Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth.
[American Psychiatric Association (2004) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. .] It is a
dissociative
Dissociatives, colloquially dissos, are a subclass of hallucinogens which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...
symptom that may appear in moments of severe stress.
Derealization is a
subjective experience pertaining to a person's perception of the outside world, while
depersonalization
Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significa ...
is a related symptom characterized by dissociation towards one's own body and mental processes. The two are commonly experienced in conjunction with one another, but are also known to occur independently.
Chronic derealization is fairly rare, and may be caused by
occipital
The occipital bone () is a cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone overlies the occipital lobes of the cereb ...
–
temporal dysfunction.
Experiencing derealization for long periods of time or having recurring episodes can be indicative of many psychological disorders, and can cause significant distress. However, temporary derealization symptoms are commonly experienced by the general population a few times throughout their lives, with a
lifetime prevalence
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of up to 26–74% and a prevalence of 31–66% at the time of a
traumatic event.
Description
The experience of derealization can be described as an immaterial substance that separates a person from the outside world, such as a sensory fog, pane of glass, or veil. Individuals may report that what they see lacks vividness and emotional coloring. Emotional response to visual recognition of loved ones may be significantly reduced. Feelings of ''
déjà vu
''Déjà vu'' ( , ; "already seen") is a French loanword for the phenomenon of feeling as though one has lived through the present situation before.Schnider, Armin. (2008). ''The Confabulating Mind: How the Brain Creates Reality''. Oxford Univer ...
'' or ''
jamais vu
In psychology, ''jamais vu'' ( , , ), a French loanword meaning "never seen", is the phenomenon of experiencing a situation that one recognizes in some fashion, but that nonetheless seems novel and unfamiliar.
Overview
Jamais vu is often desc ...
'' are common. Familiar places may look alien, bizarre, and surreal. One may not even be sure whether what one perceives is in fact reality or not. The world as perceived by the individual may feel as if it were going through a
dolly zoom effect. Such perceptual abnormalities may also extend to the senses of hearing, taste, and smell.
The degree of familiarity one has with their surroundings is among one's sensory and
psychological identity
Identity is the qualities, beliefs, personality traits, appearance, and/or expressions that characterize a person or group.Compare ''Collins Dictionary of Sociology'', quoted in
In sociology, emphasis is placed on collective identity, in which ...
, memory foundation and history when experiencing a place. When persons are in a state of derealization, they block this identifying foundation from recall. This "blocking effect" creates a discrepancy of correlation between one's perception of one's surroundings during a derealization episode, and what that same individual would perceive in the absence of a derealization episode.
Frequently, derealization occurs in the context of constant worrying or "
intrusive thought
An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compu ...
s" that one finds hard to switch off. In such cases it can build unnoticed along with the underlying
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
attached to these disturbing thoughts, and be recognized only in the aftermath of a realization of crisis, often a
panic attack
Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...
, subsequently seeming difficult or impossible to ignore. This type of anxiety can be crippling to the affected and may lead to avoidant behavior. Those who experience this phenomenon may feel concern over the cause of their derealization. It is often difficult to accept that such a disturbing symptom is simply a result of anxiety, and the individual may often think that the cause must be something more serious. This can, in turn, cause more anxiety and worsen the derealization. Derealization also has been shown to interfere with the learning process, with cognitive impairments demonstrated in immediate recall and visuospatial deficits. This can be best understood as the individual feeling as if they see the events in third person.
Causes
Derealization can accompany the neurological conditions of
epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
(particularly
temporal lobe epilepsy
Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system which is characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. TLE is the most common f ...
),
migraine
Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
, and mild TBI (
head injury
A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...
).
There is a similarity between visual hypo-emotionality, a reduced emotional response to viewed objects, and derealization. This suggests a disruption of the process by which perception becomes emotionally colored. This qualitative change in the experiencing of perception may lead to reports of anything viewed being unreal or detached.
The instances of recurring or chronic derealization among those who have experienced extreme trauma and/or have post-traumatic stress (
PTSD
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
) have been studied closely in many scientific studies, whose results indicate a strong link between the disorders, with a disproportionate amount of post traumatic stress patients reporting recurring feelings of derealization and depersonalization (up to 30% of those with the condition) in comparison to the general populace (only around 2%), especially in those who experienced the trauma in childhood. Many possibilities have been suggested by various psychologists to help explain these findings, the most widely accepted including that experiencing trauma can cause individuals to distance themselves from their surroundings and perception, with the aim of subsequently distancing themselves from the trauma and (especially in the case of depersonalisation) their emotional response to it. This could be either as a deliberate coping mechanism or an involuntary, reflexive response depending on circumstance.
This possibly not only increases the risk of experiencing problems with derealization and its corresponding disorder, but with all relevant dissociative disorders. In the case of childhood trauma, not only are children more likely to be susceptible to such a response as they are less able to implement more healthy strategies to deal with the emotional implications of experiencing trauma, there is also a lot of evidence that shows trauma can have a substantial detrimental effect on learning and development, especially since those who experience trauma in childhood are far less likely to have received adequate parenting.
