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Depersonalization and Derealization - Symptoms of Severe Anxiety

Meloncauli is a former nurse and anxiety management therapist. She hopes everyone can take something away from her articles.

When you suffer from an anxiety disorder or depression for a long time, you can become so sensitized, or over-sensitive, that you almost feel scared of your very own shadow. The nervous system takes a battering, and many wild and not so wonderful sensations and thoughts can occur. Rumination and mind chatter can take over.

Questioning of our very selves, our reality and our place in the world can become persistent. It is not uncommon to begin to suffer from a state of depersonalization and/or derealization, which can be very alarming. These perceptual distortions can most certainly be a direct result from prolonged stress, anxiety and depression.

What is Depersonalization and Derealization?

Depersonalization is a state of being hyper aware as if an onlooker outside of the body. Most people who suffer with panic attacks will encounter this feeling. The perception of being unreal can even make us wonder if we are really alive and here in the present.

Derealization is a state where everything around you seems unreal. This can make you question if you are the only thing that is real. These states of mind can thus produce a feeling of either I am real and the world is not or the world is real and I am not! It can be very disturbing and has the effect of producing yet more fear which in turn releases more adrenaline creating further sensitization. It seems to be a never ending cycle of fear/adrenaline/fear/adrenaline helping to maintain the symptoms of unreality.

If you have experienced life’s anomaly of déjà vu, you have had a minor taste of what depersonalization and derealization can feel like. Déjà vu is a fleeting feeling of having experienced a situation or place before. Likewise, epileptics or migraine sufferers can experience an aura which can also be sudden and unsettling but of a very short duration. All of these things have a dreamlike quality about them but with depersonalization and derealization the experience can sit around for a long time and be experienced every day. Imagine having déjà vu constantly for hours, days, weeks or months on end. For chronic generalized anxiety or panic sufferers, these symptoms can be the most frightening of all.

Take a Depersonalization Test

Anxiety can cause strange thoughts, feelings and behaviors. A lot of the time, people fail to believe that anxiety could possibly be the cause; after all, doesn’t everyone have some anxiety in their lives? We are not talking about healthy anxiety here but unhealthy anxiety that is chronic and debilitating. It is the fearful reaction to the symptoms brought on by the chronic anxious state that helps it to build and keep it alive.

Will I Lose my Mind?

First, it is important to understand that these states are not harmful, either mentally or physically. They may feel very alarming but you are not going insane. Many people are afraid the symptoms are an indication of the onset of psychosis, but when you have been diagnosed with an anxiety disorder and/or depression it will be highly likely to be associated with that diagnosis.

There is a condition called depersonalization disorder which is listed in the DSM (diagnostic statistical manual) as a dissociative state and can be a result of a traumatic past experience, although this is usually found with accompanying anxiety also. Some sufferers may begin to have these symptoms after taking illicit drugs, perhaps after having had a bad trip. The good news is that both depersonalization and derealization can completely go away once a person is no longer sensitized. Desensitization takes time and is subject to how much a person addresses their general anxious state.

Smoking cannabis can start up  panic attacks particularly with feelings of unreality

Smoking cannabis can start up panic attacks particularly with feelings of unreality

Treatment Options

The treatment for depersonalization and derealization in most cases would be the same treatment as that for the underlying anxiety and depression. SSRIs used as anti anxiety pills are the most common medication and in some cases benzodiazepines may be prescribed, such as xanax or valium, though these may be discouraged due to dependence issues. If the actual anxiety issues are not addressed, one may be subject to a return of symptoms after these medications are stopped. Ideally, therapy or self-help should be encouraged.

Depersonalization Panic and Drugs

One must remember that these feeling of unreality, are for the most part, usually a direct symptom of having suffered intense anxiety. The longer you suffer the more likely it will be that you may experience unreality. That said, people who use substances such as cannabis, may have a sudden onset of unreality after they have used the substances. It is my opinion that in the case of anxiety disorders, treating the underlying anxiety is key. The unreality tends to dissolve once this is addressed.

There are some things you may try to alleviate the symptoms. When we feel a sense of detachment life can become difficult, so difficult that we may avoid social activities, leaving the home and we can become further isolated. It is important to maintain as much normality as possible despite the unreality. Easier said than done but the undoing of an unreality is to face the reality of it. It will not harm you; it is a frightening experience but it seeks your fearful reaction and you must work to resist this. Without reaction it loses power somewhat. Here are some things I suggest:

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Suggestions to Cope with Unreality

  • Wear a rubber band or elasticated bracelet on the wrist. Each time an unreal feeling begins, snap the band hard on your wrist to remind you not to react with fear. It might be a good idea to have a little statement you can say to yourself at the same time such as "I am here; this feeling is a product of my anxiety only. I will be okay."
  • Look in the mirror. Go look in the mirror and touch your face or any parts of your body. Smile at yourself. Tell that statement to the mirror.
  • If you are around other people, make a point of striking up conversation and most of all encourage eye contact with the person you are talking to. This reminds us that we are real and everything around us is real.
  • If you are alone and the feelings come, go and phone someone. It is amazing how, when we divert our attention away from our own thoughts and feelings some respite is gleamed.
  • Keep a notebook with positive affirmations in it. Write down realistic statements, one on each page in bold capital letters. Read these in times of doubt and uncertainty. It may seem silly but you need to reinforce over and over the explanation for your suffering, the truth – the reality!
Phoning someone will redirect your focus and attention.

