When we talk about derealization, what exactly are we referring to? It is a pronounced state of altered perception in which the individual feels disconnected from the reality around them. This experience can be frightening and disorienting, as it affects how the person perceives both themselves and their environment. Despite this strong sense of detachment, individuals experiencing derealization remain fully conscious. They are aware that something is wrong, and they can evaluate their surroundings rationally, even while dealing with the condition. This paradox—feeling unreal yet knowing it's not normal—is what makes derealization particularly distressing.
Derealization is recognized as a dissociative disorder in clinical diagnostic manuals. Experts estimate that around two percent of the global population may experience episodes of derealization in their lifetime. While this may seem like a small number, it actually represents millions of individuals. Surprisingly, many mental health professionals continue to consider it a rare condition. One possible explanation is that dissociative disorders are often hidden beneath other psychological issues, emerging only in complex clinical pictures.
Derealization frequently occurs alongside other disorders, such as:
- Panic disorder, where intense anxiety can trigger dissociative sensations
- Major depressive disorder, which can alter perception and emotional processing
- Post-traumatic stress disorder (PTSD), where trauma disrupts the continuity of consciousness
Those who experience derealization often report a sudden, overwhelming sense of detachment from themselves, their body, or the external world. It's as though a barrier has been placed between them and reality. Identifying and diagnosing the condition can be challenging due to the subjective nature of the symptoms. Recent psychological theories, such as those proposed by Holmes, divide the condition into two major mechanisms:
- Compartmentalization : In this model, higher-level brain functions shut down in response to overwhelming stress or trauma. The person may experience dissociative amnesia or difficulty accessing important personal information.
- Detachment : This category includes depersonalization and derealization, in which the individual feels separate from their identity or the outside world.
Depersonalization
Depersonalization is often discussed alongside derealization but focuses more on internal experiences. In depersonalization, individuals feel estranged from themselves, their thoughts, emotions, and even their physical body. They might describe a sensation of observing their actions from a distance or feeling like a passive observer of their own life. These episodes are frequently accompanied by emotional numbness and a loss of physical sensation.
In contrast, derealization specifically relates to the perception of the outside world. People may describe their environment as foggy, lifeless, dreamlike, or distorted. Even everyday objects and familiar people can seem unreal or emotionally distant. It’s as if the person were watching the world through frosted glass—everything looks and sounds different, muted, and disconnected. In addition to visual distortion, time perception is also commonly affected. Time may appear to move unusually fast or slow, making it difficult for the person to orient themselves in reality.
Is it always a disorder?
Not always. Episodes of derealization can occur temporarily in response to trauma or overwhelming stress. In such cases, it functions as a psychological defense mechanism. This adaptive response allows the mind to disconnect from unbearable circumstances to protect itself emotionally and psychologically. Situations that may lead to temporary derealization include:
- Car accidents, especially those involving injury or loss
- Sudden traumatic events, such as assaults or natural disasters
- Grieving the death of a close friend or family member
When the emotional shock is too intense to process, the brain may “shut off” certain perceptual functions. This dissociation is the mind's attempt to preserve equilibrium. However, when these symptoms persist over time, and are no longer connected to a specific triggering event, derealization may become a chronic and pathological condition requiring specialized care.
Possible causes
Derealization is commonly triggered by traumatic experiences, especially those involving abuse—whether physical, emotional, or sexual. Such experiences can lead to dissociative patterns where the individual becomes increasingly disconnected from both themselves and their surroundings. Episodes tend to recur and often include a profound sense of unreality.
During such episodes, individuals frequently describe the sensation that their life is unfolding like a film or a dream in which they are not active participants. They observe what happens to them from an external vantage point, with diminished emotional involvement. Unlike psychotic conditions, individuals with derealization retain insight: they know that what they’re feeling is not real, even though the sensations are vivid and disturbing. This paradoxical awareness may intensify anxiety and cause panic attacks, as the brain struggles to reconcile rational understanding with altered perception.
It's important to distinguish derealization from other disorders like schizophrenia or hallucination-based psychoses. In derealization, the distortion is internal and recognized by the individual, whereas in psychosis, the person may not be aware that their perception is impaired. This difference makes derealization especially frightening: you know the world is real, but it doesn’t feel that way anymore.
Treatment approaches
Treating derealization effectively often requires a multifaceted approach. While medications such as antidepressants or anxiolytics may help relieve accompanying symptoms like anxiety, they are generally not sufficient to address the core dissociative issues. Psychotherapy is considered the primary mode of treatment.
The therapeutic process often follows three key phases:
- Phase 1 – Stabilization : The therapist helps the patient regain control over their emotional state. Techniques include grounding exercises, mindfulness, and the development of positive coping mechanisms.
- Phase 2 – Trauma processing : The patient begins to explore and work through traumatic memories that may have caused the dissociative symptoms. This is often done using structured therapeutic frameworks like EMDR or trauma-focused CBT.
- Phase 3 – Reintegration : The final stage focuses on consolidating gains and building a more cohesive sense of identity and reality. Patients are guided to integrate past experiences and regain a stable sense of self.
It's important to note that recovery from derealization is rarely linear. The journey may involve relapses, emotional challenges, and moments of confusion. Nevertheless, with proper support and tailored treatment, individuals can make significant progress and restore a functional connection to reality.
