Derealization, depersonalization, dissociation, and delusions with mood and anxiety disorders

Symptoms like depersonalization, derealization, dissociation, delusions, and hallucinations can be incredibly disturbing. They are often thought of as being signs of a psychotic disorder or severe trauma, but if these symptoms only occur during depressive episodes, they may actually be part of a mood disorder.
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We can also experience disconnections from reality because of intense psychological distress, including periods of prolonged or significantly heightened anxiety. Dissociation is somewhat like the mind’s version of going into shock. It’s a temporary anesthetic to protect us from the immense emotional pain that we’re experiencing.
The prefrontal cortex, the very front most region of the brain, is responsible for our orientation to person, place, and time. When activity in the frontal lobe decreases, we lose some (or all) of this ability to orient to these anchors. This can be terrifying or disturbing if you don’t know what it is or don’t realize that it’s temporary and something that is, to some degree, supposed to happen.
Understanding what all of these processes are and the neurological reasons for them makes them a lot less scary. Hopefully, that’s what you get from this episode.
Some markers:
3:58 - Depersonalization
6:27 - Derealization
8:45 - Dissociation
10:59 - Delusions
12:18 - Hallucinations
18:47 - Scott's Experience
21:37 - Differential Diagnosis
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[@age93]

Derealization feels like a dream. Walking down the street and thinking maybe if I walk in front of a car it'll snap me out of this. At the same time, understanding the consequences of doing so.

[@jonnyasis7485]

kzbin.info/www/bejne/b4atoqNmotqZqa8feature=shared

[@atomicnumber8051]

EXACTLY! sometimes if it’s really bad and not background, objects look weird asf and your perception of the room changes and it’s scary because you think something’s wrong with you? Or even like you’re about to pass out but it just seems like an abrupt change in what you can see, lack/change of peripheral vision? Static-ish vision and it makes you dizzy but not because of your balance?

[@kath5018]

Derealization. I had it for a loong time. This is when I had severe depression, It was a feeling that scared me a lot and I got panic attacks, because of this . I felt like I didn't exist. So scary. I don't wish it to my worst enemy.

[@lora4624]

How did you get healed from it??

[@jonnyasis7485]

kzbin.info/www/bejne/b4atoqNmotqZqa8feature=shared

[@kellypawspa]

​@lora4624 As stupid as this sounds, and it's really probably not a good idea... but sometimes ill have 2 or 3 shots of Tequilla. The buzz is something that feels familiar to me and the alcohol slightly mellows out my emotions to just a tolerable level. If I concemtrate on how the alcohol feels going down, then in my fingertips, then how it affects my eyes and make myself go for a walk I can get back into my body pretty quickly. I hate the feeling of being locked outside. I don't even like the booze, but find it useful here and on some of those tougher cleaning jobs. Lol

[@lora4624]

@@kellypawspa thanks for the input but for some reason the buzz does the opposite effect for me?? But yeah the feeling of drinking the shots is sometimes kinda "sobering" for the derealization lol

[@carolinebielby5924]

I had it during my bad anxiety episode and oh my gosh I felt so strange my body didn't even feel like mine kept wanting my head to clear and it wouldn't the most strange but really horrible sensation

[@accuratealloys]

I was prescribed SSRIs a few years ago and one the side effect was derealization. It was horrifying. I thought there were no consequences for anything because nothing was real. I understand mass shooter thoughts now. I’m so glad that I was able to notice that there was something wrong and was able to get off of it after a long battle. I’ll never take another psyc med ever again. I’d rather opt myself out than go through that again.

[@gabrielmorin-beland1745]

What were you taking?

[@EL-ln8ei]

BTW- the brain remembers the dissociation option/mechanism from childhood. I completely forgot some traumas for decades. I had a flashback 3 years ago that brought back all kinds of disorders and also dissociative ones. Like DP, DR & amnesia. After about a month as I relaxed and gained control back, the dissociation went away completely. Or at least went back to the my baseline level

[@SHUGBlastbeats]

You know how when your driving and you see mountains in the distance and it looks like a painting, on some bob Ross shit. That's what real life looks like with dpdr.

