Depersonalization, Derealization, and Panic Attacks

stressed woman with hands on head

Marc Romanelli / Blend Images / Getty Images

Depersonalization and derealization are two symptoms that can sometimes occur with panic attacks. They can leave you feeling uneasy, disconnected, and out of control, which can be a frightening experience when combined with other symptoms of panic.

Panic disorder is a psychiatric condition that causes recurring panic attacks—episodes characterized by a cluster of disturbing physical and psychological symptoms. Typical symptoms during a panic attack a person include shortness of breath, shaking, and chest pain that can cause someone to fear they're having a heart attack.

The mental and emotional symptoms that accompany these bodily sensations can be equally frightening. Many people who have panic attacks describe feeling as if they're going insane, losing control, or even dying.

This article discusses depersonalization and derealization in panic attacks, some of the signs, of each, and what you can do to cope. It also explores what you can do if you've had a panic attack and still struggle to feel normal afterward.

Derealization in Panic Attacks

Derealization involves feeling detached from your surroundings. You may feel disconnected from external objects in your immediate environment, including other people. Even your closest family members or friends may seem like strangers.

What does derealization feel like?

Often people describe derealization as feeling spaced out or foggy. People and objects in the environment may begin to seem unreal, distorted, or cartoon-like.

Others report feeling trapped by their environment or viewing their surroundings as surreal and unfamiliar. It could feel as if you're in a strange country or on another planet.

Depersonalization in Panic Attacks

The hallmark of depersonalization is the sensation of being detached from your body—as if you're no longer inhabiting your physical self but rather observing it from a distance.

You may feel as if you have no control over your actions. This terrifying feeling often is accompanied by thoughts and fears of losing touch with reality or losing control over yourself.

Depersonalization can cause frightening physical sensations such as numbness or tingling. It also can be a symptom of another mental illness, such as depression; a result of drug abuse; and a side effect of anti-anxiety medications.

Coping With Depersonalization and Derealization

It's not totally understood what causes depersonalization or derealization to occur during a panic attack. One theory is that these symptoms, alone or together, may serve as built-in mechanisms for coping with extreme stress and anxiety.

During a panic attack, they may allow you to put some distance between yourself and the unpleasant feelings you're having.

There's no treatment for either depersonalization or derealization alone, but it's good to note that once a panic attack begins to subside, these symptoms also will fade away and there are things you can learn to do to help speed up this process.

Coping With Derealization During a Panic Attack

If you're experiencing derealization try using your senses in any way you can to bring yourself back to reality. Some tips that can help:

  • Pinch the skin on the back of your hand.
  • Hold something that's cold or really warm (but not hot enough to burn you) and focus on the sensation of temperature.
  • Count or name items in the room.
  • Try to keep your eyes moving so that you don't zone out or start to lose touch again.

Coping With Depersonalization During a Panic Attack

If you're experiencing depersonalization, slow your breathing. Often during an anxiety attack, breathing becomes rapid and shallow, and that interferes with blood flow to the brain. Take very long, slow, deep breaths, focusing on sustaining the exhale as well as the inhale.

Since depersonalization causes feelings of detachment from others, reach out to a friend or loved one to talk to. Let them know what you're feeling and ask them to keep talking to you: It doesn't matter what you talk about as long as it keeps you grounded in the reality of the moment.

Getting Help for Derealization and Panic Attacks

As symptoms of a panic disorder, depersonalization and derealization may feel very scary and disturbing, but they aren't considered either dangerous or life-threatening. Once the panic disorder is being treated, panic attacks and the symptoms they bring on should no longer arise.

If you or a loved one are struggling with panic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database.

A qualified mental health professional who you feel comfortable with (and who accepts your insurance or has fees that are in your budget) can help you deal with panic disorder. Your general practitioner or a local mental health referral service are good places to start to look for a therapist or psychiatrist.

Treatment for panic disorder typically involves medications for panic disorder, psychotherapy, or both. Sometimes it takes a bit of trial-and-error to get craft an effective treatment plan for a mental health problem such as panic disorder, so be patient. Simply seeking help will likely have you feeling better.

Frequently Asked Questions

  • Can you have a panic attack from depersonalization?

    Depersonalization is a symptom of a panic attack and not the cause of it. When anxiety hits, people may dissociate from the experience as a way to protect themselves from feelings of anxiety. This can result in a sense of detachment in which you feel like you are watching something happen from outside of your own body.

  • Can anxiety attacks cause derealization?

    Anxiety attacks are a common cause of derealization. When experiencing derealization caused by anxiety, you might feel detached from reality and experience distortions in time and other perceptions.

    However, anxiety attacks are not the only cause of derealization. Other causes can include trauma, drug use, depression, dementia, schizophrenia, and depersonalization/derealization disorder.

  • How do you stop derealization panic?

    Some strategies that can help combat feelings of derealization and panic include deep breathing exercises and finding ways to ground yourself in reality. Focusing on sensations such as what you can touch, see, hear, and taste can be helpful.

  • What is a derealization attack?

    Repeatedly experiencing episodes of derealization might be the result of panic attacks, but it may also be a sign of depersonalization-derealization disorder. This disorder is characterized by persistent or repeated feelings that you are experiencing things from outside of your body or that the things around you are not real.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Illnesses, 5th edition, 2013. 

By Katharina Star, PhD
Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness.