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Can anxiety cause derealization


This Common Anxiety Symptom Makes Me Feel Like Reality's Slipping

Medically reviewed by Timothy J. Legg, PhD, PsyD — By Gila Lyons — Updated on April 18, 2019

I thought I was losing my mind. But I was just experiencing anxiety symptoms: derealization and depersonalization.

Health and wellness touch each of us differently. This is one person’s story.

It was like the world was made of wax.

The first time I felt it, I was walking down the streets of New York City. I’d been anxious for months, having panic attacks upon waking, while teaching, while in the back of a cab.

I’d stopped taking the subway and was walking to work when suddenly the buildings around me started to shimmer like their atoms didn’t hold together. They were too bright, immaterial, and shaking like flip-book cartoons.

I didn’t feel real either.

My hand looked garish and it panicked me to clearly feel the thought, move your hand, echo cavernously inside my head — and then see my hand move. The whole process that was supposed to be automatic, instant, and unnoticeable was broken down.

It was as if I were an outside observer of my innermost processes, making me a stranger in my own body and mind. I feared I’d lose my grip on reality, which already felt tenuous and shaky because of a severe flare-up of lifelong anxiety and panic.

I felt reality melt away a week later when I was having one of the biggest panic attacks of my life.

I was on my couch, my hands frozen into claws, the EMTs poised with an oxygen mask and EpiPen above me. I felt as though I were in a dream and everything was hyper-real — colors too bright, people too close, and huge clown-like people.

My skull felt too tight and my hair hurt. I could feel myself seeing out of my own eyes and hear myself talk too loudly inside my brain.

Aside from being deeply uncomfortable and distracting, what made it even scarier was that I had no idea what it was.

I thought it was an indication of total insanity, which caused me more anxiety and panic. It was a devastating cycle.

It would be a decade before I heard the terms derealization and depersonalization.

Although one of the most common symptoms of anxiety and panic disorder, it’s one that doctors, therapists, and people with anxiety rarely talk about.

One reason doctors may be less likely to mention derealization to patients could be because, while associated with panic, it’s not completely clear what causes it. And why it happens for some people with anxiety and not others.

According to the National Alliance on Mental Illness, about half of US adults will experience at least one depersonalization/derealization episode in their lives.

The Mayo Clinic describes the condition as, “observing yourself from outside your body” or “a sense that things around you aren’t real.”

Depersonalization distorts the self: “The sense that your body, legs, or arms appear distorted, enlarged, or shrunken, or that your head is wrapped in cotton.”

Derealization deranges the outside world, causing one to feel, “emotionally disconnected from people you care about. ” Your surroundings appear “distorted, blurry, colorless, two-dimensional, or artificial.”

However, the terms are often used interchangeably, and diagnosis and treatment are often the same.

Health Research Funding reports that stress and anxiety are the primary causes of derealization, and that women are twice as likely to experience it as men. Up to 66 percent of people who experience a trauma will have some form of derealization.

A sense of unreality came over me during times of heightened anxiety, but also randomly — while brushing my teeth with the nauseating feeling that the reflection in the mirror wasn’t me. Or eating dessert at a dinner party when suddenly my best friend’s face looked as if it were made out of clay and animated by some foreign spirit.

Waking up with it in the middle of the night was especially scary, shooting up in bed intensely disoriented, too acutely aware of my own consciousness and body.

It was one of the scariest and most tenacious symptoms of my anxiety disorder, lingering months after the acute panic attacks and phobias had eased.

When I first started seeing my therapist, I tearfully described this symptom, concerned about my sanity.

He sat in his overstuffed leather chair, completely calm. He assured me that while bizarre and scary, derealization is not dangerous — and is in fact quite common.

His physiologic explanation eased some of my fear. “Adrenaline from prolonged anxiety redirects blood from the brain to the big muscles — the quads and biceps — so that you can fight or flee. It also sends your blood into your core, so that if your extremities are cut you won’t bleed to death. With the redirection of blood from the brain, many feel a sense of light-headedness and derealization or depersonalization. It’s actually one of the most common complaints of anxiety,” he told me.

