Why Do I Feel Out of My Body?

Feeling dissociated from–or outside of–your body could be a sign of depersonalization-derealization disorder. Learn more about the signs, treatment, and the link between trauma and feeling outside of your body.

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Feeling as though you are experiencing life outside of your body, or that the world around you seems altered or unfamiliar may be a symptom of an underlying mental health issue known as depersonalization-derealization disorder. Here’s an example of someone who is likely living with depersonalization-dereleaziation disorder: 

It’s your first week of college. You have been looking forward to finally starting this new chapter of your life, experiencing a new sense of independence and making new friends. Despite your excitement, you also feel an overwhelming sense of anxiety and fear about being on your own for the first time, and whether or not people will actually want to get to know you and be your friend.

As the first few days of school set in, your feelings of insecurity and uncertainty begin to take hold of you, and you start to feel as though something is not quite right. You have a difficult time concentrating in your classes, and you have this sense that you are watching your lived experiences from outside of yourself. You feel disconnected from reality. The world around you looks different and strange, and this begins to frighten you because you know something is wrong. You begin to feel emotionally numb, almost as if you are a robot, or that you are living in a phantom body.

You keep going to your classes and trying your best to participate socially with your peers, but the feeling of disconnectedness does not go away. Your grades and your ability to function on a day-to-day basis begin to suffer. After the second week of school, you decide to seek professional help in order to better understand what is going on.

The story above exemplifies some of the common experiences of someone that is experiencing a dissociative disorder known as depersonalization-derealization disorder (DDD). It is normal for individuals to at one point experience this type of relationship between themselves and the world around them, but if the episodes are persistent and recurrent, it is possible that there may be a more serious underlying psychological cause that needs to be addressed with a licensed therapist. There are several reasons why someone might experience an altered sense of themselves and their surroundings, and feel out of their body, which will be explored in this article. 

What are dissociative disorders?

Dissociative disorders are characterized by involuntary escapes from reality, including the disconnection between thoughts, identity, consciousness, and memory. According to the National Alliance on Mental Health, up to 75% of people will experience an episode of dissociation in their lifetime; 2% of those people meet the full criteria for chronic episodes. There are four different types of dissociative disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and they vary in severity and specificity of symptoms.

Dissociation may include:

Depersonalization

Feeling detached from one’s thoughts or body, such as feeling as if they are in a dream or are outside of their body.

Derealization

Feeling detached from surroundings, such as when the world around feels distant or distorted.

For some people, dissociative symptoms are persistent and make functioning day-to-day incredibly difficult.  Patterns of dissociative symptoms usually develop after a traumatic event and are an adaptive response to manage distressing memories and events. 

What is depersonalization-derealization disorder (DDD)?

DDD is a type of dissociative disorder that involves ongoing feelings of detachment from actions, feelings, thoughts, and sensations.  Individuals feel as though they are experiencing life from outside of themselves, often described as feeling like watching a movie of their own life. This is known as depersonalization. Also, individuals may feel like people and things in the world around them are unreal. This is known as derealization. A person with DDD may experience depersonalization, derealization, or both. Symptoms can last just a matter of moments, days, months, or even years. 

Symptoms of depersonalization:

• Feeling emotionally numb, or as if the person is not controlling his or her words and actions
• Feeling detached from ordinary sensations, such as touch, thirst, hunger, and libido

Symptoms of derealization: 

• Feeling as if objects are the wrong size or color
• Feeling as though time is speeding up or slowing down
• Experiencing sounds as louder or softer than expected
• Feeling as though one is watching events and activities unfold in a movie or on a computer screen, rather than actually participating

Causes of depersonalization-derealization disorder

Similar to other dissociative disorders, DDD constitutes a disruption in the functioning of consciousness, memory, identity, perception, motor control, and behavior, and often occurs in response to acute stress or trauma. Yet, unlike other dissociative disorders, individuals who experience depersonalization and/or derealization are fully aware of the change in their relationship between themselves and the world around them. That is why in DDD, the feeling of being outside of your body or the feeling that your surroundings are altered or unreal can be incredibly scary for the person experiencing it. 

Dr. Elena Bezzubova, an expert on depersonalization, describes the way in which DDD can be seen as a psychological defense mechanism against a perceived threat. She explains, “The emergence of depersonalization at the edge of stress can be compared with the explosion of an airbag at the edge of a car crash. The fog of unreality shields from psychological traumas like an exploded airbag protects from physical injuries. The fog of unreality falls as a barrier between person and trauma as if virtually removing this person from a threatening situation.”

