Most people, most of the time, navigate reality without giving it a second thought. We move through our lives with a sense of flow and integration. The big questions of philosophy and existentialism are usually left for introspective moments, away from the daily distractions of life.

But what if that were flipped on its head, and life was a constant feeling of disintegration, of being cut off from reality, of questioning your existence? At any given time, that is the daily experience for up to 2 per cent of the population (based on epidemiological data from Germany), who live with ongoing and unwanted feelings of unreality, also known as depersonalisation disorder.

The momentary experience of depersonalisation is defined as a feeling of unreality, a sense of detachment from the self. A closely related but lesser-used term is derealisation, which is the sense that the world isn’t real. Depersonalisation is often described as feeling like you’re ‘in a dream’ or ‘not really there’. It’s actually not that uncommon to experience such feelings: up to 75 per cent of people will do so at least once in their lives, but for most of them the sensations will be fleeting. If you’ve ever been severely jetlagged or sleep-deprived, there’s a good chance that you will have experienced transient depersonalisation.

Psychologists have proposed that feelings of unreality are also used by the brain as a protective mechanism against psychological trauma, which would explain why feelings of dream-like detachment are so often reported in the aftermath of traumatic events, such as violence or disaster. Think of it like an airbag for the mind. For the most part, those feelings fade away along with the anxiety or perceived trauma that caused them.

More rarely, according to a theory developed by the neuropsychiatrist Anthony David at University College London and his colleagues, when those protective feelings of unreality are incorrectly interpreted as being dangerous (for instance, provoking worries about going crazy), they can generate a feedback loop with the anxiety that’s causing them. The depersonalisation can then persist for much longer than the trigger incident and become depersonalisation disorder (DPD), currently classified by psychiatry as one of several ‘dissociative conditions’, along with dissociative identity disorder and dissociative amnesia (it’s important to note that the latter two are very distinct from and more severe than DPD, and while they too involve feelings of detachment, in other respects they are experientially and symptomatically vastly different).

‘Between 70 to 80 per cent of people will say that they’ve felt depersonalisation, looking back on their lives,’ says David. ‘[I]t was usually a point of stress or fatigue … so it’s a normal response. But if you start interpreting that like “my brain is gone” or “I’m going to be like this forever”, that feeds into a cycle of anxiety that perpetuates the situation.’

The physiological causes and correlates of depersonalisation are not entirely understood. However, brain scans of people diagnosed with depersonalisation disorder have found that they show reduced activity in parts of the brain involved in processing emotions (including the amygdala and hippocampus) in response to emotional pictures or when memorising emotional words, as compared with controls. In evolutionary terms, this emotional blunting might have been useful in life-or-death situations as it suppresses the paralysing terror associated with mortal danger. However, when this blunting becomes chronic it could contribute to the problems of detachment and unreality associated with depersonalisation disorder.

I’ve experienced chronic feelings of depersonalisation first-hand. It began in 2005 after I suffered a massive panic attack that seemingly hit me out of nowhere. I had the sensation that I was suddenly disconnected from the world around me, like a pane of glass had slid between me and reality. It was terrifying. And though the panic attack subsided, I was left with lingering anxiety and later diagnosed with depersonalisation disorder that lasted two years.

Panic attacks and accumulated stress are known as common triggers of depersonalisation disorder, alongside trauma. In fact, around 30 per cent of people who suffer from recurrent panic attacks – often precipitated by relatively mundane situations (eg, being in a crowded bus or shop) – will report feeling depersonalised in the course of the attack. For them, the feelings of depersonalisation come and go with the panic. More rarely, the feelings of unreality persist even after the panic has subsided.

In the case of stress, essentially the same overwhelming sense of detachment that can occur in the aftermath of a serious motor accident can also be triggered by the stress that accompanies difficult life events, such as grief, divorce or a job loss.

Yet another common cause of depersonalisation is recreational drug use. While drugs can often provide pleasurable sensations, a bad drug experience can be intensely frightening. The fears of ‘dying’ or ‘going crazy’ can be interpreted by the brain as a major traumatic event, triggering the protective mechanism of depersonalisation.

Looking back on my own experience of depersonalisation, I realised later that the panic attack maybe hadn’t come out of nowhere. I had been prone to anxious thinking, I was highly self-critical. And, crucially, I’d had a very frightening experience with strong cannabis a few weeks earlier, which had left me very shaken.

