What does derealization mean

Symptoms, Causes, Diagnosis, and Treatment

Written by Natalie Slivinski

Symptoms

Derealization usually happens in episodes, which means symptoms come and go. During an episode, you might feel as if:

You are in a dream or “fog. ”
A see-through wall or veil is separating you from your surroundings.
The world appears lifeless, muted, or fake.
Objects or people look “wrong” -- blurry, unnaturally sharp, too big, or too small.
Sounds are distorted, too loud, or too soft.
Time seems to speed up, slow down, or stand still.

Episodes can end in a few minutes or stretch for months at a time. But even as you feel like you’re going “crazy,” you always recognize that something is off. This is a key difference from psychotic disorders, where you can’t distinguish what’s real and what’s imaginary.

Causes

Derealization sometimes can be a symptom of a medical condition. Other times, it can happen on its own, often in reaction to severe trauma or stress.

Health conditions linked to derealization include:

Seizures
Dementia
Drug abuse
Schizophrenia
Panic attacks
Depression
Others dissociative disorders, like amnesia

The most common event that can trigger derealization is emotional abuse or neglect at a young age. The experience prompts the child to detach from their surroundings as a way to manage the trauma. Other causes of stress might include:

Physical or sexual abuse
Witnessing domestic violence
Parents or guardians with a severe mental disorder
Unexpected death of a loved one
PTSD from war or conflict
Trauma from an accident or a natural disaster

Future episodes of derealization can be brought on by everyday stressors, including problems at work or in your relationships.

Diagnosis

Derealization almost always starts in late childhood or early adulthood. The average age it starts is around 16, and 95% of cases are diagnosed before age 25.

No lab test can diagnose derealization. Your doctor may first try to rule out physical causes. They may use imaging tests such as an MRI, EEG, or an X-ray, or a urine screen to check for toxic chemicals.

If those tests don’t show anything, your doctor will refer you to a mental health expert. They will diagnose you with derealization disorder if you:

Have constant or repeated bouts of symptoms
Know that what you’re seeing or experiencing is not real
Are deeply distressed or your symptoms severely interfere with your life

Treatment

Many people who have derealization recover fully, sometimes on their own. Others are able learn how to get through episodes calmly.

But if you’ve been enduring it for a long time or if your root cause was very traumatic, you may need professional help. That’s especially true if you also have depression or anxiety that often comes with derealization.

The No. 1 treatment for derealization is psychotherapy. This form of talk therapy teaches you ways to share your experience and strategies to handle your episodes. Your doctor also may prescribe medication, mainly to ease any symptoms of depression or anxiety that come with the disorder.

Through psychotherapy, you may learn how to:

Keep yourself from obsessing about unreal experiences.
Distract yourself with activities.
Ground yourself in reality using your five senses (for example, by playing loud music or holding something very cold).
Address negative feelings and figure out the causes of your symptoms.
Talk about your feelings using specific words.

Depersonalization/Derealization Disorder - Mental Health Disorders

David Spiegel

, MD, Stanford University School of Medicine

Last full review/revision Mar 2021| Content last modified Sep 2022

CLICK HERE FOR THE PROFESSIONAL VERSION

Depersonalization/derealization disorder involves a persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of one's life (depersonalization), and/or a feeling of being detached from one's surroundings (derealization).

The disorder is usually triggered by severe stress, particularly emotional abuse or neglect during childhood, or other major stresses (such as experiencing or witnessing physical abuse).
Feelings of detachment from self or the surroundings may occur periodically or continuously.
After tests are done to rule out other possible causes, doctors diagnose the disorder based on symptoms.
Psychotherapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more , especially cognitive-behavioral therapy, is often helpful.

(See also Overview of Dissociative Disorders Overview of Dissociative Disorders Occasionally everyone has minor problems integrating their memories, perceptions, identity, and consciousness. For example, people may drive somewhere and then realize that they do not remember. .. read more .)

Temporary feelings of depersonalization and/or derealization are common. About one half of people have felt detached from themselves (depersonalization) or from the surroundings (derealization) at one time or another. This feeling often occurs after people

Experience life-threatening danger
Take certain drugs (such as marijuana Marijuana Marijuana (cannabis) is a drug made from the plants Cannabis sativa and Cannabis indica that contain a psychoactive chemical called delta-9-tetrahydrocannabinol (THC). Marijuana... read more , hallucinogens Hallucinogens Hallucinogens are a class of drugs that cause profound distortions in people's perceptions. Hallucinogens distort and intensify sensations, but the actual effects are variable and highly unpredictable... read more , ketamine Ketamine and Phencyclidine (PCP) Ketamine and phencyclidine are chemically similar drugs used for anesthesia but are sometimes used recreationally. Ketamine is available in powder and liquid form. The powder can be snorted... read more , or Ecstasy Hallucinogens Hallucinogens are a class of drugs that cause profound distortions in people's perceptions. Hallucinogens distort and intensify sensations, but the actual effects are variable and highly unpredictable... read more )
Become very tired
Are deprived of sleep or sensory stimulation (as may occur when they are in an intensive care unit)

Depersonalization or derealization can also occur as a symptom in many other mental disorders, as well as in general medical disorders, such as seizure disorders Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more .