These are factors proven to increase susceptibility to maladaptive psychological conditions, which of course includes dissociative disorders and subsequently derealization symptoms.
Some neurophysiological studies have noted disturbances arising from the frontal-temporal cortex, which could explain the correlation found between derealization symptoms and temporal lobe disorders. This is further supported by reports of people with
frontal lobe epilepsy
Frontal lobe epilepsy (FLE) is a neurological disorder which is a subtype of the larger group of epilepsy and then focal epilepsy is characterized by brief, recurring seizures that arise in the frontal lobes of the brain, often while the patient is ...
, with those with epilepsy of the dorsal
premotor cortex
The premotor cortex is an area of the motor cortex lying within the frontal lobe of the brain just anterior to the primary motor cortex. It occupies part of Brodmann's area 6. It has been studied mainly in primates, including monkeys and humans. ...
reporting symptoms of depersonalization, while those with
temporal lobe
The temporal lobe is one of the four Lobes of the brain, major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain.
The temporal lobe ...
epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
reported experiencing derealization symptoms. This implies that malfunction of these specific brain regions may be the cause of these
dissociative
Dissociatives, colloquially dissos, are a subclass of hallucinogens which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...
symptoms, or at the very least that these brain regions are heavily involved.
Derealization can possibly manifest as an indirect result of certain vestibular disorders such as
labyrinthitis
Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear. Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages related to motion and position t ...
. This is thought to result from anxiety stemming from being dizzy.
An alternative explanation holds that a possible effect of vestibular dysfunction includes responses in the form of the modulation of noradrenergic and serotonergic activity due to a misattribution of vestibular symptoms to the presence of imminent physical danger resulting in the experience of anxiety or panic, which subsequently generate feelings of derealization. Likewise, derealization is a common psychosomatic symptom seen in various anxiety disorders, especially
hypochondria
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
. However, derealization is presently regarded as a separate psychological issue due to its presence as a symptom within several pathologies.
Derealization and dissociative symptoms have been linked by some studies to various physiological and psychological differences in individuals and their environments. It was remarked that labile sleep-wake cycles (labile meaning more easily roused) with some distinct changes in sleep, such as dream-like states, hypnogogic, hypnopompic hallucinations, night-terrors and other disorders related to sleep could possibly be causative or improve symptoms to a degree. Derealization can also be a symptom of severe
sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are test ...
s and
mental disorder
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s like
depersonalization disorder
Depersonalization-derealization disorder (DPDR, DPD) is a mental disorder in which the person has persistent or recurrent feelings of depersonalization or derealization. Depersonalization is described as feeling disconnected or detached from one ...
,
borderline personality disorder
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong ...
,
bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
,
dissociative identity disorder
Dissociative identity disorder (DID), better known as multiple personality disorder or multiple personality syndrome, is a mental disorder characterized by the presence of at least two distinct and relatively enduring personality states.
The di ...
, and other mental conditions.
Cannabis
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
,
psychedelics
Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary states of consciousness (known as psychedelic experiences or "trips").Pollan, Michael (2018). ''How to Change Your Mind: What the New Science of ...
,
dissociatives,
antidepressant
Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s,
caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...
,
nitrous oxide
Nitrous oxide (dinitrogen oxide or dinitrogen monoxide), commonly known as laughing gas, nitrous, or nos, is a chemical compound, an oxide of nitrogen with the formula . At room temperature, it is a colourless non-flammable gas, and has a ...
,
albuterol
Salbutamol, also known as albuterol and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing rel ...
, and
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
can all produce feelings of derealization, or sensations mimicking them, particularly when taken in excess. It can also result from
alcohol withdrawal
Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur following a reduction in alcohol use after a period of excessive use. Symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever. M ...
or
benzodiazepine withdrawal. Opiate withdrawal can also cause feelings of derealization, often alongside psychotic symptoms such as
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
paranoia
Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concer ...
and hallucinations.
Interoceptive exposure
Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle t ...
exercises have been used in research settings as a means to induce derealization, as well as the related phenomenon depersonalization, in people who are sensitive to high levels of anxiety. Exercises with documented successes include timed intervals of hyperventilation or staring at a mirror, dot, or spiral.
Popular culture
Derealization, as a concept, is referenced in the 2021 comedy special by
Bo Burnham
Robert Pickering "Bo" Burnham (born 1990) is an American comedian, musician, songwriter, actor, and filmmaker. His comedy work often combines musical, sketch, and stand-up elements with filmmaking.
Following his success as one of the earliest ...
called ''
Bo Burnham: Inside''; specifically, it is mentioned in the song "That Funny Feeling" in which derealization is showcased as a central theme.
See also
References
{{reflist, 30em
Neurology
Dissociative disorders