Phoning someone will redirect your focus and attention.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


David on June 09, 2017:

I loved reading this post and knowing you're a nurse with personal experience dealing with this. I've been horribly anxious and depersonalized since taking Zoloft and I've since been recovering for 2+ months. I'm doing better and better and this post really helped. Thank you so much for your insight and encouragement :D

Robin on January 25, 2017:

I am so lost in cry all the time and can't keep a job lost my family, my 3 ex husbands and friend (who I thought was in love with me), for 5 years, is not but verbally and a couple of times physically abusive, my last ex-husband was mean all alcoholics, dieing of cancer has both of our children, supported by his parents. I have lost the myself and my family and I have social anxiety disorder and major depression, haven't been able to to work since I fell and I am lost finding out that my psychiatrist said that my prognosis is poor and doesn't want me to work. I have not filed for disability benefits or workman's compensation when I should have. So I talk to representatives about this topic and I get paperwork but don't follow up. I don't want to be disabled. I want to find myself and pay for my car and phone, rent and bills, I am afraid on medical insurance through the state. I just wanted to be happy and healthy. Enjoy my family, my 15 year old son won't talk to me. There is so much more, but I don't have any money, ashamed of my self,and life and don't know what to do. I get up do my chores go on interviews and, no call backs, I am just wanting to be me, and I need help, but now just lost, I don't want it to be true that the doctors say my prognosis is poor. Any suggestions on self help or something

Richard J ONeill from Bangkok, Thailand on June 27, 2016:

Great hub, well written, and some useful information there.

I think I may have suffered from both depersonalization and derealization before, and I know I most definitely suffer from anxiety.

As you say, the root cause is trauma from childhood.

I would sit and cover my ears in my room upstairs as my mum and dad screamed the house down, and then there was always the fear of the door opening and more abuse raining down on me.

I still suffer today because of that.

Great tips. Thank you. :)


Ashley Ferguson from Indiana/Chicagoland on February 06, 2016:

Interesting topic. Hoping there is an end one day to depression and anxiety. :(

HaddieHope on February 06, 2016:

Thank you for this article! I always wondered why I felt calmer looking in the mirror.

Lisa VanVorst from New Jersey on February 06, 2016:

This was a very educational hub. I believe we all at one time or another suffer from anxiety, however for some it is severe. I do not believe that society should all be placed on medications as you said these medications can be very addictive and going off them is dangerous and can increase one's anxiety. I do suffer from anxiety and need to take medication. However I take a very low dose and none of which you mentioned above. I also have recently been diagnosed with seizures and for the remainder of my life will have to take medication. Some people I know have Post Traumatic Stresss Disorder and are on anxiety medications as well. Doctors need to find ways to decrease symptoms of anxiety without medication. However I also know people who do not take any type of medication and their anxiety is out of control. So I feel the care our doctors give up should be personalized, not generalized. Thank you for this hub. I am sure it will guide people with anxiety in the right direction.

Nigel789 on February 05, 2016:

Just like some countries have Suicide Hotlines, wouldn't it be nice (but probably totally unrealistic) to have Depression Hotlines.

I have no one to talk to when depressed, DP, DR or anything else.

Andrei Andreescu from Seattle, Washington on December 06, 2015:

Well done.I think this hub might help many people with anxiety.I did not suffer from anxiety but I had been through neuro-gastric eating disorders such as bulimia and binge eating disorder.

Shannon on August 26, 2015:

Thank you for this articlethese coping skillsI have been dealing with this dp for about 4 weeks and im praying it gos away ... I am also very sensitive to light and everything looks so unreal when I go outside it really scares me or from bipolar 2 general anxiety disorder and post traumatic stress disorder .....i just want it to end

Susan Trump from San Diego, California on May 22, 2015:

Nice article. Many deserved comments. Sounds like you are reaching an audience that needed hearing from you. I'm curious to know how you include the references in blue back to your other articles.

meloncauli (author) from UK on October 12, 2012:

Thanks for your comment time2rite! I shall look out for your articles with interest :)

Kathryne Waller from Knoxville, TN USA on October 11, 2012:

Wow, wow, wow! You have hit the nail on the head with this one.

I am a sufferer of panic disorder, OCD, and depression. I have experienced the derealization and depersonalization, and it is quite scary and unsettling.

I began a hub tonight called "My Trip Through Grief." This is but a first of many installments I will be posting which will chronicle how I am coping with this disorder along with becoming divorced.

I'm glad you chose this topic and you have explained quite clearly just how bizarre these feelings can be. Your tips to cope I have found myself doing, especially the night of my final hearing...I stood before the mirror touching my face and hair while looking at my reflection; subconscious way of coping I had no idea was the very thing I needed to do.

Great hub!

meloncauli (author) from UK on October 08, 2012: