed, and Cleveland Clinic notes that research has not yet settled which approach works best.

What about medication?

The MSD Manual notes that no medicine has been proven effective for depersonalization itself, but a doctor may prescribe medication for the anxiety or depression that comes with it, and Cleveland Clinic lists SSRI antidepressants among these options. The MSD Manual also warns that some anti-anxiety medicines can sometimes increase the sense of detachment. That is why choosing a medicine is the doctor's decision alone: never start, stop or change any medicine by yourself, and don't turn to sedatives without a prescription.

How long does depersonalization treatment take?

There is no fixed timeline that suits everyone. Cleveland Clinic notes that improvement often starts within a few months of treatment, and the MSD Manual says that full recovery is possible, especially when the stresses behind the condition are dealt with. Learn about psychotherapy sessions at Oxygen.

When should you be assessed by a psychiatrist?

If the feeling came for a few seconds with tiredness or fear and then passed, that is common. But ask a psychiatrist for an assessment if:

• The feeling lasts, comes back often, or occupies most of your day
• It starts to disrupt your studies, work or relationships
• It appeared after using cannabis or any other substance
• It comes with panic attacks, or with ongoing sadness and loss of pleasure
• It comes with new physical symptoms; the doctor may order tests to rule out a physical cause such as epilepsy
• You are no longer sure whether what you see, hear or believe is real, which needs a prompt assessment

The 2005 review reports that, in one case series, symptoms had lasted on average more than 12 years by the time of the first visit to a specialist clinic, so don't wait until you get used to suffering. As Cleveland Clinic notes, the doctor usually asks about your symptoms, how often they happen and how they affect your life, and looks for anything that may come with them, such as depression, anxiety, obsessive-compulsive disorder or post-traumatic stress disorder.

At Oxygen, you can start with an appointment with a psychiatrist to assess your condition. Doctor appointments and therapy sessions are available for men and women aged 15 and over, with a guardian's consent for those under 18. We then work out a plan with you that fits your situation, and you can contact us at any time to book an appointment.