Mental health conditions
Depersonalization disorder: Symptoms, causes and treatment
Feeling detached from yourself or reality? Learn what depersonalization-derealization disorder is, what causes it, and how it's commonly treated.
By Ryan DeCook, LCSW • Clinically reviewed by Caitlin Pugh, LCSW
Feeling disconnected from yourself and the world around you can be a scary experience. Things may feel like they’re not real or like your viewpoint is disoriented.
When this happens consistently over time, it’s called depersonalization-derealization disorder (DPDR) — and it’s more common than you might think. Research suggests that it affects about 1 to 2% of people.
This informational guide explains DPDR, the signs, the causes, and possible paths for treatment. If you've spent years wondering why you feel this way, or if you've never had a name for it, this is a good place to start.
What is depersonalization disorder?
DPDR is known for a feeling of being detached from your own self or your surroundings. Depersonalization is the disconnection from yourself and feeling “out of body.” Derealization is the disconnection from your surroundings where things feel fuzzy or like you're in a dream. You can experience depersonalization, derealization, or both. Even so, you'll still be able to reality-test — you'll know the detachment isn't actually real.
When you have DPDR, these experiences happen consistently. The intensity and consistency of these episodes can start to cause problems: in relationships, at work, or with daily activities. It’s common for people to have short moments of depersonalization or feeling detached. These typically are not a cause for a concern or diagnosis. It’s most helpful to be assessed by a mental health professional to make a decision about whether or not you have DPDR.
What are the symptoms of depersonalization disorder?
Signs of DPDR can vary. For a diagnosis, the symptoms must cause clinically significant distress, such as getting in the way of functioning at school, work, in relationships, or at home.
The symptoms are often hard to put into words, which is part of why DPDR goes unrecognized for so long. Ahead, find some of the most common signs of DPDR.
Depersonalization symptoms
- Feeling like an outside observer of your own thoughts, feelings, or body: This can feel like being “out of body.” Some people describe it as a “split-self” where one part of you is watching and the other is actively participating. You might feel disconnected from your entire self or just parts of yourself.
- Emotional numbness or feeling disconnected from your own reactions: You might realize that you have emotions, but you’re not able to feel them. This can play out in relationships, too, where you just don’t feel much. It becomes hard to access and describe your emotions.
- Distorted sense of time or memory feeling unreal: Time may feel very fast, slow, or like it’s completely stopped. It can also be hard to access past memories or know that they feel real. They might not feel like your memories.
- Physical sensations feeling muted or unfamiliar: Hunger, thirst, your sex drive, or your sense of touch might feel distant, strange, or hard to connect with. Some research has shown that the nervous system tends to react less when in depersonalization, which can be part of this experience.
- Feeling like your actions or speech are automatic, as if on autopilot: It can feel like you’re not in control of talking or certain bodily actions, almost as if you were a robot.
Derealization symptoms
- Surroundings appearing foggy, dreamlike, or visually distorted: The world may look like it is fuzzy or behind a pane of glass. There can be distortions in what you see and hear.
- A persistent sense that the world isn't real: Your surroundings can feel like a dream or like there is a veil between you and the world. Things may seem fake or unreal.
- Familiar places or people feeling strange or unfamiliar: This fogginess and the distortions can make familiar places or people seem different. It can alter their appearance or how you feel around them, making them seem strange or foreign.
- Objects appearing the wrong size, shape, or distance: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) notes that derealization can involve visual changes, including distortions in the perceived size, shape, or distance of objects.
Causes of depersonalization disorder
The root causes of DPDR are not fully understood, but existing research points to a likely combination of biological, psychological, and environmental factors. The most commonly identified contributing factors include:
- Trauma or adverse experiences: This is one of the most commonly cited reasons for DPDR. Early experiences of trauma or abuse can lead to DPDR. Research specifically identifies emotional abuse and neglect as high-risk factors for DPDR, alongside other forms of childhood adversity.
- Severe stress or anxiety: Situations that cause stress and anxiety over time can factor into DPDR. The impact of major daily life stressors, divorce, relationship problems, financial issues, or ongoing challenges at work can accumulate over time.