“Also, when nervous, people tend to over-breathe, which changes the composition of blood gasses, which affects how the brain works. Because anxious people can be hypervigilant of their bodies, they notice these subtle changes that others wouldn’t and interpret them as dangerous. Because this scares them, they keep hyperventilating and derealization gets worse and worse.”

Depersonalization can be its own disorder, or a symptom of depression, drug use, or psychotropic medications.

But when it occurs as a symptom of severe or prolonged stress and anxiety, experts agree that it’s not dangerous — or a sign of psychosis — like many people fear.

In fact, the quickest way to return the brain to normal functioning is to deescalate anxiety and panic, which often means meeting the dissociative feelings with calm and acceptance, a herculean task at first.

My therapist explained that adrenaline is metabolized in two to three minutes. If one can calm themselves and their fear of the derealization, the production of adrenaline will cease, the body can eliminate it, and the feeling will pass more quickly.

I’ve found that listening to soothing, familiar music, drinking water, practicing deep breathing, and listening to affirmations can help take the focus off the strange zinging awareness and bring me back into my body.

Cognitive behavioral therapy has also shown to be one of the most effective treatments for anxiety-induced depersonalization/derealization. It can help train the mind away from obsessing over the troubling state, and help you build skills and tools to redirect attention where you want it to go.

As intense and all-encompassing as it feels, derealization does abate with time.

I used to have bouts of it several times a day, every day, and it was incredibly distracting, uncomfortable, and scary.

While I was teaching, shopping, driving, or having tea with a friend, it would send a shock through me and I’d have to retreat to bed, to the phone with a friend, or another safe space to deal with the fear it aroused. But as I learned not to react with terror — as I learned to ignore derealization with the confidence that it would not catapult me into insanity — the episodes got shorter, milder, and less frequent.

I still experience unreality sometimes, but now I ignore it and it eventually fades. Sometimes within minutes. Sometimes it takes an hour.

Anxiety is a lie. It tells you you’re in mortal danger when you’re safe.

Derealization is one of anxiety’s lies that we have to see through in order to gain our freedom and comfort. When you feel it coming, speak back to it.

I am myself; the world is here; I am safe.

Gila Lyons’ work has appeared inThe New York Times, Cosmopolitan,Salon,Vox, and more. She’s at work on a memoir about seeking a natural cure for anxiety and panic disorder but falling prey to the underbelly of the alternative health movement. Links to published work can be found atwww.gilalyons.com. Connect with her onTwitter,Instagram, andLinkedIn.

Derealization - A Scary Anxiety Symptom

In cases of severe anxiety, a person may feel as though they're going crazy. They may feel as though something is off in reality and the world around them is essentially crashing. In some cases, this may cause the world to feel "unreal," as though something is not quite right in the world around them.

This is known as derealization, and for those who experience it, it can be a frightening symptom of anxiety. Derealization is also completely subjective, making the experience sometimes very difficult to understand unless you've experienced it.

Causes of Derealization From Anxiety

Derealization is incredibly complex. It's not entirely clear what occurs in the brain to cause people to enter a trance-like state and feel out from reality. It is believed to be a natural coping mechanism created within our bodies. During intense periods of anxiety (as occurs with panic attacks), the mind seems to decide it's going to tune the world out in order to, at least temporarily, eliminate thinking about the anxiety inducing stimuli.

Since the mind keeps working during this ‘tune out,’ the world becomes a place that feels unreal. Those who experience derealization will usually find it occurs in the peak of an anxiety attack, along with other symptoms that are characteristic of an anxiety disorder.

Trying to Make Sense of a Loss of Reality

For those who have not personally experienced derealization it may help to imagine being transported into a place that you do not recognize nor do you understand. In this place you cannot seem to follow what's going on or make sense of the world around you. Your brain’s failure to process the information being taken in by your sense (sight, sound, etc) results in even the most familiar places looking unfamiliar and strange.

There's no denying that this experience is profoundly unusual and frightening one. It can often feel like you're not really in the environment surrounding you, or that the world around you is unreal. You may feel like you're watching something going on with no understanding of what it is, or that the world is a dream that you aren't able to escape. In some cases, derealization may be combined with depersonalization, which can make it feel like you're watching yourself.

Other anxiety symptoms may make the feeling of derealization worse. During anxiety attacks your pupils may dilate, and this can cause unusual vision. Anxiety may also weaken your muscles, making you feel lighter. There are countless ways that your anxiety symptoms may interact and potentially exacerbate one another.

How to Stop Derealization

Derealization - when it comes from anxiety - is not considered dangerous. It generally goes away on its own and only comes during periods of intense anxiety. If your derealization is so persistent that it's altering your sense of reality, or if it lasts for a long period of time, you should contact a doctor immediately.

Doctors and psychologists generally agree that the best way to stop derealization is with mindfulness. Mindfulness is the act of becoming more aware of your own present. Mindfulness can be completed in a variety of ways, but the easiest way is to simply get yourself to perform an action and focus as much as possible on that action in order to get yourself back into the world.

For example:

  • Touch something warm or cold. Focus on the warmth or cold.
  • Pinch yourself so that you feel how real you are.
  • Try to find a single object and start identifying what it is and what you know about it.
  • Count something in the room. Identify what they are.
  • Utilize your senses in any way possible.

Some also advise that you keep your eyes moving and try to get your brain thinking. Don't simply zone out to a single thought.

Consider starting with the following exercise, and see if this helps with the derealization. You can also try search engines or speak to a therapist/counselor about other successful techniques:

  • The moment you feel as though you may be experiencing de-realization, go through the 5 senses with your surroundings.
  • Start with taste. It helps to keep a mint with you. Place the mint in your mouth and focus on the flavor. Try to place the mint on all corners of your tongue.
  • Next is smell. You can either smell the mint carton or smell in your surroundings and try to identify the source of each smell.
  • Next is touch. Try touching what’s around you and slowly feel the textures. Explore more than one texture. 
  • Next is hearing. Listen for what’s around you and identify the sounds.
  • Finally, sight. Now that you’ve gone through the other 4 senses, look for things out in the distance and identify what they are, or count them, or otherwise immerse your vision. 

It may be helpful to also meditate or perform these exercises even when you’re not experiencing de-realization so that you get into the practice of utilizing your senses to experince what is “real.” 

Remember, derealization is an anxiety symptom. It doesn't mean you're psychotic, nor does it mean anything is wrong with your mind. As such, part of overcoming derealization is simply to wait it out, then address your anxiety symptoms in order to make sure you don't experience that intense level of anxiety again.  

Summary:

Derealization is a feeling as though you have lost touch with reality. It occurs often during anxiety attacks, but may occur in other situations as well. It’s important to create a personal strategy to help you get “back” to reality, and to start addressing your anxiety to prevent these experiences from happening again. 

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What is depersonalization and derealization and how to detect them

Perhaps at least once in your life you felt that your body does not belong to you or that what is happening around you seems to be happening not to you and not really. These are quite common in society syndromes of depersonalization and derealization, which can manifest themselves both together and one by one. Due to similarities, the terms are often used together. Zaborona journalist Polina Vernigor figured out what are the signs of these symptoms, when to see a doctor, how to deal with it, and whether it is worth it.

What is depersonalization and derealization?

In themselves they are symptoms. Like headache, dizziness or restlessness. But there is a disorder of depersonalization-derealization, which is already a full-fledged psychiatric diagnosis. The disorder itself occurs in only about 2% of the population, but at least 50% of people experience symptoms at least once in their lives.

As symptoms, depersonalization and derealization can indicate mental disorders (panic attack, phobias, post-traumatic stress disorder, depression, schizophrenia, borderline personality disorder, etc.) or neurological (convulsions, brain tumor, post-concussion syndrome, metabolic disorders, migraines, Meniere's disease, etc.). They can also occur as a reaction to stress or trauma, and are also found in people with alcohol or drug addiction.

