Depersonalization in Schizophrenia: What It Is and How to Manage It

“It’s an experience of feeling detached from your mind, feelings, sensations — kind of like a sense of unreality,” says the clinical psychologist Lauren Gonzales, PhD, an assistant professor of medical psychology at Columbia University Irving Medical Center in New York City and the director of CBT for psychosis services at the New York State Office of Mental Health. “People often describe it as feeling like you’re an outside observer, looking in at yourself.”

Here’s what to know about the symptoms and causes of depersonalization, and how to manage it if you or a loved one experiences this symptom.

• Disconnection from your thoughts, feelings, and body
• Feeling robot-like
• Emotional and physical numbness
• Distrusting your memories
• An inability to describe or identify with your emotions or experiences
• Feeling like you’re observing your life from outside your body or that you’re living in a dreamworld
• Sadness or anxiety

“People describe this kind of permeability of solid objects: like things appear as if they’re melting — but it’s not necessarily a hallucination, it’s more a sense of unreality,” Dr. Gonzales says, citing research from a project called Psychosis Outside the Box, in which researchers documented firsthand accounts of psychosis and symptoms of depersonalization.

Someone experiencing depersonalization may also seem completely preoccupied, despite being in the same room with you or in the middle of a conversation, Dr. Crawford says.

“It’s like something is playing out in their head and they’re trying to work it out,” says Crawford. “And because they’re so preoccupied by that internal experience, they are detached from what’s happening in their present, current moment.”

As mentioned, depersonalization frequently occurs as a defense mechanism in response to trauma, either in the immediate moment or due to a traumatic memory. “It comes from a very helpful, adaptive, and protective place,” Gonzales says. “It’s your body and brain’s way of protecting you and taking a break when you don’t have anything else to regulate your emotional experience.”

• Extreme stress from personal or work-related situations
• Persistent anxiety or depression
• Illicit drug use

Treating depersonalization in people with schizophrenia involves treating schizophrenia, the root cause of this symptom first, says George Keepers, MD, a professor of psychiatry at Oregon Health & Science University School of Medicine in Portland and lead author of the American Psychiatric Association’s practice guidelines for the treatment of schizophrenia.

“Successful treatment of psychosis will generally resolve experiences of depersonalization,” Dr. Keepers says.

Some schizophrenia treatments and coping strategies that can be particularly helpful for managing depersonalization are:

• Medication The mainstay treatment for schizophrenia is antipsychotic medication. These medications treat symptoms of psychosis (a detachment from reality that can happen with schizophrenia) such as hallucinations and delusions.

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• Cognitive Behavioral Therapy for Psychosis CBTp is another crucial component of treatment. Research suggests CBTp can reduce the distress related to symptoms like depersonalization and improve day-to-day functioning. Some individuals experience depersonalization because they don’t have strategies or tools for how to navigate difficult situations, and therapy teaches new skills, Crawford says.

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• Grounding Techniques Gonzales teaches her patients grounding techniques to help them stay rooted in reality. Grounding techniques are strategies that activate the five senses: taste, touch, smell, hearing, and sight. Some effective examples are smelling a candle with a strong scent, holding an ice cube, or eating sour candy, because these intense sensations can help refocus your attention on the present moment. “It really brings you back into your own body,” she says. Other ways to keep yourself grounded, says Gonzales, include asking yourself questions, such as “Where am I?” or “Who am I?” or “What is the date today?”

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