Depersonalisation & Derealisation (DPDR): Causes, Symptoms & Treatment

Dr Millia Begum is a Consultant Psychiatrist with extensive experience working with dissociation in the context of complex trauma, including depersonalisation and derealisation (DPDR).

She also carefully assesses common co-occurring difficulties such as panic disorder, depression and neurodivergence, so that treatment is based on the wider clinical picture rather than on the dissociative symptoms alone. Therapy may then draw on a combination of approaches according to the individual’s needs.

What is depersonalisation?

Depersonalisation is a dissociative experience in which a person may feel disconnected from their own body, emotions, thoughts or sense of self.

Some people describe feeling as though they are observing themselves from a distance, rather than fully experiencing their life from within.

They may recognise that their body, thoughts and feelings belong to them, yet no longer experience the usual sense of familiarity or emotional connection.

What is derealisation?

Derealisation is a dissociative experience in which the outside world may feel distant, unreal, dreamlike or strangely unfamiliar.

A person may recognise familiar people and places, yet feel disconnected from them. Their surroundings may seem flat, artificial or as though they are looking at the world through a screen.

The important distinction is that the world has not necessarily changed. Rather, the person’s experience of the world has changed.

What is the difference between depersonalisation and derealisation?

Depersonalisation and derealisation commonly occur together. Both are dissociative experiences, but the emphasis is slightly different.

• Depersonalisation involves a disruption in the felt sense of connection with one’s own self or the body. 
• Derealisation involves a disruption in the felt connection with the external world and people around them.

Is DPDR the same as psychosis?

One of the important differences between DPDR and psychosis is reality testing.

In depersonalisation and derealisation, the person generally knows that the world has not literally become unreal, but what has changed is their felt sense of connection with reality.

In psychosis, reality testing itself may have become impaired.

It is vital that a careful professional assessment is carried out in distinguishing DPDR symptoms from symptoms of psychosis.

What causes depersonalisation and derealisation?

DPDR can arise for different reasons.

Possible contributors include:

• severe anxiety or panic attacks
• traumatic experiences
• developmental or attachment trauma
• Substance-related DPDR
• some neurological or medical conditions
• prolonged stress or emotional overwhelm
• as part of other dissociative disorders

Understanding why DPDR developed in a particular person is important because the treatment may be different depending on the underlying cause.

Transient depersonalisation and derealisation can occur during stress or panic. Depersonalisation–derealisation disorder requires additional diagnostic considerations, including persistence or recurrence, distress or impairment, intact reality testing, and exclusion of alternative explanations.

Can panic attacks trigger depersonalisation?

Yes. Panic attacks can trigger depersonalisation or derealisation, particularly when the experience has been intense.  But the relationship between panic attacks and DPDR can also work in the opposite direction.

A sudden episode of derealisation may itself feel frightening and trigger panic. This can create a self-perpetuating cycle:

DPDR → fear → panic → increased DPDR → more fear

Understanding this cycle can itself be helpful for some people. 

Can cannabis or other substances trigger persistent DPDR?

Cannabis and other mind-altering substances can trigger depersonalisation and derealisation in some people.

For some, the experience resolves when the effects of the substance wear off. For others, symptoms may persist. The mechanisms are not fully understood.

In some cases, a substance may intensify pre-existing tendency towards dissociation.

In others, an altered state of consciousness from having used the substance may trigger intense fear or panic, after which the person becomes highly vigilant to changes in perception and continues to experience DPDR.

These symptoms should be carefully assessed by an appropriate clinician and avoid any self-diagnosis. 

What is trauma-related DPDR?

Depersonalisation and derealisation can occur during or after overwhelming traumatic experiences.

In some people, depersonalisation or derealisation may emerge during overwhelming experiences and may be understood as a form of psychological distancing from intense emotional or bodily experiences. However, the mechanisms underlying DPDR remain incompletely understood. 

Can early attachment trauma contribute to DPDR?

Early attachment experiences may contribute to vulnerability to dissociative symptoms in some people.

When a child’s relationships with important caregivers are repeatedly frightening, unpredictable or emotionally unavailable, this can affect how they develop a sense of safety, emotional connection and continuity of self.

In some individuals, these experiences may be associated with a later sense of disconnection from themselves or others.

However, not everyone experiencing DPDR has a history of childhood trauma, and attachment experiences are only one part of a broader clinical understanding.

What happens in the brain during DPDR?

The neuroscience of depersonalisation and derealisation is still developing. Research suggests that these experiences may involve changes in how the brain processes emotion, bodily sensations, attention and the sense of self.

Some studies have found altered patterns of emotional responding and activity within networks involved in integrating our internal experience with the outside world.

However, DPDR cannot currently be explained by a single brain region or one established neurological mechanism.

How is depersonalisation and derealisation treated?

Psychoeducation can be very helpful, particularly when fear of the symptoms is perpetuating a panic-DPDR cycle.

Grounding, orienting and present-awareness may also help some people reconnect with their body and environment. 

CBT-based approaches have been studied for DPDR, although the evidence base remains limited.

Approaches such as EMDR, Deep Brain Reorienting (DBR) and Internal Family Systems (IFS) may be relevant when addressing associated traumatic experiences, emotional distress or difficulties with internal connection.

However, there is currently insufficient high-quality research to establish these approaches as effective treatments specifically for depersonalisation–derealisation disorder.

For some people, treatment of persistent anxiety, depression or another underlying mental health condition may also be important.

When should I seek professional help?

Any new-onset, unusual or rapidly changing DPDR symptoms may require medical assessment, particularly if associated with confusion, altered awareness or other neurological symptoms.

Professional assessment becomes particularly important when DPDR is:

• persistent or recurrent
• causing significant distress
• affecting work, study or daily functioning
• making relationships or social connection difficult
• associated with panic attacks
• accompanied by depression or increasing withdrawal
• difficult to distinguish from other mental or neurological symptoms

A careful assessment can help identify what may be driving the symptoms and what form of treatment is most appropriate.

• Merck Manual Professional — Depersonalization/Derealization Disorder. Particularly useful for diagnostic criteria, differential diagnosis and treatment.

• Wang et al. — The Treatment of Depersonalization-Derealization Disorder: A Systematic Review. Published in Journal of Trauma & Dissociation, 2024.

• Cleveland Clinic — Depersonalization-Derealization Disorder. Useful for patient-friendly clinical explanations.