Within the realm of psychiatric disorders, there are different conditions that can be easily confused with one another.  Whether it be due an overlap of symptomology or some other external factors, some mental illnesses can be misconstrued or wrongly attributed to when there is really something else going on.  In today’s blog, we will tackle the difference between depersonalization disorder and psychosis.  Both of these terms deal with similar types of concepts, as depersonalization and psychosis both affect the way that people think, feel, and perceive.  Of course, the same thing can be said about a number of different mental illnesses. What makes these two different, though? And maybe more importantly, what makes them so similar?


Depersonalization Disorder: What is it?

Have you ever felt an out-of-body experience? Almost like you are watching yourself move, speak, and act from the outside? Maybe it isn’t even that severe, and maybe sometimes you just feel like you are detached from your body or the things that surround you.  To some extent, most people will experience some degree of depersonalization or derealization.  However, this detachment becomes an issue when feeling this way persists for a long duration of time.  Being in a constant out-of-body state can be quite disruptive to daily life, and recognizing it as an issue is a great start to treating its symptoms.

As it is defined by the APA, depersonalization disorder (or derealization disorder) is a type of dissociative disorder.  It refers to feelings of detachment from one’s thoughts, feelings, self, and environment.  The onset of depersonalization is usually rapid and begins as a feeling of separation from oneself.  The way that a person views their own thoughts and feelings may become distorted, and even the way they visually perceive themselves and the environment can become distorted as well. A major thing to understand about people who undergo derealization:

Individuals are aware that their detachment from themselves and the outside world is a feeling — NOT their reality.



Depersonalization, or derealization, can manifest itself in different ways, including:

  • Feeling like you are a robot
  • Feeling as though you are living in a dream or fantasy world
  • Disconnected from the things and surroundings in your environment
  • Feeling like you are observing your thoughts and feelings from the outside, not like you are living through the moments yourself
    • For example, you may feel like you are floating outside of your body just watching yourself do and say things
  • Feeling like your extremities have changed in appearance or even size
  • Seeing one’s self from a distance
  • Feeling like you do not own your memories or not being able to trust them
  • Feeling like you are not in control of your own thoughts or feelings
  • Feeling like you are living in a cloud or watching yourself through a movie or glass 
  • Feeling a sense of numbness — either physically or emotionally
  • Feeling depressed, anxious, or emotionally disconnected from everything around you
  • Finding a lack of meaning of life or outside surroundings
  • Experiencing a distortion of reality or time
    • For example, recent memories may feel like something that happened a long time ago
  • Feeling as though you are ‘going crazy’

Some individuals with depersonalization disorder experience symptoms for a few hours, days, or even weeks.  On the other hand, there are some who experience symptoms for months at a time, and the chronic presence of this disorder can lead individuals to develop serious functional disabilities.  Those who experience fleeting moments of depersonalization are experiencing a phenomenon called transient depersonalization.  For a few short moments or even minutes, individuals feel like they are detached from themselves and their surroundings.  They feel as though they are looking into their lives instead of actually experiencing it for themselves.  This experience becomes a full-fledged disorder once depersonalization is occuring all of the time.  When people cannot stop feeling as though they are living outside of their bodies, depersonalization becomes chronic and this typically affects 2% of the population.


Causes of Depersonalization

Let’s begin with this thought: what is significant about the fact that depersonalization is a dissociative disorder?  Well, dissociative disorders are mental conditions in which individuals feel a disconnection between themselves and their thoughts, actions, self, and environment.  In this blog, we go into depth about dissociation and its effects on people.  In short, dissociative disorders impair daily functioning, and can cause serious issues for those with the condition.  Some people with dissociative disorders may repress memories to keep the difficult, painful memories out of their consciousness, and some might even experience dissociative amnesia or alternative identities to protect themselves from their memories and thoughts. 

