Dr. Ali Al Farhan
Consultant Psychologist and Psychotherapist · Associate Professor of Psychology
You may sit among people you know, hear the conversation and take part, yet feel a barrier between yourself and the room. You may look at your hands and know they are yours, while the experience of them feels unfamiliar. It can be difficult to describe: "I am here, but I do not feel fully present."
This experience deserves attention and assessment. Naming it accurately requires understanding what happens, for how long and under what circumstances. Detachment can occur in different conditions; it does not by itself establish a dissociative disorder.
Dissociation involves a disruption in the usual integration of experiences such as memory, awareness, identity and the sense of self and surroundings. Dissociative disorders include depersonalization/derealization disorder, dissociative amnesia and dissociative identity disorder. These are different conditions, not inevitable stages through which a person progresses. [1]
Brief daydreaming or not recalling details of a familiar journey is insufficient for diagnosis. Assessment considers recurrence, severity and impact, while excluding other explanations. In depersonalization/derealization disorder, reality testing remains intact: the world feels strange or unreal, but the person knows it is real. [1, 2]
These fictional scenes are not client accounts or evidence of any particular diagnosis.
After weeks of work pressure and poor sleep, "Salma" enters a meeting and finds everyone's voices seem distant. She knows where she is and who is present, but feels frightened: "Why does everything seem strange?" She spends the meeting monitoring herself to check whether she feels normal again.
Assessment can begin with describing the episode and reviewing sleep, anxiety, medication, substances and medical history. This scene does not establish childhood trauma or an identity disorder. Similar experiences can occur with panic or medical conditions, making assessment necessary before interpretation. [2]
One area to explore is whether detachment occurs as certain feelings become difficult to bear. A clinical reference on depersonalization/derealization discusses psychodynamic work with emotions, conflicts and experiences that are hard to integrate. This is a possible approach to some cases, not an established explanation for every dissociative symptom. [2]
Imagine "Omar," who describes a humiliating encounter in precise detail, then says, "I know it was painful, but I feel nothing." The therapist might ask what he notices now and whether he can remain with a small amount of feeling while staying present in the conversation.
His lack of emotion might relate to dissociation, but exhaustion, depression or other factors might explain it. An observation does not become a ready-made conclusion. Here, the focus is on helping Omar approach his experience while remaining present, rather than forcing tears or demanding a story that explains everything.
Many people with dissociative disorders have experienced trauma, but a symptom does not prove that a specific event occurred. Feelings of unreality or memory gaps alone do not establish forgotten abuse. [1, 3]
Specialist guidelines emphasise a balanced approach to memory accounts, avoiding suggestion or imposing an interpretation. Memory is not a photographic record, and emotional intensity alone does not establish the accuracy of an event's details. Current distress can be addressed while uncertainty remains open. [3]
Assessment considers symptoms, their course, effects on safety and functioning, and medical and psychological history. Medical evaluation may be needed to exclude causes such as seizures or effects of substances and medication. Loss of consciousness, sudden confusion or new neurological symptoms warrant urgent medical assessment. [2]
Specialist guidance for dissociative identity disorder and similar presentations recommends an approach involving safety and stabilisation, processing difficult experiences according to capacity, and improving integration and everyday life. These recommendations concern those conditions; they are not a plan to impose on everyone who experiences derealization. [3]
Work may begin with recognising early signs of detachment, adjusting the pace of sessions and finding ways to reconnect with the present. The therapeutic relationship can be explored for what supports safety and what brings fear, without treating every interruption as deliberate "resistance." Co-occurring difficulties are addressed according to assessment.
A 2025 systematic review examined treatment studies involving adults with dissociative identity disorder and related dissociative disorders. It reported encouraging findings while highlighting the need for stronger controlled research. This does not establish one approach as superior or justify extending the findings to every dissociative disorder. [4]
It may involve noticing detachment earlier, reconnecting with the present more readily, reducing gaps that disrupt daily life, or naming a feeling without becoming overwhelmed. Goals are individual; success is not measured by recovering a memory or fitting a theoretical interpretation.
Progress may mean approaching your experience at a tolerable pace and recovering a sense of continuity and choice in everyday life.
If experiences recur or affect your safety or daily life, seek specialist assessment. Risk of self-harm or inability to remain safe calls for urgent help. This content is educational and cannot diagnose your condition.