Reviewed by: Pavel Kornilov, MD, psychiatrist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F48.1
- Who provides care
- A psychiatrist and a psychotherapist; a neurologist when indicated to rule out organic causes
- Format
- Video consultations and online psychotherapy; neurological examination and EEG in person on referral
- Duration
- Initial appointment about 60 minutes; a course of psychotherapy usually takes 12 to 20 sessions
- Confidentiality
- Medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- When it is urgent
- Loss of insight, hallucinations, confusion, seizures, thoughts of death — call 103 or 112
- Outcome
- An understanding of how the symptoms work, less intense symptoms and anxiety, and a renewed sense of being present
What you should know
Depersonalization-derealization syndrome is coded F48.1 in ICD-10, and in ICD-11 it is classified among the dissociative disorders. Brief episodes of such sensations occur in many people during severe fatigue, stress or lack of sleep. It is considered a disorder when the experiences are persistent or recurrent, cause marked distress and interfere with life. An important feature is preserved insight: the person understands that the world and they themselves are real, even though they perceive them differently.
Depersonalization and derealization often accompany anxiety disorders, panic attacks, depression and PTSD, and can also occur after using psychoactive substances. At Psychiatry Online, help is provided by psychiatrists and psychotherapists via video call. An online psychiatrist consultation in Stepnogorsk allows you to describe unusual sensations in a calm setting, get an explanation of how they arise and draw up a plan for tests and treatment.
What Derealization and Depersonalization Feel Like
- a feeling that the world around you is unreal, flat, foggy or behind glass
- perceiving people and objects as artificial, unfamiliar or far away
- a feeling of watching yourself from the outside, as if in a movie
- detachment from your own emotions, thoughts or parts of your body
- an altered sense of time, a feeling that your actions are “on autopilot”
- awareness that the sensations are unusual, with your connection to reality intact
- anxiety and fear of “going crazy” because of these experiences
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.
Causes of Derealization
Depersonalization and derealization are regarded as the mind’s protective reaction to overload: during intense anxiety or trauma, emotional perception seems to be “turned down.” The most common triggers are severe stress, panic attacks, chronic anxiety, depression and traumatic experiences, especially in childhood. Symptoms are maintained by constant self-monitoring and fear that the sensations mean a serious illness.
Episodes can be triggered by cannabis and other psychoactive substances, severe sleep deprivation and certain medications. Similar sensations occur in epilepsy, migraine, after traumatic brain injuries and in other neurological diseases, as well as at the onset of some psychotic disorders. That is why the doctor rules out these causes and, if necessary, refers you for a neurological examination.
How Online Help for Derealization Works
During the video appointment, the doctor asks in detail about the nature of the sensations, how long they last, how they relate to anxiety, stress, sleep and substance use, and about past injuries and neurological symptoms. Preserved insight is assessed and psychotic features are ruled out. Questionnaires such as the Cambridge Depersonalization Scale are used. You will need a device with a camera, a stable internet connection and a place where you can talk calmly.
A neurological examination, EEG and brain imaging, which are required if an organic cause is suspected, cannot be done online — they are carried out in person. Whether prescription medications can be prescribed depends on the legislation of the Republic of Kazakhstan and the requirement for an initial examination. Hallucinations, loss of the sense of reality, confusion or seizures require urgent in-person help: call 103 or 112.
How we help
Assessment and Psychoeducation
A detailed explanation of how depersonalization and derealization work reduces anxiety in itself: the person learns that the condition is not a sign of psychosis and does not lead to losing one’s mind. The doctor rules out organic and psychotic causes and assesses co-occurring anxiety and depression. This forms the basis for the further treatment plan.
Cognitive Behavioral Therapy
CBT adapted for depersonalization aims to reduce self-monitoring, catastrophic interpretations and avoidance. Patients learn to shift attention to the outside world, gradually return to activities they have been avoiding, and track how symptoms relate to anxiety. The course is well suited to the online format and includes homework.
Treating Co-Occurring Disorders
If derealization occurs against a background of panic disorder, generalized anxiety, depression or PTSD, treating the underlying condition often reduces the dissociative symptoms as well. When there is a traumatic experience, trauma-focused methods are used. The doctor builds the plan taking into account all the disorders identified.
Medication Support
There are no medications specifically approved for treating depersonalization. Medication is considered when there is marked co-occurring anxiety or depression and is selected by the doctor with its effect on symptoms in mind. Giving up psychoactive substances, including cannabis, is an important part of treatment and of preventing further episodes.
Myths and facts
MythDerealization is the first sign of schizophrenia
FactIn depersonalization and derealization, the person keeps the understanding that the sensations are unusual and the world is real. This distinguishes them from psychosis. A psychiatrist consultation is held to rule out other conditions, but in most cases the syndrome is related to anxiety and stress.
MythYou need to keep checking whether the sensations have gone
FactFrequent checking and self-monitoring intensify and maintain the symptoms. Psychotherapy teaches you to shift attention to the outside world and everyday activities, which gradually reduces the intensity of the experiences.
MythThis condition cannot be cured
FactDepersonalization can last a long time, but with treatment of co-occurring anxiety and psychotherapy, symptoms ease or disappear in many people. It is important not to delay seeking help and to give up substances that trigger episodes.
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 Stepnogorsk
| 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
You can book in Stepnogorsk online or at one of two branches: 153 Tselinnaya St., Stepnogorsk, 153 Abaya St., office 22, Stepnogorsk. Our coordinator replies on WhatsApp within minutes at any time, and a doctor usually connects by video the same day; home visits are available too — all city districts and nearby settlements.
Confidential and private
An online appointment in Stepnogorsk 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 life-threatening and does not lead to losing your mind, but it causes severe discomfort and anxiety. It is important to rule out neurological and psychotic causes. If the sensations are accompanied by hallucinations, confusion or seizures, call 103 or 112.
Why did derealization start after a panic attack?
During intense anxiety, the mind can “turn down” perception to protect itself from overload. After an attack, the feeling of unreality sometimes persists, and fear of it keeps it going. Treatment for panic disorder and CBT usually help break this cycle.
Can cannabis cause depersonalization?
Yes, using cannabis and other psychoactive substances is a known trigger. In some people, symptoms persist after they stop using. Giving up substances is necessary for recovery; if this is difficult, you can get an online consultation with an addiction specialist (narcologist) at Psychiatry Online.
Can I get help entirely online?
The diagnostic interview, psychoeducation, CBT and follow-up are successfully carried out by video call. A neurological examination may be needed in person to rule out organic causes. An online psychiatrist consultation in Stepnogorsk helps determine whether it is needed in your case.
How long does treatment last?
The timeframe depends on how long the symptoms have lasted and on co-occurring disorders. When they are linked to anxiety, improvement often comes within a few weeks of starting treatment; in chronic cases, a course of psychotherapy may take 4–6 months or more.
Is the consultation confidential?
Information about the patient is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System” and is disclosed only in cases provided for by law. The video appointment takes place over a secure channel; you can give just the name you would like to be called.
Where can I be seen in Stepnogorsk?
Online — from anywhere in the city or region. In person — at two branches: 153 Tselinnaya St., Stepnogorsk and 153 Abaya St., office 22, Stepnogorsk. 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
