Depersonalization and Derealization: Causes, Symptoms and the Brain

Depersonalization is the experience of feeling cut off from yourself. You watch your own life as if from a few feet away, your voice sounds like someone else’s, and feelings you expect to have do not arrive. Derealization turns the same distance outward, so familiar streets and rooms look flat, foggy or staged. Both often start as a response to overwhelming stress, anxiety or fear. For most people they pass. In some, the detachment keeps returning or never fully lifts, and when it causes distress or disrupts daily life, it is a disorder.

What makes it so unsettling is that your mind keeps working. You can think, plan and hold a conversation, and you usually know that something is wrong. One model proposes why: emotional signals are turned down while attention stays switched on, so the world arrives in sharp focus but without the feeling that makes it real and yours.

What does depersonalization feel like?

People with it describe feeling like a robot going through the motions, or like an actor watching themselves on a screen. Some describe a pane of glass between themselves and others. Their own hands can look unfamiliar, and the face in the mirror can feel like a stranger’s. Emotions seem switched off, even with the people they love most.

Derealization is the outward version. A familiar office can look like a stage set. Colors seem dull, sounds seem far away, and time can feel strange. The two often come together, and the current psychiatric manual treats them as a single condition, depersonalization-derealization disorder.

Both experiences are frightening. People often fear they are losing their mind or developing a serious brain illness. A cognitive-behavioral model covered below proposes that this fear can keep the detachment going.

How common is depersonalization?

Brief episodes are common. Elaine Hunter, Mauricio Sierra and Anthony David reviewed the surveys that measured how often this happens. Between about a quarter and three quarters of people said they had one at some point; during a traumatic event, the figure was about a third to two thirds.

A lasting disorder is much less common. Surveys of the general public that used standard diagnostic interviews found that about 1 to 2 percent of people have depersonalization or derealization serious enough to count as a clinical problem. Some live with it for years before anyone puts a name to what they feel. For many people, learning that it has a name, and that scientists have studied how it works, makes it less frightening.

What causes depersonalization?

Depersonalization disorder often starts young, and it often has a trigger. Daphne Simeon and colleagues at Mount Sinai studied 117 adults with the disorder. It typically began around age 16. The most common triggers right before it began were severe stress, depression, panic, and using marijuana or hallucinogens (drugs such as LSD). Some people can name a stressful time when it began; others cannot point to any single event.

Early life matters too. A child cannot fight or flee from the adults they depend on. Detaching may be the only defense available. In an earlier study, Simeon’s group compared 49 people with the disorder to 26 healthy volunteers. Trauma in childhood that involved other people strongly predicted the disorder, and emotional abuse was the strongest single predictor. Most often, one or both parents were the emotional abusers.

What is the brain doing during depersonalization?

Most people know the fight-or-flight response, where the brain’s fear system revs the body up to act. Depersonalization can work more like a dimmer on feeling. When a threat feels inescapable, the brain can turn experience down instead of up: emotion goes flat, the body feels distant, and the scene seems to be happening to someone else. In the moment, that distance can be protective.

Mauricio Sierra and German Berrios set out an influential model of how this works. In their account, attention systems in the prefrontal cortex, the front part of the brain that directs attention and self-control, stay switched on. That keeps alertness high. At the same time, a separate prefrontal circuit acts as a brake on the amygdala, a threat-detection hub, and mutes the body’s emotional response. The world arrives clear but without its usual emotional color, and people feel that as unreality.

Brain imaging offers some support. In a small brain-imaging study in London, six people with depersonalization disorder looked at disturbing and neutral pictures, along with two comparison groups. They rated the disturbing pictures as far less upsetting. Brain areas that respond to emotion were less active in them, including the insula, which tracks what is happening inside your body. Part of the right prefrontal cortex linked to controlling emotion was more active. The researchers called their paper “thinking without feeling.”

Six people is a very small sample, so the finding is suggestive and needs larger studies. It does fit what people report. They can see and think clearly, yet nothing feels real or theirs, and they usually stay aware that something is wrong.

Where does depersonalization sit among the dissociative disorders?

Depersonalization belongs to a wider family. Psychiatrists group it with the dissociative disorders, conditions in which a person’s sense of body, memory, surroundings and identity stops fitting together. It helps to picture a scale. At one end are everyday moments, such as arriving home with no memory of a familiar drive. Further along are moments of feeling unreal during a crisis. At the far end are the recognized disorders.

