Depersonalization and Derealization in Depression

Medical Reviewer

One of the lesser-known aspects of depression is something called "dissociation." This is a mental process, a form of defense, in which the person disconnects from the world. Dissociation typically occurs as a response to trauma, but it’s also a feature of various mental health problems, one of which is depression.

Most people can identify with dissociation. We can make ourselves dissociate from a situation as a way to calm down. We dissociate when we daydream, and how many of us have driven for miles and when we arrive at our destination can barely recall the route we took?

Escapism can be a pleasant distraction, but there are circumstances where there is no escape from trauma and the only option left open to people is to escape from themselves, mentally. A single severe trauma can bring this about, but so can cumulative stress leading to depression.** Derealization and depersonalzation**

There are various recognized forms of dissociation, but the two I’m focusing on in this post are derealization and depersonalization. I’ve chosen these because these symptoms of dissociation work in two ways. First, people with major depressive disorder may experience symptoms of dissociation; secondly, people who suffer from a dissociative disorder may also suffer from depression and anxiety symptoms.

Derealization symptoms:

  • A sense that the world is unreal, lifeless, two-dimensional
  • Recent events may feel as though they are much older and further away
  • Either a heightened awareness of surroundings and actions, or distortions
  • Emotional disconnections from people around you -- who themselves may not seem real

Depersonalization symptoms:

  • The sense that you are outside of yourself, sometimes looking in
  • Feelings that your actions and emotions are acting independently of you
  • A feeling that your limbs are misshapen and distorted
  • Feeling that you are floating away


Unfortunately the causes of depersonalization and derealization aren’t fully understood. We know much more about the situations that can lead to symptoms than what is actually occurring as a process within the brain or elsewhere within the body. For the moment, we have to assume the three most likely interactions, which are social, psychological, and neurochemical, lead to brain vulnerability.

How common is dissociation?Marlene Steinberg, M.D., argues that dissociative symptoms are as common as anxiety and depression. She has written that the symptoms are frequently overlooked or misdiagnosed and people with Dissociative Identity Disorder often seek treatment for various problems, including depression. Antidepressant medication may help to alleviate the symptoms of depression, but they do nothing for the symptoms of dissociation.

When to seek help

When dissociation feels unsettling, occurs repeatedly and interferes with daily living and possibly relationships, it’s time to seek help.

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Dr. Jerry Kennard is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry's clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of