Depersonalization DisorderSymptoms Causes and Treatment Methods

A person may sometimes experience moments in which they feel disconnected from themselves, as though they are watching their life from the outside, or as though the world around them seems strange and unreal, despite knowing that everything is actually normal. This experience can be confusing and frightening, especially when the person does not understand why it is happening or fears that it may be a sign of losing their mind.These symptoms are commonly described as depersonalization and derealization, two psychological experiences that may be associated with severe anxiety, panic attacks, psychological stress, trauma, and certain other mental health conditions. In some people, the symptoms may be temporary, while in others they may recur or persist and begin to interfere with daily life.In this article from Dalili Medical, we explore depersonalization and derealization disorder, the differences between them, their main causes and symptoms, how they are diagnosed, and the available psychological and medical treatments. We also discuss how to cope with the feeling of not existing and when these symptoms may require help from a doctor or mental health professional.

What Does the Feeling of Not Existing Mean?

The feeling of not existing is an experience that a person may describe as feeling disconnected from themselves or their body, or as though they do not feel their own existence in a normal or familiar way. This feeling may occur as part of depersonalization and may also be accompanied by derealization or severe anxiety.

Does the Feeling of Not Existing Mean That I Am Losing My Mind?

No. Experiencing a feeling of not existing or depersonalization does not necessarily mean that a person is losing their mind or developing a serious mental illness. The sensation can be extremely frightening and confusing, but the person is often aware that what they are experiencing is an unusual feeling rather than an actual change in themselves or in the world around them.

Is the Feeling of Not Existing the Same as Depersonalization?

Not necessarily. Depersonalization primarily refers to a feeling of detachment from oneself, one’s body, or one’s emotions, as though the person is observing themselves from the outside or does not feel naturally connected to themselves.

Derealization, on the other hand, refers to the feeling that the surrounding environment or the world around the person is unreal, strange, distant, foggy, or dreamlike. Depersonalization and derealization can occur at the same time.

Why Do I Feel Like I Do Not Exist?

This feeling may be associated with several factors, including severe anxiety, panic attacks, psychological stress, trauma, depression, sleep deprivation, or the use of certain substances. In some cases, other psychological or medical causes may be involved. Therefore, the cause cannot be determined based on this symptom alone.

Is the Feeling of Not Existing Dangerous?

By itself, the feeling of not existing does not necessarily indicate an immediate danger. However, it can be distressing and frightening and may interfere with daily life. Medical or psychological evaluation becomes more important if the feeling persists for a long time, occurs repeatedly, or is accompanied by other unusual symptoms.

Can the Feeling of Not Existing Last for a Long Time?

Yes. For some people, these symptoms may be brief and temporary, while for others they may persist or recur. However, the symptoms can often be managed and improved. The appropriate approach depends on the underlying cause, the person's psychological state, and the factors that contribute to worsening symptoms. Treatment may include psychotherapy, such as cognitive behavioral therapy (CBT), depending on the individual's condition and needs.

Does Anxiety Make the Feeling of Not Existing Worse?

Yes. Anxiety can intensify this feeling. A person may initially experience a sense of detachment or dissociation, then become frightened by the sensation and start monitoring it closely. This may increase anxiety, which can in turn intensify feelings of depersonalization and derealization, creating a recurring cycle between anxiety and symptoms.

Can Constantly Thinking About the Symptoms Make Them Worse?

Excessive focus on the symptoms and constantly monitoring them may make them feel more noticeable and distressing. Therefore, it may be helpful to gradually redirect attention toward the activity you are doing and the environment around you rather than repeatedly testing or checking the sensation.

What Should I Do When I Feel Like I Do Not Exist?

When experiencing a feeling of not existing or detachment from oneself, try to calm your breathing and direct your attention toward the things around you. You can engage your senses by noticing what you see, hear, and touch. Remind yourself that what you are experiencing is a sensation and not evidence that you have lost your existence or your mind.

Can Lack of Sleep Make the Feeling of Not Existing Worse?

Yes. Fatigue and sleep deprivation may increase anxiety and may contribute to worsening symptoms of depersonalization and derealization in some people. Therefore, maintaining a regular sleep schedule and getting enough rest can be an important part of managing these symptoms.

Can Drugs Cause the Feeling of Not Existing?