Depersonalization, as with other dissociative disorders, may stem from a reaction to trauma. In truth, researchers and health professionals do not know the root cause for the disorder, but biological and environmental factors may contribute to its fruition.  Things related to abuse in childhood, extreme levels of stress in personal and work environments, physical conditions (such as seizure disorders), accidents, natural disasters, sudden death, personality or mental disorders, and so many other things can play a part in causing depersonalization to take place.


Psychosis: What is it?

Switching gears, we will discuss what psychosis is and how it is different from depersonalization. Psychosis is not one single mental health condition, but rather it is a collection of symptoms.  Many individuals undergo psychosis in concurrence with other mental health disorders, such as schizophrenia, depression, delusional disorder, personality disorders, bipolar disorders, and other substance-induced psychotic disorders. Other physical conditions may induce psychosis as well, such as lyme disease, multiple sclerosis, stroke, or vitamin deficiencies.

During psychosis, a person becomes disconnected from reality and may experience or believe things that are not real.  Those who undergo psychosis cannot tell the difference between what is actually occurring in their environment and what is made up. There are two ways that people can experience psychosis: delusions and hallucinations.  In a recent blog where we explored manic episodes, it was discussed that a major characteristic of manic episodes is the presence of delusions and hallucinations. However, it is important to note that mania and psychosis are not the same thing.  Psychosis is an experience that may occur during manic episodes, but they are not interchangeable terms.  Psychosis can also occur during depressive episodes, but they are more commonly associated with manic episodes.


Symptoms of Psychosis

As mentioned above, the two ways that people can experience psychosis are through delusions and hallucinations.  Delusions refer to an experience in which people hold false beliefs about the world.  For example, an individual with paranoid delusions may believe that they are being stalked, surveilled, or even targeted by other people. Hallucinations, however, refer to experiences in which people see or hear things that are not really there.  For example, hallucinations may cause people to hear voices or see people that do not exist.

Some signs and symptoms to look out for suspected psychosis include:

  • Acting afraid or suspicious of other people
  • Showing a decrease of emotion
  • Avoiding activities that one usually enjoys
  • Difficulty with focusing
  • Disruption of sleep
  • Having a hard time differentiating between what is real and what is fake
  • Feeling detached from other people or yourself
  • Becoming less social and spending more time in isolation
  • Having trouble communicating
  • Feeling like you are cut off from the world
  • Slurred, nonsensical speech
  • Feeling detached from your own feelings and thoughts


A major thing to understand about psychosis is this:

Individuals are NOT aware that their detachment from themselves and the outside world is a feeling — they can no longer differentiate what is imagined from what is reality.


Major Differences between Depersonalization and Psychosis

For both depersonalization and psychosis, individuals undergo some kind of detachment from themselves.  They may experience feelings of being ‘outside’ of their bodies and feel distanced or even isolated from the people or objects in their environment.  Both disorders commonly manifest in people who have experienced some kind of trauma, and can occur concurrently with other mental disorders.  Those with either disorder may feel as though their thoughts are confused, detached from their own brain, and even feel like what they are experiencing is nonsensical.

However, the main difference between depersonalization and psychosis is that those with depersonalization or derealization know that their detachment from themselves and the environment is not actually happening to them.  It is a more passive experience, in which individuals may feel like they are watching their lives from the outside.  There is still a grip on reality who experience depersonalization. They understand that what they are feeling is simply a feeling, and they know that they are not actually existing outside of their bodies.  On the other hand, those with psychosis truly believe that the detachment from themselves and surroundings is actually happening.  They are not aware that the delusions and hallucinations they experience aren’t real, and it is less of a passive experience as depersonalization may be.  They are more paranoid, suspicious, hostile, and skeptical than those who are experiencing depersonalization.

Whether or not a person knows that their experiences are a break from reality or not, those who suffer from either depersonalization or psychosis may greatly benefit from  a variety of support programs.  Options range from community support programs, multiple types of therapy (including CBT and group therapies), a selection of medications, and other peer groups that specifically deal with the condition you or a loved one may be suffering from.

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