Reviewed by: Pavel Kornilov, MD, psychiatrist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F48.1
- Who leads care
- A psychiatrist and a psychotherapist
- Format
- Video consultations, psychotherapy, online progress monitoring
- Duration
- First appointment 50 minutes; a course of therapy lasts from several weeks
- Confidentiality
- Medical confidentiality under the Kazakhstan Code “On Public Health”
- When it is urgent
- Hearing voices, seeing things, loss of insight, suicidal thoughts — call 103, 112, or 150
- Outcome
- A sense of reality returns, and anxiety and the fear of “going crazy” fade
What you should know
People describe derealization like this: “the world is behind glass,” “it’s all like a movie,” “the colors have faded.” And depersonalization like this: “I’m watching myself from the outside,” “my hands feel like someone else’s,” “my emotions are switched off.” These states are frightening, and people often fear they are going crazy. It is important to know that in depersonalization and derealization, insight is preserved: the person understands that the sensation comes from within — one of the key differences from psychotic disorders.
The mechanism is explained as a protective reaction of the brain: when overloaded with anxiety, it “turns down” the emotional coloring of perception. Brief episodes happen to many people under severe stress or lack of sleep, but if the sensation is persistent and interferes with life, help is needed. At Psychiatry Online, consultations take place over video: there is no need to travel across the whole city — for example, from the Nura district to the right bank — when even the street feels unreal.
Signs and Symptoms of Derealization and Depersonalization
- a feeling that the world is unreal and flat, as if behind glass or in a dream
- a sense that you are watching yourself from the outside, like a character
- detachment from your own body, hands, voice, or reflection in the mirror
- emotional numbness: feelings seem switched off or muted
- distorted perception of time, sounds, distances, and sizes
- fear of going crazy while still understanding that the sensations are internal
- constantly checking yourself and your surroundings: “is this real right now?”
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
What Causes Derealization
The most common cause is severe anxiety, panic disorder, depression, or chronic stress. Research shows changes in the systems that link perception with emotional evaluation: the brain seems to lower the intensity of experience to protect itself from overload. Triggers include a panic attack, lack of sleep, a traumatic event, the use of psychoactive substances including cannabis, and sometimes severe exhaustion.
The state is maintained by a vicious circle: the person is frightened by the sensation, starts checking themselves constantly, anxiety grows, and derealization intensifies. The demanding schedules of the civil service and offices with chronic lack of sleep, a long winter, and short days when people rarely go outside all contribute to exhaustion and can keep symptoms going. Less often, derealization has neurological causes, so an in-person evaluation is sometimes needed.
How Online Help for Derealization Works
At the first video consultation, the doctor asks when and after what the sensations appeared, how constant they are, and whether you have anxiety, panic attacks, low mood, sleep problems, or substance use. A depersonalization rating scale is used. The specialist explains how the state works — for many people, this is the first step toward relief: the fear of “going crazy” goes away. Have headphones, a quiet place, and a list of the medications you take ready.
A neurological examination cannot be done online. If derealization comes with episodes of loss of consciousness, headaches, or speech problems, or appeared after a head injury, the doctor will refer you for an in-person examination and tests. If you start hearing voices, seeing things, losing insight, or having suicidal thoughts, call 103, 112, or 150. Prescriptions are issued in accordance with Kazakhstan law.
How we help
Treating the underlying disorder
If derealization is a symptom of an anxiety disorder, panic disorder, or depression, the main focus is on treating that condition. As anxiety decreases, the sense of unreality usually fades. That is why the psychiatrist starts with an accurate diagnosis: it determines which psychotherapy methods and, if needed, which classes of medication will be effective.
Cognitive behavioral therapy
CBT for depersonalization works with catastrophic interpretations (“I’m going crazy,” “this will never go away”) and with the behaviors that keep the symptom going: constant checking, avoidance, and self-focused attention. The patient learns to respond to the sensations more calmly, and this gradually reduces their intensity.
Grounding and attention techniques
Shifting attention to external stimuli — sounds, textures, details of your surroundings — helps reduce the intensity of an episode. The specialist practices with you exercises that you can do at home, at the office, or outdoors. This is not the main treatment but a tool for difficult moments that restores a sense of control.
Sleep, routine, and avoiding substances
Lack of sleep and psychoactive substances, including cannabis, are common triggers of derealization. Restoring a regular sleep pattern, limiting caffeine and alcohol, and regular physical activity lower the baseline level of anxiety. At Psychiatry Online, the specialist helps you draw up a plan you can realistically keep with your work schedule.
Myths and facts
MythDerealization is the beginning of schizophrenia
FactIn derealization, insight is preserved: the person understands that the sensations come from within. This distinguishes it from psychotic disorders. Most often, derealization is linked to anxiety and stress and responds well to treatment.
MythIt will never go away
FactThe feeling that the state is permanent is a common part of anxiety. For most people, derealization eases or disappears with treatment of anxiety and depression and a restored routine. Even with a long course, there are effective forms of help.
MythYou need to fight the sensation and keep checking yourself
FactConstant checking and trying to “bring back reality” through willpower keep anxiety going and make symptoms worse. It is more effective to learn to notice the sensations calmly and shift your attention to the outside world.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
An online consultation for “Derealization and depersonalization help online” is available to people across Astana and Akmola Region 24/7 — from home, work or while travelling. For an in-person visit, Psychiatry Online in Astana has two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Doctor home visits: all city districts and nearby settlements.
Confidential and private
An online appointment in Astana is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
Is derealization dangerous?
Derealization in itself is not dangerous and does not lead to loss of control or psychosis. But it can be a sign of an anxiety disorder, depression, or, less often, neurological problems, so persistent symptoms should be discussed with a psychiatrist, with tests if needed.
Why did derealization appear after a panic attack?
A panic attack is a peak of anxiety, and the brain may “switch on” a protective dampening of perception. After the attack, the person is frightened by this sensation, starts monitoring it, and it persists. Treating panic disorder usually helps reduce derealization as well.
Can derealization be caused by cannabis?
Yes, using cannabis and other psychoactive substances is a known trigger of derealization, sometimes a persistent one. If you notice a connection, it is important to stop using and see a doctor. The specialist will help both with derealization and with giving up substances.
How long does treatment take?
If derealization is linked to anxiety or stress, improvement often comes within a few weeks of starting treatment for the underlying disorder. With a long-standing depersonalization disorder, therapy may take several months.
Can I work during treatment?
In most cases, yes. Online consultations can be held in the morning, in the evening, or during your lunch break — for example, from an office in the Baikonur district. The specialist will also help you adjust your workload during treatment to reduce stress and avoid aggravating symptoms.
Is it confidential?
Yes. Information about your consultation is protected by medical confidentiality under the Kazakhstan Code “On Public Health and the Healthcare System.” You can seek help anonymously, and information may be disclosed only in cases expressly provided for by law.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