[@SnowieShiba]

I experience psychosis almost daily and I've been told by a few psychiatrists that I'm not schizophrenic. I've learned to cope the best way I can on my own and when I do try to talk about it it feels like whoever I talk to is trying to minimize the impact it has on my life because I've lived with it so long untreated. I didn't know there could be other reasons for my experiences so I was shocked to hear that I'm not schizophrenic, but it was also distressing at the same time because they had given me NO further explanation of what else it COULD be. I was left completely in the dark and turned to do research on my own because I needed to know what other things could cause the same symptoms. I'm glad that I'm not completely alone in my experiences.

[@DannyD-lr5yg]

Have you looked into schizotypal personality traits (or in more intense cases, “personality disorder”)? Cause guess what: like most other things, schizotypal symptoms ALSO exist on a continuum!! I was concerned for a couple of bad years that I might be developing schizophrenia, but that never quite happened. However, when I heard people with schizophrenia talk about their initial symptoms, or their breakthrough symptoms, I go “Hey…I experience all that fairly often!!” Anyways, it’s been freeing and helpful for me to learn more about schizotypal traits! I encourage you to look up a schizotypal trait assessment/personality inventory, and see if any of that resonates with you :) Oh and also, since you didnt specify exactly which symptoms: schizotypal traits & symptoms are, to put it simply, a lesser version of the “positive” symptoms of schizophrenia. If you experience things more similar to the “negative” symptoms of schizophrenia, check out schizoid traits/schizoid personality disorder!

[@aleniha933]

I seem to have had derealization/depersonalisation for my entire life. I gave up trying to fix it a long time ago. I was really happy to see you've made a video on that🖤

[@ericblair54]

When I go out for a walk I feel like I'm on the outside looking in, not a participant in life, an observer. All this life going on around me and I feel like I'm walking on air. Nothing is real, I don;t feel my body. Also I will be walking and all of of sudden I will be weeping. I wrote this as I was listening o the video. When you menioned "observer" I got the chills.

[@kirstencourtney8792]

This sounds like derealization. It happened to me several years ago when I was in an extremely stressful, almost undoable, and unlivable new job in a new state, by myself, with 2 young children. I also found myself rocking in a ball back and forth when I was at my worst. My theory is that when life just gets too stressful, it literally can start to seem unreal because our brain won't/doesn't want to accept that world. It seems like everyone around you is living in that world just fine, but your world has literally fallen apart. What helped me was someone to talk to validate my terrible situation, going on Prozac (this or other antidepressant can be helpful short or long term if necessary, and may not be necessary, but for me it helped snap me out of the derealization, not medical advice tho,) and moving to another state with a relative for awhile, while taking a break and then looking for another job. I realize doing all this may not be possible for every person, but find whatever way you can to help reduce the stress in your life. I'd say the first step would be to realize that this can happen to anyone in certain situations and don't feel alone about that. Then take baby steps to reduce stress and be patient with yourself. I'm not a doctor, just sharing my experience. I hope this helps and I hope you are feeling better soon!

[@ericblair54]

@@kirstencourtney8792 Thank you for your kindness, compassion and advice. Yesterday was so awful, I had stomach and abdominal cramps and when I ate, a few hours later, diarrhea. My stomach is still roiling.

[@kirstencourtney8792]

​@@ericblair54You're welcome! I'm sorry to hear about your bad day and stomach issues too. I have had lymphocytic colitis for over 20 years, so I can relate to having the big D also! I do hope it clears up for you soon!

[@carolinebielby5924]

Yes, the observer is exactly it 😢it's frightening for sure your head feels blocked somehow

[@si-1255]

This feeling is so uncomfortable. I'm sick of it. Makes me so numb to anything. I don't even Live any experience fully .

[@fabianshedenhelm2986]

It's been going on for years and years. I have a theory of it being trauma based.