In fact, depersonalisation disorder can often be triggered by a single bad drug experience. ‘Cannabis may be connected with the onset of depersonalisation,’ says Anna Ciaunica, a philosopher and cognitive scientist who studies the condition. It’s especially an issue among younger people. ‘[W]hen you’re young, you have a lot of stress. You have your exams, you want to move out of your house. You have potentially a lot of triggers which in itself is a lot to take. And we know that, at that age, the brain is still developing,’ she says. When the developing brain encounters potent, high-THC weed (containing high levels of tetrahydrocannabinol, the main psychoactive compound), the experience can be overwhelming, triggering panic attacks and depersonalisation. If the feelings of depersonalisation persist after the drug experience, it can often lead to the mistaken conclusion that the person is ‘still high’, even after the drug is out of their system.

‘Maybe 20 per cent of people will say that depersonalisation started from drug use, most commonly cannabis,’ says David. ‘And often you hear the story that “I’ve used cannabis for ages, it’s always been fine. And then there was this one time, and I thought it would go, but it’s just stuck with me.”’

Whatever the cause of momentary depersonalisation, it is when the feelings of unreality become present throughout your day-to-day life that you might be given a diagnosis of depersonalisation disorder, as I was. I found this period of my life incredibly distressing and others with the diagnosis have told me it was the same for them. It felt like a literal existential crisis. My fear of going crazy was near-constant, as were intrusive thoughts about consciousness, the nature of reality, and solipsism. I thought at different times that I had died, that I was in a coma, that I was dreaming and couldn’t wake up.

‘The fear of losing your mind is very common, and can lead to a vicious circle, to make the person even more anxious and frightened,’ says David. ‘Checking all the time, am I going mad, looking in the mirror, asking people “Do you think I’m OK?” – and to the outside observer, you look fine.’

For this Guide, I’ve consulted experts and drawn on the latest mental health advice, and my own experiences, to provide you with some basic practical steps on how to cope with feelings of unreality or depersonalisation, specifically those arising due to anxiety and bad drug experiences. Feelings of unreality can also be triggered by physical illness and injury, such as concussion, head injuries and in transient form from conditions such as Ménière’s disease and temporal lobe epilepsy, and I do not deal with those conditions here. While I hope this Guide will be helpful, it’s not a substitute for professional medical advice. This fact sheet from the British Medical Journal is an excellent source of further medical information. If you have any ongoing concerns or issues, I strongly recommend you consult with your doctor.

Recognise the feelings

One of the main reasons that feelings of unreality can persist is simply the misunderstanding of what they actually are. In the same way that heart palpitations are often incorrectly interpreted as heart attacks, the feelings of unreality that occur with anxiety can be interpreted as ‘going crazy’, generating a feedback loop between the depersonalisation and the anxiety that’s causing it. Recognising the feelings as a normal and harmless part of the fight-or-flight response can help you stop that feedback loop and allow the feelings to fade away naturally. The good news is that, in its transient form, depersonalisation is an odd, but only momentary sensation.

‘Even if it feels that you have lost touch with yourself, and lost control, it’s important to recall it is still you who feels that loss of control,’ says Ciaunica. ‘And that’s good because it means you still have the freedom and agency to do it. And you’re not just depending on a reflex mechanism. You’re a free agent.’

In its chronic form, depersonalisation is a profoundly bizarre and frightening experience. People diagnosed with the condition have described it as feeling as if:

• they’re seeing the world from behind a pane of glass;
• their head is full of cotton wool
• they’re stuck in a dream;
• they or the people around them aren’t real or are like ‘robots’;
• their perception of time is altered;
• their vision is ‘off’ or ‘changed’; or
• time has been changed or sped up.

It’s also very common to experience:

• intrusive existential and philosophical thoughts;
• emotional numbness;
• a ‘blank mind’, or the feeling of having no thoughts; or
• memory issues.

If you’ve been having such feelings over a sustained period of weeks or months, I would advise you to seek professional support.

Reality testing is a positive sign, but try to avoid constant checking

When a person experiences psychosis, they will usually lack insight into their symptoms – that is, they believe their hallucinations or paranoid delusions are literally real. With depersonalisation, by contrast, people usually have more insight and awareness of what’s actually happening. For instance, if you are experiencing depersonalisation, you might describe your symptoms with ‘as if’ phrasing, such as:

• ‘It feels as if I’m stuck in a dream.’
• ‘It’s as if time is speeding up.’
• ‘It feels as if the people around me are robots.’

