Depersonalisation-Derealisation: real or dream?

medyouthalliance
2 days ago
4 min read

Written by: Emman Allahgul

Med Youth Alliance | October 2025

I’ve decided to focus on something a bit more niche and a bit more unspoken about this month, a condition that feels a bit personal to me as well.

Depersonalisation-derealisation (DPDR) is a mental health condition which seems small and manageable but in fact impacts lives significantly, with it often not being recognised at all or confused with just "zoning out". It often raises questions like:

“I feel like I’m in a dream” (depersonalisation)

“My body doesn’t feel real” (depersonalisation)

“I feel like I’m acting automatically with no thought” (depersonalisation)

“My surroundings feel fake” (derealisation)

“Time feels distorted” (derealisation)

“People seem like robots/unreal” (derealisation)

Mind's visual representation of how DPDR can feel

Symptoms?

For individuals it varies, but common ones are identified such as:

Feeling a sense of disconnection from yourself/surroundings
Feeling “numb”
Forgetting information about certain events/yourself
Having multiple distinct identities

The time of dissociation often varies, from a few hours or days to weeks or months, depending on the individual.

Causes?

PYSCHOSOCIAL:

Dissociative disorders have very little information of them, with causes not being very distinct however it has been often linked to being developed due to:

Traumatic events from childhood/PTSD
Anxiety

Some examples of traumatic/stressful events include:

Invasive medical procedures
War
Sexual, physical or emotional abuse
Childhood events
Drug misuse

It is normal for humans to feel dissociated after traumatic events/stressful situations such as invasive medical procedures or war, however it becomes a problem when disconnection happens outside of stressful/traumatic environments

NEUROBIOLOGY:

It’s unclear if genetics plays a role in DPDR however there are many neurochemical and hormonal changes in individuals with DPDR
Could be associated with the dysregulation of the hypothalamic pituitary adrenal axis (complex set of direct influences and feedback interactions among three components: the hypothalamus, the pituitary gland and the adrenal glands) area involved in flight or flight response
Patients also demonstrated abnormally high cortisol levels
Vestibular systems (a sensory based system that aids with spatial awareness and coordination), which have roles in balance, self awareness, motor coordination and spatial orientation, could also lead to DPDR if disrupted, as it can cause detached feelings from surroundings (derealisation)

Types:

There are 3 main types of dissociative disorders according to the NHS:

Depersonalisation-derealisation (DPDR)
Dissociative amnesia (when individuals cannot remember periods/events of their life and can forget a learned talent or skill. Can have “blank episodes” of not knowing where they are/what they were doing)
Dissociative identity disorder (individuals may feel uncertain on their identity or feel multiple distinct identities, each having their own personality, character, voices and manners)

Diagnosis:

It can taken years to receive an official diagnosis of DPDR as there's no definitive, one-size-fits-all cure according to several experiences of individuals who have faced DPDR

(you can read this story was written by Iona about her experiences of depersonalisation-derealisation disorder (DPDR) at Living with depersonalisation-derealisation disorder | Mind)

Due to the often links of dissociative disorders and other conditions such as anxiety and depression, GPs may often do multiple examinations to determine if a patient has other conditions, such as:

PTSD
depression
Mood swings
Anxiety
Eating disorder
OCD
Suicidal tendencies/self harm

After, a specialist may carry out an assessment, in which patients are asked several questions about their thoughts, feelings and symptoms.

Treatment:

There is no “medicine” to cure dissociative disorders such as depersonalisation-derealisation however specialist often approach patients with talking therapies such as CBT or try to help with another problem that could be causing DPDR (such as giving antidepressants if a patient is depressed as depression is linked to sometimes causing DPDR/other dissociative disorders)

CBT:

Cognitive behavioural therapy (CBT) is a structured, goal-oriented type of talk therapy.

professionals look carefully at your thoughts and emotions to help patients understand how their thoughts impact their actions. Through this patients can “unlearn” their negative thoughts, resulting in a more positive outcome to healthier thinking.
It can be used alone or paired with medication such as antidepressants

Eye movement desensitisation and reprocessing (EMDR)

a psychological treatment that can help reduce the symptoms of post-traumatic stress disorder (PTSD). It is sometimes used to treat dissociative disorders.

This method involves moving your eyes a specific way while you process traumatic memories, focusing on changing emotions, thoughts or behaviours post traumatic experiences.

Personal experiences:

Growing up I often had these phases where I would blank out during class, not remember what was said and have even forgotten certain chunks of my life. Since then I have been able to manage it by ensuring I do not stress myself too much during school or exam seasons, as growing up I was a child who had craved and achieved academic successes. As a consequence, I would end up stressing over too much at once and hence going into phases where I would disconnect from my environments. Obviously as a child I had no idea why that would happen or even what DPDR was, until I was in my year 10 GCSE Psychology class, learning about the negative effects of stress on the brain and behaviour. That cue had invited me to finally research what those dissociative phases were.

As someone who has strongly experiences the negative consequences of DPDR, I would advise others who face similar struggles to find the root cause or trigger for dissociative episodes, which has helped me massively in preventing myself in dissociating.

To conclude, although DPDR affects roughly only 2% of the population, it impacts individuals significantly, especially with the lack of research towards this topic, so please do take care of your peers :)

WHAT WOULD YOU DO IF YOU SAW SOMEONE EXPERIENCING SYMPTOMS OF DPDR?