Derealisation and Depersonalisation: The Anxiety Symptoms No One Explains

Derealisation is the experience of the external world feeling unreal, distant, dreamlike, or as though it is behind a pane of glass. Colours may appear washed out. Familiar surroundings may seem strange or two-dimensional. People and objects may appear slightly surreal, as though they are props rather than real.

Derealisation typically increases in intensity during periods of high anxiety or panic and may be persistent in people with chronic anxiety disorders. It is deeply uncomfortable but medically harmless.

Depersonalisation is the experience of feeling detached from one's own body or mind — as though observing yourself from outside, or as though your thoughts and feelings belong to someone else. Sufferers describe feeling like a robot, feeling empty, feeling as though they are watching a film of their own life, or feeling that their own hands and face look unfamiliar.

Like derealisation, depersonalisation is a symptom of anxiety (particularly chronic anxiety and panic disorder) and resolves as the anxiety resolves. It can also be triggered by sleep deprivation, drug use, or extreme stress — all of which lower the threshold of the amygdala.

The mechanism is protective. During extreme anxiety, the brain can enter a dissociative state in which the emotional intensity of experience is dampened — a kind of neurological shock absorber. The perceptual distortions of derealisation and depersonalisation represent this protective dissociation.

At the neurological level, derealisation and depersonalisation appear to be associated with altered activity in the right hemisphere of the prefrontal cortex and the amygdala, in a way that produces a felt disconnection from both internal states and external reality. These changes are functional — not structural — and they reverse as anxiety resolves.

Derealisation and depersonalisation are particularly distressing because they create a sense of existential threat — a fear that the self or reality is dissolving — that intensifies the anxiety that caused them in the first place. This creates a feedback loop: the symptoms cause more anxiety; more anxiety causes more symptoms.

Furthermore, they are poorly understood even by many GPs and junior doctors, who may not be able to explain them reassuringly, leaving sufferers convinced that something catastrophic and rare is occurring.

If derealisation or depersonalisation is new, persistent, worsening or affecting daily life, consider seeking professional assessment rather than assuming it is caused by anxiety. A healthcare professional can discuss possible causes and suitable support. If you feel unsafe or need urgent help, contact local emergency services.