Derealization: Symptoms, Causes, & Treatments

What is Derealization?

Derealization is the experience of feeling detached or separate from your surroundings and experiences.^1,2,4 It’s normal to occasionally feel ‘spaced out’ or detached, but people who struggle with derealization have these episodes more frequently, and find it hard to stop or control them.^3,4,5 Dissociative symptoms can make it difficult to focus, interact with others, and function normally.

People who experience derealization often describe feeling more like an ‘observer’ of their life and surroundings rather than a participant in them. They are usually aware of where they are and what’s happening around them, but their experience of reality feels unreal during dissociative episodes. They may report that the world seems foggy, artificial, or far away.^1,3,5,6

Depersonalization/Derealization Disorder

Sometimes, derealization is a sign of depersonalization/derealization disorder (aka DDD or DPDR), which is a kind of dissociative disorder that causes people to feel detached from themselves, their surroundings, or both. Some people with DDD have occasional, sporadic dissociative episodes, while others experience them more regularly.^3.5 Depersonalization-derealization disorder is rare, affecting 1.9% or less of the population. Most of the time, dissociative symptoms like derealization are caused by another underlying mental illness.⁷

Symptoms of Derealization

Derealization is a dissociative symptom that can occur during a PTSD flashback, psychotic episode, or during times of high stress or anxiety. The primary symptom of derealization is the feeling that your surroundings are unreal or feeling detached or separate from them.^1,5

Some of the other signs and symptoms of derealization can include:^1,3,4

• Feeling ‘far away’ or distant from your physical surroundings
• Feeling stuck in a dream-like state or like reality is ‘unreal’
• Objects around you appearing different in size, shape, or color
• Feeling like your surroundings are unfamiliar
• Being unable to recognize familiar people or faces
• Having blurred or foggy vision
• Sounds being muffled or sounding softer or louder
• Numbed or altered sensations
• Altered sense of time (moving faster or normal than usual)
• Feeling like you’re in a movie or watching a movie

Some people with DDD experience only derealization (detachment from external surroundings), and others also experience depersonalization (detachment from yourself, your body, thoughts, or feelings).^1,2,5
When derealization is caused by another mental illness, it may overlap with other symptoms like changes in mood, symptoms of anxiety, or psychotic symptoms.^3,5,6

Derealization, Depersonalization, & Dissociation

Both derealization and depersonalization are dissociative symptoms that can occur together or separately. Derealization is when you feel detached or separate from your external environment and surroundings, while depersonalization is feeling detached from yourself, your body, thoughts, or feelings.^1,2,5

When someone ‘dissociates’, they feel disconnected or distant from some aspect of themselves or their reality. In a dissociative state, they may feel ‘far away’ from themselves or their surroundings, have out of body experiences, or even experience dissociative amnesia and be unable to remember things that occurred.^2,4

What Causes Derealization?

It’s relatively normal to experience occasional derealization or dissociation symptoms, especially when you’re stressed, sleep deprived, or overstimulated. In fact, about 50% of the population experience at least one temporary episode of derealization.⁴ In most instances, these are isolated episodes that resolve on their own without treatment.^3,6 However, experiencing frequent or uncontrollable episodes is often a sign of an underlying problem or condition.

The most common cause of derealization is experiencing a traumatic event. Research shows that up to 74% of trauma survivors will experience derealization at some point in their lives.^4,6 For people with PTSD or a trauma history, derealization often co-occurs with other PTSD dissociative symptoms or happens when they experience flashbacks.^4,5

Childhood trauma, including physical or emotional abuse and neglect, can have lasting effects on a person, such as periodic dissociative symptoms like derealization.^2,3,6 Derealization can be triggered by stress, anxiety, PTSD flashbacks, or any strong emotional reaction.^4,6,8

Other possible causes of derealization include:^3,4,5,6,9

• Illnesses and injuries: Being very ill or severely injured can lead to dissociation from your body and surroundings; a full or partial loss of consciousness; and other symptoms of dissociation and derealization.
• Brain injuries or a neurological disorder: In rare instances, derealization can be triggered by a traumatic brain injury or underlying neurological condition such as epilepsy. Dementia or cognitive impairment due to long term drug abuse can also trigger derealization.
• Anxiety disorders: High levels of anxiety or panic attacks can cause chemical changes in the body and brain that alter perception, and lead people to temporarily dissociate from their bodies or surroundings.
• Prescribed or illicit substances: Derealization is sometimes an adverse effect of a prescribed medication, or the result of someone taking or withdrawing from a mind or mood-altering drug. Certain illicit drugs like marijuana and psychedelics are more likely to trigger dissociative symptoms.
• Mood disorders: Depression or bipolar disorder can also cause symptoms of derealization during either manic episodes, depressive episodes, or both.
• Psychosis or psychotic disorders: Some people who have schizophrenia, brief psychotic disorder, or psychosis experience derealization during times when their symptoms aren’t managed.
• Dissociative disorders: Derealization is sometimes a symptom of a dissociative disorder like DDD, Dissociative Identity Disorder, or Dissociative Amnesia and may occur with other dissociative symptoms including memory loss and identity confusion.
• Personality disorders: Certain personality disorders like Borderline Personality Disorder can cause abnormalities in the way people think and perceive reality, and may lead to derealization for some people.
• Extreme stress: Dissociative symptoms such as derealization are sometimes a defense mechanism in response to extreme stress or danger. These symptoms will almost always resolve on their own.

