Depersonalization and dissociation refer to a dreamlike state when a person feels disconnected from their surroundings. Things may seem ‘less real’ than they should be.

Sensations of depersonalization and dissociation 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” and is generally aware that their sensations are unusual.

Depersonalization is one aspect of dissociation. The term is used to describe a feeling of detachment, especially from oneself and one’s identity.

It may also be associated with derealization, which is characterized by an altered perception of or detachment from one’s surroundings.

This article will take a closer look at the causes and symptoms of depersonalization and dissociation, as well as the ways that they may be diagnosed and treated.

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PTSD or past trauma can lead to depersonalization, when people feel detached from themselves. Image credit:
Tomazl/Getty Images

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 and is a way of detaching from past experiences that may be difficult to tolerate.

According to the American Psychiatric Association, symptoms can begin in early childhood or adolescence. In fact, less than 20% of people with depersonalization-derealization disorder first experience symptoms after age 20.

A number of factors can make a person more likely to experience dissociation and depersonalization.

Recreational drugs

Some recreational drugs affect the chemicals in the brain, which could trigger feelings of depersonalization.

  • Ketamine: People often use this dissociative anesthetic as a recreational drug. Some people may take it because they seek an “out-of-body” experience.
  • Cannabis use: Though uncommon, some people may experience dissociation and depersonalization with cannabis use and withdrawal.
  • Alcohol and hallucinogens: These could trigger depersonalization in some people.

People have also reported perceptual disturbances such as depersonalization when withdrawing from benzodiazepines.

Other conditions

Many people who experience depersonalization also have another mental health condition.

Some kinds of dissociation can occur with the following conditions:

Dissociation and depersonalization disorders

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Some people will have an out-of-body experience or feel as if they are watching themselves from a distance. Image credit: Volkankurt/Getty Images

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 sensations 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 or emotions
  • 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.

Occasional feelings of dissociation or detachment are common and may not necessarily be cause for concern.

However, if a person experiences ongoing or severe sensations of dissociation, they may want to consider talking to a doctor or mental health professional.

A person should also consult with a doctor if these symptoms interfere with relationships or daily activities, including work or school.

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Doctors use specific criteria to diagnose dissociation and depersonalization. Image credit: Maskot/Alamy Stock Photo

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 counseling may help.

Medications

Though therapy is typically recommended as the first line of treatment for depersonalization disorder, a doctor may prescribe medications to treat associated conditions or other symptoms that a person may be experiencing.

For example, antidepressants may be recommended to treat conditions like anxiety, depression, or panic attacks.

Some studies have found that other medications may also be beneficial, such as lamotrigine or naltrexone, but more research is needed.

Cognitive behavior therapy (CBT)

This type of talk therapy can help people understand and cope with the underlying cause of their disorder and practice techniques to manage symptoms of the condition.

Additionally, CBT may help to reduce the anxiety, depression, and obsessive behavior that can occur alongside depersonalization and dissociation.

Depersonalization, dissociation, and related experiences can happen for a number of reasons, including PTSD, the use of some substances, and other mental health conditions.

Though it can cause several adverse symptoms, medications and counseling may be beneficial.

A doctor can also help determine the cause and best course of treatment to help manage other symptoms and conditions that might be associated with dissociation or depersonalization.