In short: the de-personalization (feeling that you are being watched from outside) and the de-realization (feeling the environment strange or unreal) are dissociative experiences that are frightening, but they do not mean that you have lost contact with reality. Fear and constant vigilance often keep them in check. With proper evaluation and therapy, you can understand what is happening, reduce anxiety, and feel more present.
«I know that I am here, that this is my home and I recognize the people around me. But sometimes I feel as if I am watching my life from outside. It’s as if something separates me from everything, even myself, as if I see what is happening from outside as an observer.».
There are people who come to the consultation trying to explain a feeling that is difficult to describe. They don't always know how to put a name to it. They say they feel strange, that the world seems different, that they act automatically, or that they have stopped feeling connected to their emotions.
Some say they look in the mirror and, although they recognize their own face, they feel it strange. Others describe the feeling of being inside a film, of walking down a familiar street and perceiving it as if they had never been there, or of conversing with a loved one without feeling the usual emotional closeness.
Often, what scares them the most isn’t just the sensation itself, but not understanding what’s happening to them: «What if I’m going crazy?» «What if I stay like this forever?» «Why do I know that everything is real, but I can’t feel it like before?».
To understand these experiences, it is important to explore not only the symptoms but also the circumstances in which they appear, the meaning that the person attributes to them, and the way in which they try to cope with them.
1. The case: «It's like I'm living in automatic mode»
Imagine Daniel, a 32-year-old man who comes to see a doctor because he has been feeling disconnected from himself and his surroundings for several months.
After a period of accumulated stress, he began to experience episodes in which the streets, people, and familiar places seemed strange to him. Sometimes he felt as if he were observing his own life from outside, although he knew where he was and recognized perfectly the people around him.
At first, these sensations appeared sporadically. However, he began to worry about them and constantly check to see if he had regained normal consciousness.
When she noticed that she was still feeling strange, her anxiety increased. She had stopped enjoying some activities and was paying more and more attention to her internal sensations, fearing that they were a sign that something serious was happening.
Daniel not only wanted to stop experiencing those sensations. He wanted to understand what was happening to him and regain the confidence to live his day-to-day life without constantly being on guard for himself.
This case is fictional and is used for informational purposes.
2. What are depersonalization and depersonalization?
Despersonalization and de-realization are dissociative experiences which can appear temporarily or recurrently.
The de-personalization It consists of experiencing a sense of distance from one’s own body, thoughts, emotions, or actions. The person may say:
- «It's like he's watching me from outside.
- «I do things automatically».
- «I know I want my family, but it's hard for me to connect with what I feel.».
The de-realization, For its part, it refers to a sense of strangeness or unreality regarding the environment. It can be expressed through phrases such as:
- «It seems like I’m inside a dream.
- «My home is the same, but I feel different.».
- «People and places seem distant to me.».
Although these experiences can be very distressing, they do not necessarily mean that the person has lost contact with reality. Many people acknowledge that the environment remains real, even though they cannot experience it in the usual way.
It is important to perform an individual assessment, because these sensations can appear in different psychological contexts and they also require evaluating possible medical or substance-related causes.
3. My clinical conceptualization: What may be keeping the problem going?
When conceptualizing a case, I try to understand how the symptoms relate to the person’s personal history, current circumstances, and the strategies they use to cope with the distress. In a situation like Daniel’s, I would explore three main areas.
Triggering factors
What was happening when the symptoms started? Was there intense stress, sleep problems, anxiety, a loss, or some particularly difficult experience? I would also appreciate medical history, medication, and substance use.
Predisposing factors
We would explore their personal history, their emotional experiences, and the way they have learned to cope with difficulties. We would also investigate possible traumatic experiences, without assuming that they must exist or necessarily explain the symptoms.
Maintaining factors
In Daniel, the constant concern about what he feels stands out. Every time the disconnection appears, he fears it is a sign of something serious, increases his internal vigilance, and checks to see if he has returned to feeling normal. This can create a cycle of maintenance:
- There is a sense of disconnection.
