Derealisation and depersonalisation: when the world feels unreal

“I don’t know how to tell you this without sounding mad. I was at work, sitting across from a colleague I talk to every single day — and suddenly I felt like I was watching a film about myself. His voice came from somewhere far away. My hand on the desk was my hand, I know it was, but it did not feel like mine. I spent the rest of the day checking whether I was still here.”

I have heard that description in my room so many times that I could write it from memory. It always arrives with the same hesitation: the person apologises first, convinced that what follows will sound like proof that they are losing their mind. Almost every time it turns out to be derealisation or depersonalisation — two of the most frightening and, at the same time, most common companions of anxiety and panic.

I am writing this mostly to take one belief away from you: the belief that this means you are losing touch with reality. In the vast majority of cases it does not mean that. It does mean something else, which is worth understanding — and in a minority of cases it genuinely is a sign that you should see a doctor.

Two words for two different experiences

Derealisation is the sense that the world has changed. The room looks like a stage set. Colours are flatter, or oddly sharp. Familiar faces feel foreign. People most often describe it with glass, fog, a plastic film, or the feeling that everything looks like footage.

Depersonalisation is the sense that you have changed. That you are observing yourself from outside. That your hands, your voice, your thoughts are somehow detached from you. That you are present without being there.

In practice the two can barely be separated — most people experience them together, which is why the field treats them as one. What matters is what they share: the experience of reality changes, while the judgement about reality stays intact. You know throughout that the world is not made of stage sets, and that knowledge is precisely what torments you. If you believed the world had really changed, you would not be so frightened.

How common this actually is

More common than you would think. Systematic reviews suggest that roughly half of people experience at least one brief episode of derealisation or depersonalisation in their lifetime. Among students during exam periods the numbers are higher still. It appears transiently with exhaustion, after a sleepless night, after cannabis, with severe pain, on long drives, with a fever.

Among people with panic attacks it is almost the rule. The diagnostic criteria for a panic attack list “feelings of unreality or being detached from oneself” as one of its symptoms — on equal footing with palpitations and trembling. It is not an add-on, not a complication, not a sign that things are worse. It is part of the picture.

Quite different is the persistent form that runs for weeks or months almost without a break. That one is rare — estimated at around one per cent in the general population. I write about it below.

Why it happens during panic in particular

The most sensible explanation is that this is a circuit breaker. When the surge of arousal begins — I wrote about it in the piece on what happens in the brain during anxiety — a system switches on that prepares the body for action. If arousal passes a certain threshold and there is nowhere for action to go (a meeting, a queue, behind the wheel), a second mechanism engages: dampening.

Brain imaging in people with depersonalisation shows increased activity in regions that inhibit emotion and a reduced response in regions that generate it, particularly the amygdala. Put simply: the brake is pressed harder than the accelerator, and the result is numbness. Because the sense of belonging to your own body is largely built out of the emotional response to what you perceive, when that response drops away perception is left without feeling. You see the hand; you do not feel it is yours.

That last line matters more than anything else. The mechanism itself is unpleasant, but it is not dangerous and it settles on its own. It only becomes unbearable once the feeling of unreality turns into a new threat that has to be controlled.

Why it feels worse than a pounding heart

When your heart hammers during an attack, you fear for your body. When the sense that this is you disappears, you fear for yourself. That is a different category of fear, and people experience it that way — attacks with strong derealisation are usually described as more frightening, even when the physical symptoms are milder.

A second problem comes with it: this is unspeakable. You tell a doctor about chest pain without embarrassment. “I don’t feel like I’m me” you tell nobody, because you are sure it will change how people look at you. So people carry it alone for months and years, building the worst explanations in the meantime. A textbook case of catastrophising: one unpleasant sensation becomes an entire future in which the sensation never ends.

No, this is not psychosis

This is the question people most often do not ask out loud, even though it is the reason they came. The distinction is reasonably clean and worth knowing.

In derealisation a person says: “It seems to me as if the world isn’t real — I know it is, but that’s how it seems.” In psychosis a person says: “The world is not real.” The first is a complaint about one’s own experience; the second is a belief about the world. The first person is frightened by their experience; the second accepts it as fact.