Yes. Certain recreational drugs, particularly some hallucinogens, cannabis, and stimulants, may cause symptoms of depersonalization and derealization or make them more severe in some people.

Can Someone With Depersonalization Live a Normal Life?

Yes. Many people can improve their symptoms and return to functioning well in their daily lives with appropriate treatment, by reducing sources of stress, addressing any coexisting psychological or medical conditions, and following the treatment plan recommended by a qualified professional.

Does the Feeling of Not Existing Require a Psychiatrist or a Neurologist?

A psychiatrist is usually a suitable starting point for evaluating these symptoms and identifying any associated psychological factors. If unusual physical or neurological symptoms are present, the psychiatrist or another physician may recommend additional medical or neurological evaluation.

When Does the Condition Become an Emergency?

If the feeling is accompanied by a clear loss of contact with reality, severe confusion, hearing voices that are not actually present, or thoughts of harming yourself or others, urgent medical evaluation should be sought rather than relying solely on managing the symptoms at home.

Forms of the Feeling of Not Existing in People With Depersonalization

The feeling of not existing or being disconnected from oneself may appear in different forms in people experiencing depersonalization. The intensity and way these symptoms are described may vary from one person to another. Some of the most common forms include:

1. Feeling Disconnected From Oneself

A person may feel disconnected from themselves or their identity, as though they are observing themselves from the outside rather than experiencing their life normally.

They may describe it by saying:

“I feel like I’m not myself.”

2. Feeling That the Body Is Unreal or Strange

A person may feel that their body has become unfamiliar or strange, or that certain parts of their body, such as their hands or face, do not feel as though they belong to them.

Examples include:

“I feel like my body isn’t really my body.”
“I feel like I’m moving automatically.”

3. Feeling as Though They Are Watching Themselves From the Outside

A person may feel as though they are watching themselves from a distance or observing their own actions and behavior, rather than experiencing them naturally and directly.

4. Feeling Disconnected From Emotions

A person may feel disconnected from their emotions or less able to experience them, even though they intellectually understand what they are feeling and know that they love, care, or feel sad.

They may describe it by saying:

“I know that I love my family, but I don’t feel the same emotions toward them as I used to.”

5. Feeling That Life Is Happening Automatically

A person may feel as though they are carrying out their daily activities automatically, without a normal sense of participation or presence, as if they are functioning on “autopilot.”

6. Feeling That Thoughts Are Strange or Distant From the Self

A person may feel that their thoughts have become distant or unfamiliar, or that they are observing their thoughts rather than experiencing them as a natural part of their inner experience.

7. Feeling That the World Around Them Is Unreal

This feeling is more closely associated with derealization. The surrounding world may appear dreamlike, like a movie, or somehow unreal, even though the person understands that reality itself has not actually changed.

8. Feeling That People and Places Are Unfamiliar

Places that the person has known for years may suddenly seem strange or distant. They may also feel that people close to them do not seem as familiar as they normally do.

9. Changes in the Perception of Time

A person may feel that time is passing extremely quickly or unusually slowly, or that events are happening at a distance from them or feel disconnected from their normal experience.

10. Feeling Physically Present but Psychologically Absent

A person may remain conscious and physically present in a particular place and understand what is happening around them, while internally feeling absent, detached, or disconnected from the events they are experiencing.

Causes of the Feeling of Not Existing, Depersonalization, and Derealization

Feelings of detachment from oneself or derealization may occur due to various psychological or physical factors. The underlying causes can differ from one person to another. Common contributing factors include:

1. Severe Stress and Psychological Pressure

Ongoing psychological stress may contribute to feelings of detachment from oneself or the surrounding environment, particularly when a person is exposed to stress that exceeds their ability to cope with it.

2. Anxiety and Panic Attacks

Symptoms of depersonalization or derealization may occur during periods of severe anxiety or panic attacks. A person may feel as though they are observing themselves from the outside or that the world around them seems unreal or dreamlike.

3. Psychological Trauma

These symptoms may be associated with exposure to painful or traumatic experiences, particularly when a person feels unable to cope with the intensity of the experience. Feelings of detachment can sometimes occur as a psychological response to severe emotional stress.

4. Depression

Some people with depression may experience feelings of detachment from themselves or a reduced ability to experience emotions and their surrounding environment normally. They may feel as though they are going through life automatically or are emotionally distant from what is happening around them.

