The distance between you and yourself: understanding depersonalisation disorder Premium

The distance between you and yourself: understanding depersonalisation disorder Premium

Imagine waking up one morning to find the world around you feel unreal. Your hands move, but they don’t feel like yours. The sounds of daily life seem distant, as if coming from another room, even another world. The world, once vivid and textured, appears distant and dreamlike. For many with a particular mental health condition, this isn’t just an abstract idea — it’s their reality.

Depersonalisation and derealisation disorder (DPDR) is a mental health condition where individuals experience persistent feelings of detachment from themselves or their surroundings. DPDR often emerges during periods of acute stress, trauma, or anxiety, says Thomas John, a psychiatrist in Kochi. “Individuals with DPDR often describe feeling as if they are watching themselves from outside their body. There is a sense of estrangement from one’s thoughts, and the surrounding environment may appear distorted or unfamiliar,” he says.

Although fleeting sensations of depersonalisation are not uncommon — many people experience a sense of disconnect after long or stressful days — persistent symptoms that interfere with daily life indicate a deeper concern. The disorder is estimated to affect 1 to 2% of the population, predominantly youngsters.

According to U. Vivek, consultant psychiatrist, Renai Medicity, Kochi, DPDR rarely occurs in isolation. “The condition is just the tip of the iceberg. It often signals an underlying mental health condition, such as depression, borderline personality disorder, and post-traumatic stress disorder. DPDR can also be triggered due to severe stress, trauma, anxiety disorders, depression, and substance use. The disorder is a symptom, not a standalone diagnosis,” he adds.

Dr. Vivek recalls a case of a young woman who reported feeling increasingly disconnected from herself over time. “She described looking in the mirror and feeling as though she was seeing a stranger. On the surface, her life appeared stable — she had a steady marriage and a comfortable home. However, familial tensions, particularly with her in-laws, created an undercurrent of stress. During arguments, her symptoms worsened. Medication and behavioural management helped her understand how unresolved emotional conflict contributed to her condition,” says Dr. Vivek.

In another case, a teenage girl sought help for persistent feelings of detachment. Later, it emerged that she had been silently enduring sexual abuse. “Her mind had created a psychological barrier as a means of coping with trauma,” says Dr. Vivek. “Dissociation became her refuge, but with careful intervention, she began to reconnect with herself and the world around her.”

Neuroscientific research attributes DPDR to disruptions in brain regions responsible for emotional regulation and sensory perception, including the prefrontal cortex and amygdala. These areas govern how we process stress and interpret reality.

Symptoms of DPDR include a sensation of being in a dream or fog; the world appears flat, colourless, or artificial; distortions in visual perception, with objects appearing either blurred or unusually sharp; sounds that seem either amplified or muted; and an altered perception of time, which may seem to move too fast or too slow

The condition has featured in a few movies too. In the 2007 film Numb, the protagonist — a screenwriter — played by actor Matthew Perry, suffers from the disorder. Similarly, Jonathan Caouette’s documentary Tarnation delves into his encounters with depersonalisation.

“Despite its unsettling nature, DPDR is neither a specific sign of psychosis nor insanity. However, those affected by the disorder often feel isolated. Friends and family may dismiss the symptoms as mere overthinking or stress, which can worsen the individual’s sense of alienation,” says Dr. Thomas. 

According to experts, DPDR is treatable. “Treatment often involves addressing the root cause — whether it be anxiety, trauma, or depression. Medication and behavioural management is effective in treating the condition,” says Dr. Vivek.

Simple exercises designed to re-anchor individuals to their environment are helpful during episodes. These can include: holding textured objects, breathing exercises, and describing immediate surroundings aloud.

In some cases, medication may be prescribed to manage co-occurring anxiety or depression.

For those experiencing DPDR, timely intervention is crucial. “Seeking professional help can make a significant difference. With the right treatment, individuals can regain a sense of connection and fully engage with life,” adds Dr. Thomas.