Derealization and Depersonalization (DPDR): When You or the World Feels Unreal

You’re in your own kitchen, and it suddenly looks like a stage set. Or you’re talking with a friend and feel like you’re watching yourself from a few feet away, saying words that don’t quite feel like yours. You know nothing has actually changed. That’s part of what makes it so unsettling.

These experiences have names. Derealization is the sense that the world around you is unreal, distant or dreamlike. Depersonalization is the sense that you are detached from yourself: your body, your thoughts or your feelings. When they last or keep coming back and cause real distress, clinicians call it depersonalization-derealization disorder, often shortened to DPDR.

Brief episodes are common. A lasting disorder is less common, and it can be treated. Here’s what’s known, what isn’t, and what can help.

What Derealization and Depersonalization Feel Like

People often struggle to put this into words. The descriptions below come up again and again in clinical references and research.

Derealization is about the world around you. It can feel like:

• Being in a dream or a fog, or seeing everything through glass or a veil.
• Familiar places and people looking strange, flat, lifeless or artificial.
• Objects looking blurry, unusually sharp, or the wrong size or distance away.
• Sounds seeming louder or softer than they should.

Depersonalization is about you. It can feel like:

• Watching yourself from the outside, like an observer of your own life.
• Your body, hands or voice not feeling like your own.
• Acting on autopilot, like a robot, without feeling in control of what you do or say.
• Emotions feeling muted or numb, even toward people you love.
• Time feeling strange, as if it’s rushing by or crawling.

The two often happen together, and many people have a mix of both. They’re two sides of the same experience: a feeling of disconnection from yourself or from your surroundings.

The Most Important Thing to Know: You Know It Isn’t Real

With derealization and depersonalization, your sense of reality stays intact. You know the world hasn’t actually turned into a movie set and that you haven’t actually left your body. It feels that way, and you know it’s a feeling. Clinicians call this intact reality testing, and it’s what separates DPDR from a psychotic disorder such as schizophrenia, where people hold beliefs that don’t match reality without realizing it.

That awareness is also why it’s so distressing. You notice the gap between how things feel and how you know they are, and it’s frightening. Many people worry they’re “going crazy” or that something is permanently wrong with their brain. Those fears are common, and they’re a recognized part of the experience, not a sign of what’s to come.

Derealization vs. Depersonalization

Derealization is about the world around you; depersonalization is about you. You can have one without the other, but they often show up together, which is why they’re grouped as one condition.

How Common Is It?

Brief episodes are very common. According to the Merck Manual, between a quarter and three-quarters of people have had at least one fleeting episode, often during intense danger or stress, after using certain drugs, or when very tired or short on sleep.

Depersonalization-derealization disorder, where the feelings persist or keep returning and cause real distress or trouble functioning, is much less common: about 1 to 2% of people. It affects men and women about equally, and it usually starts in the teens or early adulthood.

What Can Cause or Trigger It

Derealization and depersonalization aren’t a single illness with a single cause. They can show up in many situations, and often more than one is at play.

• Panic and anxiety. Feeling unreal or detached is a recognized symptom of panic attacks, and anxiety is common in people with DPDR. In a U.S. study of 117 people with the disorder, panic was one of the most common things that set it off. Here’s more on what panic attacks are and aren’t and on panic disorder.
• Depression. Depression and anxiety often occur alongside it, according to a large UK study, and worsening mood can make symptoms worse.
• Trauma and PTSD. Detaching can be the mind’s way of getting through something overwhelming. Some people with PTSD have a dissociative form marked by derealization and depersonalization. Severe stress, including emotional abuse or neglect in childhood, is a common background. Here’s more on PTSD care and on emotional flashbacks.
• Severe stress and sleep loss. In a lab study from the Netherlands, healthy students kept awake for 36 hours reported more dissociative symptoms than those who slept. Exhaustion and lack of sleep can make existing symptoms worse.
• Cannabis and other substances. This one gets its own section below.
• Medical causes. Less often, similar experiences come from a medical condition. Some seizures can cause feelings of unreality or detachment, as a study from Switzerland described. Problems with the inner ear’s balance system have also been linked with these symptoms, according to a review from Italy. Drugs such as hallucinogens, ketamine or ecstasy can also bring it on, and your provider will review any medicines you take. That’s why a careful evaluation looks for other causes first, especially if symptoms start after age 40 or don’t follow the usual pattern.

In some people, no clear trigger is ever found.

Can Weed Cause Derealization?

It can, at least for a while. In a U.S. lab study, healthy volunteers who smoked marijuana, but not a placebo, had significant depersonalization, strongest about 30 minutes after a high-potency cigarette.

For a smaller group of people, the feeling doesn’t go away when the high does. In one U.S. online survey of 394 adults with lasting symptoms, about half said their symptoms first started after taking a drug, most often cannabis or hallucinogens, and most of them had used only modestly before. The survey drew people who sought it out, so the share among everyone with DPDR is likely much lower. A case series from Switzerland described teenagers who developed lasting symptoms after cannabis.

The research has real limits. It comes mostly from surveys and case reports, so it can’t show how often cannabis causes lasting DPDR, or why some people are affected and most aren’t. One hopeful finding: in that U.S. survey, people whose symptoms began with a drug improved more over time than people whose symptoms began some other way.

If cannabis seems to set off your symptoms, stepping away from it is a reasonable part of recovery, and a provider can help you plan that. We don’t recommend cannabis to treat anxiety; patients should talk with their provider. Our post on cannabis and mental health covers the wider research.

Is It Dangerous? Am I Going Crazy?

No, you’re not going crazy. Derealization and depersonalization feel alarming, but they aren’t psychosis, and they don’t mean you’re losing your mind. The key difference: with DPDR, you know the unreal feeling is a feeling. In psychosis, people don’t recognize that their thoughts don’t match reality.

Feelings of unreality can also happen alongside other conditions, including psychosis, as a UK review notes. So it’s worth getting evaluated promptly if you also notice things like hearing or seeing things other people don’t, or becoming convinced of beliefs that the people close to you find hard to understand.

Get urgent care, by calling 911 or going to the nearest emergency room, if feelings of unreality come with sudden numbness or weakness on one side, sudden confusion or trouble speaking, trouble seeing, loss of balance or a sudden severe headache, or if you have a seizure or faint. Those need medical attention right away.

If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

What Helps Right Now

These are practical steps, not a cure, and they work best when you practice them before you need them. Grounding with the senses is a commonly used technique for these feelings. People with the disorder have also reported that comforting time with others and relaxation tend to ease their symptoms, while stress and unfamiliar places tend to make them worse.

• Name what’s happening. Say to yourself, “This is derealization. It feels strange, and I know it’s a feeling.” Taking the threat out of the feeling is a core part of the therapy approach that has been studied.
• Slow your breathing. Breathe out a little longer than you breathe in, for a few minutes. If panic is driving the feeling, calming your body can help it pass.
• Ground yourself in your senses. Name five things you can see, four you can hear, three you can touch. Notice the weight of your feet on the floor or the texture of the chair.
• Turn your attention outward. Call a friend, step outside, or get absorbed in a task. Staying busy with something engaging can make the feelings less noticeable.
• Stop checking. Constantly testing whether you still feel unreal tends to keep the feeling going. Reducing that kind of symptom monitoring is one of the aims of treatment.
• Look after the basics. Sleep, regular meals, and avoiding alcohol, which can worsen anxiety and disrupt sleep, give your nervous system less to fight against.

How It’s Treated

Therapy is the main treatment for depersonalization-derealization disorder, but the evidence is limited, and research is still catching up. The best-studied approach is a form of cognitive behavioral therapy designed for depersonalization. It helps people see their symptoms as less threatening and cut back on avoidance and constant self-checking. In an open study from the UK, 21 people who received it improved on several measures, and about 3 in 10 no longer met the criteria for the disorder by the end. That study had no comparison group. A 2023 UK study of 36 people, from the same research group, found medium-sized improvements during CBT compared with a waiting period, though treatment wasn’t randomly assigned. A small UK trial comparing this CBT with usual care found that a full-scale trial is feasible, but that larger trial hasn’t been done yet, so the evidence is still limited.

Reviews of the research agree that the evidence is thin. A review of randomized trials, led by researchers in Israel and South Africa, found inconsistent results for medication and no clear benefit for other treatments tested. A 2024 systematic review from China found mostly small studies and case reports, and called for better research.