[@Rizzaknits]

Thank you. I have experienced psychosis and it is one of the most terrifying things I've ever gone through. Even more so, processing the experience afterward was intense and scary, and I still have ptsd from it. It made me realize how fragile our connection to reality can be, and how our own brain can be untrustworthy. But enough time has finally passed that I have some peace and understanding. I did a *ton* of research afterwards because I had to understand what happened to me and why. I have a strong support system in place now and no shame around talking about it because that has been the biggest safety for me. I let too much time pass thinking I could get a handle on it by myself and eventually it just got worse. If anyone else watching this video feels like they are too ashamed to tell anyone that they're experiencing symptoms of psychosis, just know that you are not alone and it's nothing to be ashamed of. It can get better with proper support. You don't have to deal with it on your own.

[@DrScottEilers]

No shame in talking about it is absolutely critical ❤️

[@jonnyasis7485]

kzbin.info/www/bejne/b4atoqNmotqZqa8feature=shared

[@hartleyb8356]

I experienced so many of the things you talked about whenever I had Psychosis. You explained it better than anyone I’ve ever heard explain it! Especially when you were talking about how things you see everyday look “the same but different.”because for me everything was the same just the colors were much brighter or sometimes I couldn’t put my finger on it but I could just tell that something was “off” and it’d drive me crazy (lol) trying to figure out what was different in the room I was in.

[@DrScottEilers]

I’m glad this makes sense to you

[@hollydayz1010]

or like I'm not supposed to be here...like I wasn't made for acceptance, love, joy, success...I wasn't like this until I started using cm when I tried reviving my relationship with my ex...she started me then tortured me then left me and married my old friend...got clean and left me here alone addicted lost heartbroken and very angry...

[@mariagoodey1153]

Oh lord the disassociation thing i reconise. I thought it was my brain being under to much stress and had pulled the plug for a while! It was pretty scary, it would resolve after some time. Thank you could never really articulate this before!!

[@shey1865]

Thank you! This is so affirming. When I’ve googled dissociation in the past I’ve never come across the definition that describes it like a childlike regression but your description is so accurate to how I feel when I dissociate. Thanks again!

[@DrScottEilers]

You're so welcome!

[@Mgt44411]

To know we are not alone in our struggles gives us courage to get help. To know that 60 million people have experienced these things helps me understand how not alone I am! Your very natural manner of speaking is so reassuring and your willingness to share your own story gives hope that there is light at the end of the tunnel. I thank you so incredibly much for sharing this information and for your time and effort to do these videos. You are helping people in a profound way!🌟

[@dcat1730]

This is really interesting, thanks for making a discussion of this topic. In college I took chloroquine for a tropical field biology course where we went to Belize (it's a malaria prophylactic) and had a rare (but well documented) neurophysiological reaction to it (as it turns out, I'm a poor metabolizer of any drugs in the D26 enzyme class and get something like a 4x dose). It caused me to feel severely depressed and depersonalized--I was aware I was controlling my actions, but I'd look at my hands while writing or studying and feel an intense revulsion because they felt so foreign to me. I was intensely aware I was looking through my eyes with a first person view, like an automaton or a video game, and it was horrifying. In my intro bio classes we had talked about alien limb syndrome and capgras syndrome, where folks don't recognize parts of themselves or their family members respectively, and I suspect from research on these topics it's to do with the proper emotional context is suddenly lacking due to some misfiring or maladjjustment of whatever pathways that normally give you that familiar feeling when you look at your hands or you see your mother. Intellectually I knew they were my hands, I was making them write in my notebook but I'd just watch them crawling around and they might as well have been tentacles as far as I was concerned emotionally. Always be open to getting 3rd, 4th opinions if you need to! The first doctor I saw at the university clinic told me it wasn't a drug reaction ("chloroquine can't do that" you're just psychotic/having a neurological issue. Yeah okay buddy) and it wasn't until I saw this lovely Irish psychiatrist in Amherst MA who listened calmly to the various drugs I'd had serious side effects from, looked at a slip of paper on his desk and was like "yep your a poor metabolizer of this enzyme like 10% of caucasians. Everything you've mentioned in this class. Well, saves you the cost of getting the genetic test--can still get it if you like but it's pretty proof positive." Saved me from a world of gaslighting and self-blame because he was a doctor who paid attention in his clinical pharm/molecular bio training. I'll always be thankful I happened to make an appointment with him. No one else I saw (probably the 5th or sixth shrink I had talked to) ever mentioned it. The uneven-ness of healthcare is deeply saddening to me. Do remember folks doctors are like auto-mechanics. They're understanding might be deeply nuance, or they might just do oil changes all day.