5. Sleep Deprivation and Fatigue

Severe sleep deprivation and ongoing exhaustion can increase anxiety and affect mental clarity and the normal perception of reality. This may contribute to the development or worsening of derealization symptoms in some people.

6. Use of Certain Substances

Depersonalization and derealization symptoms may occur after using certain recreational or psychoactive substances. These symptoms may be more noticeable in some people after using cannabis, certain hallucinogens, or stimulants.

7. Certain Medications or Medical Conditions

In some cases, these symptoms may be associated with the effects of a particular medication or with an underlying neurological or medical condition. Therefore, if feelings of detachment from reality appear suddenly or become severe, medical evaluation may be important to rule out other possible causes.

8. Intense Fear and Excessive Preoccupation With the Symptoms

A person may sometimes become caught in a cycle of anxiety. They may notice a slight change in how they feel, become afraid that it indicates a serious problem, and then begin constantly monitoring themselves and their symptoms. This can increase anxiety, which may in turn intensify symptoms of depersonalization and derealization.

Symptoms of the Feeling of Not Existing, Depersonalization, and Derealization

Symptoms can vary from one person to another in terms of their nature, intensity, and duration. Depersonalization and derealization may occur separately or may occur together.

First: Symptoms of Depersonalization

Depersonalization primarily refers to a feeling of detachment from oneself, the body, or emotions. Common symptoms may include:

Feeling detached from the body or as though you are observing yourself from the outside.
Feeling that the body or certain parts of it have become strange or unfamiliar.
Feeling that emotions have become distant or less vivid, as though you no longer experience things in the same way as before.
Feeling that daily life is being experienced automatically, as though you are carrying out actions without a normal sense of inner participation.
Feeling that thoughts or memories seem distant or unfamiliar, while generally remaining aware that they are your own thoughts and memories.
Feeling different from yourself or as though you are no longer the same person you used to be.
Feeling emotionally detached from people close to you, despite still knowing how important they are to you.
Feeling that speech, movement, or certain actions are happening automatically.

Second: Symptoms of Derealization

Derealization refers to a feeling that the external world is unreal or unfamiliar, while the person usually remains aware that reality itself has not actually changed. Possible symptoms include:

Feeling that the world around you resembles a dream or a movie.
Feeling that people or places seem unreal or strange.
Feeling that the surrounding environment is distant or foggy.
Feeling that objects appear flat or different from usual.
Feeling that colors or sounds seem strange or abnormal.
Feeling that time is passing extremely quickly or unusually slowly.
Feeling that familiar places have suddenly become strange or unfamiliar.
Feeling that people around you seem distant even though they are physically present.

Third: How Might a Person Describe the Feeling of Not Existing?

A person may describe this experience in different ways, such as:

“I feel like I don’t exist.”
“I feel like I’m living inside a dream.”
“I feel disconnected from myself.”
“I feel like I’m watching my life from the outside.”
“I feel like my body isn’t really my body.”
“I feel like the world around me isn’t real.”
“I feel like I’m living on autopilot.”
“I feel physically present, but psychologically absent.”

Fourth: Associated Symptoms

Depersonalization and derealization may occur alongside other symptoms, particularly when they are associated with anxiety or psychological stress. These may include:

Persistent anxiety and stress.
Panic attacks.
Fear of losing control.
Fear of having a serious mental health condition.
Excessive thinking about the meaning of these sensations and repeatedly trying to explain them.
Repeatedly monitoring oneself or the body.
Difficulty concentrating.
Fatigue and exhaustion.
Sleep disturbances.
Feelings of emotional detachment or emotional numbness.

Complications of the Feeling of Not Existing in People With Depersonalization

The feeling of not existing or depersonalization can be distressing and frightening. When symptoms persist or become the focus of excessive attention, they may lead to various psychological and practical effects. These may include:

1. Increased Anxiety and Fear

A person may fear that the feeling of unreality is a sign of a serious illness or that they are about to lose control of themselves. This fear can increase anxiety, which may in turn intensify symptoms of depersonalization and derealization.

2. Panic Attacks

A sudden feeling of detachment from oneself or the surrounding environment may trigger a panic attack, particularly when the person begins closely monitoring the sensation and becoming frightened by it.

A recurring cycle may develop:

Feeling of unreality → fear of the sensation → increased anxiety → increased depersonalization and derealization symptoms.

