What Is Derealization?

Derealization is the feeling of being detached from your environment. If you're having a derealization episode, you may perceive your surroundings as being dream-like, unreal, distant, or distorted. Derealization is considered a type of dissociation—or, a disconnection between your body, thoughts, and sense of self.

Having a mild or short-term derealization episode is common. In fact, studies show that between 26% and 74% of people have experienced short-term derealization symptoms at least once in their life. You might experience derealization for a variety of reasons, such as stress, anxiety, fatigue, or substance use. However, chronic (long-term) derealization is often due to trauma or underlying health conditions. 

Long-term or intense derealization episodes can significantly affect the quality of your life, making it hard to feel present and connected to the world. Learning how to cope and seeking out therapy can help you better navigate this condition and recover.

Symptoms

Episodes of derealization can be brief, lasting a few minutes to a few hours. More chronic derealization can last for days, weeks, or even months at a time. When experiencing derealization, you may feel like:  

• The objects around you are unreal or distant
• A familiar place is strange and unfamiliar 
• You are looking at the world through a fog 
• Time is distorted (e.g., a few minutes feels like an hour) 
• You're unable to remember what you're doing
• Your surroundings are distorted or changing 
• The sounds near you are muffled or the lights are brighter

For people who experience more chronic derealization, these symptoms can cause worry and anxiety, functional impairments (e.g., performing poorly at work or school), and disconnection from others.

Causes

Derealization can happen due to a variety of factors. The reason you're experiencing derealization can also depend on whether you're having a short or long episode.

Causes of Short-Term Derealization

The following factors can cause a short-term derealization episode:

• Stress
• Anxiety
• Fatigue
• Jet lag
• Changes in sleep habits
• Using substances like alcohol or marijuana
  

Causes of Long-Term Derealization

If your derealization episodes last several days, weeks, or months, a more serious issue could be causing your symptoms. These may include:

• Trauma: Childhood abuse, car accidents, natural disasters, war, poverty, racial violence, and sexual assault, among other traumatic or life-threatening experiences
• Mental health conditions: Dissociative disorders including depersonalization/derealization disorder (feeling detached from your environment and yourself), dissociative amnesia (not being able to remember information about your environment or yourself), and dissociative identity disorder (having alternative identities take over your consciousness)
• Neurological (brain-related) conditions: Seizures, migraine, traumatic brain injury, or cerebrovascular disease
  

Diagnosis

While you can often self-diagnose mild or short-term episodes of derealization, consulting a healthcare provider can help determine the cause of chronic derealization. Your healthcare provider will likely ask you about your medical history, lifestyle habits (such as sleep patterns, substance use, or stress levels), and the symptoms you're experiencing.

Once they have a better understanding of what you're feeling, your provider may also perform a physical exam, order a magnetic resonance imaging (MRI) scan to rule out neurological conditions, or refer you to a psychologist or psychiatrist for an evaluation to see if your episodes are due to an underlying mental health condition. A mental health provider can use the following questionnaires to give you a proper diagnosis:

• The Dissociative Experiences Scale (DES-II) 
• The Multidimensional Inventory of Dissociation
• Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D)

Treatment

For people who experience chronic derealization, the goals of treatment can include:

• Learning grounding techniques to help reduce derealization symptoms
• Processing past traumas that may be contributing to derealization
• Gaining coping skills for emotions and situations that may trigger derealization 

There is currently no approved medication to treat derealization, but your provider might prescribe medication if you have a co-occurring diagnosis for an anxiety or depressive disorder. That said, psychotherapy, or talk therapy, is the first line of treatment for derealization. Your therapist may use one of the following types of therapies during your session:

• Psychodynamic therapy: A talk-based therapy that explores the unconscious forces and childhood experiences that affect your emotions and behaviors
• Cognitive behavioral therapy (CBT): A type of therapy that focuses on the relationship between your thoughts, emotions, and behaviors and challenges negative thought patterns and feelings to help improve overall well-being
• Dialectical behavioral therapy (DBT): A behavioral therapy that teaches mindfulness, radical acceptance, emotional regulation, and interpersonal skills
• Eye movement desensitization and reprocessing (EMDR): A form of trauma therapy that helps you process traumatic memories and reduce emotional distress
  

How to Prevent Derealization

While you can’t prevent derealization entirely, there are ways to manage triggers that can cause derealization. Strategies that might help reduce derealization include: 

• Reducing drug and alcohol intake
• Getting enough sleep 
• Practicing stress management techniques (such as exercising or journaling)
• Starting a mindfulness practice  
• Seeking support from your loved ones and healthcare team

Preventing childhood trauma and supporting trauma survivors is also an important way to prevent more chronic cases of derealization and the development of dissociative disorders. While the causes of child abuse are complicated, some structural or societal ways to prevent child abuse include:

• Strengthening economic support for families 
• Affordable, high-quality childcare 
• Mentoring programs and after-school programs 
• Awareness campaigns about the signs of child abuse

Complications

While derealization is a common, occasional experience, it also can be a symptom of a dissociative disorder. It’s important to consult a healthcare provider if you’re experiencing long or frequent episodes of derealization. Derealization is also a secondary symptom of many other mental health conditions, including:

• Borderline personality disorder (BPD)
• Obsessive-compulsive disorder (OCD)
• Major depressive disorder (MDD)
• Post-traumatic stress disorder (PTSD)
• Panic disorder

A Quick Review

For some people, derealization, or the feeling of being detached from your surroundings, is an occasional response to stress, lack of sleep, or anxiety. For others, the experience is recurring and long-term, making the world around them feel “unreal” and causing stress, worry, and functional impairments.

Chronic derealization often occurs due to more serious issues such as childhood trauma or abuse and underlying health conditions like disorder like depersonalization/derealization disorder. Thankfully, there are ways to treat and manage both short and long-term derealization. Getting enough sleep and managing stress can prevent more short-term episodes of derealization. But, learning coping skills and processing trauma can improve long-term derealization episodes.