Need to know
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.