- The person interprets it as a threat.
- They increase fear and anxiety.
- Start paying attention to your sensations and checking if they have disappeared.
- The experience continues to occupy his attention and increases his discomfort.
This hypothesis does not explain all cases, but it allows us to understand how fear and constant surveillance can contribute to maintaining the symptoms. It would also explore whether the person has started to avoid situations, isolate themselves, or abandon important activities out of fear of feeling the same way again.
4. How would this case work in therapy?
Treatment should be tailored to the needs and circumstances of each person. In a case like Daniel’s, the initial goals could be:
- Understanding the symptoms: explain what these experiences are and reduce the fear they generate.
- Managing anxiety: identify catastrophic interpretations and reduce the constant verification of sensations.
- Reclaiming contact with the present: use environmental orientation and sensory connection strategies that are useful for the person.
- Resume meaningful activities: gradually recover the routines and situations that have been avoided.
- Exploring the emotional history: understand what personal factors or past experiences may be contributing to the distress.
Depending on the assessment, the tools of cognitive-behavioral therapy and other strategies for emotional regulation may be useful. If relevant traumatic experiences are identified, they can also be evaluated. EMDR when it is indicated and there are appropriate conditions for working safely.
It is not necessarily about starting with traumatic memories, but about first understanding what is happening to the person, what they need, and what goals are prioritized.
5. Reclaiming a sense of presence
One of the difficulties of depersonalization and derealization is that the person may end up organizing their life around the need to feel like before again.
Stop enjoying a conversation because he is checking if he feels connected. Do an activity while analyzing whether he is feeling okay. Take a walk, work out, or listen to music, but a part of his attention remains focused on one question: «Am I already feeling normal?».
In therapy, we seek to help the person understand what is happening to them and to gradually recover their life, so that each sensation does not have to become a sign of danger.
Improvement is not always immediate or linear. Each process is different, but understanding the symptoms, reducing fear, and reclaiming meaningful activities can help lessen the impact these experiences have on everyday life.
And what if it's happening to you?
Perhaps you have ever felt like you were inside a dream, that the world seemed strange, or that you were watching yourself from a distance. It may be difficult for you to explain it to other people, or you may have spent a long time searching for answers, worried about whether you will ever feel the same way again.
You don't need to know exactly what's happening to you to ask for help. A psychological assessment can help you understand your symptoms and explore which approach best suits your situation.
If you experience persistent feelings of disconnection from yourself or your surroundings and they are affecting your well-being, you can contact me through my website to assess your situation.
Frequently asked questions about depersonalization and derealization
What is the difference between depersonalization and derealization?
Despersonalization is feeling distanced from one's own body, thoughts, or emotions («I observe myself from outside,» «I do things automatically»). Desrealization is feeling the environment strange or unreal («it seems like a dream,» «my house is the same, but I feel it different»). They can appear together or separately.
Does that mean I'm losing touch with reality?
Not necessarily. Most people who experience it know that the environment is real, even if they cannot feel it as they did before. It is a dissociative experience, not a loss of reality judgment. Nevertheless, an individual assessment is advisable to rule out medical or substance-related causes.
Why doesn't it leave me?
Often what keeps the symptom is fear: interpreting the sensation as a threat, monitoring the body and checking again and again whether «I am already normal». This cycle increases anxiety and keeps the focus on the disconnection. It is a hypothesis that does not explain all cases, but many certainly do.
How is dehumanization treated?
First, understanding what these experiences are and reducing fear. Then, regulating anxiety, regaining contact with the present and resuming activities that have been avoided. If there are relevant traumatic experiences, EMDR can be considered when appropriate and with appropriate safety conditions.
If at any time you feel you can’t take it anymore or have thoughts of harming yourself, call the 024 (suicide behavior hotline, free and 24-hour service) or go to the emergency room.
Sonia López Cano, health psychologist Member M-25306 at the Official College of Psychology of Madrid and as an EMDR therapist. I treat online therapy by video call, in Spanish and English.