Diagnosing Derealization

Derealization can be a normal phenomenon. For example, experiencing derealization when you’re really stressed, anxious, tired, or overstimulated is fairly common, especially if it only happens once or twice.^4,6 However, if derealization occurs more often or begins to interfere with your ability to focus or function, it is a good idea to consult with a licensed health or mental health professional. Getting an accurate diagnosis is important, and helps to ensure that you receive the right kind of treatment.

A clinician may use a variety of different methods to diagnose derealization including:^3,6

• Questions about your mental and physical health and any symptoms you’re having now and in the past
• Questions about your family history, including family members diagnosed with a mental health, physical, or neurological disorder
• Surveys, questionnaires, or assessments to help diagnose an underlying mental health condition
• A mental status assessment with simple tasks, questions, and words and sentence repetition.
• Questions about any traumatic events you have experienced recently or in childhood
• Information about any prescribed or illicit substance use, and possibly requesting a blood or urine drug screen (merck)
• Brain imaging scans like an MRI to rule out brain injuries or abnormalities

Treatment for Derealization

Because derealization isn’t always a sign of a mental illness, it doesn’t necessarily require professional treatment. For instance, when it is caused by stress, sleep deprivation, or is a side effect of drugs, derealization will resolve without treatment.^3,4,6,9 In cases where derealization becomes a more frequent or severe problem, it may require the help of a counselor, psychiatrist, or both.

The specific kind of therapy or medication used depends on what the underlying disorder is, which can only be determined by a licensed professional during a diagnostic assessment at the first appointment you make with a psychologist, therapist, or psychiatrist. In this initial appointment, you can expect to receive a diagnosis and also have the clinician go over recommendations and options for treatment.

Treatment options may include:^3,6,8,9

• Trauma-informed therapies: Because trauma is the most common cause of derealization, therapies like eye movement desensitization and reprocessing therapy (EMDR) , cognitive processing therapy (CPT), accelerated resolution therapy (ART), and even brainspotting may help treat trauma-induced derealization
• Cognitive therapies: Cognitive therapies like cognitive behavioral therapy (CBT) have been shown to help improve symptoms. In one study, almost one third of patients reported having no dissociative symptoms after six months of CBT therapy sessions
• Third Wave therapies: Third wave behavioral therapies like acceptance and commitment therapy (ACT) or dialectical behavioral therapy (DBT) may help people reduce dissociative symptoms through the use of mindfulness and acceptance strategies, while also helping to improve their ability to regulate emotions
• Psychiatric medications: While there are no specific approved medications to treat dissociative symptoms, antidepressants, mood stabilizers, or anti-anxiety medications may help to treat underlying conditions and symptoms that contribute to derealization

How to Cope With Derealization

If you or a loved one is struggling with derealization, it’s important to make an appointment with a licensed mental health professional who can accurately diagnose you. Many people begin the process by using an online therapist directory that allows them to find the right therapist near them who accepts their insurance and specializes in a certain issue or type of therapy.

There may be some things you can do on your own to manage and cope with derealization including:^3,4,9

• Avoid drugs and alcohol: It might be helpful to note whether symptoms occur with drugs and alcohol. Avoid using them, since drugs and alcohol can alter thoughts and emotions.
• Be more physically active: Physical exercise and activity help to lower stress hormones and balance your brain chemistry. Since stress is often a trigger for derealization, incorporating more physical activity into your routine can help reduce your symptoms.
• Redecorate your space: Consider taking small steps to make the spaces you spend the most time in more relaxing, inviting, and comfortable. For example, add a plant, a lamp that gives low light, some colorful throw pillows, or a picture of the beach to your home office or bedroom. By making your surroundings more enjoyable to be in, you might also find that you dissociate less often.
• Ground yourself by focusing on one sense: Another way to prevent dissociation and derealization is to focus your full attention on something you can see, hear, touch, taste, or smell. By focusing attention on just one sense, you can sometimes stay present and avoid slipping into derealization.
• Dial down stress and anxiety with relaxation techniques: Another way to reduce dissociative symptoms is to use relaxation techniques like deep breathing, mindfulness, guided meditations, or progressive muscle relaxation. These can help quiet the mind, deactivate the nervous system, and reduce stress and anxiety, lowering the risk of dissociation.

Final Thoughts

Derealization is a dissociative symptom in which someone feels unreal or detached from surroundings. Dissociating or “spacing out” can be normal with stress, anxiety, high emotion, fatigue, or illness. If symptoms are frequent  or interfere with your ability to function, a professional can assess whether there is a mental health issue. Symptoms often improve or resolve.  with the help of a therapist.