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

In schizophrenia, depersonalization may appear in different ways. For instance, you or a loved one with schizophrenia may feel disoriented, overwhelmed by strange physical sensations, or see things that aren’t grounded in reality.

“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.

A loved one experiencing depersonalization may also seem completely preoccupied despite being in the same room with you or in the middle of a conversation with you, Dr. Crawford says. It’s often because they’re grappling with something internally — they might be listening to voices they’re hearing, seeing visual hallucinations they’re not comfortable communicating to other people about, or responding to other internal stimuli, she adds.

“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 in the immediate moment or 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.”

If, for example, someone is overwhelmed by paranoid delusions (unshakable false beliefs that external forces, such as a person or the government, are out to harm or sabotage you), this may trigger an episode of depersonalization in which they step away from the experience as an act of self-preservation.

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

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

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 treat symptoms of psychosis (a detachment from reality that can happen with schizophrenia) such as hallucinations and delusions.

  [8]

• Cognitive behavioral therapy for psychosis: CBTp is another crucial component of treatment. Research suggests CBTp can reduce the stress that may trigger symptoms like depersonalization and improve day-to-day functioning.

  [9]

   “Some people put themselves in that state because they’re lacking strategies or tools for how to navigate a difficult moment, so therapy teaches new skills,” Crawford says.
• 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, adds Gonzales, include asking yourself questions, such as, “Where am I?,” “Who am I?,” or “What is the date today?”

• Depersonalization is a common symptom among people with schizophrenia that can cause them to feel detached from their body, mind, feelings, and actions.
• It may appear as if the person is disconnected from reality or in another world despite being present physically.
• It’s often triggered in response to stressors or trauma — people may dissociate as a means of self-preservation to protect themselves from harmful thoughts or situations.
• Depersonalization in schizophrenia can be treated through a combination of medication, cognitive behavioral therapy for psychosis, and other strategies.