Derealization: symptoms, causes, and ways to overcome

If the world around you seems unreal, like an image on a screen. Familiar streets look like props, voices sound as if behind a glass wall, and your own hands feel чужими. At the same time, you are fully aware of the strangeness of what is happening and understand that reality has not changed — your perception has. This is derealization — a neuropsychological state that every second person experiences at least once in life.

Many people experiencing derealization for the first time feel strong fear. It seems that you are losing your mind or something serious has broken in your psyche. This fear is understandable, but it is important to know: derealization is not a sign of a mental illness and not the beginning of something irreversible. It is a protective brain response to overload, temporarily reducing the intensity of emotional experience.

What is derealization and how common is it?

Derealization is a symptom of depersonalization-derealization disorder, officially described in the diagnostic manual DSM-5-TR. The key feature: reality is perceived as “unreal,” but critical thinking remains intact. You understand that the world has not changed — your perception of it has changed. This fundamentally distinguishes derealization from psychotic states, in which a person truly loses the ability to distinguish real from unreal.

Statistics may surprise you. According to the research of Sierra & Berrios (1998), up to 50-70% of people experience at least one brief episode of derealization during life, especially under strong stress, sleep deprivation, or emotional exhaustion.

This makes derealization one of the most common, yet little-known psychological phenomena.

The chronic form of the disorder, when derealization persists for a long time, is found in 1-2% of the population, according to World Health Organization data (ICD-11). The peak of first symptom onset occurs at age 16-25, after 40 years the primary onset of derealization becomes rare.

Especially often, derealization accompanies anxiety disorders. Studies by Hunter et al. (2004) show that among people with panic disorder 70-80% have experienced at least one episode of derealization, and with generalized anxiety disorder this figure reaches 60%.

Derealization and depersonalization: what is the difference?

These two concepts are often confused, and not surprising — they are closely related and often occur simultaneously. Both states are described in DSM-5-TR as forms of dissociation, but the vector of perceptual disturbance is different.

Derealization — this is when perception of the outside world is distorted. Attention is focused on the surrounding environment. The world seems “like in a movie” or “like in a dream.” Colors may look too dull or, conversely, unnaturally sharp. Space seems flat or artificial. There is a sense of distance between oneself and reality. At the same time the feeling of “I exist” remains, and you understand that the world has not actually changed.

Depersonalization — this is when the sense of self is distorted. Attention is focused on your own body, thoughts, and emotions. A sense arises that you are observing yourself from the outside. The body feels чужим or functioning on autopilot. Emotions are muted or seem “not yours.” Thoughts come, but without ownership — as if someone else is thinking with your head. At the same time, contact with reality and the understanding that “I am not going crazy” remain intact.

A simple distinction: with derealization the world is distorted (“I am here, but the world is strange”), with depersonalization the self is distorted (“the world is normal, but I seems not there”). When both states are present simultaneously, a person may feel that “neither I nor the world exist” — subjectively this is the most frightening experience, but clinically it is still a non-psychotic, reversible state.

Derealization symptoms

According to the Cambridge Depersonalization Scale, used by specialists for diagnosis, typical manifestations of derealization include:

Visual distortions — the world is perceived as “flat,” like a two-dimensional image. Objects may seem hyperclear or, conversely, blurred and unclear. Some describe it as “life in a movie” or “a look through a camera lens.”

Sensation of a barrier — between you and the surrounding world there seems to be an invisible glass barrier. You see everything that happens, but feel detached from it, as if watching from afar.

Emotional detachment — events that would normally evoke strong feelings leave you indifferent. This is not depression and not apathy — rather, emotions exist, but they do not fully reach you.

Distortion of color and light — surrounding colors may seem muted, faded, or on the contrary — too bright and artificial. Light may be perceived strangely, creating a sense of unreality of what is happening.

Absence of a sense of presence — you are physically in a place, but do not feel “here.” This is not forgetfulness and not absent-mindedness — this is precisely the feeling that you are not fully present in the moment.

In derealization there are no hallucinations, no delusions, no loss of ability to test reality. You do not see what is not there, and you do not believe in false things. You simply perceive the real world differently and recognize this perceptual oddity.