Almost always, these symptoms appear either in late childhood or early adulthood. On average, onset occurs at age 16, and 95% of cases are diagnosed before age 25. The first experience of depersonalization can be scary, as patients fear losing control and separating themselves from the rest of society. Most people with these symptoms misinterpret them as signs of severe psychosis or brain dysfunction. This usually leads to an increase in anxiety and obsessions, which contributes to the worsening of symptoms.

  • Francisco Goya, Witches' Sabbath (1797-98) / Wikimedia

renamed Depersonalization/Derealization Disorder (DPDR). This diagnosis is classified as a dissociative disorder.

The latest International Classification of Diseases (ICD-11) reclassified DPDR as a disorder rather than a syndrome as before, and reclassified it as a dissociative disorder from the list of neurotic disorders. The description that is used in ICD-11 is similar to the criteria found in DSM-5.

How do I know if I have depersonalization or derealization?

You can notice the symptoms yourself, but depersonalization-derealization disorder is a diagnosis that only a doctor can make. No laboratory tests reveal either the symptoms themselves or the disorder. To rule out the physical causes of these conditions, your doctor may order magnetic resonance imaging (MRI), electroencephalography (EEG), x-rays, or a urine test for toxic chemicals. If all these studies turn up nothing, then the cause is most likely mental states.

Signs of depersonalization:

  • the feeling that you are watching your thoughts, feelings, body or parts of it from the side - for example, as if you are floating in the air above you;
  • feels like a robot and/or has no control over your speech and/or movements;
  • your body or parts of it seem distorted, deformed, and your head seems to be wrapped in cotton wool;
  • emotional or physical numbness of feelings or reactions to the environment;
  • your memories lack emotion, and doubts arise whether they are really your memories.
  • Henry Fuseli, Nightmare (1781) / Wikimedia

Signs of derealization:

  • a feeling of alienation or ignorance of one's surroundings - for example, as if you are living in a movie or in a dream;
  • emotional isolation from people close to you, as if you were separated by a glass wall;
  • the environment appears distorted, blurry, colorless, two-dimensional or artificial;
  • distortion in the perception of time, for example, recent events are perceived as the distant past;
  • distortion of the distance, size and shape of objects.

Depersonalization-derealization disorder can be considered if these symptoms recur frequently and for a long time and are not the result of some other disease or disorder. In any case, if it drains you emotionally or interferes with your life, contact a specialist.

What to do about it?

Very often, both the symptoms and the disorder do not require special treatment and go away on their own. But it depends on their nature and how much they bother you. For many patients, a full recovery is possible, especially if the symptoms are related to another disorder/disease that is being treated, or to stress that is being relieved. In other cases, depersonalization and derealization become more chronic and less noticeable. Even persistent or recurring symptoms can cause only minimal disturbance if you learn to perceive them correctly - for example, to focus on other thoughts or actions.

  • Mikhail Vrubel, “Demon Defeated” (1901-02) / Wikimedia

If we still talk about the treatment of depersonalization-derealization disorder, then psychotherapy helps here. Treatment should take into account all the stresses associated with the onset of the disorder, as well as earlier traumas (eg, childhood abuse or neglect, physical, psychological or sexual abuse, etc.) that may cause patients to have a late onset of depersonalization and/or derealization. .

Different psychotherapeutic methods are successful for different patients. Cognitive techniques can help block intrusive thoughts about an unreal state of being. Behavioral techniques can help patients perform tasks that distract them from depersonalization and derealization. Grounding Techniques use various senses (such as playing loud music or holding a block of ice) to help patients feel more real in the moment and more connected to the body and surroundings. Psychodynamic Therapy helps patients cope with negative feelings, hidden conflicts or experiences that, due to accumulation, provoke symptoms.

Various drugs are also used, but none of them has been clearly proven to be effective.

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