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Anxiety Disorders

Derealisation and Depersonalisation

Depersonalisation and Derealisation are very common symptoms of spontaneous panic attacks and belong to a group of sensations/feelings often known collectively as Dissociation.

The ability to dissociate is on a scale 0 -10 and people with panic disorder are about 4 - 5 on this scale. Many people with panic disorder report that their panic attacks begin with the experience of depersonalisation and/or derealisation.

Dissociation is also known as a 'self induced (hypnotic) trance states' or 'altered states of consciousness'. The sensations of dissociation are many and varied. They include the following:


A feeling that you and/or your surroundings are not real
And/or experience your surroundings through a diffused light, fog or mist.


Feeling as if you are "outside of your body"/ 'detached from your body', as though you are either standing alongside, above or behind it

Other dissociative sensations

Sensitivity to light and sound
Tunnel vision
Feeling as if your body has expanded so that it feels larger than normal
Feeling as if your body has shrunk to minute proportions
Stationary objects may appear to move
Driving a car and suddenly realise you don't remember what has happened during all or part of the trip
Listening to someone talk and realise you did not hear part or all of what was said
Sometimes sit staring off into space, and not being aware of the passage of time

It is interesting to note, that although depersonalisation and derealisation symptoms are recognised as two of the most common spontaneous panic attack symptoms, the ability to dissociate is not mentioned in the main panic disorder literature. Nor is it mentioned that many people dissociate first and experience a panic attack in reaction to the dissociation.

There has been speculation amongst psychiatrists who work in the area of dissociation, that people with panic disorder do in fact dissociate first and then panic, but there has been no substantial research in this area. Which is disappointing. We have been researching this for over 10 years and we know from the feedback from clients and from emails that this is the cause of the panic for so many of people.

People who do dissociate have had this ability since childhood, although many people have forgotten they were able to do this as children. This ability can be activated once again as an adult as a result of a major stress and/or not eating or sleeping properly.

Some of the research shows a trance state can be induced within a split second. Most of us who have panic disorder are not aware of how we can 'trance out' so easily, and we can then panic when we move into an altered state. Our research also shows that people can experience an 'electric' shock feeling or a burning heat or a tingling heat in these altered states. This also adds to the fear and panic that we are dying or going insane.

Another research study shows that people can experience dizziness as a result of derealisation. The research shows it is not so much the derealisation that causes the dizziness, rather it is the magnitude in the change of consciousness that can causes the feelings of dizziness.

Many people who experience depersonalisation and derealisation can be woken from sleep with a nocturnal panic attack. Research shows these attacks happen on the change of consciousness, going into sleep, moving into dreaming sleep or to deep sleep or back to dreaming sleep. The change in consciousness during sleep, is similar to the change in consciousness people can experience when they dissociate during the day.

Some people with panic disorder are frightened of their ability to dissociate, other people are not. One of the easiest way people can induce a trance state is when they are relaxed and/or when they are staring : out of the window, driving, watching TV, reading a book, using the computer, when talking with someone. Fluorescent lights can trigger a trance state, so too can self absorption. The more absorbed we become, the more we can induce a trance stare.

For more information see a An Analysis of a spontaneous panic attack

We teach people to become aware of how they are inducing a trance state. When people can see this, we teach them to work with their thinking and not buy into the panic/anxiety thoughts, 'What's happening to me'...'I'm going insane' etc. The way we think about our symptoms only creates more stress and anxiety which in turn only makes us more vulnerable to dissociated states.

Panic Disorder