A 26-year-old graduate student presents with persistent experiences of feeling detached from his own body, as if he is observing himself from outside, and a sense that the world around him appears unreal, 'like being inside a movie or dream.' These experiences have been nearly continuous for 8 months. He reports that during these episodes, he knows he is not actually outside his body and that the world is real, but the feeling persists despite this awareness. He denies hallucinations, delusions, substance use, and has no history of seizure disorder. MRI and EEG are normal.