Let me add a fact that usually reassures people more than any explanation: in research, derealisation does not show up as a predictor of later psychosis. The persistent form is classified as a dissociative disorder in its own right, not as a precursor to something worse. Not every feeling of unreality belongs in the same drawer — but the one that grows out of panic stays in its own.

What makes it worse

Almost everything a person would naturally do. The first is checking: staring at your hands, touching walls, repeating your own name, searching the mirror for evidence that you still look “normal”. Every check acts as confirmation that something is wrong, and directs still more attention at the thing that frightens you.

The second is internal monitoring. Spend the day measuring how real the world feels and you will find hourly evidence that it is not quite right. Attention does not observe neutrally — whatever you measure grows.

The third is avoidance: shopping centres with artificial light, motorways, long corridors, meetings. The place is not at fault, but once you have avoided it you are left feeling you barely escaped — and next time is worse.

And the fourth, rarely mentioned with panic: too little sleep. Nothing raises the feeling of unreality as reliably as a fortnight of poor sleep. If that sounds familiar, read the piece on how arousal and insomnia hold each other up.

What helps in the moment

None of this is a switch for turning the feeling off. The aim is not to banish it — the aim is to stop fighting it, because the fight is exactly what renews it.

What works most reliably is turning towards an action with an external purpose. Not “notice five things around you” as a checking ritual, but something that demands attention for its own sake: tidy a row of books, read the sign on the next building out loud, walk and count steps up to seven, then start again. The difference is small but decisive — attention needs an errand, not the task of proving that you are here.

Temperature and pressure help too: cold water on the wrists, a firm squeeze of your own palm, feet pressed hard into the floor. The body gets a clear signal that is difficult to damp down.

And what helps is a sentence prepared in advance, not invented mid-attack: “This is a circuit breaker, not a fault. It lasts as long as it lasts, and it passes.” In studies of cognitive-behavioural work with depersonalisation, people who learn to explain the sensation neutrally report meaningful improvement — not because it stops appearing, but because it stops being a threat.

When this is no longer just panic

Now the part I must not leave out. There are situations in which a feeling of unreality deserves a medical assessment, not only a conversation with a therapist.

See a doctor if it appears for the first time after the age of forty with no obvious psychological trigger. If it comes with gaps in memory, smells or tastes that are not there, déjà vu in repeated short bursts, twitching or brief lapses of consciousness — all of that needs neurological exclusion, because some forms of epilepsy resemble it. The same goes for severe headache, double vision, or trouble with speech or balance.

See a doctor too if it began with a new medication or on stopping one, with regular cannabis use, or with other substances. If it lasts almost continuously for weeks and takes away your capacity for work and relationships. And certainly if it distresses you so much that you are thinking about taking your own life — that help does not wait for the next free appointment.

When the doctor is the first stop rather than the last, I described in the piece on when to see a psychiatrist first. Let me only add that an assessment is not an accusation. It does not mean something worse is going on — it means we stop guessing.

Where my explanation runs out

Everything written above has limits, and I have to say them out loud.

First: the “dampening” account is the best model we have, not a proven mechanism. Research here is small, samples often number a few dozen people, and imaging studies do not fully agree. I have written down a picture that holds together, not a fact.

Second: in the persistent form that runs for years, panic often turns out to be the companion rather than the source. For some people the background is prolonged exposure in which absence was the only available exit — I wrote about that in the piece on trauma in the body. There, reassurance along the lines of “it isn’t dangerous” is neither enough nor fair, and the work goes elsewhere.

Third: for some people grounding techniques do nothing but tire them out. If nothing shifts after a few months, that is not your failure — it is information that the method does not fit and it is time for something else.

And fourth: none of us should hand out diagnoses through an article. What a diagnosis says and does not say, I explained in the piece on the diagnosis as a map. What we read here is a map — you are the terrain.

What to remember

The sense that the world is not real, or that you are not quite you, is a common symptom of an aroused nervous system. It is not a sign that you are losing touch with reality — quite the opposite: the fact that it bothers you shows your judgement about reality is intact.

The experience is kept alive mainly by checking, monitoring and avoidance. The less you measure it, the sooner it retreats.

In the moment, what helps is an action with an external purpose and a clear physical signal, not talking yourself round.

And still: with a first appearance after forty, with neurological signs, with substances involved, or after weeks of unbroken duration, go to a doctor. Once, thoroughly — and then you can turn to what is actually going on.