Watan-Barry Miskin had recently become pregnant when she began noticing changes in her appearance. Dark spots resembling watercolor stains appeared on her skin, and a “forest” of hair sprouted on her upper lip and chin.
The external world was changing too. In her neighborhood in Astoria, Queens, New York, bright lights seemed to halo objects, blurring her vision.
Miskin, 46, said her coworkers and even her doctors started appearing like “alien versions of themselves.”
“I felt like I was seeing the world through a dirty glass pane,” she added. Yet, Miskin knew these perceptions were illusions, prompting her to seek help.
It took over a year of consultations with mental health professionals before Miskin finally received an explanation for her symptoms: she was diagnosed with a dissociative condition called Depersonalization/Derealization Disorder (D.D.D.). Before her pregnancy, Miskin had stopped taking antidepressants. Her new psychiatrist suggested that her symptoms were likely caused by months of untreated depression that followed.
While Miskin felt isolated in her mysterious illness, she was not alone. Tens of thousands of social media posts mention depersonalization or derealization, with some describing it as “living in a movie or dream” or “observing the world through a fog.”
People with depersonalization may feel detached from their own minds or bodies, while derealization involves a sense of disconnection from the environment, making people and objects seem unreal.
Elena Bezzubova, a psychoanalyst specializing in treating the condition, explained that individuals with D.D.D. are “painfully aware” that something is wrong. “It’s like looking at an apple and feeling it’s so strange it doesn’t seem real, even though you know it is,” she said.
The disorder is thought to affect about 1% to 2% of the population, though anyone can experience transient symptoms, according to the report.
Mental health professionals sometimes dismiss D.D.D. as a standalone diagnosis, not only because it is poorly understood but also because its symptoms overlap with conditions such as depression, anxiety, or panic disorders.
With new research emerging, the disorder is gaining recognition and broader discussion. The second edition of Feeling Unreal, a foundational book on D.D.D. originally published in 2006, was released in 2023. Miskin also published a memoir on the topic, titled Hell Gate Bridge, in June.
That same month, the novel Please Stop Trying to Leave Me was released, featuring a protagonist with D.D.D. The author, Alanna, is intimately familiar with the condition, having been diagnosed herself years ago.
Speaking of her experience with the disorder, she said, “It’s a bit like what I imagine a drug trip to be like. But it’s 2 p.m., and I’m completely sober.”
The Cambridge Depersonalization Scale is widely considered the most reliable measure for the disorder. Patients are asked to rate the frequency and duration of 29 different experiences. Examples include feeling like a “robot,” losing physical sensations such as hunger or thirst, and perceiving the world as “flat” or “lifeless,” like a picture.
People with D.D.D. can feel detached from themselves and their surroundings for months or even years at a time. In rarer cases, they may also experience auditory distortions, such as muted or amplified sounds.
D.D.D. is often linked to a history of emotional abuse or neglect. Symptoms can be triggered by anxiety, depression, resurfacing early trauma, major life stress, cannabis, or hallucinogens, according to Dr. Daphne Simeon, an expert on the disorder and co-author of Feeling Unreal.
In some individuals, multiple triggers may be involved, especially if there is an underlying predisposition to dissociation.
“You might meet someone who had their first episode during a panic attack, then it happened again when they became depressed, and a third time during a terrible divorce,” Dr. Simeon explained.
Researchers have theorized that depersonalization/derealization may be part of the mind’s defense mechanism.
“Your body and mind are telling you something,” Dr. Simeon added. “You’re experiencing something unbearable, which you then have to dissociate from.”
Jeffrey Abugel, Dr. Simeon’s co-author on Feeling Unreal, lived with D.D.D. for over a decade before finally receiving a diagnosis. He knows exactly where it originated: “Cannabis, plain and simple,” he said, adding that the drug pushed him “to the brink,” triggering a “massive panic attack.”
Now a health and wellness coach, Abugel eventually found help. He offers private consultations and virtual support groups for those living with the disorder.
Miskin’s symptoms improved with a combination of psychotherapy and medication. She resumed taking antidepressants and also began using lamotrigine (Lamictal), a medication known for treating seizures and bipolar disorder.
Recovery was a painful process. “You have to relearn how to exist in the world,” she said, even though “you just want to lie in bed, pull the covers over your head, and never come out.”
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