Depersonalization-derealization disorder (DPDR) is a dissociative condition characterised by persistent or recurrent experiences of feeling detached from one's own mental processes or body — as if observing oneself from the outside — and/or feeling that the surrounding world is unreal, distant, dreamlike, or artificially constructed.
These experiences are among the most disorienting and difficult to describe in psychiatry. Patients frequently report that they cannot explain what is happening to them, that ordinary language does not capture their experience, and that people around them — including clinicians — do not understand or believe what they are going through. This difficulty in being understood often adds significantly to the distress the condition itself causes.
DPDR is more common than is often recognised and is frequently misdiagnosed or dismissed. Many patients spend years in the medical system without receiving a correct diagnosis.
Depersonalization refers to detachment from one's own mental processes, thoughts, emotions, body, or sense of self. Patients describe feeling like an outside observer of their own thoughts and actions — watching themselves in a film, performing on autopilot without a sense of presence. Emotional numbing is common — feelings seem flat, distant, or inaccessible even in situations that would ordinarily produce a strong emotional response.
Derealization refers to the experience of the external world as unreal, dreamlike, distant, foggy, or visually distorted. Familiar environments feel strange. Objects may appear flat, colourless, or unnaturally sharp. Time feels altered. Other people may feel like automatons rather than living beings.
In DPDR, these experiences are persistent or recurrent, cause significant distress or functional impairment, and — critically — the person retains insight throughout: they know that what they are experiencing is a change in perception, not objective reality. This preserved insight is what distinguishes DPDR from psychosis, and it is clinically important.
DPDR is classified in DSM-5 and ICD-11 as a dissociative disorder. It may present as a primary condition or as a symptom within anxiety disorders, PTSD, depression, panic disorder, and personality disorders. Drug-induced DPDR — most commonly following cannabis use — is also frequently encountered clinically.
Patients often describe feeling like they are in a dream, behind glass, or separated from the world by an invisible barrier. Sensory experiences may feel dulled or distorted. Emotional responses feel blunted or absent. Familiar places, people, and the self feel strange — a phenomenon sometimes described as jamais vu. Memory and concentration difficulties are common.
Many patients experience significant anxiety about their symptoms — particularly fear of going insane or developing psychosis — which can maintain and amplify the experience. The difficulty communicating what is happening and the fear of not being believed contribute substantially to the psychological burden of the condition.
DPDR is underdiagnosed for several reasons. The symptoms are subjective and difficult to describe. Patients often fear their experience sounds strange or that they will be judged. Clinicians unfamiliar with the condition may dismiss symptoms as anxiety or depression. Patients may receive multiple diagnoses before DPDR is identified.
At IsraClinic, DPDR is a recognised clinical presentation. Accurate diagnosis requires a clinician who is familiar with dissociative presentations, takes the patient's subjective experience seriously, and conducts a thorough differential diagnostic assessment.
Assessment includes a comprehensive clinical interview exploring the nature, onset, triggers, and context of dissociative experiences; detailed psychiatric history addressing co-occurring conditions; assessment for trauma history; neurological assessment and where indicated laboratory workup to exclude organic contributions; and careful differential diagnosis — particularly distinguishing DPDR from psychotic disorders, derealization within anxiety or panic, and drug-induced dissociative states.
DPDR does not have a single evidence-based first-line treatment. What works varies substantially between individuals depending on aetiology, co-occurring conditions, and the patient's psychological profile.
Psychotherapy is the primary treatment modality. CBT adapted for DPDR reduces secondary anxiety about symptoms and the cognitive patterns that maintain dissociative states. ACT — with its emphasis on acceptance of difficult internal experiences — is particularly well-suited to DPDR. Where trauma is a contributing factor, EMDR is indicated.
Mindfulness-based approaches require careful application in DPDR — for some patients, focused attention on internal experience amplifies dissociation rather than reducing it, and the approach must be individualised.
Where DPDR is a symptom of an underlying condition, treating the primary condition is the most direct therapeutic pathway.
Pharmacotherapy has a limited evidence base specifically for DPDR but may be indicated for co-occurring anxiety, depression, or other conditions. Medication is prescribed individually. Digital prescriptions are issued through the Yarpa system.
All treatment is delivered within the framework of the Psychoergonomic Method.
If you are experiencing persistent feelings of unreality, detachment from yourself or your surroundings, or a sense that the world has become dreamlike — particularly if causing significant distress or affecting your ability to function — professional assessment is appropriate.
DPDR is a recognisable and treatable condition. Receiving an accurate diagnosis is itself frequently a significant source of relief for patients who have spent years without an explanation for their experience.
IsraClinic accepts patients for in-person consultation in Tel Aviv and online, in English, Russian and Hebrew. No referral is required.
Clinical Reviewer: Dr. Mark Zevin, MD — Senior Psychiatrist | IsraClinic | Last reviewed: 2026
If the world feels unreal or you feel disconnected from yourself — you are not alone and this is not imaginary. Help is available in English, Russian and Hebrew.