Depersonalization and disassociation refer to a dreamlike state when a person feels disconnected from their surroundings. Things may seem ‘less real’ than they should be.
These types of sensations vary in severity and can result from a range of conditions, including post-traumatic stress disorder and the use of recreational drugs.
The person may feel as if they are watching themselves from a distance. Some take on a different identity. The person is able to do a “reality check.” They are aware that they their sensations are unusual.
Depersonalization is an aspect of dissociation.
- Dissociation is a general term that refers to a detachment from many things.
- Depersonalization is specifically a sense of detachment from oneself and one’s identity.
- Derealization is when things or people around seem unreal.
Causes and risk factors
The exact cause of dissociation is unclear, but it often affects people who have experienced a life-threatening or traumatic event, such as extreme violence, war, a kidnapping, or childhood abuse.
In these cases, it is a natural reaction to feelings about experiences that the individual cannot control. It is a way of detaching from the horror of past experiences.
According to Mind, a mental health charity based in the United Kingdom, dissociation can be a strategy for calming down, to help a person cope in times of stress.
Neurologically, it may involve an imbalance in brain chemicals.
A number of factors can make a person more likely to experience dissociation and depersonalization.
Some recreational drugs affect the chemicals in the brain. These can trigger feelings of depersonalization.
Ketamine: People use this dissociative anesthetic as a recreational drug. They take it because they seek an “out-of-body” experience.
Cannabis use: People have experienced dissociation and depersonalization with cannabis use and withdrawal.
Alcohol and hallucinogens: These may trigger depersonalization in some people
People have reported perceptual disturbances such as depersonalization when withdrawing from benzodiazepines.
As a symptom of another condition
Many people who experience depersonalization also have another mental health condition.
Some kinds of dissociation can occur with the following conditions:
- obsessive-compulsive disorder (OCD)
- phobic disorder
- post-traumatic stress disorder (PTSD)
Dissociation and depersonalization disorders
According to the National Alliance on Mental Illness (NAMI), dissociative disorders that feature dissociation or depersonalization are:
- Dissociative amnesia: People forget information about themselves or things that have happened to them.
- Depersonalization-derealization disorder: This can involve out-of-body experiences, a feeling of being unreal, and an inability to recognize one’s image in a mirror. There may also be changes in bodily sensation and a reduced ability to act on an emotional level.
- Dissociative identity disorder: A person becomes confused about who they are and feel like a stranger to themselves. They may behave differently at different times or write in different handwriting. This is sometimes known as multiple personality disorder.
In some cultures, people seek to attain depersonalization through religious or meditative practices. This is not a disorder.
Dissociation can happen in different ways.
A study published in Access Advances in Psychiatric Treatment notes that symptoms can include:
- changes in bodily senses
- a reduced inability to react emotionally
Here are some of the experiences a person may have:
- an out-of-body experience, in which they feel as if they are floating away or watching themselves from a distance or as if in a film
- a sense of disconnection from their own body
- the feeling that life is a dream, where everyone and everything seems unreal
- a sense of not being in control of their actions
- gaps in memory, especially of specific people, events, or periods in life
- obsessive behavior, for example, repeatedly looking in a mirror to check that they are real
Some people may travel physically to another place and take on a different identity while there. The individual may not remember their own identity.
Anxiety can be a cause or a result of dissociation.
A doctor will ask a person about their symptoms and their personal and medical history.
The doctor may recommend neurological tests to rule out conditions such as epilepsy.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) lists the following as diagnostic criteria for depersonalization disorder:
- The person persistently or repeatedly has a sense of depersonalization or derealization.
- During these experiences, the person is aware that these changes are not reality.
- These symptoms result in distress and difficulty carrying out routine tasks.
- The symptoms do not happen because of another disorder or the use of a medication or other substance.
There is no specific treatment for this condition, but medication and counselling may help.
A 2013 review found that doctors may prescribe a combination of medications, specifically lamotrigine (Lamictal), selective serotonin reuptake inhibitors (SSRIs), and other drugs.
However, the authors called for further research to confirm whether the drugs currently in use are suitable. Experts still do not agree on whether people can or should use medication.
Cognitive behavior therapy (CBT)
This type of therapy can help people to see their symptoms in a nonthreatening way. This may help to reduce the anxiety and obsessive behavior that can occur alongside them.
Depersonalization, dissociation, and related experiences can happen for a number of reasons, including PTSD, the use of some substances, and some lifelong conditions.
It can cause worry and anxiety, but a doctor may be able to help if you persistently experience these symptoms.