This article originally appeared in the Spring 2026 issue of On The Level.
This research paper reviews decades of studies exploring an important but often overlooked question: Can problems with the vestibular (balance) system contribute to feelings of depersonalization and derealization?
Depersonalization refers to feeling detached from your own body or sense of self (for example, feeling “outside” yourself).
Derealization refers to feeling disconnected from the world around you, as if things don’t feel quite real.
The authors examined 23 studies involving more than 3,500 people, including both individuals with vestibular disorders (such as Ménière’s disease, vestibular neuritis, bilateral vestibular loss, PPPD, and vestibular migraine) and healthy volunteers who underwent artificial vestibular stimulation (for example, caloric testing or rotation).
Findings
Across these studies, nearly 87% found that vestibular dysfunction or stimulation was associated with depersonalization and/or derealization symptoms.
A consistent finding was that people with dizziness or balance disorders report depersonalization and derealization far more often than people without dizziness. In some studies, over half of people with dizziness reported at least one depersonalization or derealization symptom. These experiences were not limited to psychiatric conditions as they frequently appeared alongside clearly defined inner-ear or balance problems.
Two factors showed up again and again as closely linked to these symptoms:
- Spatial disorientation – difficulty knowing where your body is in space, feeling off-balance, or struggling to orient yourself.
- Anxiety – especially anxiety related to movement, balance, or fear of symptoms.
possible explanation
The authors propose that when vestibular signals from the inner ear are disrupted, the brain has trouble integrating balance information with vision, body sensation, and internal awareness. This mismatch can lead to a feeling that the body or the world is “off,” unfamiliar, or unreal.
Brain areas involved in this process include regions responsible for spatial awareness, self-perception, and emotional regulation, such as the temporoparietal junction, insula, hippocampus, and cingulate cortex.
connected recovery
Importantly, the review also found that depersonalization and derealization symptoms often improve as vestibular function stabilizes or as patients recover, suggesting these experiences are not permanent personality changes but rather reversible responses to sensory disruption.
In some cases, treatments or recovery from vestibular injury were associated with improvements in both balance and feelings of unreality.
Key Takeaway
Overall, this review supports a powerful and validating message for patients: feelings of depersonalization and derealization can be a direct consequence of vestibular dysfunction, not “just anxiety” or “all in your head.”
Understanding this connection may help clinicians better recognize these symptoms, reassure patients, and develop more effective, whole-person treatment approaches that address balance, spatial orientation, and emotional well-being together.
Source
Cento S, Gammeri R, Zavattaro C, Cirillo E, Serra H, Ricci R. The role of the vestibular system in depersonalization and derealization: Evidence from a systematic review. Journal of Vestibular Research. 2026;0(0). doi:10.1177/09574271251412707