No medication is FDA-approved for depersonalization-derealization disorder, and none has clearly been shown to treat it. When medication is part of care, it’s usually to treat the anxiety, panic or depression that often come with it, decided after a full evaluation. Treating those conditions can ease unreal feelings that come with them, though in depersonalization-derealization disorder the feelings can continue even when anxiety is under control.

We don’t offer standalone weekly therapy, but we’re happy to help you find a therapist and, with your permission, we’ll coordinate with them.

How Long Does Derealization Last?

It varies a lot. Derealization during a panic attack usually fades as the panic does. Panic attacks often last from a few minutes to an hour. Episodes tied to stress, lack of sleep or a substance often ease once that trigger is dealt with.

Depersonalization-derealization disorder is different. Its course varies, and for many people it’s long-lasting: episodes can last hours, days, weeks or years, and symptoms may come and go or stay steady. A large UK study of 204 people found the disorder tended to be chronic and persistent. That’s why it’s worth getting help rather than waiting it out. Treatment can help people cope with the feelings and improve, especially when the stresses or conditions behind them are addressed.

How We Can Help

Looking for a psychiatrist in New Jersey? Our providers are board-certified psychiatric nurse practitioners (PMHNPs), who provide psychiatric evaluation and medication management. When derealization or depersonalization is part of the picture, a careful evaluation can help:

• Work out what’s driving it, such as panic, anxiety, depression, trauma, sleep loss or a substance.
• Treat the anxiety, panic or depression that often come with it.
• Look for medical causes that need checking. If you’d like us to, and with your permission, we can share information with your primary care provider so your care fits together.
• Connect you with a therapist for the therapy side of care.

If you’re not sure what’s behind your symptoms, our page on diagnostic clarification explains how we approach a careful second look. You can also read more about anxiety disorders.

Most patients start with our secure intake packet, and our practice coordinator will call you to schedule.

Frequently Asked Questions

What does derealization feel like?

People describe the world looking foggy, dreamlike, flat or far away, as if they’re watching it through glass or in a movie. Familiar places can seem strange. Throughout, you know it’s a feeling and that the world hasn’t actually changed.

Can anxiety cause derealization?

Yes. Feeling unreal or detached is a recognized symptom of panic attacks, and anxiety is one of the most common things linked with derealization and depersonalization. When these feelings come with anxiety or panic, they often ease when the anxiety is treated. In depersonalization-derealization disorder, though, the feelings can continue even after anxiety is under control, which is one reason a careful evaluation matters.

Can weed cause derealization?

It can. Cannabis can cause depersonalization while you’re high, and some people report symptoms that continue afterward. The research comes mostly from surveys and case reports, so it can’t say how often this happens. If cannabis seems to trigger your symptoms, talk with a provider about stopping.

How long does derealization last?

It depends on the cause. Episodes during panic usually pass within minutes to an hour. Episodes tied to stress, sleep loss or a substance often ease once that’s addressed. When it’s a lasting disorder, it’s often long-term, coming and going or staying steady, and treatment can help you cope and improve.

Is derealization a sign of schizophrenia?

On its own, no. With derealization, you know the unreal feeling isn’t true, and that awareness is what separates it from psychosis. If you also notice things like hearing voices others don’t, or beliefs that others find hard to understand, get evaluated promptly.

Is a psychiatric nurse practitioner the same as a psychiatrist?

No. Psychiatrists are medical doctors (MD or DO) who complete a residency in psychiatry. Psychiatric nurse practitioners are advanced practice registered nurses with graduate training in psychiatric care, and ours are board-certified (PMHNP-BC). In New Jersey, both can evaluate, diagnose and prescribe psychiatric medication. Our providers focus on careful evaluation and medication management.

When should I see someone?

See a provider if the feelings keep coming back, last more than brief moments, frighten you, or get in the way of work, school or relationships. Seek urgent care if they come with sudden physical symptoms such as weakness, confusion, trouble speaking or a seizure. If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

If derealization or depersonalization is getting in the way of your life, a psychiatric evaluation can help sort out what’s going on, and medication management can help if anxiety, panic or depression has taken hold.

This article is for general educational purposes only. It does not constitute medical advice, does not establish a provider-patient relationship, and is not a substitute for individual evaluation, diagnosis, or treatment by a qualified clinician. If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.