While these thoughts and feelings might be frightening, it’s important to remember that the ‘as if’ nature of your thoughts indicates that your ‘reality testing’ remains intact – and that’s a good sign.

‘The person still has that objectivity to know that “it’s just the way I’m feeling”. It’s not really like that, but that’s how it feels,’ says David. ‘The rational awareness of the strangeness of the experience can add to the fear of it. But in actual fact, this awareness is a positive thing, and a sign that what you’re experiencing is not as severe as other conditions.’

The problem becomes more serious if you find it difficult to stop reality checking. A person with a diagnosis of depersonalisation disorder might end up concluding that they have a ‘blank mind’. They will often report visual symptoms such as visual snow, floaters and tracers. Even though these can be attributed to the effects of the fight-or-flight response (dilated pupils, light sensitivity), the sufferer will often catastrophise that it’s part of ‘going crazy’.

The risk is that you end up feeling overwhelmed by the symptoms and unable to participate in or enjoy daily activities or socialising. ‘The constant checking becomes a problem,’ says David. ‘Thoughts like: “Am I really feeling this? Are these really my hands in front of me?” … can become a source of rumination and preoccupation that makes things worse. And what often happens is that people get very self-conscious and they avoid social situations, which of course makes you feel even more isolated.’ Again, if your problems have escalated to this level, I encourage you to consult a medical professional.

Don’t fight the feelings, focus on other activities

As with all intrusive thoughts, you might experience a strong temptation to try to push away your feelings of unreality. Unfortunately, if you do this, you’ll likely to run into a phenomenon that the psychologist Daniel Wegner in 1994 dubbed ‘ironic process’, in which attempts to suppress certain thoughts actually make them more likely to occur.

Try to pose for yourself this task: not to think of a polar bear, and you will see that the cursed thing will come to mind every minute.
– from the essay ‘Winter Notes on Summer Impressions’ (1863) by Fyodor Dostoevsky

In trying to push the thoughts and feelings away, you are inadvertently acknowledging and empowering them. It’s like having an annoying song stuck in your head; thinking about the song in either positive or negative terms is futile. Instead, you should focus away from it altogether, the classic solution being to simply listen to other music. What you soon realise is that the only reason the song was stuck in your head in the first place was because you were worried about the song being stuck in your head.

In that same sense, gently turning your attention away from the thoughts of depersonalisation can help you contextualise them as being innocuous, and allow them to fade away naturally. Remember that, for the vast majority of people who experience depersonalisation, the feelings are brief and fade away naturally. They might later recall the experience as ‘feeling dreamy’ but little more than that.

Practise grounding techniques

This process of redirecting your attention to other activities is effective regardless of how long depersonalisation has been present. The thoughts might seem urgent and distressing, but the simple act of focusing away from them towards the outside world (known as ‘grounding’), such as via conversation, reading, work, radio, nature, learning, can be very effective. Here are some grounding techniques that I found most effective for reducing my own depersonalisation:

• Sound and vision

Focus on engaging stimuli around you. Watch your favourite TV show. Do puzzles such as crosswords and sudoku. If you’re reading a book, read it out loud. You might have specific images or videos that you find relaxing, diverting or inspirational. For me, I made sure I had a portable games device to hand and lots of podcasts and music loaded on my phone.

• Breathing

Simply being aware of your breathing can be a great tool in reducing levels of anxiety and its symptoms, including depersonalisation. There are various breathing techniques for grounding yourself during anxiety, but an easy-to-remember method is simply to inhale for a count of six seconds, then exhale for the same. Don’t rush, continue this for up to 10 minutes if you can, and you will hopefully find it calming.

• Learning

One technique I found to be very helpful was focusing on learning a new skill. This could be a new language, a song on the guitar, or anything that you find interesting and enjoyable. When actively learning, you are even more involved than if you were passively watching something. The focus and concentration involved in learning a new skill is an excellent way to stay grounded.

Consider taking up regular exercise

For me, a good exercise routine was a vital part of recovery from depersonalisation. Going to the gym felt stressful at first; in the midst of intense anxiety and feelings of unreality, going to a brightly lit, busy sports club was the last thing I wanted to do. But the routine and strength, both physical and mental, I gained from it were hugely beneficial.