Trauma, stress, and dissociation 

Often, repetitive childhood physical and/or sexual abuse and other forms of trauma are associated with the development of dissociative disorders. In situations of chronic, repetitive trauma, dissociation can be considered an adaptive survival mechanism that can help aid the individual suffering from the trauma to survive the experience by reducing the level of distress being consciously experienced by the victim. That being said, in adulthood, if the initial threat of abuse is no longer present, and the individual is still dissociating during experiences in which there is a perceived threat, real or imagined, the dissociation is then considered maladaptive. These episodes of maladaptive dissociation can severely affect an individual's ability to engage in the world around them and can leave them feeling incapable and confused. 

Triggers of depersonalization-derealization episodes

In the example used above about the new college student, the individual begins to experience the dissociative symptoms of depersonalization and derealization as a subconscious defense mechanism against the fear and anxiety surrounding their time at school. More often than not, DDD symptoms will increase during periods of increased stress in the face of a perceived threat. That being said, there are several other factors that can contribute to an individual experiencing episodes of depersonalization and derealization. For example, being tired, anxious, or intoxicated (with alcohol, cannabis, ketamine, and other mind-altering substances) can be triggers for dissociation, although, in these situations, the symptoms are often transient. Also, the symptoms of depersonalization and derealization can often be found in individuals that have other psychological diagnoses such as severe anxiety or panic disorder, depression, post traumatic stress disorder, obsessive compulsive disorder, and schizophrenia.  

Medical conditions and depersonalization-derealization 

It’s important to note that there are some medical conditions that can cause an individual to experience depersonalization and derealization. Some examples of this can be found in seizure disorders, epilepsy, brain tumors, and brain injuries. For a person to be diagnosed with DDD, the cause of the dissociative episodes needs to be psychological in nature, and not due to a structural abnormality such as in the case of a tumor, or because of another medical diagnosis. In other words, while individuals with a medical diagnosis may experience the symptoms of depersonalization and derealization, that does not mean that they are suffering from DDD. 

If you are experiencing any of the symptoms of depersonalization or derealization listed above on a consistent basis, it is imperative that you consult a healthcare professional. During this consultation, the healthcare professional will take your medical history and perform a physical, as well as perform tests to rule out any medical conditions that might be causing symptoms such as memory loss and a sense that the world around you is no longer real.

How do I know if I have depersonalization-derealization disorder?

During your initial consultation with a licensed professional, the most important thing is to be honest about your symptoms and your experiences so that the person doing the assessment has the proper information to make an accurate diagnosis. Psychological tests and special structured interviews and questionnaires will help the licensed professional rule out any other mental health diagnoses and gain further insight into your lived experience. To help rule out an underlying medical diagnosis that may be the cause of the symptoms, other tests and studies such as magnetic resonance imaging (MRI), computed tomography (CT), electroencephalography (EEG), and blood and urine tests to check for drugs may be ordered. 

Diagnosing DDD is based on the reported experience of the individual suffering from the symptoms. If your episodes of depersonalization or derealization happen regularly or last for a long period of time; if you are fully aware of the fact that your symptoms represent something outside of your normal way of experiencing life and are able to identify them as such; and if your symptoms are causing distress and challenges in your ability to function on a day to day basis, a medical professional may explore the possibility that you have DDD. It should be mentioned that the diagnosis and treatment of any mental health disorder should always be done in collaboration with a licensed mental health professional, and that self-diagnosis and self-guided treatment can lead to misdiagnosis and the exacerbation of symptoms. Therefore, if you are experiencing any of these symptoms, there is help available. 

How Charlie Health can help

There are several types of psychotherapy that are used to help people take control of dissociative processes and cope with symptoms. In therapy, you can learn to better understand the triggers of your depersonalization-derealization symptoms and how to use different tools and techniques to manage them when they do arise. For many individuals, simply being able to receive a proper diagnosis to help better explain their symptoms can result in a great deal of emotional relief. Individuals suffering from dissociative episodes often feel like they are alone in their experience. Being able to be reassured that there is an identifiable cause of your symptoms and that there is a way to get better is a great first step toward recovery.

Two approaches that are used in Charlie Health’s Intensive Outpatient Program that help individuals with depersonalization-derealization disorder are cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) skills.

Cognitive behavioral therapy (CBT) is a logic-based approach to psychotherapy that was designed to help people grow more aware of their thoughts and feelings. One of the reasons that it is so effective is because it shows people how to recognize and reframe the patterns that prevent them from healing. CBT can also help people to improve their self-confidence, improve their relationships, and manage anxiety and depression.

Dialectical behavior therapy (DBT) is another type of talk therapy that teaches people how to understand and regulate their emotions. Through individual therapy, group skills training, and ongoing coaching, DBT imparts the skills to manage uncomfortable thoughts, feelings, and behaviors.

If you identify with any of the information above, it is essential that you take the first step and reach out to a licensed professional for help. Charlie Health is here for you when that time comes, and we have Admissions Team members available 24/7. Reach out today to get started on your journey toward better mental health