Depersonalization vs. Derealization: What's the Difference?

In this article, we will cover the overlap and difference between depersonalization and derealization, including important considerations for people who experience these symptoms. 

Depersonalization vs. Derealization at a Glance

Symptoms of feeling detached from yourself or your environment are a type of dissociation. People experiencing dissociation feel disconnected from reality against their will. This can include disconnection from oneself (physically, emotionally, mentally), one’s memories, and the external world. 

While experiences of depersonalization and derealization are different aspects of one mental health disorder, depersonalization/derealization disorder (DPDR), some people may experience both types of symptoms, while others may primarily experience one type.

DPDR is one of four dissociative disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), which also includes 

• Dissociative amnesia: This condition impacts people’s memories, making them unable to remember parts of their life. 
• Dissociative identity disorder (DID): Individuals with DID have two or more distinct personalities. 
• Dissociative fugue: A type of amnesia or memory loss that can be reversed and involves a disruption of memory, identity, or personality.  

What Is Depersonalization?

Depersonalization is feeling detached or disconnected from yourself. Some wonder, “Is depersonalization dangerous?” and the answer is typically no, because people know what they are experiencing isn’t real. People who experience this report experiencing: 

• Having an “out-of-body” experience where one feels as if they have left their body and are watching themselves in a movie 
• Trouble recognizing emotions 
• Being unable to feel emotions or physical sensations
• Feeling like a robot
• Having trouble or being unable to control one’s movement or speech
• Feeling as if your memories or experiences happened to someone else 
• Sensing that your body is distorted, such as parts becoming shrunk or enlarged
• Fuzzy feeling in one’s head, such as feeling as though one’s head is full of cotton

What Is Derealization?

Derealization is feeling detached or disconnected from your environment, including the objects or people in it. People experiencing derealization often report:

• Feeling as if one is in a fog or that there is a pane of glass separating them from the world, or feeling as if one is in a dream or bubble
• Disruptions or distortions in sounds 
• Seeing the world as surreal; this can include things looking cartoonish, vibrant, colorless, or blurry, or the shape of objects or their distance becomes distorted
• Being overly aware of your surroundings 
• Confusion as to when events occurred, such as feeling as if something that happened recently happened a long time ago

Key Similarities and Differences Between Depersonalization and Derealization

One important characteristic of depersonalization/derealization disorder is that people know what they are experiencing isn't real. This can be very distressing, make people fear for their mental health, and contribute to or worsen symptoms of depression and anxiety. 

People may develop fears about their experiences that lead them to perform “checking” behaviors to test whether what they are experiencing is real. 

The key difference between depersonalization and derealization is that depersonalization involves symptoms related to oneself, while derealization includes distortions in how one perceives their external environment. 

What Causes Depersonalization and Derealization?

There are many known causes of experiencing symptoms of depersonalization and derealization, as well as many contributing factors that increase someone’s risk of developing these specific dissociative symptoms.

Trauma and chronic stress

Experiencing trauma and chronic stress can make people more vulnerable to experiencing symptoms of depersonalization and derealization. The risk is even greater if the abuse or trauma occurs in childhood. 

Experiences of trauma and abuse can include emotional, sexual, or physical abuse, neglect, witnessing intimate partner or domestic violence, or a loved one dying unexpectedly and in a traumatic way. Chronic stress such as financial problems, unsafe living conditions, relationship problems, work-related stress, or other severe life stressors can make people vulnerable to experiencing depersonalization and derealization.

Depression, anxiety, and panic

People with preexisting mental health conditions, such as anxiety or depressive disorders, are at a heightened risk of dissociative symptoms, and if these conditions are not managed, they can cause negative impacts on people’s lives. This can create a vicious cycle where people’s life stressors increase as well, putting them at risk of increased mental health symptoms.

Avoidance, or trying to deny or forget difficult things, can also contribute to people’s risk.

Substances, sleep loss, and medical causes

Our minds are greatly impacted by our physical health. Substance use, even recreational use, can cause episodes of dissociation. Sleep deprivation can make people more susceptible to experiencing depersonalization and derealization, as can traumatic brain injuries. 