Depersonalization/derealization feelings are considered a disorder when the following occur:

Depersonalization or derealization occurs on its own (that is, it is not caused by drugs or another mental disorder), and it persists or recurs.
The symptoms are very distressing to the person or make it difficult for the person to function at home or at work.

Depersonalization/derealization disorder occurs in about 2% of the population and affects men and women equally.

The disorder may begin during early or middle childhood. It rarely begins after age 40.

Depersonalization/derealization disorder often develops in people who have experienced severe stress, including the following:

Being emotionally abused or neglected during childhood
Being physically abused
Witnessing domestic violence
Having had a severely impaired or mentally ill parent
Having had a loved one die unexpectedly

Symptoms can be triggered by severe stress (for example, due to relationships, finances, or work), depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to. .. read more , anxiety Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more , or use of illegal or recreational drugs Recreational Drugs and Intoxicants . However, in 25 to 50% of cases, stresses are relatively minor or cannot be identified.

Symptoms of depersonalization/derealization disorder may start gradually or suddenly. Episodes may last for only hours or days or for weeks, months, or years. Episodes may involve depersonalization, derealization, or both.

The intensity of symptoms often waxes and wanes. But when the disorder is severe, symptoms may be present and remain at the same intensity for years or even decades.

Depersonalization symptoms involve

People may also say they feel unreal or like an automaton, with no control over what they do or say. They may feel emotionally or physically numb. Such people may describe themselves as an outside observer of their own life or the “walking dead.”

Derealization symptoms involve

People may feel as if they are in a dream or a fog, or as if a glass wall or veil separates them from their surroundings. The world seems lifeless, colorless, or artificial. The world may appear distorted to them. For example, objects may appear blurry or unusually clear, or they may seem flat or smaller or larger than they are. Sounds may seem louder or softer than they are. Time may seem to be going too slow or too fast.

The symptoms almost always cause great discomfort. Some people find them intolerable. Anxiety and depression are common. Many people are afraid that the symptoms result from irreversible brain damage. Many worry about whether they really exist or repeatedly check to determine whether their perceptions are real.

Stress, worsening depression or anxiety, new or overstimulating surroundings, and lack of sleep can make symptoms worse.

Symptoms are often persistent. They may

Recur in episodes (in about one third of people)
Occur continuously (in about one third)
Become continuous (in about one third)

People often have great difficulty describing their symptoms and may fear or believe that they are going crazy. However, people always remain aware that their experiences of detachment are not real but rather are just the way that they feel. This awareness is what separates depersonalization/derealization disorder from a psychotic disorder. People with a psychotic disorder always lack such insight.

Doctors suspect the disorder based on symptoms:

People have episodes of depersonalization, derealization, or both that last a long time or recur.
People know that their dissociative experiences are not real.
People are very distressed by their symptoms or their symptoms make them unable to function in social situations or at work.

A physical examination and sometimes tests are done to rule out other disorders that could cause the symptoms, including other mental health disorders, seizure disorders Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more , and substance abuse Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more . Tests may include magnetic resonance imaging (MRI), computed tomography (CT), electroencephalography (EEG), and blood and urine tests to check for drugs.

Psychologic tests and special structured interviews and questionnaires can also help doctors with the diagnosis.

Complete recovery is possible for many people with depersonalization/derealization disorder, especially if the symptoms result from stresses that can be dealt with during treatment. Other people do not respond well to treatment, and the disorder becomes chronic. In some people, depersonalization/derealization disorder disappears on its own.

Symptoms, even those that persist or recur, may cause only minor problems if people can keep their mind busy and focus on other thoughts or activities, rather than think about their sense of self. However, some people become disabled because they feel so disconnected from their self and their surroundings or because they also have anxiety or depression.

Depersonalization/derealization disorder may disappear without treatment. People are treated only if the disorder persists, recurs, or causes distress.

Psychodynamic psychotherapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more and cognitive-behavioral therapy have been effective for some people. Depersonalization/derealization disorder is often associated with or triggered by other mental health disorders (such as anxiety Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more or depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more ), which require treatment. Any stresses that triggered the symptoms or that may have contributed to development of depersonalization/derealization disorder must also be addressed.

