Yes. Depersonalization and derealization are dissociative symptoms that may manifest along with symptoms of post-traumatic stress disorder (PTSD).

Dissociation is a term that describes a broad range of disruptions in a person’s self-perception. It involves changes to your sense of self and how you perceive your place in the world.

Dissociation may be a different experience for everyone, but it is often described as a sense of strangeness, detachment, or unfamiliarity with your physical body, emotions, or environment. It can affect anyone, and it isn’t always associated with a mental health diagnosis.

Dissociative symptoms affect as many as 15%-30% of people with PTSD. When these symptoms are severe or persistent, doctors refer to it as a subtype of PTSD.

Under diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the official diagnosis in this case is PTSD with dissociative symptoms.

PTSD with dissociative symptoms is a diagnosis that includes all of the common symptoms of PTSD in addition to those of dissociation.

To reach a PTSD diagnosis, doctors will explore if you meet the following criteria:

  • Experience involving a significant threat or death, serious injury, or sexual violence in at least one of the following ways:
    • witnessing the traumatic event
    • learning that a traumatic event happened to a loved one
    • experiencing repeated or extreme exposure to the details of the traumatic event
  • One or more of the following intrusion symptoms related to the traumatic event:
    • intense or prolonged distress from reminders of trauma
    • significant physiological (body) reactions to reminders of trauma
  • Displays of avoidance behaviors related to the traumatic event, such as:
    • avoiding thoughts, feelings, or memories associated with the traumatic event
    • avoiding people, places, objects, activities, or situations that are reminders of the traumatic event
  • Two or more of the following changes in mood or mental function after the traumatic event:
    • persistent and exaggerated negative beliefs about yourself or the world
    • blaming yourself without justification
    • persistent negative feelings of fear, horror, guilt, or shame
    • feelings of detachment or separation from others
    • inability to experience positive emotions
  • Two or more of the following symptoms of arousal or reactivity after the traumatic event:
    • irritable behavior or angry outbursts
    • recklessness
    • hyperactive startle response
    • reduced concentration
    • sleep disturbances
  • Symptoms have been present for at least one month.
  • Symptoms cause significant impairment (disturbance) across important areas of function.
  • No other medical condition or substance use explains the symptoms.

For a diagnosis of PTSD with dissociative symptoms, the criteria for standard PTSD must be met first. Doctors then screen for two specific dissociative symptoms: depersonalization and derealization.

  • Depersonalization is a sense of separation or detachment from your body or thoughts. This is sometimes called an “out-of-body” experience and may feel like watching yourself from an outside point of view.
  • Derealization is a feeling that the environment around you is unreal, distorted, distant, or part of a dream. Events or experiences might not seem like they’re actually happening. Your surroundings can suddenly feel fake or unfamiliar, even if you’ve been there before.

If one or both of these symptoms occur persistently and you have PTSD, you may meet the criteria for an official diagnosis of PTSD with dissociative symptoms.

PTSD with dissociative symptoms is treated similarly to other PTSD manifestations. Doctors recommend psychotherapy combined with medications like antidepressants to relieve symptoms and improve everyday function.

Psychotherapy for PTSD focuses on frameworks to release and heal traumatic experiences. Called “trauma-focused therapy,” these methods incorporate techniques from:

The goal of psychotherapy for PTSD symptoms is to identify and restructure unhelpful patterns of thinking while working on fear reduction and desensitization in a safe, controlled environment.

For PTSD with dissociative symptoms, many experts advocate for a staged approach, where skill-building to manage dissociative symptoms is started before trauma processing.

PTSD with dissociative symptoms responds to treatment, so it is possible to find relief from these symptoms. According to a 2020 meta-analysis, having dissociative symptoms does not negatively affect or change PTSD treatment outcomes. You can still experience improvement on both PTSD and dissociative symptoms.

According to the World Health Organization (WHO), up to 40% of people living with PTSD show improvement within a year of starting treatment. Other research suggests that approximately one-third of people with PTSD may still have symptoms 1 year after diagnosis, and another third will still experience symptoms 10 years after diagnosis.

Help is available for PTSD with dissociative symptoms. You or a loved one can find treatment locations, support groups, and community connections through these resources:

Persistent dissociative symptoms in PTSD mean you meet the criteria for a PTSD diagnosis, but you also experience ongoing symptoms of depersonalization or derealization.

Treatment is available and effective for PTSD with dissociative symptoms. Trauma-focused psychotherapy and medications can help reduce and manage symptoms long term, and improve your quality of life.