Besides depersonalization-derealization disorder, the group includes dissociative amnesia: gaps in memory for important personal information, usually around stressful or traumatic events, that normal forgetting does not explain. It also includes dissociative identity disorder, the most severe form, which is closely tied to severe, repeated trauma in early childhood. Memory gaps can also have medical causes, including head injury, seizures, some medications and drug or alcohol use.

Dissociation also shows up in post-traumatic stress disorder, or PTSD. More commonly, people with PTSD feel too much: memories that intrude, a racing body and a feeling of being flooded. Ruth Lanius and colleagues described a smaller group with the opposite pattern. In them, the inner, midline part of the prefrontal cortex appears to hold back the deeper brain areas involved in emotion too strongly. The current psychiatric manual lists this as PTSD “with dissociative symptoms.” It applies when someone has a full PTSD diagnosis and also has depersonalization or derealization that lasts or keeps coming back.

In this pattern, the prefrontal cortex appears to hold the brain’s emotional centers down so firmly that experience goes flat.

Depersonalization-derealization disorder is a separate diagnosis. Detachment is the main experience, and it can happen without the flashbacks and constant alarm of PTSD. That may explain why a person who dissociates can seem calm under pressure, to others and to themselves. That calm can be control, or it can be a shutdown in which the person keeps going while feeling little, and to an observer the two look alike.

Why does fear of the symptoms keep them going?

Much of what keeps depersonalization going may happen after the first episode. Elaine Hunter and colleagues, who argue that the disorder is linked to the anxiety disorders, especially panic, proposed a cognitive-behavioral model. It explains how thoughts and habits keep a problem going. In their model, part of the problem is how people read their symptoms. If you take a moment of unreality as proof of madness or brain damage, anxiety rises. In their model, that anxiety then feeds the depersonalization, so the symptoms you feared come more often and the loop tightens.

The same model points to small habits that keep the loop alive. People avoid places where episodes happened, lean on “safety behaviors,” precautions to get through the day, and watch closely for the next sign of unreality. Each habit keeps attention on the symptoms and stops the person from learning that the disaster they fear does not come. Safety habits play a similar part in social anxiety, where they keep the fear from updating.

Other conditions move the symptoms too. In Simeon’s study, negative feelings, stress, social situations that felt threatening and unfamiliar places tended to make them worse. Comforting time with other people, strong emotional or physical stimulation, and relaxation tended to ease them.

How long does depersonalization last?

It depends on which kind you mean. A brief episode around a shock or a panic attack is common, and it usually fades as the trigger passes. The disorder is different. In the Mount Sinai study, it typically lasted a long time and was often present without a break. How long someone had lived with it did not predict how severe it was, and its intensity still rose and fell with the conditions that affect it.

What does integration work involve?

If depersonalization is the brain turning feeling down to stay safe, the work runs the other way, toward recalibrating how the brain responds to threat, and it has to go slowly. Understanding why you detach is useful, but insight alone rarely changes the point at which detachment switches on.

Real-Time Neuroplasticity™, Dr. Sydney Ceruto’s method at MindLAB Neuroscience, works in the live moments when detachment begins rather than only in reflection afterward. The work also includes regulation of the stress response and attention to the nervous system’s baseline stress threshold, so the circuits being reconnected are not constantly pushed back into shutdown.

The pace matters. Pushing too fast toward feeling can trigger the very shutdown the work is trying to retire. Taken slowly, the work aims for a nervous system that can stay present when stress arrives.

Limits of the research

The brain research here comes mostly from small samples. The imaging study above included six people with the disorder, and models such as Sierra and Berrios’s are proposals that researchers are still testing. Group findings also cannot tell any one person why their own detachment behaves as it does, and no scan can confirm a diagnosis.

Signs that dissociation is more than a passing moment

Dissociation deserves attention when it is frequent, unpredictable, or getting in the way of daily life, memory or relationships. Signs include losing stretches of time you cannot account for, regularly feeling detached from your body or surroundings, or finding evidence of things you did but do not remember doing.

This article explains the neuroscience underlying depersonalization. For a personal read, contact MindLAB Neuroscience directly.

A consultation with Dr. Ceruto is a one-hour phone conversation about your own pattern. She looks at what sets the detachment off, how it shows up in your body, and whether this work fits.