Does Depersonalization/Derealization Disorder Ever Go Away?

Having depersonalization/derealization disorder can make life feel as though you are on autopilot, stuck in a dream from which you can't wake. These feelings can be deeply disturbing, especially when they're recurring or long-lasting.

Depersonalization is a sensation similar to an out-of-body experience. When you're depersonalized, you feel as if you're watching yourself go through the motions from a distance, disconnected from yourself and your feelings. Derealization, on the other hand, occurs when a person feels disconnected from and unfamiliar with their surroundings.

Luana Bessa, a licensed psychologist who specializes in trauma work at Bela Luz Health, a behavioral health organization she founded in Boston, Massachusetts, said both depersonalization and derealization fall under the larger umbrella of dissociation.

"In the case of depersonalization, an individual feels disconnected from their bodily experiences," Bessa explained. "They may feel an inability to access their own emotional or physical experiences, feel numb or confused, feel that they are looking at themselves from above or behind, have difficulty accessing their own thinking processes, and may even feel like physical parts of themselves are disconnected."

"In the case of derealization, an individual feels disconnected from their experiences of the outside world," she continued. "They may feel as though they're in a bit of a funhouse, with external stimuli seeming to shift proportion or feeling 'dreamlike.' Individuals can experience one or both."

It's not uncommon to have fleeting sensations of depersonalization or derealization, but if you experience persistent or recurrent episodes, you may have depersonalization/derealization disorder. According to the Mayo Clinic, those episodes can vary in length ranging from hours to days or even months.

Researchers do not yet fully understand the causes of depersonalization/derealization disorder. However, some theorize that individuals who have experienced severe trauma or stress, or who have substance abuse issues, certain personality traits or a history of anxiety and depression may be at a greater risk for developing the disorder.

"In my work with individuals experiencing symptoms of dissociation, it is most often in the context of a history of complex trauma—meaning prolonged trauma over years in childhood/adolescence—or multiple traumatic experiences that layer over each other to produce complex post-traumatic stress symptoms," Bessa said.

Trauma, she added, refers to situations that overwhelm an individual's emotional, cognitive or relational coping resources. These situations can range from single or multiple instances of physical or sexual abuse and neglect, to experiencing military combat or even a car accident. When a person experiences trauma, their bodies naturally activate a fight-or-flight response.

"When we're not able to fight off a threat physically or flee from a threat physically, we may flee from the threat mentally and emotionally through a dissociative response," Bessa noted. "We may do so in the moment of experiencing the trauma, and we may also find ourselves returning to that dissociative state after the trauma if something in our environment or mind triggers any association to the trauma, consciously or not. For some of us, we may live in a chronic state of dissociation, or even make conscious efforts to avoid our internal experiences because we find them overwhelming. This leads to a sense of living on autopilot that alternates with feelings of being overwhelmed."

Left untreated, depersonalization/derealization disorder can begin to affect a person's ability to complete daily responsibilities. Because of the feelings of disconnection that come along with the disorder, individuals can also face difficulties maintaining meaningful relationships and may experience anxiety and depression.

Joe Perkins is a trustee of Unreal, a charity based in the United Kingdom dedicated to spreading awareness about depersonalization/derealization disorder, as well as connecting and supporting people who suffer from it. Perkins said he has struggled with chronic depersonalization/derealization disorder himself for the past 14 years. Perkins said most people he meets through his work with Unreal who also struggle with the disorder typically recover from it in a relatively short period of time, especially with professional help.

"But that said, for a lot of people, like me, I've had it solidly for 14 years, and it doesn't seem to be going anywhere at the moment, though I still kind of have that hope," Perkins said. "I've spoken to people who have had it very long-term, it's been chronic, they've kind of given up hope—and they're now completely free of it. So sometimes those feelings may go away on their own, but very often it requires a therapist to kind of look at it and work with them."

Depersonalization/derealization disorder can be isolating because of the feelings of disconnection that characterize it. The symptoms can be difficult to articulate to people who have never experienced it. Perkins explained that although his symptoms were not as severe as they are now when he first developed the disorder, the first few years were the most difficult because he didn't know the name for what he was experiencing. Now he finds comfort in connecting with others who have the disorder through the free peer-support groups facilitated by Unreal.

"I've connected with hundreds of people all over the world who go through exactly the same thing," Perkins noted. "And you have that strange sense of community. When you meet someone on a Zoom call with a charity, for example, you meet 20 people, and you know that even though it's the first time we've ever come face-to-face, albeit virtually, they know what my life is, like, so much more than anybody who's actually in my circle in real life. You know, parents, partners, whoever—they try to understand. But unless you've been through it yourself, you can only get up to a certain level of understanding. People who've lived with it chronically, they know what it's like, and you can have a real conversation with them about it."

Since the disorder causes you to feel disconnected from yourself, both physically and emotionally, it's no surprise that living with the disorder can create complications in romantic relationships and in your sex life. However, with an abundance of communication between you and your partner, and an active effort to get help and find ways to cope with your symptoms, a fulfilling relationship is achievable.

Perkins said communication is the most important key to navigating his long-term romantic relationship while suffering from depersonalization/derealization disorder.

"I think as soon as you need to accommodate any sort of illness into a relationship, you need that two-way dialogue," he said. "And you need to be honest about how you're feeling at any point in time."

So how do you know when it's time to talk to a doctor about your symptoms? According to experts, you should seek help from a mental health professional if your feelings of depersonalization or derealization (or both) either keep returning or don't dissipate at all. You should also reach out for help if your symptoms interfere with your emotional or physical well-being and your overall quality of life.

"Sometimes other people in our lives notice things before we do," Bessa said. "Maybe a teacher or boss is expressing concern about your ability to concentrate or effectively engage with tasks, or your partner is noticing that you seem disconnected. You may notice yourself feeling flat or on autopilot. Or perhaps you realize that you're using substances in order to feel more or less of your emotions.

"If you're unsure whether your symptoms require professional support, it may be helpful to seek a consultation with a mental health professional for guidance," she added. "If there are any concerns about one's safety or the safety of others, I would highly recommend seeking immediate help."

Psychotherapy is the primary treatment for depersonalization/derealization disorder, though medication is sometimes used to manage symptoms caused by the condition, according to the Mayo Clinic.

Bessa noted that psychotherapy treatment should go beyond traditional talk therapy to fully address the issue of dissociation.

"In my clinical practice, I spend a lot of time helping people learn skills for practicing mindful embodiment," she explained. "If dissociation is a feeling of disconnection from oneself and one's experiences in and of the world, as we have discussed, then healing from dissociation looks like consistently practicing reconnecting to oneself and to one's world."

Although reconnecting to your body may be a major goal for someone struggling with depersonalization, it can be a difficult feat to accomplish if your body has historically been in an unsafe place, which is often the case for people with severe trauma histories, Bessa noted.

"Beginning to practice a sense of embodiment takes an enormous amount of courage and patience," she said. "I spend a lot of time building safety and trust in the therapeutic relationship with a client, utilizing that as the foundation for the work of reconnecting with themselves and their bodies.

"Practicing mindfulness through grounding practices, breathing exercises and meditation, as well as engaging in physical activities like running or yoga, can help a person reconnect with both their minds and their bodies," Bessa added. "Healing does not always need to happen in treatment, but treatment can help direct healing in an intentional and guided way, and in the context of a supportive relationship with a knowledgeable provider."