3. Excessive Preoccupation With Symptoms

A person may begin constantly monitoring themselves and repeatedly asking questions such as:

“Do I feel my body normally?”
“Is the world around me real?”
“Do I really exist?”
“Has the way I feel changed?”
“Will I continue feeling this way?”

Constantly focusing on these questions and repeatedly checking the sensation may increase attention to it and make it feel more noticeable and distressing.

4. Difficulty Concentrating

A person may have difficulty concentrating on school or work because of constant preoccupation with the feeling of unreality or fear that the symptoms may appear. A significant portion of their attention may become focused on monitoring their condition rather than concentrating on the task at hand.

5. Sleep Disturbances

Persistent anxiety and repeated thoughts about the symptoms may make it difficult to fall asleep or may cause frequent nighttime awakenings. Sleep deprivation may, in turn, increase anxiety and feelings of depersonalization and derealization in some people.

6. Avoidance of Activities and Places

A person may begin avoiding certain activities or places, such as going out, driving, traveling, or being in crowded places, because they fear that the symptoms will appear or that they will be unable to cope with them.

Over time, this avoidance may lead to reduced daily activity and increased anxiety and fear.

7. Impact on School and Work

If the symptoms become frequent or severe, they may affect concentration, attention, and the ability to perform tasks, potentially affecting academic or professional performance.

8. Impact on Social Relationships

A person may feel emotionally disconnected from others or have difficulty enjoying social interactions. Fear of the symptoms or constant preoccupation with them may lead to withdrawing from family and friends and participating less in social activities.

9. Development of Depressive Symptoms

Persistent symptoms, along with the distress, sense of helplessness, or difficulty understanding what is happening, may be associated with the development of depressive symptoms in some people, particularly when the condition significantly affects daily life.

10. Reduced Quality of Life

A person may feel that they are no longer living their life normally because of persistent feelings of detachment or unreality. They may lose interest in activities they previously enjoyed or become less involved in school, work, and social relationships.

Medication Treatment for the Feeling of Not Existing in People With Depersonalization

There is no single medication that is considered a specific and guaranteed treatment for depersonalization and derealization in everyone. The choice of treatment depends on the underlying cause, severity, duration, and associated symptoms. Therefore, medications should be used under the supervision of a qualified medical professional.

1. Antidepressants

A doctor may prescribe certain antidepressants when depersonalization is accompanied by depression, anxiety, or panic attacks.

Medications that may be used in these situations include:

Sertraline
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine

Using these medications does not necessarily mean that a person has depression. They are also not automatically used to treat depersonalization on its own. Rather, a doctor may prescribe them when there are coexisting symptoms or conditions that may respond to these medications.

Antidepressants generally take some time to produce noticeable effects, and they should not be stopped suddenly without consulting a doctor.

2. Medications for Anxiety and Panic Attacks

If the feeling of not existing or derealization occurs mainly during panic attacks or severe anxiety, the doctor may focus on treating the underlying anxiety disorder.

Self-medication with sedatives is not recommended, particularly with benzodiazepines such as:

Alprazolam
Diazepam
Lorazepam

These medications may cause dependence and tolerance in some people, and stopping them after regular use can be difficult. Therefore, they should only be used according to a clear prescription and under appropriate medical supervision.

3. Antipsychotic Medications

Antipsychotic medications are not considered routine treatment for depersonalization and derealization themselves.

A doctor may use them when there are psychotic symptoms or another mental health condition that requires this type of treatment.

Examples include:

Risperidone
Olanzapine
Aripiprazole
Quetiapine

These medications should not be used simply because a person feels that “the world is not real” without an appropriate medical evaluation.

4. Naltrexone

Some small studies have investigated the possible use of naltrexone for depersonalization symptoms. However, the available evidence is not sufficient to consider it a standard or established treatment for this condition.

Therefore, naltrexone should not be used independently to treat depersonalization. The decision to use it should be left to a doctor after evaluating the individual's condition and the potential benefits and risks.

5. Treating the Underlying Condition Is More Important Than Trying to Treat the Sensation Alone

In many cases, the main goal of treatment is to address the condition that causes, maintains, or worsens the symptoms.

For example, a cycle may develop as follows:

Severe anxiety → panic attacks → feeling of unreality → fear of the symptoms → increased anxiety → increased feeling of unreality.

When the underlying anxiety disorder or panic attacks are treated appropriately, symptoms of depersonalization and derealization may also improve.

