Derealization and depersonalization

In our PLOS One study, we asked if people had experienced difficulties lasting longer than a day after psychedelics. We received 608 responses from people who said yes, and then thematically analysed their descriptions. 15% were themed as ‘derealization’ (feeling you’re in a dream or the world is unreal) and 15% were themed as ‘depersonalisation’ (feeling disconnected from your self). Here are two examples of the latter theme:

•     ‘I spent a long time looking at myself in the mirror, feeling like my soul was missing. Like i was a hollow shell of myself and like I had already died.’

•     ‘I felt like my mind had been shattered into a million pieces, like my mind was no longer connected to my body, afraid that I was having a psychotic break, im still not 100% right but I’m so grateful just to be back in my own reality’

Derealisation involves a sense of disconnection from reality, where individuals may perceive their surroundings as surreal, dreamlike, or somehow distorted. It can manifest as feeling detached from one's environment, as if the world around is unreal or unfamiliar. One may feel like in a dream, a movie, a computer game, afterlife or a fake reality. Individuals experiencing derealisation may struggle with distinguishing what is real and what is not, leading to confusion and distress.

“Almost exactly 2 months after the trip, something happened. I was in a restaurant and all of a sudden I began to feel like something was wrong. I went to the bathroom. All of a sudden, the bathroom was not real. It just looked WRONG. I had to get out of there. But when I left the restaurant, the street outside was not real either. The whole world was simply not real, and I felt like I had to vomit.”

Evans et al. (2023)

Depersonalisation involves a feeling of detachment from oneself, one's body, or one's sense of identity. It can manifest as feeling like an outside observer of one's thoughts, feelings, or actions, or experiencing oneself as unreal or robotic. Individuals with depersonalisation may feel disconnected from their emotions, memories, or sense of self, leading to a profound sense of alienation and emptiness.

“I felt like the person I was before had been entirely wiped from all sense memory and I felt completely dissociated from the body I was inhabiting…[I] essentially felt like I was completely disintegrating. My life has and never will be the same.”

Evans et al. (2023)

These two symptoms, if they become chronic (ie lasting for several months or longer), are sometimes called Derealization Depersonalization Disorder (DDD). However, often they pass within a few days or weeks.

Scientific understanding of DDD is limited but it’s thought that it often emerges as a trauma response - in crisis situations, the organism flattens its emotional response as a defense mechanism to prevent emotional overwhelm, leading to a feeling of detachment , disconnect or unreality. The triggering incident could be abuse, near-death accident, violent assault, or a bad drug experience involving cannabis, psychedelics, or other drugs. Some people’s limbic systems can then get stuck in this response, and what was initially defensive becomes maladaptive. Although some people might find light feelings of derealization or depersonalization interesting or even pleasant, if it often occurs it can be intrusive and upsetting.

Many people report some degree of derealization, depersonalization and deconditioning during and after psychedelic experiences, and for many it is pleasant or interesting. It can also last beyond the trip itself, and again, some might find this pleasant. However, some people find the symptoms of derealization or depersonalisation to be intrusive, distracting, upsetting, socially disconnecting or destabilizing.

For most individuals in our data set, these challenges persist for 0-6 months following the psychedelic experience. The second most common duration is between 7 to 12 months. For some people it can last longer than this, sometimes years, though many learn to accept the symptoms they experience, so they are no longer so bothered by them.

In our research, approximately a quarter of people reported these difficulties as very severe, significantly disrupting their lives. For 35-41% of individuals, the challenges were moderately severe, causing some minor disruptions to their daily lives. Meanwhile, 36-39% experienced these difficulties as not severe, with no significant impact on their life.

Coping Strategies

Individuals experiencing depersonalisation and derealisation may find particular benefit in practices that promote grounding, acceptance, and connection with the body and surroundings. Specifically, the coping strategies most commonly reported as helpful include reading or viewing materials about the condition, cultivating an attitude of acceptance and surrender, seeking support from peers and family, and spending time outdoors and in nature. Additionally, for managing depersonalisation, people have found physical exercise particularly beneficial. It can also be helpful to use distraction techniques to take one’s attention away from the inner symptoms and instead focus on the outside world - on relationships, sport, nature, work and so on.

Experiencers of these symptoms sometimes report certain things make the symptoms worse - cannabis, say, or caffeine, or stress or lack of sleep. You can learn to be the expert of your own mental health, keeping track of what makes the symptoms less or more severe.

It is essential to explore and integrate these strategies in a way that resonates with personal preferences and needs, seeking support from professionals or trusted sources as needed.

The first graph below shows which coping strategies people found most helpful when dealing with derealisation and the second graph shows coping strategies for depersonalisation.