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Learn more about depersonalisation & derealisation disorder
Depersonalisation and derealisation disorder (DPDR) is a dissociative condition in which a person experiences persistent or recurrent feelings of detachment from themselves, their body, or their surroundings. Depersonalisation involves feeling like an outside observer of your own thoughts, feelings, or actions. Derealisation involves the surrounding world feeling dreamlike, distant, or unreal. Recognised in the DSM-5, DPDR causes significant distress or impaired functioning when episodes are persistent rather than transient. Brief experiences of depersonalisation or derealisation are common in the general population, particularly under stress or sleep deprivation; the diagnosis applies when these experiences become a persistent source of difficulty.
DPDR is often difficult to describe because it involves a disruption to ordinary subjective experience rather than a visible change in behaviour.
Common signs
- Feeling detached from your body, thoughts, or emotions, as though watching yourself from outside
- A sense of going through the motions automatically, without feeling present in what you are doing
- Your surroundings feeling dreamlike, flat, or visually distorted
- Familiar places or people feeling strange or unreal
- Emotional numbness, including difficulty feeling pleasure, sadness, or connection
- Hyperawareness of your own thinking, which can feel mechanical or alien
Other common experiences
- Intense anxiety about the experiences, particularly fear of going mad or of permanent unreality
- The experiences intensifying when you focus on them or try to make them stop
- Episodes triggered by anxiety, stress, fatigue, or substance use
Treatment for DPDR typically focuses on reducing the anxiety and hypervigilance that maintain the episodes, rather than trying to stop the experiences directly.
- CBT (Cognitive Behavioural Therapy) CBT for DPDR addresses the patterns of attention, monitoring, and anxious interpretation that keep the experiences active, and helps build more flexible ways of relating to unusual perceptual states.
- Trauma informed care Trauma-informed approaches are important when dissociation is rooted in earlier adverse or threatening experiences, providing a safe and carefully paced framework for the work.
- Somatic experiencing Somatic experiencing helps restore a felt sense of connection to the body, which is often disrupted in DPDR, working at the level of the nervous system rather than through verbal analysis alone.
- Psychodynamic therapy Psychodynamic work can explore the emotional and relational roots of dissociative experiences, including the function that detachment may be serving as a response to earlier difficulty.
It's Complicated is a therapist-founded mental health platform connecting clients with verified practitioners across Europe and globally, in over 60 languages. We work with over 2,500 vetted therapists, with in-person availability in Berlin, Amsterdam, Barcelona, Lisbon, Vienna, and other major cities, alongside online sessions worldwide. It's Complicated is free to use, and you pay your chosen therapist directly at rates they set.
DPDR is poorly understood by many generalist therapists, which means finding someone with relevant experience matters more than it might for other presentations. Our matching service is built to remove that friction. You complete a short survey, our psychologists combine data-driven insights with human judgement to identify the right therapists for your situation, and you choose from a shortlist of strong candidates. You can also browse our directory directly if you'd prefer to choose yourself.
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