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Understanding Depersonalization And Derealization

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are comprehensive sources of information for your clients. Concepts are explained in an easily digestible way, with plenty of case examples and accessible diagrams. Understanding Depersonalization And Derealization is designed to help clients who experience depersonalization and derealization to understand more about their condition.

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A psychoeducational guide. Typically containing elements of skills development.


Languages this resource is available in

  • English (GB)
  • English (US)
  • Spanish (International)

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Introduction & Theoretical Background

At some point in their lives (usually when they are tired or when their body or mind is under stress) most people have at least one experience of feeling detached from themselves, or from the world. Feeling detached from yourself is called depersonalization: you might feel like you are dreaming, or watching yourself through glass. Feeling detached from the world around you is called derealization: the world seems unfamiliar or artificial. It’s normal to have brief experiences of depersonalization and derealization. If they become regular, more severe, and interfere with your ability to live your life, you may be suffering from depersonalization-derealization disorder. It is thought that 1 or 2 people in every 100 will experience depersonalization-derealization disorder, and people often suffer with the symptoms for a long time before seeking help. Fortunately, cognitive behavioral therapy is a helpful treatment for depersonalization and derealization. This guide will help you to understand:
  • What depersonalization and derealization are.
  • Why depersonalization and derealization might not get better by themselves.
  • Treatments for depersonalization and derealization.

Therapist Guidance

Our ‘Understanding…’ series is designed to support your clients:
  • Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
  • Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
  • De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
  • Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
  • Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.
Each guide includes:
  • Case examples to help your clients relate to the condition, and to normalize their experiences.
  • Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
  • A symptom questionnaire for screening assessment.
  • An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
  • A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

References And Further Reading

  • Baker et al (2003) Depersonalisation disorder: clinical features of 204 cases. British Journal of Psychiatry, 182, p428-433.
  • Blanke, O. (2012). Multisensory brain mechanisms of bodily self-consciousness. Nature Reviews Neuroscience, 13(8), 556-571.
  • Dewe, H., Watson, D. G., & Braithwaite, J. J. (2016). Uncomfortably numb: new evidence for suppressed emotional reactivity in response to body-threats in those predisposed to sub-clinical dissociative experiences. Cognitive Neuropsychiatry, 21(5), 377-401.
  • Hunter, E. C. (2013). Understanding and treating depersonalisation disorder. In Cognitive behavioural approaches to the understanding and treatment of dissociation (pp. 160-72). Routledge Press.
  • Hunter, E. C., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour Research and Therapy, 43(9), 1121-1130.
  • Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: a cognitive–behavioural conceptualisation. Behaviour Research and Therapy, 41(12), 1451-1467.
  • Hunter, E.C.M., Salkovskis, P.M. & David, A.S. (2014) Attributions, appraisals and attention for symptoms in depersonalisation disorder. Behaviour Research and Therapy, 53, 20-29.
  • Lewis, G. C., Platts-Mills, T. F., Liberzon, I., Bair, E., Swor, R., Peak, D., … McLean, S. A. (2014). Incidence and Predictors of Acute Psychological Distress and Dissociation After Motor Vehicle Collision: A Cross-Sectional Study. Journal of Trauma & Dissociation, 15(5), 527–547.
  • Medford, N., Sierra, M., Baker, D., & David, A. S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11(2), 92-100.
  • Myers, D. H., & Grant, G. (1972). A study of depersonalization in students. The British Journal of Psychiatry, 121(560), 59-65.
  • Noyes Jr, R., & Kletti, R. (1976). Depersonalization in the face of life-threatening danger: A description. Psychiatry, 39(1), 19-27.
  • Roydeva, M. I., & Reinders, A. A. (2020). Biomarkers of pathological dissociation: a systematic review. Neuroscience & Biobehavioral Reviews, 123, p.120-202
  • Schauer, M., & Elbert, T. (2010) Dissociation following traumatic stress. Zeitschrift fur Psychologie/ Journal of Psychology, 218(2), p.109-127.
  • Sierra, M. (2008). Depersonalization disorder: pharmacological approaches. Expert Review of Neurotherapeutics, 8(1), 19-26.
  • Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. Biological Psychiatry, 44(9), 898-908.
  • Sierra, M., Medford, N., Wyatt, G., & David, A. S. (2012). Depersonalization disorder and anxiety: a special relationship?. Psychiatry Research, 197(1-2), 123-127.
  • Simeon, D. & Abugel, J. (2006) Feeling Unreal: Depersonalization Disorder and the Loss of the Self. Oxford University Press, UK.
  • Simeon, D., Guralnik, O., Schmeidler, J., Sirof, B., & Knutelska, M. (2001). The role of childhood interpersonal trauma in depersonalization disorder. American Journal of Psychiatry, 158(7), 1027-1033.
  • Van der Kolk, B. A., & Van der Hart, O. (1989). Pierre Janet and the breakdown of adaptation in psychological trauma. American Journal of Psychiatry, 146(12), 1530-1540.