Synopsis
Recognise depersonalisation, derealisation and other dissociative symptoms, exclude acute neurological or substance-related causes, and provide stabilising, trauma-informed care without suggestive or coercive exploration.
- Depersonalisation is a distressing sense of detachment from oneself; derealisation is a sense that surroundings are unreal, distant or altered.
- Reality testing is usually retained: the person recognises the experience as a feeling rather than accepting an external change as fact.
- Dissociation can involve gaps in autobiographical memory, altered identity experience, trance-like absorption or reduced connection with body and surroundings.
- Symptoms occur across panic, trauma-related disorders, depression, sleep deprivation and substance effects as well as dissociative disorders.
- Assess neurological, metabolic, medication and substance explanations before assuming a primary dissociative mechanism.
- In acute distress, orient to the present, reduce stimulation and use collaborative grounding rather than forcing detailed trauma disclosure.
- Talking therapies are central; no medicine specifically treats dissociation, although medication may address a clearly diagnosed comorbid disorder.
- Ask about self-harm, lost time, vulnerability and safety during episodes, and develop a practical plan for early warning signs and support.
Key red flags
Fluctuating attention, disorientation, fever, head injury, focal deficit or abnormal vital signs suggests delirium, intoxication or neurological illness.
Unexplained collapse, stereotyped episodes, tongue injury or post-event confusion requires assessment for seizure, syncope and other medical causes.
Suicidal intent, severe self-neglect, inability to care for dependants or dangerous behaviour during amnestic periods needs urgent risk management.
Current abuse, coercive control, exploitation or unsafe accommodation requires sensitive safeguarding action that preserves the person's agency where possible.
Investigation priorities
Clarify detachment, unreality, memory gaps, identity experience, awareness, insight, duration, triggers and functional consequences in the person's words.
Management branches
The person feels detached or unreal but is medically stable and can engage.
- Introduce yourself, state the place and time, reduce stimulation and ask what the person calls the experience and what usually helps.
- Offer simple grounding through external sights, sounds, posture or paced breathing while avoiding touch or intense sensory prompts without consent.
- Assess medical and psychiatric risk, identify support and agree what to do if awareness, self-harm urges or physical symptoms worsen.