Dissociation: when everything feels unreal

It can come on suddenly: an ordinary street, a familiar room, a conversation with a friend – and everything seems strange, as if in a dream. A person’s own hands look as though they belong to someone else, their voice sounds unfamiliar, and it feels as if they are watching themselves from the side, like a character in a film. Feelings fade too: even close people seem far away. The most frightening part is often the thought that comes with it: “I’m going mad.”

This experience is called dissociation: a sense of disconnection from oneself or from the world around. When a person feels detached from themselves, their body or their feelings, it is called depersonalisation. When the world seems unreal, foggy or lifeless, it is called derealisation. They often come together. The NHS describes dissociation as a way the mind copes with too much stress.

How it shows up

Many researchers describe dissociation as a spectrum. At one end are everyday moments: driving a familiar route on autopilot and not remembering the journey, or becoming so absorbed in a book that the room disappears. In the middle are short episodes of unreality during strong stress, panic or exhaustion. They are very common: by some estimates, up to 74% of people experience them at least once in their lives. At the other end is a persistent state, when the feeling of unreality stays for months or keeps returning. This affects about one person in a hundred.

From the inside it can feel like this: the world looks too dull or too sharp, colours and sounds seem muted, time stretches or shrinks. The body may feel numb or light, and actions seem to happen automatically, without the person really taking part. Emotions are dulled, as if someone has turned the volume down. An episode can last a few minutes, or it can come and go for a long time.

Why it happens

Dissociation is thought to be one of the ways the mind protects itself from overload. When stress, fear or tension become too strong, the brain seems to turn down the emotional reaction. A small study at the Institute of Psychiatry in London, part of King’s College London, found an interesting detail: the bodies of people with persistent depersonalisation reacted more weakly to upsetting pictures than other people’s did, yet reacted faster than healthy volunteers’ to a sudden loud clap. So the body stays on alert, while feelings are muted.

The most common triggers are severe stress, panic attacks, low mood and cannabis; lack of sleep can also bring episodes on. In one experiment, a night and a day without sleep increased dissociative symptoms in healthy volunteers. Sometimes the tendency to dissociate is linked to difficult experiences in childhood, especially growing up with frequent criticism, humiliation or fear at home.

Why this is not “going mad”

The most important thing to know: in depersonalisation and derealisation, a person understands that the unreality is a feeling. The world seems strange, but they know it has not actually changed. This is what distinguishes these states from psychosis, in which a person loses that understanding.

It is the fear of going mad that often keeps the state going. A person notices the unreality, becomes frightened, starts checking themselves (“do I feel real now?”, “has it got worse?”) and anxiety rises, and with it the unreality. Researchers describe this vicious circle well: the more frightening the meaning given to the symptoms, and the more attention they receive, the stronger they become.

Who is prone to it

Dissociation is especially common in people with anxiety and panic attacks, and in those living through depression or a long period of stress. The persistent form usually begins in the teenage years or in early adulthood. This is not dissociation in the clinical sense, but it can add to the feeling of disconnection from oneself.

What it leads to

Short episodes usually pass on their own. The persistent form is harder: it can last for years, interfere with work, study and relationships, and often comes with depression and anxiety. People often wait a long time before someone recognises what is happening to them, because the experience is hard to put into words and not every doctor is familiar with it.

What helps

Knowing what it is: understanding that this is a known reaction of the mind to overload, not a sign of madness, takes away a large part of the fear. And with less fear, the state itself often eases.

Not checking all the time: constantly testing “am I real?” only fixes attention on the symptoms. It helps more to let the feeling be there and turn attention to what is happening: a conversation, a task, a walk.

Contact and warmth: people with persistent depersonalisation report that comforting time with others, strong emotional or physical sensations, and relaxation tend to make it less intense.

Sleep and avoiding cannabis: because lack of sleep and cannabis can bring on or worsen episodes, regular sleep and avoiding cannabis are sensible first steps.

Dealing with what lies behind it: if episodes of unreality are linked to anxiety, panic or depression, helping with these usually reduces dissociation too.

In a small study in London, almost a third of people with persistent depersonalisation no longer met the criteria for the condition after a course of psychotherapy designed for it, though the study had no comparison group. There is no specific medicine for dissociation; antidepressants are prescribed when it comes with depression, anxiety or panic attacks.

When it is worth getting help

If the feeling of unreality lasts for weeks, keeps returning or gets in the way of life, or if there are gaps in memory, it is worth talking to a GP or a mental health professional.

If the unreality stops feeling like a feeling and starts to seem like real changes in the world, or if it comes with headaches or other physical symptoms, it is worth seeing a doctor without delay.

Psychotherapy can help a person understand what triggers dissociation and find ways to feel present in their own body and life again.