[@gwenadubois5044]

Me dealing with it since years , from anxiety and ptsd

[@Heather-fz6xe]

Im so happy I found this :) Makes me feel less weird about it. I brought it up to my therapist but he didnt seem to understand WTF I was talking about.

[@melidacartagena8355]

To my 60 million brothers and sisters…..WE ARE NOT ALONE!!!💪🏼🙏🌷

[@nmash6835]

You explain everything so well

[@DrScottEilers]

I appreciate that

[@algudboison4827]

From early middle school to late high school I barely have memories, and the ones i do have are hard to place. There was one year before changing schools when I isolated myself so much and was so negative that it even drove my parents mad.

[@LoneWolfMoonChild]

With my BPD I get visual / auditory / physical touch and smell hallucinations Including DP & DR…. It’s having now, keep seeing shadow people out the corner of my eyes, I also hear really loud music, and it’s music I don’t know, it’s bizarre. How can my brain conjure up music it doesn’t know

[@tlwf.system]

I love my psych but I would gladly gladly have you as my psych any day. And I don’t like many psychs bc of my disorders. I don’t trust. But your honesty, experience in real life, explanations, knowledge… I would almost recommend your videos to my psych so she can explain things to me like you do! ❤ if you ever take on zoom call meetings from overseas 😂 please sign me up with your services. You’re amazing 🥲

[@baconandbeans]

Thank you

[@jonnyasis7485]

kzbin.info/www/bejne/b4atoqNmotqZqa8feature=shared

[@michaelharned8741]

I have had these episodes in my younger years

[@MyCatholicBookNook]

I have dissociation. I start to feel like I can’t feel/control my body. I used to be a professional musician but had to quit due to this and severe panic attacks. Treatment didn’t work for me. Now I am trying to train for a new career, but struggling with the stress of being in school and not really liking what I’m studying so I’m still dissociating. I have OCD and the resulting depression from battling this since I was 6 years old. I wouldn’t say I am delusional but OCD does make me feel like I have committed a terrible crime even though I know I haven’t.

[@NeonDungeon]

I get this. OCD coupled with an overactive imagination and in my case also having C-ptsd and being the other side of a 20 year drug addiction (sober) the intensity of the things that I feel guilty for gets wild. Especially since I've lived a pretty chaotic life myself. All I've really done is been in my house, alone for 15 months, journalling my innocence, just in case. 🙁

[@barbconquest]

I feel like I'm going to slip into a dream or nightmare. I had a similar sensation coming off of pain meds.

[@j.p.3697]

I definitely appreciate this video and come back to watch it when the derealization bubbles up again, but I'm here to say that Overblood is like the mother of all sci-fi horror videogames and was great for its time.

[@nancybaumgartner6774]

Stealth infection that causes neural inflammation can cause all of the discussed symptoms. I experienced it 20 years ago , due to a tick bite that transmitted borrelia and anaplasmosis , as have many of my clients. Stealth infection remains largely unrecognized to this day, despite significant activist effort .

