Depersonalisation vs Derealisation
Depersonalisation Derealisation
Overview
These two so often travel together that students end up treating them as one phenomenon, but they describe unreality in two different directions: depersonalisation is a felt change in oneself, while derealisation is a felt change in the world around oneself. Both leave reality-testing intact, which is what keeps them out of the realm of psychosis.
| Dimension | depersonalisation | derealisation |
|---|---|---|
| What feels unreal | The person's own self, body, thoughts, or emotions — a sense of being detached from, or an outside observer of, oneself | The external environment — people, objects, and surroundings feel strange, distant, artificial, or lifeless |
| Typical description | "I feel like I'm not really here," "like I'm watching myself from outside," or "my emotions feel like they belong to someone else" | "Everything looks flat, like a stage set," "the world feels like it's behind glass," or "nothing around me feels real" |
| Insight | Retained — the person recognises the change is a subjective alteration in their own experience, not an actual change in themselves | Retained — the person recognises the world has not actually changed, only their experience of it |
| Common accompanying feature | Often described alongside emotional numbing or a sense of mechanical, automatic action | Often described alongside a dreamlike or 'unreal' quality to perception, sometimes with mild perceptual distortion in vividness or distance |
| Typical context | Severe anxiety, panic attacks, depressive illness, dissociative states, sleep deprivation, or as a standalone syndrome | The same range of contexts as depersonalisation, and very frequently occurs together with it in the same episode |
| Diagnostic weight alone | Low in isolation — occurs across many conditions and even in healthy people under stress or fatigue; significant mainly by frequency, distress, and persistence | Low in isolation, for the same reasons; its diagnostic significance comes from context and persistence rather than the symptom itself |
Common confusion
Students often try to keep these two permanently separate, but in clinical practice they very commonly co-occur in the same episode, and a patient describing one will often go on to describe the other in the same breath. The useful distinction is not that a patient has 'either/or' — it's knowing which word to use for which part of what they're describing, and recognising that neither one, alone, amounts to a loss of insight or a delusion.
Clarifying questions
- When this happens, does it feel like something has changed about you, or about the world and people around you?
- Do you still know, even while it's happening, that you and the world haven't actually changed?
- Does this tend to happen together with strong anxiety, or out of nowhere?
Provenance
Class B · tier T1 · lifecycle migrated_candidate
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 7, 'Disorders of the Experience of Self'.