Emmily Hovhannisyan, MSW, ACSW, of the OCD Center of Los Angeles, writes on depersonalization and derealization in OCD, with a focus on existential OCD.
What is depersonalization and derealization?
Depersonalization and derealization (DP/DR) are experiences of estrangement or dissociation from oneself or reality. Depersonalization is a sense of disconnection from one’s body, mind, or emotions. The experience of depersonalization may look like the following:
- Feeling on autopilot, as though you do not have control of your body
- Having out-of-body experiences or feeling separated from oneself
- Numbness of senses or emotions
Derealization, on the other hand, is a feeling of detachment from one’s surroundings, often resulting in fogginess or unfamiliarity. Derealization can manifest in several ways:
- Feeling like your surroundings are dreamlike, including the shapes and sizes of objects
- Feeling as though others around you are not real
- Experiencing the world as either hyper-clear or two-dimensional and lacking color
DP/DR is different from psychosis, which is a loss of touch with reality that involves perceptual disturbances and delusions. In fact, DP/DR happens in a range of mental disorders, and milder forms can even happen after low-to-moderate bouts of stress. An often-overlooked mental health condition that can coincide with DP/DR is obsessive-compulsive disorder (OCD), and several reasons explain the connection between the two.
Why does DP/DR occur with OCD?
OCD and DP/DR share common features, and both experiences can also exacerbate each other. As mentioned earlier, DP/DR can act as the brain’s defense mechanism for stress. Because OCD can cause intense anxiety and distress, dissociation occurs to protect individuals from overwhelm.
In a 2023 research article on obsessive-compulsive symptoms and DP/DR, Soffer-Dudek discussed several links between the two. Excessive rumination and immersion into internal experiences are related to an increase in dissociative symptoms. Individuals with OCD often get absorbed into their obsessions and compulsions, especially in “pure-O” OCD themes, which can bring upon feelings of DP/DR. The foggy and disconnected nature of dissociation may also cause uncertainty about previous occurrences and experiences, which could trigger OCD feelings of doubt and anxiety. Finally, an underlying similarity that OCD and DP/DR share is a sense of uncertainty about one’s identity. While these factors are applicable to all themes of OCD, one subtype may be particularly relevant: existential OCD.
Why is DP/DR often related to existential OCD?
While DP/DR experiences could occur within any subtype of OCD, existential OCD uniquely highlights the dynamic relationship between obsessive-compulsive symptoms and dissociation. Existential OCD often involves an excessive concern with philosophical matters, including the meaning of reality (e.g., “What if I live in a simulation?”), a sense of self and one’s purpose, and the meaning of life and death. For more detailed information on existential OCD, please read our existential OCD blog article.
As mentioned earlier, OCD and DP/DR could trigger each other in several ways, leading to a debilitating cycle. For instance, someone with existential OCD could experience DP/DR due to the severity of their stress levels. Then, dissociation could exacerbate feelings of uncertainty about one’s reality (e.g., “Feeling numb and detached must mean I’m actually in a dream.”). Overvaluation and hyper-focus on sensory or experiential cues can maintain this OCD and DP/DR loop and feed into checking, rumination, or other mental compulsions. The overlap in self-detachment in OCD and DP/DR may also heighten the experience of uncertainty in the sense of self in the existential subtype of OCD.
While existential OCD and DP/DR are tremendous struggles, evidence-based treatments could provide support and long-lasting symptom management. Connecting with an OCD specialist for evidence-based treatment is a great place to start.
Treatment for OCD and DP/DR
Acceptance and Commitment Therapy (ACT) is an evidence-based treatment for OCD that focuses on accepting uncertainty and leading a values-based life despite OCD fears. Mindfulness tools, often incorporated in ACT, are also excellent for building distress tolerance. Mindfulness tools also help with DP/DR, as they can involve sensory grounding to reconnect with the body and the external world.
Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), the gold-standard treatments for OCD, involve challenging and reframing catastrophic thinking and gradually exposing oneself to OCD fears. Early research also shows the efficacy of CBT for DP/DR.
Existential OCD can be all-consuming, and DP/DR may add a challenging layer to the experience. However, there is hope for improving your existential OCD, and you are not alone. If you would like to connect with an OCD specialist and begin your treatment journey, please reach out to the OCD Center of Los Angeles for support.
References
Elevate Psychiatry. (n.d.). Existential OCD: Symptoms, causes, and treatment for adults. https://elevatepsychiatry.com/blog/existential-ocd/
Hunter, E. C. M., Wong, C. L. M., Gafoor, R., Lewis, G., & David, A. S. (2023). Cognitive behaviour therapy (CBT) for depersonalization derealization disorder (DDD): A self-controlled cross-over study of waiting list vs. active treatment. Cognitive Behaviour Therapy, 52(6), 672–685. https://doi.org/10.1080/16506073.2023.2255744
Kaye, A. M. (2025, November 25). Existential OCD: When “Why am I here?” won’t let go. Psychology Today. https://www.psychologytoday.com/us/blog/the-compassionate-brain/202511/existential-ocd-when-why-am-i-here-wont-let-go
Lee, E. B. (2025). Acceptance and commitment therapy for obsessive-compulsive disorder. Psychiatric Clinics of North America, 48(3), 457–466. https://doi.org/10.1016/j.psc.2025.02.004
National Institute of Mental Health. (n.d.). Understanding psychosis. U.S. Department of Health and Human Services, National Institutes of Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
Quick, S. (2023, February 20). Fear of depersonalization. NOCD. https://www.treatmyocd.com/what-is-ocd/common-fears/fear-of-depersonalization-ocd
Soffer-Dudek, N. (2023). Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice. Frontiers in Psychology, 14, 1132800. https://doi.org/10.3389/fpsyg.2023.1132800
•Emmily Hovhannisyan, MSW, ACSW, is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions. In addition to individual therapy, the center offers nine weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.