The fear of going crazy is one of the most common fears with derealization and depersonalization. On this page I answer that question in seven forms, because the way you ask it changes the answer you get.
Can DPDR make me go crazy?
No. DPDR does not make you go crazy and it does not lead to psychosis or schizophrenia.
The fear of going crazy is one of the most common fears in DPDR. Almost everyone who comes to me after a bad trip has had that thought. The fact that you are asking the question at all says something important.
In depersonalization and derealization your sense of reality stays intact. You know the world feels strange, and at the same time you know the world has not actually changed. You notice that something is off in how you experience it. That awareness is exactly what separates DPDR from psychosis, where that insight is missing.
In diagnosis this is not a side note but a condition. Intact reality testing is part of the diagnosis. Someone who can no longer test reality has, by definition, something other than DPDR.
If you want to know whether your complaints fit this picture, take the test.
DPDR, with the stress, anxiety and panic that come with it, is heavy and often severely limiting, and it can last for years. But it does not have to be an early stage of something worse.
Will derealization make me go crazy?
No. Derealization is a symptom of dissociation, not the beginning of madness.
Derealization means the world around you feels unreal. As if there is a glass wall between you and everything else, as if you are living in a dream, as if people are not really there. That is an intrusive experience and it is understandable that you think something serious is wrong.
Derealization is a protective mechanism.
But notice what you are doing right now: you are aware that the world feels different from normal. You are comparing it to how it should be. You can only do that if your grip on reality is intact.
The fear of going crazy often keeps derealization going. The more you monitor yourself and wonder whether it is getting worse, the more tension you build, and tension is exactly what feeds derealization. That is one of the reasons this can be so persistent. Read more about the symptoms of derealization.
Will depersonalization make me go crazy?
No. Depersonalization is your system protecting itself, not a sign that you are losing your mind.
In depersonalization you feel unreal to yourself. As if you are watching yourself from the outside, as if your body is not yours, as if you are a robot going through the motions. Some people do not recognise themselves in the mirror for a moment.
That is an alienating experience, but it is not a loss of sanity. It is a response of your system to something that was too threatening or too much. Your feelings move away to protect you. Unpleasant, but not a defect.
The same applies here: you notice yourself that it is not right. That awareness does not disappear. Read more about the symptoms of depersonalization.
Will depersonalization-derealization disorder make me go crazy?
No. Depersonalization-derealization disorder is a dissociative disorder, not a psychotic one. It does not turn into schizophrenia.
These are two separate categories in diagnosis, with a different course and a different treatment. DPDR falls under the dissociative disorders. Schizophrenia and other psychotic disorders do not.
The confusion arises because both experiences are so strange that people lump them together. But the difference is clear: in DPDR you know your experience does not match reality. In psychosis that insight is missing.
However long you have had DPDR, it does not turn into something else.
Can a bad trip make me go crazy?
A bad trip itself does not make you permanently crazy, but it can set off complaints that persist.
During a bad trip you can experience things that resemble psychosis: fear, confusion, the feeling of losing control, sometimes hallucinations. Those belong to the substance and disappear once it wears off. A bad trip is temporary.
What can happen, and what I see often, is that the fear and the DPDR from that experience stay behind. You have felt what it is like to lose yourself and you never want to go through it again. That fear can keep derealization and depersonalization going, long after the substance has left your body. For a number of the people I treat, a bad trip was the starting point.
So that is not going crazy, but it is a complaint that can last a long time without targeted help. Read more about derealization after using cannabis.
There is one important exception. In people who are vulnerable to it, drug use can trigger a genuine psychosis. That is the next question.
Can cannabis cause psychosis?
Yes, it can. Not in everyone, but the risk is real and it is greater than was long assumed.
I want to be honest about this, because psychosis is something other than derealization.
The EU-GEI study, published in The Lancet Psychiatry in 2019, found the following. Researchers compared 901 people with a first episode of psychosis to 1,237 controls, across eleven sites in Europe and Brazil. People who used cannabis daily had roughly three times the odds of a first-episode psychosis diagnosis. With daily use of high-potency cannabis, above 10 percent THC, that rose to almost five times. The effect was clearest in Amsterdam and London, precisely because strong cannabis is widely available there.
At the same time it is not true that everyone who smokes develops psychosis. The large majority of users do not. Researchers see a clear association, but whether cannabis is the direct cause or mainly an accelerator in people who are already vulnerable has not been settled.
A psychosis is also not the same as schizophrenia. Psychosis is a period in which contact with reality falls away, where hallucinations or delusions can occur and are acted on. A single psychosis can pass. Schizophrenia is regarded as a persistent condition. So one psychosis does not mean you have schizophrenia. It is a signal to take seriously, to stop using, and to contact a doctor.
My experience: most people who come to me after using cannabis have not had a psychosis, but derealization or depersonalization, with stress, anxiety and panic. That is a different complaint, with a different course and a different approach. Anyone who has developed DPDR through recreational drugs stays vulnerable to new episodes in the future.
What is the difference between derealization and psychosis?
In derealization you know your experience does not match reality. In psychosis that awareness is missing.
That single difference is the most important one there is, and it is what the diagnosis rests on.
| Derealization and depersonalization | Psychosis | |
|---|---|---|
| Awareness that it is not right | Present | Absent |
| What you experience | The world or you yourself feel unreal, vague or fake. The feeling of being a robot, no connection to the world or to yourself, alienation. Visual snow. Anhedonia may be present. Depression may be present. | Delusions and hallucinations: you perceive things that are not there or believe things that are not true. Intense fears, paranoia, persecutory delusions. Possibly mania, with extreme elation that is temporary. No visual snow. Anhedonia may be present. Depression may be present. |
| Category | Dissociative disorder | Psychotic disorder |
| Course | Acute, episodic or chronic | Acute, episodic or chronic. A psychosis is regarded as an episode, schizophrenia as persistent |
| Treatment | Specialized therapy. Medication is not effective | Medication is primary and effective. Therapy is sometimes added |
Someone with derealization says: it feels as if the world is fake, but I know it is not. Someone in psychosis does not say that, because for them the experience is reality.
If you are unsure which of the two applies to you: asking the question already says a great deal.
Do you recognise yourself in this?
Derealization and depersonalization rarely pass on their own, but they are treatable. I have specialized in these complaints since 2016 and treat them online, worldwide. Get in touch if you want to know what is possible in your situation.
If you feel you are losing contact with reality, or you are seriously worried about yourself, contact your doctor. If you need help right away, findahelpline.com lists free, confidential crisis lines in your own country.
Source
Di Forti M, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry, 2019.