Exercise releases endorphins and generates a strong sense of accomplishment. It also promotes socialising, and the change in environment alone can help to break negative thought patterns.

If possible, start off by doing a minimum of 15-30 minutes of exercise per day. Ideally, make some of this outdoor cardiovascular exercise, such as running or cycling. This will also help to tire you out and maintain healthy sleep patterns. Then, as best you can, start building up to a more intense exercise regime and sign up for a gym membership if possible.

Avoid potential depersonalisation triggers

The steps I’ve mentioned already will hopefully help you cope with feelings of unreality as they emerge, but it also makes sense to address your lifestyle to make it less likely that such feelings will arise in the first place. For that reason, I recommend avoiding the following, at least until you’re fully recovered:

• Caffeine

Many people misinterpret feelings of depersonalisation as a sign of tiredness. The person might also feel like they’re ‘living in a dream’ (at the same time, they might be experiencing insomnia or fitful sleep). So they drink coffee or caffeine-rich soft drinks in order to ‘wake up’. However, this is a bad idea because caffeine tends to increase anxiety levels, which in turn can increase feelings of depersonalisation.

• Recreational drugs, including cannabis

As with all anxiety-based conditions, it’s a good idea to avoid any and all drugs, at least until you are fully recovered. This is especially true with drug-induced depersonalisation, since there can be a strong anxious association with the drug that could trigger more anxiety. Cannabis is generally (and correctly) regarded as a relaxant, but it’s best avoided in the context of recovery from depersonalisation.

• Constant research

Researching depersonalisation and its associated symptoms online, with guides such as this, can provide you with some much-needed initial clarity and advice. However, be mindful that this can turn into its own problem if it develops into obsessively searching through forums and groups. As with all anxiety-based conditions, depersonalisation needs space in which to dissipate. Logging on to forums and groups each day, comparing symptoms and discussing the condition exhaustively can be counterproductive to that goal.

Specific advice following a bad experience with a recreational drug

As the legalisation of cannabis continues around the globe, drug-induced depersonalisation disorder is becoming more common and widely known in the medical community. The experience usually sounds something like this: you’ve had a bad experience on weed, LSD etc, maybe even had a panic attack while high, and now you are experiencing feelings of depersonalisation hours or days later. Here are some tips for this specific scenario:

• Don’t panic

There can be a strong urge to jump to scary conclusions such as ‘I’m still high and I’ll never come down’ or ‘I’m going crazy.’ These catastrophic thoughts are the result of anxiety, so take comfort that those things are not actually happening. You are not still high, you’re not going crazy, and you’re not in danger.

• Remember: the drug is out of your system

Remember that the ongoing sensation of disconnection is not being caused by the drug. The drug has not permanently affected your perception: at a physiological level, once it’s out of your system, it’s out of your system. The feelings of unreality you’re experiencing are part of your body and brain’s natural, evolved response to stress and anxiety.

• Don’t take more drugs

People sometimes assume that since this happened while on a specific drug, taking more of that same drug might be a way to stop the feelings. Unfortunately, this can often increase anxiety levels and make things worse, so avoid this course of action.

The Unreal charity homepage. Unreal is a UK-based charity that raises awareness of depersonalisation and derealisation disorder, and provides online resources.

The DPD Diaries YouTube channel offers a helpful and informative series of videos presented by Joe Perkins, a trustee of the Unreal charity, who has first-hand experience of depersonalisation disorder. He uses his channel to discuss various aspects of the condition.

The British Medical Journal’s infographic for assessing the severity of depersonalisation symptoms. If you are planning to seek professional help, you might find it useful to share this with your doctor, if you feel it is appropriate.

The book Life on Autopilot (2021) by Joe Perkins. Advice and insight on depersonalisation disorder based on the author’s own experiences and the input of medical experts.

My own book, The DP Manual (2007), which is a guide to recovery based on my experience with depersonalisation disorder. It also includes a more extensive list of tips on preventing drug-induced depersonalisation.

Finally, the book Overcoming Depersonalisation and Feelings of Unreality (2nd ed, 2018), which is a cognitive behavioural therapy-based guide to overcoming depersonalisation, co-authored by Anthony David.