[@lailanitukuafu]

This is gonna be a long one, sorry. I've experienced some of the depersonalization and derealization, but I'd say my case is usually pretty mild compared to that of other people. The times that it happens to this level of severity are, understandably, the times I feel I'm in a sort of crisis and it doesn't happen very often. These are the most prominent examples that come to mind from my own life: one time when I had a two-hour long anxiety attack, the few times I've had active SI, and a time in high school that was basically all of my mental health struggles converging into one day. It feels weird and very hard to describe. It's filled with extreme paradoxes that don't really make a lot of sense. Time is both really fast and painstakingly slow, my 5 senses are both really sharp and really dull, I feel like I look totally normal but also completely shattered, I feel immensely heavy and also weightless, and I'm feeling extremely emotional but also completely numb, empty, and devoid of any feeling. If you've seen the end of Gravity Falls where everything is wrong and discordant in some way, the world feels a bit like that. It doesn't look any different than usual, but everything in me is screaming that something is very wrong. It feels like I'm moving through syrup. When I see myself in the mirror I can't really believe that that's me, and when I look down at my body it seems like I'm looking at a video game in first-person perspective like Fallout. Some of the time, it does feel more like I'm watching the world from a distance or looking at the past. Many people are saying that their experiences with psychotic symptoms are terrifying and the scariest things they've ever gone through. I've thought about these experiences a lot and I believe they happen to me because the things I'm feeling are way too huge for my mind to handle, so I suck all the emotion out of the present until I can put it back safely. Because my brain did all it could to shove the numbness and emptiness in place of any emotion in these moments, I really don't think of them as scary or embarrassing or shameful. They're completely neutral. The things that triggered this response? Oh yeah, absolutely terrible. But the nature of my depersonalization and/or derealization literally prevents me from feeling anything about it. I honestly don't feel the need to talk to a mental health professional about it because 1) It doesn't feel like a big deal for me and 2) It doesn't happen very much. So I wonder if I actually really do need to address it and it's more serious than I think it is. It just feels like I would be invalidating other people to say I'm going through something serious when others are going through horrifying, traumatic stuff with it. Because how can numbness be worse than trauma? I know it's not a competition, but the only thing making me consider addressing my symptoms is that I understand that they may come with a lack of inhibition because nothing feels like it matters in the moment, including consequences

[@brianbrenton1025]

I feel like it goes this way: if you can self-regulate, you're probably, mostly normal.

[@RobinsTinyHomestead]

All the time.

[@cindyrobertson3780]

I feel like I am not really there.😊

[@shanebelter1837]

Doc, what is the difference between DPDR and schizophrenia? I’ve suffered from dpdr for months now… just wanted to be filled in on the differences.. thank you 😊

[@Maverick305Bliss]

Over blood & OB2; video games in mid to late 90’s… it had its moments; quite a slow paced game but it passed some time for me… I had psychotic episodes dating back to 14/15 years old; my parents didn’t believe in psychology so they told me it was just something I was making up and that I could control the thoughts (it was an ultra religious family; I have no problem with religion, I still have my beliefs, just not the same or same way as my parents) I ended up getting professional help once I was in my mid-twenties and pretty much as you said here, the psychotic tendencies were related to a very deep and poorly managed depression. I still have them from time to time but I now have a real support system in place with people that don’t deny that I am dealing with something. Love your videos dude; keep putting them out there, they do help people like me.

[@DrScottEilers]

They made a sequel??

[@Maverick305Bliss]

@@DrScottEilers yes. There was a second one put out. It was still a slower pace than I liked, but it was cool enough for what it was.

[@pillarsoflight2607]

Having DPR convinced me that I was due at some point to lose my conscious awareness of who I was etc.

[@Ballard206Journal]

ME too

[@jonnyasis7485]

kzbin.info/www/bejne/b4atoqNmotqZqa8feature=shared

[@KarmasAbutch]

Where does Maladaptive Daydreaming fall?

[@jadeybabes33]

I would be EXTREMELY interested in this too. I have suffered from MD severely since I was five years old (I'm now in my 40s)

[@KarmasAbutch]

@@jadeybabes33 for me it was “controlled” dissociation and a preferable place to be than where I actually was - as well as a way to Channel and process intrusive rumination into something else where I could generate different outcomes, or protect myself through different characters this time. Took decades to climb out of the habit of it.

[@grizzlybear4]

The opposite may be fewling trapped in self... without feeling your true feelings. Please comment at some point. Thanks for all your info.

