Feeling Unreal (Depersonalisation and Derealisation)

What it is

This condition involves persistent or recurrent experiences of detachment. In depersonalisation, the detachment is from oneself: feeling unreal, robotic, numb, or as though observing one's own thoughts, feelings or body from outside. In derealisation, the detachment is from the surroundings: the world feels unreal, dreamlike, foggy, flat, or as if seen through glass. Many people experience both. A defining and reassuring feature is that throughout these experiences the person knows that this sense of unreality is not literally true; their grip on reality is intact, which distinguishes the condition from psychosis.

Brief moments of depersonalisation or derealisation are extremely common and normal, especially with stress, exhaustion, anxiety or after a frightening event; most people have felt something like it. It becomes a disorder only when the experiences are persistent or recurrent, cause real distress, and interfere with daily life.

What it can feel like

People reach for metaphors, because the experience is so hard to describe: living behind a pane of glass, watching a film of one's own life, feeling like a robot going through the motions, the world looking two-dimensional or unreal, one's own hands or voice seeming foreign. Emotions may feel muted or absent, which is itself distressing. A particularly frightening aspect is the fear that these strange experiences mean one is going mad or losing control, which then fuels anxiety and, in turn, more detachment, a self-reinforcing loop. Understanding that the condition is recognised, not dangerous, and does not lead to madness is itself an important part of breaking that loop.

How common is it

Transient depersonalisation and derealisation are among the most common psychological experiences, reported by a large proportion of people at some point, especially in association with anxiety, panic, tiredness, or cannabis use. The persistent disorder is less common but far from rare, and it often begins in adolescence or early adulthood. It frequently accompanies anxiety and depression and is commonly under-recognised, partly because people struggle to describe it and fear being thought mad if they try.

What causes it

The condition is often linked to severe stress, trauma (including emotional abuse and neglect), anxiety and panic, and sometimes to cannabis or other drug use, which can trigger it. It is understood as a protective response in which the mind, in effect, turns down the intensity of experience to cope with something overwhelming, a kind of emotional anaesthesia. Once triggered, it can be maintained by the anxiety and fearful self-monitoring it provokes. As with the other dissociative conditions, it sits on a continuum from a normal, fleeting human experience to a persistent and distressing disorder.

How it is diagnosed

A clinician makes the diagnosis from the characteristic, persistent experiences of detachment from self or surroundings, with intact reality testing, and after ruling out other causes. It is important to exclude physical contributors such as seizures and the effects of substances, and to distinguish the condition from anxiety and panic disorders (with which it overlaps), from depression, and from psychosis, where insight into the unreality is lost. Because people often cannot find words for the experience or fear being judged mad, a clinician who recognises and names it can bring considerable relief.

How it is treated

The condition is treatable, and an essential first step is simple but powerful: understanding what it is. Learning that these experiences are a recognised, harmless if distressing phenomenon, not a sign of madness or impending breakdown, reduces the fear that drives the cycle. Psychological therapy, particularly cognitive behavioural approaches adapted for depersonalisation and derealisation, helps by reducing the anxious self-monitoring and catastrophic interpretations, addressing underlying stress or trauma, and gradually re-engaging the person with their feelings and the world. Treating co-occurring anxiety and depression often improves the dissociation substantially, since these so frequently drive it. No medication is specifically approved for the condition, but medicines for co-occurring anxiety or depression can help as part of treatment. Reducing cannabis and other triggers matters where relevant.

Depersonalisation in the African context

This condition is widely unknown here, and people who try to describe feeling unreal or detached are often misunderstood, or fear being thought mad or bewitched, so most never speak of it. Because it can be triggered by cannabis, which is common, and by stress and anxiety, it is not rare. The single most helpful thing is recognition: a clinician who names the condition, and the reassurance that a person's grip on reality is intact and that it responds to treatment, can lift a great deal of fear.

Managing it day to day

Alongside therapy, these steps help ease the cycle.

• Learn what the condition is, since understanding that it is harmless, if distressing, reduces the fear that feeds it.
• Try not to constantly check whether things feel real, since this self-monitoring deepens the detachment.
• Reduce cannabis and other drugs, which can trigger and maintain it.
• Manage stress, sleep, and anxiety, with grounding and slow breathing when symptoms rise.
• Stay engaged with ordinary activities and people rather than withdrawing, since re-engagement helps.

Helping someone

If someone you care about describes feeling unreal or detached, your response helps.

• Take it seriously and try not to dismiss it as imagination, while reassuring them that it is a known condition and not madness.
• Avoid alarm, since fear feeds the cycle. Calm understanding helps more.
• Encourage professional help, and offer to help find it. Our find a therapist page can help.
• Support them in reducing cannabis and managing stress, and stay connected.