6. Are There Medications That Can Immediately Eliminate the Feeling of Not Existing?

There is no medication that can be considered a guaranteed, rapid treatment that immediately eliminates the feeling of not existing or depersonalization.

Repeatedly trying to control these symptoms with sedatives without medical supervision may also lead to additional problems, including medication dependence in some cases.

7. What About Psychotherapy?

Medications alone should not necessarily be relied upon in all cases of depersonalization and derealization. Psychotherapy may be an important part of the treatment plan, particularly cognitive behavioral therapy (CBT), along with learning skills to manage anxiety and reduce excessive monitoring and preoccupation with symptoms.

Some therapeutic approaches and practical skills may help redirect attention toward the surrounding environment, the body, and the senses. These may include grounding and breathing exercises, as well as maintaining regular sleep and reducing stress.

Prevention of the Feeling of Not Existing in People With Depersonalization

Certain habits and strategies may help reduce the severity of depersonalization and derealization symptoms and limit factors that may worsen them. These include:

1. Reducing Stress and Psychological Pressure

Severe and ongoing stress may worsen symptoms of depersonalization and derealization. Therefore, it may be helpful to:

Organize daily tasks and avoid taking on more than you can handle.
Take appropriate breaks throughout the day.
Practice activities that promote relaxation.
Learn healthier and more balanced ways to cope with stress and problems.

2. Getting Enough Regular Sleep

Sleep deprivation and fatigue may increase feelings of detachment and unreality in some people. Therefore, it is recommended to:

Maintain a consistent sleep and wake schedule whenever possible.
Get an adequate amount of sleep.
Avoid repeated late nights.
Reduce the use of phones and electronic devices before bedtime.

3. Managing Anxiety and Panic Attacks

If anxiety or panic attacks are major triggers for the symptoms, managing them appropriately may help reduce episodes of depersonalization and derealization.

A person may benefit from:

Psychotherapy.
Breathing and relaxation exercises.
Cognitive behavioral therapy when appropriate.
Learning how to respond to frightening thoughts rather than constantly monitoring and analyzing the symptoms.

If a doctor prescribes medication for an associated condition, such as anxiety or depression, it is important to follow the doctor's instructions and not change the dose or stop the medication without medical advice.

4. Avoiding Drugs and Substances That May Worsen the Symptoms

Certain substances, particularly cannabis, some hallucinogens, and stimulants, may cause symptoms of depersonalization and derealization or increase their severity in some people.

Therefore, it is recommended to avoid recreational drugs and not use any substance in an attempt to get rid of these symptoms.

5. Avoiding Constant Monitoring of the Sensation

Repeatedly checking how you feel may increase your attention to the symptoms. For example, a person may repeatedly ask:

“Do I feel like I exist?”
“Is the world around me real?”
“Can I feel my body right now?”

The more a person focuses on and analyzes the sensation, the more noticeable and distressing it may become. Therefore, it can be helpful to gradually redirect attention toward the activity at hand rather than continuously monitoring the sensation.

6. Using Grounding Exercises

When feelings of unreality occur, attention can be redirected toward the senses and the surrounding environment. For example:

Describe the things you can see around you.
Touch an object with a noticeable texture and focus on how it feels.
Pay attention to the sounds in your surroundings.
Focus on breathing slowly and steadily.
Remind yourself: “This is a temporary sensation, and I am in a safe place.”

7. Engaging in Physical Activity

Regular physical activity can help reduce stress and anxiety and improve sleep and mood. These factors may influence the severity of depersonalization and derealization symptoms.

8. Staying Consistent With Psychotherapy

If a person has been diagnosed with depersonalization and derealization disorder, attending psychotherapy sessions consistently may help them learn better ways to manage the symptoms and the anxiety associated with them.

Cognitive behavioral therapy (CBT) may be helpful for some people, depending on the assessment of the treating professional.

9. Taking Prescribed Medications as Directed

If a doctor prescribes medication to treat an associated condition, such as anxiety or depression, it is important to take it exactly as prescribed and not change the dose or stop the medication suddenly without consulting the doctor.

10. Avoiding Social Isolation

Continued withdrawal from family and friends may increase anxiety and preoccupation with symptoms. Therefore, it can be helpful to maintain an appropriate level of social contact and continue participating in daily activities, even if this is done gradually.