[@RaspberryCharlotteProductions]

Sometimes when I look at trees, they look like stickers I can just peel off a page.

[@user-fe2ri1dc4y]

Dissociating is great because you can force the body to do work that it wouldn't normally do. Otherwise not useful for social behavior. In fact too much dissociating and consumption of media can lead to the unconscious mind reaching an irreconcilable difference. "You're not Bruce Banner, you don't have the education or experience" yet the dissociating person craves that "idol". You're not ______, yet you consume media made by people who have no idea how to do what _____ does. The dissociated person can be driven to psychosis. It's like the cat experiment. To tell Dr. Den's cat that humans are not anthropomorphic cats and to apply the breaking of dissociation to the cat. The cat experienced psychosis. That cat was truly crazy. The cat lived in a brutal world that would drive the average depressed person to their utmost limit. An "isekai" world where if you're lucky, you can be "taken away to paradise". Adopting the cat or giving the cat means of livelihood. Instead, Dr. Den's cat was actively recorded with a delusion of seeing a human being as a cat. Truly incendiary research. Even a depressed suicidal person sees the benefit of the technology, seeing into the visual data. I can picture one day, therapists could use the device and guided imagery to treat phobia, depression, suicidality. I'm sure the thoughts look like "something". Mine involve cutting. Lots of cutting involving scissors and knives, to the point where my self doesn't care if certain body parts are missing. I mean that, the toes of the feet I "wouldn't care" at their amputation. It is funny to examine self harm thoughts, mine involve the extremities.

[@ct00001]

I feel like I may be misunderstanding this, because these symptoms are how I'd be inclined to describe how I often experience both meditation and psychedelics, and I experience them as sublime.

[@strongcurrents2488]

DP/DR is not a form of psychosis because reality checking remains in tact the entire time

[@kita476]

I recently had an experience of zoning out at home and when I zoned back in I was driving and I’m not sure what happened but the surprise either made me hit the breaks or I crashed into something which of course caused me to panic and then I realized I wasn’t driving I was still at home but at some point when I zoned out I landed driving in a car O_o is that potentially some type of dissociation?

[@KaoXoni]

Your event coukd as well be an example of ordinary (however vivid) daydreaming, depending on the level and knd of activity that you zoned out of. Had it been the other way round - actually in the midfle of drving a car and zoning out thinking you are hat home doing xyz or nothing...- that would be scary!

[@djangoapple8230]

I call it my " Gary Bussey moment " or " The Gary Bussey Disorder ".

[@homiekeen23]

Is the only solution for this meds? I don't want to get on meds , (from all the expériences of people either getting addicted to them or getting long term damage from them) , but all I get when talking anout this is = meds.

[@en-jm2kb]

I think its triggering to put psychosis next to dp/dr

[@LoneWolfMoonChild]

I’m in The Truman Show

[@Portia620]

Yes, I died and went to hell😂

[@catalystcomet]

Just looking at the thumbnail kind of rubbed me the wrong way. Psychosis and dissociation are two completely different things. Also, it really sucks to always be portrayed as some kind of scary monster. I haven't looked at the video but, that's a big reason people are going to click on it, and even more so, people are going to associate those of us with dissociative identity disorder or any of the dissociative disorders, as being psychotic. Just from a thumbnail. An overly dramatic thumbnail. I bought your book, I love your stuff, I'll continue to love your stuff, but I don't like that thumbnail.

[@Portia620]

The bugs hallucination sounds like drug addicts and what they experience!

[@KarmasAbutch]

Yeah but it also happens if ur in bed and just saw a house centipede or some other Stephen King level insect in the bedroom and now you cant sleep and keep feeling weird tickles on your limbs from nothing at all - lol jus sayin’ 😯

[@pedromateo7970]

H hkouuoh 21:34

[@DisEnchantedPersons]

Bell's inequality has been solved, there is nothing locally real, you are actually spread out throughout the known universe.

[@Peace-tk3gr]

Many of the things you have described are ego-dystonic and therefore NOT psychosis! Good grief, I was just starting to trust you.