Derealisation and depersonalisation are among the most frightening anxiety symptoms — partly because they are so difficult to describe, and partly because they are so rarely explained by doctors or anxiety resources. Many people who experience them fear they are losing their mind, developing psychosis, or experiencing a neurological emergency. In the vast majority of cases, they are experiencing anxiety symptoms — and they will resolve as the anxiety resolves.
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.
The most important thing to understand about derealisation and depersonalisation in the context of anxiety is that they are symptoms, not conditions. They do not require their own treatment — they resolve as the underlying anxiety disorder resolves.
Many LAR coaches experienced derealisation and/or depersonalisation as part of their anxiety disorder, and are able to speak from direct personal experience about both how frightening these symptoms are and how completely they resolve in recovery. If you are living with derealisation or depersonalisation on the Costa, do not be deterred from seeking support: these symptoms are not signs of serious mental illness, and they can end.