It usually arrives without warning. You are doing something ordinary — crossing a road, sitting in a meeting — and suddenly you are watching yourself do it. Your hands do not feel like yours. Your voice sounds like a recording. The room looks correct and somehow not real.
It can last minutes or weeks. And the first thought most people have is: I am losing my mind.
You almost certainly are not. This has a name, it is well described, and it is more common than its reputation suggests.
Two words for two experiences
Depersonalisation is detachment from yourself. Watching your own actions from outside. Your body feeling unfamiliar, or not quite yours. Emotions feeling muffled or distant. Some people describe it as being a passenger in their own head.
Derealisation is detachment from your surroundings. The world looking flat, two-dimensional, dreamlike or stage-set. Colours seeming off. Familiar places feeling subtly wrong. Sounds arriving as though through water.
They frequently occur together, and people rarely separate them when describing it. The NHS lists depersonalisation-derealisation disorder as one of the three main types of dissociative disorder, and describes dissociation itself as something that can arise as a way of coping.
The reassurance that actually matters
Two things are worth saying plainly, because they are what people are afraid of.
This is not psychosis. In psychosis, a person loses the ability to tell what is real. In depersonalisation and derealisation, you know perfectly well that things are real — that is precisely why it is so disturbing. The insight is intact. The feeling is what has changed.
It is not dangerous in itself. Unpleasant, frightening, sometimes exhausting — but it is not a sign that something is about to happen to you.
Those two sentences resolve a great deal of the distress on their own, which is why they come first.
Why it happens
Anxiety and panic
The most common context. Intense anxiety can produce a sense of unreality, and during a panic attack it is a recognised feature. Unfortunately it then feeds the panic — the strangeness is itself alarming, which raises anxiety, which sustains the strangeness. See panic attack vs anxiety attack.
Stress and exhaustion
Sustained pressure, poor sleep, long exam periods or extended caring responsibilities can all produce it. Many people first experience it during a period they describe afterwards as the hardest months of their life.
Trauma
Detachment is a well-recognised response to overwhelming experience, and can persist long after. See trauma and PTSD treatment.
Depression
Emotional flatness and a sense of distance frequently accompany depression, and can shade into this.
Substances
Cannabis is a common trigger, particularly for a first episode, and the experience can outlast the intoxication by a long way. Alcohol withdrawal and some medications can also be involved.
Physical causes
Less commonly, migraine, inner-ear problems, thyroid disorders, vitamin deficiencies and certain neurological conditions can produce similar sensations. This is one of the reasons an assessment is worth having rather than assuming it is psychological.
The trap that keeps it going
There is a specific loop worth understanding, because recognising it is often the turning point.
You notice the strangeness. It frightens you. You start checking — do I feel real now? what about now? — and monitoring your own sense of reality is itself a form of self-focused attention that makes the strangeness more prominent. You check more. It gets worse.
People can spend months in that loop. The way out is generally not to fight the sensation but to stop interrogating it, which is easier said than done alone and is exactly the kind of thing therapy is good at.
What to do when it is happening
In the moment, the instinct is to check whether you feel real yet. That is the one thing that reliably prolongs it. These work better.
Engage a sense deliberately, without assessing it. Cold water on the wrists. Something strongly flavoured. Bare feet on a cool floor. The aim is not to make the feeling go away — it is to give attention somewhere specific to sit.
Do something with your hands that has a result. Washing up, folding, tidying a drawer. Activity with a visible outcome anchors attention better than trying to relax.
Slow the out-breath. Longer out than in. Where anxiety is driving the episode, this does more than trying to think your way calm.
Let it be there. This sounds like resignation and is actually the active ingredient. The sensation is unpleasant but harmless; treating it as harmless is what eventually stops it commanding attention.
Do not test yourself. No checking whether your hands look right, no staring in mirrors, no asking people whether you seem normal. Every check teaches your brain that this is a threat worth monitoring.
People often report that the episodes shorten noticeably once they stop fighting them — which is frustrating advice to receive and, in practice, the thing that works.
When to get it assessed
- It has lasted more than a few weeks
- It returns regularly
- It is interfering with work, study or relationships
- You are avoiding situations in case it happens
- It began after a head injury, a new medication, or substance use
- There are other neurological symptoms — visual changes, severe headache, weakness, confusion
That last group warrants medical review promptly rather than a psychiatric appointment in due course.
What treatment looks like
Treatment is usually aimed at the cause rather than the sensation. Where anxiety or panic is driving it, treating that typically resolves it — and the National Institute of Mental Health sets out the established approaches for anxiety disorders. Where trauma is involved, trauma-focused therapy is the route. Where a physical cause is found, that is treated.
Talking therapy also targets the monitoring loop directly, which is often what maintains the problem long after the original trigger has gone.
What generally does not help is being told it is nothing. It is not nothing — it is a real symptom with real causes, and dismissing it tends to send people away to keep checking in private.
What to note down before an appointment
This is unusually hard to describe in a consulting room, because the words sound alarming out loud and because the experience often eases while you are sitting there being distracted by conversation. People routinely under-report it as a result.
A few lines written in advance solve most of that. Useful to note:
- When it started, and whether anything coincided — a panic attack, a bereavement, a new medication, a period of very little sleep, cannabis or another substance.
- Whether it is constant or in episodes, and roughly how long an episode lasts.
- What makes it worse. Most people find tiredness, crowded or brightly lit places, screens and caffeine aggravate it.
- What interrupts it, even briefly — cold water, physical activity, being outdoors, talking to someone.
- Whether anxiety comes first or follows. This genuinely helps with the formulation, and it is almost impossible to reconstruct from memory later.
- What you have stopped doing because of it. Avoidance is often the most treatable part.
One phrase worth borrowing if you cannot find your own: "I feel as though I am watching myself from outside, and things around me look unreal. I know they are real." That last clause matters clinically, and it is the part people forget to say.
Frequently asked questions
Does this mean I am going mad?
No. Awareness that things are real is preserved throughout, which is the opposite of what happens in psychosis. The experience is distressing precisely because you can tell something is off.
How long does it last?
It varies enormously — moments during a panic attack, or a persistent background state over months. Duration mostly reflects the underlying cause and how much the monitoring loop has taken hold.
Can cannabis cause this?
Cannabis is a recognised trigger, including for episodes that continue well beyond the intoxication itself. If it started after use, say so at assessment — it changes the picture.
Will it go away on its own?
Episodes tied to a brief period of stress often settle. A state that has persisted for months, with checking behaviour established, usually needs something to interrupt it.
Is medication needed?
Not usually for the sensation itself. Where an underlying anxiety or depressive disorder is being treated, medication may form part of that, but therapy is commonly the first approach.
If this is you
The most useful thing is often simply learning that the experience has a name and a short list of causes — a great deal of the fear comes from not knowing what it is.
If it has gone on for more than a few weeks, an assessment with SSHIMOH's clinical team will establish what is driving it. Many people also find why do I feel disconnected from everyone useful, which covers the related but distinct experience of feeling separate from other people.