• Depersonalisation and derealisation are characterised by feeling detached from your self or environment

  • Psychotherapist Jake Freedman explores these symptoms from a psychodynamic viewpoint and relation to childhood trauma

What is depersonalisation?

Depersonalisation (DP) involves experiencing an unreality or detachment from your sense of self, whereas derealisation (DR) involves experiencing an unreality or detachment from your external environment. 

If you experience depersonalisation or derealisation (DPDR), these experiences are often so ineffable that you might describe them in an "as if" manner:

“It feels as if I don't exist.” (depersonalisation)

“It feels as if I'm living in a perpetual dream.” (derealisation)

“It feels as if my voice doesn't belong to me, like I don't have control of my own speech, and I'm listening to someone speak who isn't me.” (depersonalisation)

“It feels as if I'm observing everyone else through a pane of glass; like they're all in one universe and I'm looking at them all on my own through another.” (derealisation).

“It feels as if my hands aren't mine; when I look at them, they seem strange and different in size.” (depersonalisation)

The "as-ifness" of these experiences is part of what distinguishes them as dissociative rather than psychotic experiences. For example, if you experience depersonalisation, you know in fact that you exist, but it feels as if you don't. 

Experiences being dissociative means that they have the quality of separateness or of a split between two things. Other dissociative phenomena involve a split, for example, in dissociative identity disorder, there is a split between multiple self states. However, in DPDR, the split is more about a quality of separateness or splitness in the experiences themselves.

Causes of depersonalisation

Various things may trigger experiences of depersonalisation and derealisation, such as cannabis use, panic attacks and an acute or sustained period of stress. 

There appears to be a correlation between experiences of DPDR and certain factors. These include a childhood involving accumulative experiences of relational neglect and covert abuse and living in an individualistic as opposed to collectivistic social structure (Sierra, 2009) (BMJ, 2017).

Depersonalisation and psychodynamic therapy

The psychosocial treatment recommendation for depersonalisation and derealisation, as proposed in the British Medical Journal (2017), is a model of cognitive behavioural therapy (CBT) that has been specifically designed for DPDR. Whilst many individuals have experienced either relief or full recovery through cognitive behavioural interventions, for others, the symptoms remain chronic. If this is the case for you, you might be motivated to make sense of and address your DPDR on a deeper level. This is where psychodynamic psychotherapy may be helpful. 

Psychodynamic treatment primarily offers the potential for a rich understanding of the meaning of your DPDR. This can involve insight into how experiences within your family of origin are linked to your DPDR and unconscious psychic mechanisms that contribute to and sustain it. Whilst symptomatic relief can be a byproduct of this approach, it is not its primary purpose. However, a potential outcome of psychodynamic treatment is that you move from a desire to seek symptomatic relief to developing a curiosity and understanding of the intrapsychic, relational, and social aspects of your suffering.

Psychodynamic theories generally conceptualise DPDR as defence mechanisms; that is, methods that your mind utilises to protect you from thoughts, impulses, or aspects of your personality that are unconsciously experienced as threatening. In DPDR, what exactly might be being defended against will differ from person to person. It is not possible for me to give a comprehensive account of the various things DPDR may function as a defence from. Furthermore, I cannot provide an overview of the various psychodynamic theories and case studies of DPDR, which diverge from one another in important ways. What I will focus on then is a particular defence mechanism I believe many people with depersonalisation mobilise, and that experiences of DPDR will continue for as long as the defence is relied upon.

Depersonalisation and identification with the aggressor

I mentioned earlier that a correlation has been identified between DPDR and experiences of neglect and covert emotional abuse in childhood. In some cases, it may not be immediately obvious that there was any early abuse in your family of origin. However, a distinct kind of abuse may have occurred, which is characterised both by a lack of attunement to your emotional needs as a child and your parent/s exploiting your talents or gifts for their own narcissistic gratification.

I have termed the defence mechanism that is mobilised to defend against this abuse as "identification with the observer." It is based on the psychoanalyst Sandor Ferenczi’s (1933) theory of identification with the aggressor. Ferenczi proposed that those who are abused may develop a defence mechanism of taking on the role and attributes of their abuser or "aggressor". In cases of depersonalisation, you might adopt the role and traits of the "observer-abuser”; the abuser whose gaze is ominously felt by the observed individual.

"Identification with the observer" is predominantly adopted by individuals who, as children, were chronically scrutinised, controlled, and observed by their parents. It is not observation itself that is inherently damaging, but the nature and quality of the observation can take on a malign quality. As a depersonalised adult, you might have been an intelligent or "gifted" child who had at least one caregiver adopt the role of a "talent manager" rather than an emotionally nurturing parent.

An example of this in film is the character of Rose in Gypsy (1993), played by Bette Midler. Rose is portrayed as an overbearing stage mother, whose relentless drive for her daughters' success is motivated by her own narcissistic need to live vicariously through them. This ultimately exerts a profound emotional and psychological impact on her daughter, Louise.

When you as a child were seen as succeeding in your parents' eyes, you were praised and made to feel special. As an adult, you may derive your sense of worthiness from achievements or feeling remarkable in a particular life domain. This can give rise to a way of seeing yourself that is founded upon perfectionistic standards. If your sense of self begins to depend on having your achievements recognised by others, then your motto might become something like; ‘if I’m not recognised as the best, then I don’t exist’. Thus, when this recognition is absent, you feel unreal, non-existent, because there is nobody there to watch you.

A likely effect of this is that you, as the chronically and malignly observed child, learn to construct and sustain a sense of self around your achievements and, more generally, how you appear in the gaze of others as opposed to how you feel inside. It is in this sense that you have formed an identification with the observer. As Schilder puts it:

"By identification with the parents, self-observation will take the place of the observation by others" (Schilder, 1951: 276).

How psychotherapy can help

Psychotherapy offers you, in the context of a trusting and reliable relationship, the opportunity to feel and know, perhaps for the first time, that you are not expected to put on a show or take the role of a performing object for your therapist’s gratification. Ultimately, putting on a show will not help you to better know your own mind. 

If you can begin to feel safe enough to sink into your internal world, then a deeper exploration of your unconscious desires, wishes, somatic sensations, and impulses etc. can occur. If you can develop a greater intimacy with these parts of yourself, then they are perhaps no longer experienced as foreign to you. It is then that you can begin the transition from the role of observer of yourself to that of inhabiting your mind as a subject. It is in inhabiting the mind of the subject that you can begin the process of, to use a Winnicottian (2016) term, “personalisation”.

Jake Freedman is a verified Welldoing psychotherapist in Central London and online

Further reading

Dissociation: Understanding the impact of relational trauma

How to help someone who is dissociating

Reparenting: Ways to inner healing

An early death from within: The impact of childhood trauma


BMJ. (2017). Depersonalisation and derealisation: assessment and management. [Infographic]. BMJ, 356, j745. Available at: https://www.bmj.com/content/356/bmj.j745/infographic.

Ferenczi, S. (1933). Confusion of tongues between adults and the child: The language of tenderness and of passion. In Final contributions to the problems and methods of psycho-analysis (pp. 156-167). London: Karnac Books.

Schilder, P. F. (1951). Psychotherapy. London: Routledge & Kegan Paul Ltd.

Sierra, M. (2009). Depersonalization: A New Look at a Neglected Syndrome. Cambridge: Cambridge University Press.

Winnicott, D. W. (2016). Basis for Self in Body. In Psychoanalytic Explorations (pp. 225-234). Oxford University Press. doi: 10.1093/med:psych/9780190271411.003.0044.