Depersonalization/Derealization Disorder

It’s estimated that up to 75% of adults will experience at least one episode of depersonalization or derealization during their lifetime. Not everyone who experiences these symptoms will develop depersonalization/derealization disorder. 

How it's diagnosed

Depersonalization/derealization disorder is diagnosed by a licensed mental health professional after a comprehensive assessment to rule out other causes for one’s symptoms. This assessment may include interviews about one’s experiences and history, diagnostic assessment tools or tests, and coordination with past providers. 

When symptoms become a disorder

Symptoms of depersonalization and derealization become in the range of meeting the criteria for a disorder when they occur for a specified amount of time, cause significant distress, and interfere with one’s ability to function in important areas of life, such as in relationships or at school or work.

Another key aspect of this disorder is that the person knows these experiences are not real. People who are not aware that they are experiencing similar disturbances are more than likely experiencing symptoms of psychosis or another mental health condition.

How to Manage Depersonalization and Derealization

Managing depersonalization and derealization is possible. It is understandably upsetting to have experiences such as those associated with depersonalization/derealization disorder. With the right support and treatment, there is good reason to hope for relief. 

In-the-moment strategies

Here are some ideas to try if you are experiencing depersonalization and derealization. These strategies are no substitute for professional help, and we encourage people to seek professional advice if experiencing any of the symptoms outlined above. 

• Take slow, deep breaths. Try breathing only with your belly, not your upper chest. Take one breath in for four seconds, hold it for four seconds, slowly exhale for four seconds, and pause for four seconds. 
• Name 5 things you see around the room. 
• Use scent or taste to ground you. 
• Gently pinch yourself on the arm or hand. 
• Use a cold compress on your face or neck. 
• Drink a warm beverage or take a warm shower. 
• Run your hands under alternating hot and cold water.

Over time, mindfulness practices like meditation can also be very beneficial. Use these with caution, and if symptoms worsen, discontinue and consult with a healthcare professional. 

Longer-term treatment options

Cognitive-behavioral therapy and dialectical behavioral therapy have been shown to help people manage and reduce DPDR symptoms. 

If one has experienced trauma and has developed post-traumatic stress disorder (PTSD), treating the underlying impact of trauma can help to reduce symptoms of depersonalization and derealization. The American Psychological Association names three front-line, or most research-backed, therapies for PTSD. These include cognitive processing therapy, prolonged exposure, and cognitive behavioral therapy. They also name several other promising second-line treatments, including eye movement desensitization and reprocessing (EMDR) therapy, narrative exposure therapy, and some medications. 

If someone is experiencing symptoms of other mental health conditions that are increasing their stress and negatively impacting their life, making them more vulnerable to depersonalization and derealization, treatment (therapy and medication management) of those disorders can often result in a decrease in depersonalization and derealization symptoms. can help

How Willow Health Can Support Your Mental Health Journey

Willow Health is here to support you on your path towards recovery. We accept most insurance plans and offer a virtual IOP and crisis program in New York and North Carolina, with services expanding to other states soon. All new patients receive a comprehensive evaluation by a mental health therapist and a psychiatric medical provider, and we offer individualized care plans to address your most important needs. We offer same-day or next-day appointments to ensure people get timely treatment. Visit our website to talk to a clinician now, or call us at 646-814-1530 to learn more about our crisis program and intensive outpatient program (IOP).

FAQs

Here are some commonly asked questions about depersonalization and derealization.

Is derealization worse than depersonalization?

No, they are both aspects of the same disorder. How people experience them both varies from person to person. 

How long does depersonalization last?

Symptoms of depersonalization and derealization can vary in how long they last. Many people experience them briefly for up to a few hours, while others can experience them for years. 

Can depersonalization be permanent?

For some people, they may have experiences of depersonalization and derealization throughout their life, but with the right support, treatment, and lifestyle changes, occurrences can become less frequent and intense. 

Sources 

Dissociative Disorders | NAMI

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  

Treatments for PTSD