Skip to main content

What Keeps Depersonalization And Derealization Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Depersonalization and Derealization Going? is designed to help clients experiencing depersonalization and derealization understand more about their condition.

Download or send

Choose your language

Professional version

A PDF of the resource, theoretical background, suggested therapist questions and prompts.

Client version

A PDF of the resource plus client-friendly instructions where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Translation Template

Are you a qualified therapist who would like to help with our translation project?


Languages this resource is available in

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

Problems this resource might be used to address

Techniques associated with this resource

Introduction & Theoretical Background

It’s normal to have brief experiences of depersonalization and derealization, but if they become regular, more severe, and interfere with your ability to live your life, you may be suffering from depersonalization-derealization disorder. Symptoms of depersonalization and derealization include:

  • You feel remote and detached.
  • Your emotions feel numbed or superficial.
  • The world feels unfamiliar or artificial.
  • Images and sounds are distorted.
  • You know these experiences aren’t felt by other people, and aren’t caused by real changes in the world.
  • Your body feels numb, weightless, or hollow.
  • You struggle to concentrate.
  • You keep thinking about what is real and what isn’t.

The psychological treatment for depersonalization and derealization that has the strongest research support is cognitive behavioral therapy (CBT). CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. 


In 2003, Elaine Hunter and her colleagues at the Institute of Psychiatry in London published a model of depersonalization and derealization, which explains the ‘parts’ that make its symptoms more distressing for some people. The What Keeps Depersonalization and Derealization Going? information handout describes some of the key factors which act to maintain depersonalization and derealization. It illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes is an essential part of cognitive therapy for depersonalization and derealization. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

Therapist Guidance

“One interesting way of thinking about depersonalization and derealization is to look at why, for some people, they do not get better by themselves. This handout shows some of the most common reasons why some people keep experiencing symptoms of depersonalization and derealization. I wonder if we could look at it together and think about whether it describes some of what is happening for you?”

References And Further Reading

  • Blanke, O. (2012). Multisensory brain mechanisms of bodily self-consciousness. Nature Reviews Neuroscience, 13(8), 556-571.
  • 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.
  • Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. Biological Psychiatry, 44(9), 898-908.