Causes: what triggers derealization?

Anxiety and stress

Derealization is a form of protective dissociation. When the brain faces intense stress or anxiety, it can “disconnect” part of the emotional contact with reality to protect the psyche from overload. This is an evolutionary mechanism that once helped our ancestors survive traumatic situations. Research by Daphne Simeon (2004) confirms that derealization most often arises as the brain’s response to increased emotional load.

Neurobiological mechanisms

Modern studies using functional MRI show an interesting picture. In derealization there is hyperactivation of the prefrontal cortex — the area of the brain responsible for cognitive control and analysis — and simultaneous suppression of the limbic system, especially the amygdala, which is responsible for emotional reactions. Studies by Phillips et al. (2001) demonstrate that as a result emotions are “muted,” and analytical processes overloaded. The brain seems to switch into a mode of cold observation, losing emotional connection with what is happening.

Panic attacks

Derealization is often a consequence, not a cause, of a panic attack. During a panic attack there is hyperventilation — rapid breathing, which leads to a drop in carbon dioxide in the blood. This affects brain function and can cause a sense of unreality. Hunter et al. (2004) note that many people who experienced a panic attack with derealization fear the recurrence of this sensation more than the panic itself.

Psychotropic substances

Cannabis — one of the most common triggers of derealization, especially in people with high anxiety sensitivity. Medford et al. (2005) indicate that for some people even a single use can trigger an episode of derealization, which is then sustained by anxiety and fear of repetition.

Chronic sleep deprivation and exhaustion

When the brain does not get enough rest, its ability to correctly process sensory information decreases. Prolonged sleep deprivation, emotional burnout, or physical exhaustion can create favorable ground for the development of derealization.

What actually helps: evidence-based methods

Cognitive-behavioral therapy

CBT shows the best results in treating derealization. Studies by Anthony David (2012) show a reduction of symptoms in 60-70% of patients. The focus of therapy is to stop constantly monitoring one’s own sensations. Paradoxically, the more you check whether the world is real, the stronger the derealization becomes. CBT teaches shifting attention from internal sensations to external activity and interaction with the surrounding environment.

Working with baseline anxiety

Derealization disappears when the overall level of anxiety decreases. This means that fighting the sensation of unreality itself is ineffective. Instead you need to address what sustains anxiety: normalize sleep, reduce stress, learn emotion regulation techniques, possibly reassess lifestyle.

Body-based practices

Returning to contact with the body helps restore the sense of presence. Grounding exercises are effective: focusing on physical sensations (touching textures, feeling body weight, temperature), breathing practices, moderate physical activity. These methods help switch the overloaded prefrontal cortex and activate bodily perception.

Pharmacological support

Medication for derealization has limited effectiveness. SSRIs (selective serotonin reuptake inhibitors) can have an indirect effect by reducing overall anxiety. Lamotrigine shows moderate effectiveness in combination with CBT, according to Sierra et al. (2006). However, medications are not the main treatment method and are used as an adjunct.

What DOES NOT work

Constant reality-testing — pinching yourself, seeking confirmations that the world is real — only reinforces fixation on symptoms. Avoiding sensations or situations where derealization arises reinforces fear and makes the condition chronic. Studying symptoms for hours on the Internet increases anxiety and hypercontrol of perception.

Conclusion

Derealization is not a breakdown of the psyche and not the onset of a serious mental illness. It is an overloaded safety system of the brain that temporarily changed the way reality is perceived to protect you from emotional overload. The good news: this condition is reversible.

The key to overcoming derealization is not fighting the sensation of unreality itself, but reducing the anxiety that sustains it. The less you fight the derealization as a threat, the less you check and control your sensations, the faster the brain returns to its normal mode of perception.

This condition does not require “enlightenment” or special spiritual practices. It requires patience, reducing overall stress, returning to contact with the body, and, most importantly, stopping hypercontrol of perception. If necessary, consult a professional practicing cognitive-behavioral therapy — this is the most effective path to recovery.

Remember: what you are experiencing, millions of people before you have experienced as well. And most of them successfully coped with this condition, restoring the fullness of life perception.