Complex PTSD: Understanding & Managing Derealisation and Depersonalisation

Ashley Peacock
6 min readApr 3, 2023

Introduction

Living with Complex PTSD can be a challenge, particularly when it comes to managing symptoms such as derealisation and depersonalisation. These experiences can leave individuals feeling disconnected from their surroundings and their own sense of self, making it difficult to navigate everyday life. However, understanding the nature of these symptoms, learning effective coping strategies can help those with Complex PTSD reclaim a sense of control, improve their overall well-being and even uncover new aspects of their inner selfs.

In this article, we will explore what derealisation and depersonalisation are, the relationship to Complex PTSD, lived experience of derealisation in addition to practical tips for managing and exploring these states.

What is derealisation, dissociation and depersonalisation?

A simple form of dissociation can be entering a room and not knowing why you are there, driving and not remembering the journey. Derealisation and depersonalisation is a more severe form of dissociation.

Derealisation and Depersonalisation occur when a person experiences high anxiety or stress that overwhelms one the nervous system for long periods of time. Dissociation is the bodies natural protective mechanism against direct impact of high-stress or traumatic experiences. However, the mechanism can malfunction and switch on all the time, and this creates a dream-like experience, known as derealisation. In its more severe form, depersonalisation is reported and this is when an individuals identity and sense of self breaks.

My experience of walking towards the entrance of a train station with derealisation

Derealisation remains a poorly understood symptom in the medical community, with many mental health professionals lacking awareness of its existence. This oversight can lead to individuals experiencing a crisis being misdiagnosed as psychotic, or their symptoms being dismissed altogether. However, it’s essential to distinguish between derealisation and psychosis, as the former allows the individual to maintain some level of awareness, whereas the latter typically impairs awareness.

Despite the lack of recognition in Western medicine, I found validation in Chinese medicine, where a practitioner explained how the individual’s essence, consciousness, or spirit can turn away from itself. This understanding allowed for the development of treatment methods, such as acupuncture, to support the healing process.

Prevalence

More than half of the population will experience DDD at some point in their lives. For most people it will be a fleeting experience lasting a few minutes to a few hours. However, for 2% of the population, it will be experienced commonly enough to become a full disorder.

What causes it?

The severity and effects of derealisation and depersonalisation can vary widely from person to person, as these experiences are unique and subjective. Individuals who experience these symptoms may feel a sense of disconnection from their surroundings, as if they are in a dream or that the world is not real.

During periods of depersonalisation, I individuals find myself deeply questioning the very nature of reality and existence.

What does friendship mean? Wait, what does meaning even mean?

In my experience dissecting the world in such detail, I started to understand how little in the world was really fixed, but it can too take it’s toll, it’s exhausting to live in a space where even opening the door requires so much thinking to reason about and my sense of identity is completely broken. I’m grateful to have had some meditation practice in advance of this.

The causes of derealisation and depersonalisation are not fully understood, but there are various theories. One possibility is that the body enters dissociation as a means of self-protection from further harm. By disconnecting from the world around them, the individual is less emotionally affected, which may help to prevent further psychological damage. Another theory suggests that these experiences are a response to overwhelming stimuli. When faced with too much information, the brain may shut down certain systems in order to cope, leading to feelings of detachment and disorientation. For some, these episodes may only last a few seconds, but when the safety mechanism malfunctions due to chronic stress or trauma, derealisation and depersonalisation can become a pervasive and debilitating part of everyday life.

Managing these symptoms effectively requires a tailored approach that may involve therapy, lifestyle changes, and stress reduction techniques to regain a sense of control and improve overall well-being.

A depiction of what the world can see and feel like as you walk down the street.

If you’re experiencing derealisation or depersonalisation, it is a fairly strong sign that life is becoming too much.

What is the experience of derealisation/depersonalisation?

Derealisation can make objects seem unsolid, diminished in size or two-dimensional, and it can feel like you are living in a glass container or peering at the world through a fog. You feel as if you are walking in a dream, living in a glass-like container, the world unreachable and meaningless. It can make it difficult to trust yourself or make decisions, because you cannot trust what you see, sense or feel.

Derealisation can be extremely distressing and make it difficult to function day-to-day. The memory is significantly impaired. I often cannot remember what had happened during theday and may have no recollection of the previous day. If the body is in fight/flight/freeze and therefore it is paying attention to what matters most — dealing with a threat, at which point memory is less important, escape is.

it can feel like you are living in a glass container or peering at the world through a fog

Even when speaking to people you know well, their voices may sound different, their appearance will feel as if you don’t know who they are. Your mind will tell you it is who you think it is but everything is weird and out of place. Am I speaking to who I think I am?

The sense of speaking to people even when you have known them for years

“The lack of awareness and understanding of the condition is very frustrating and makes trying to get help and get better so much harder.” — Mind

Depersonalisation can leave a person feeling disconnected. Have you ever felt like your thoughts and actions are not your own, or like you are watching yourself from the outside? I would describe this as if becoming an alien who has arrived on a new planet and everything looks new and strange.

Derealisation can look a bit like the image below. Except in my case the floor also looks and feels a bit like a bouncy castle:

In a state of derealisation it is likely your nervous system is overactive, and you will feel like you are in fight or flight. Anything can happen because you feel like you are in a dream. It’s hard to explain what it feels like to live in a world that looks like it could collapse at any moment. And because of the overlap with the dream-state, well anything can happen in a dream so logically the world could collapse at any moment.

Objects change colour, vision is blurred, comprehending information is slower, speaking is harder, memory is impaired. Senses are heightened, being touched gently hurts, noises hurt, reading is impossible, watching films is impossible.

Avoiding any and all triggers, no matter how minor, feels essential. This includes people, who are extremely unpredictable, leading to isolation. Unfortunately if the cause is related to Complex ptsd, a part of the healing process is learning to connect to those around us.

How do other people describe derealisation and depersonalisation?

“[I have] occasional depersonalization disorder, (which makes me feel utterly detached from reality, but in less of a “this LSD is awesome” kind of way and more of a “I wonder what my face is doing right now” and “it sure would be nice to feel emotions again” sort of thing).”

Jenny Lawson, Furiously Happy: A Funny Book About Horrible Things

“It was strange when I would hear myself talking. Who was this person speaking words out of my mouth? I didn’t feel like it was me.”

― Malia Bradshaw, A Return to Self: Depersonalization and How to Overcome It

Getting help

If you are struggling with derealisation, it is important to seek out help. Simply vocalising the experience can lessen its power over you. You may have to educate your GP and you may need to find someone who is genuinely trauma-trained who can help you to manage the symptoms and anxiety.

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Ashley Peacock

UX, inclusive design, neuroscience, mental health and building accessible technology. Entrepreneur. ADHD & Dyslexic #a11y advocate.