Techniques that can help include the following:

Cognitive techniques can help block obsessive thinking about the unreal state of being.
Behavioral techniques can help people become absorbed in tasks that distract them from the depersonalization.
Grounding techniques use the five senses (hearing, touch, smell, taste, and sight) to help people feel more connected to themselves and the world. For example, loud music is played or a piece of ice is put in the hand. These sensations are difficult to ignore, making people aware of themselves in the present moment.
Psychodynamic techniques focus on helping people work through intolerable conflicts, negative feelings, and experiences that people feel they must detach themselves from.
Moment-to-moment tracking and labeling of dissociation and affect (the outward expression of emotions and thoughts) teaches people to recognize and identify their feelings of dissociation. Such recognition helps some people. This technique also helps people focus on what is actually happening in the moment.

Various drugs have been used to treat depersonalization/derealization disorder, but none has been proved to be effective. Antianxiety drugs Treatment Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more and antidepressants Drug Treatment for Depression Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more sometimes help, mainly by relieving anxiety or depression, which are present in many people with depersonalization/derealization disorder. However, antianxiety drugs may also increase depersonalization or derealization, so doctors carefully monitor use of these drugs.

Generic Name	Select Brand Names
ketamine	KETALAR

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Where does derealization come from and what to do with it?

What is derealization

Derealization is a constant or periodic feeling of the unreality of the surrounding world. In moments of fear or anxiety, a person may feel as if he is abstracting from what is happening and watching from the side. This is necessary to protect the brain and psyche from a strong shock.

The first symptoms usually occur in adolescents or young adults. Constant or periodic derealization makes you constantly check what is real and what only seems to be. It feels like you're going crazy. This interferes with relationships and work, scares and even limits the fullness of life: it becomes difficult to concentrate on everyday affairs, a feeling of hopelessness arises, anxiety and depression increase.

Derealization is often mentioned together with depersonalization. So called detachment or alienation of the individual from himself. A person experiencing this feels like a robot or an outside observer of his body and mind. Derealization and depersonalization can occur together—for example, in dissociative disorders—or they can occur separately.

About 50% of people in the world at least once in their lives felt the unreality of what was happening. So there is no need to worry about it. But if derealization happens often and interferes with life, then you need to find out why it appeared.

Why derealization occurs

Until now, doctors do not know the exact causes. Some people are more susceptible to it due to genetic factors or personality traits. For example, if a person avoids difficult situations, it is harder for him to adapt to stress.

Derealization often occurs in response to severe traumatic events, especially in childhood. For example, due to domestic abuse. It occurs in people with post-traumatic stress disorder, severe lingering depression, and panic attacks.

Derealization can also be a symptom of:

epilepsy;
brain lesions;
disorders of the vestibular apparatus or labyrinthitis;
severe sleep disorders;
various personality disorders;
schizophrenia.

Sometimes manifestations of derealization occur due to the use of alcohol, benzodiazepines and certain illegal drugs.

What are the symptoms of derealization

People describe their symptoms in different ways. For example, they feel that:

they are in a movie or in a dream, and the whole environment is unfamiliar to them;
close people became indifferent, as if they were separated by a glass wall;
everything around is distorted, blurry, colorless, two-dimensional or artificial, or, conversely, more clear and distinct;
time does not flow correctly - for example, recent events seem to have happened in the distant past;
distance, sizes and shapes of objects are surreal and implausible;
"have already seen" something unfamiliar - déjà vu, or "have never seen" something familiar - jamais vu.

What to do if you feel derealized

Patients with derealization often improve without intervention, especially if the symptoms are caused by short-term stress. To distract yourself from your subjective self-perceptions, you can try to focus on other thoughts or actions.

If the symptoms persist for a long time and reduce the quality of life, a psychotherapist should be consulted. He will ask about the manifestations and medications taken, conduct an examination and prescribe treatment.

Psychotherapy

Depersonalization is usually treated with psychotherapy. It helps:

to find out why there are problems;
work through the traumas that led to derealization;
learn to be distracted from its manifestations;
deal with stress so that it occurs less frequently;
Treat comorbid mental conditions such as anxiety or depression.

For treatment, psychodynamic therapy is used, which examines the influence of unresolved past conflicts on human behavior. They also use cognitive-behavioral therapy - it helps to realize past actions in order to change behavior now.

Medicines

There are no medicines for derealization. However, a doctor may recommend supplements to help reduce symptoms of anxiety or depression. If derealization is caused by some disease of the brain or vestibular apparatus, then its manifestations will decrease when the underlying disease is treated.

What are depersonalization and derealization and how to detect them? 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 may 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 preparations are also used, but none of them has been clearly proven to be effective.

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