- Other mental health conditions: Anxiety, depression, OCD, panic disorder, and other dissociative disorders are most commonly diagnosed along with DPDR. There can be an overlap in symptoms and some of these disorders can trigger DPDR, but DPDR will not be diagnosed if depersonalization or derealization only happens in the context of one of the other disorders (e.g. only during panic attacks with panic disorder).
- Substance use: Use of substances can cause the onset of DPDR in some cases. Marijuana, hallucinogens, ketamine, MDMA, and salvia have been specifically identified as some of the substances that can trigger depersonalization/derealization.
- Anxiety and personality traits: Research shows that people who experience high levels of anxiety, especially starting in childhood, may be more vulnerable to developing DPDR. Certain personality traits, like a tendency to avoid harm or rigid thinking patterns, have also been linked to the disorder.
How is depersonalization disorder diagnosed?
DPDR can only be formally diagnosed by a licensed mental health or medical professional after doing a full evaluation. A professional evaluation is the only reliable way to know for certain. Self-diagnosis can miss the overall clinical picture.
A licensed professional will start by asking about your experience and history, and will assess whether you meet the DSM-5-TR criteria for DPDR, including ruling out other medical, psychiatric, or substance-related causes.
Many professionals will also walk you through standardized questionnaires that are used to test for these experiences. Some of the most trusted and widely used include the Cambridge Depersonalization Scale (CDS) or the Dissociative Experiences Scale (DES-II).
Some people may go undiagnosed for years. Speaking with a professional is often what finally gives people the language and clarity they've been looking for.
How to manage and treat depersonalization disorder
If you do get diagnosed with DPDR, there are some things that have shown promise to help. Treatment options can be combined and tailored to your needs, especially if you have other conditions as well.
- Cognitive behavioral therapy (CBT): This is the most well-studied therapy for treatment of DPDR. CBT focuses on shifting thoughts that can reduce distress and some of the intense ways physical symptoms of DPDR get interpreted.
- Trauma-informed therapy: If trauma is part of your history, trauma-informed therapy may be especially helpful. Dialectical behavioral therapy (DBT) can be helpful for learning emotion management and distress tolerance skills. Eye movement desensitization and reprocessing (EMDR) has shown benefits for people who have trauma and feel detached or dissociated. It can help process specific traumatic memories that might be at the root of your dissociation.
- Mindfulness-based approaches: Mindfulness-based approaches for DPDR can have benefits, but a few things are worth knowing before you start. Mindfulness practices that focus too much just on observation or non-reactivity can actually make DPDR symptoms worse in some cases. The best types of mindfulness-based exercises are those that focus on being non-judgmental and action with awareness. Examples of helpful exercises are counting and paying attention to your breath, connecting with your environment through your five senses, or mindful walking.
- Medication: There is no medication FDA-approved specifically for DPDR. Still, SSRIs are commonly used when anxiety, depression, or PTSD are present alongside it. In some smaller studies, Lamotrigine has shown benefit for reducing DPDR symptoms when added to an SSRI. Clonazepam may also help, particularly for people who struggle with high levels of anxiety alongside DPDR, and appears most beneficial when combined with an SSRI. Benzodiazepines such as clonazepam are not an established treatment for DPDR itself and carry risks including dependence. Any medication decisions should involve a licensed medical doctor or psychiatrist.
- Somatic therapy: Because DPDR often involves feeling disconnected from your body, body-focused approaches like somatic experiencing may help rebuild awareness of physical sensations through grounding exercises, breathwork, and tracking bodily feelings. These are often used alongside trauma-informed care..
- Psychoeducation: Education about DPDR can be empowering. Understanding what's happening can help you avoid jumping to worst-case conclusions about your symptoms.
Any of these approaches work best when you're working with a provider who knows your full history and can adjust the plan as you go.
Getting the right support starts with the right provider
If this article resonated with you, it may be time to take the next step. A licensed therapist or psychiatrist can formally evaluate you and help guide your care — and finding the right fit doesn't have to feel overwhelming. The Headway directory connects you with trained mental health providers who accept your insurance, with transparent pricing and instant booking.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.
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