Derealization Explained

Medically Reviewed by Jennifer Casarella, MD on December 03, 2021
3 min read

Derealization is a mental state where you feel detached from your surroundings. People and objects around you may seem unreal. Even so, you’re aware that this altered state isn’t normal.

More than half of all people may have this disconnection from reality once in their lifetime. But about 2% of people experience it often enough for it to become a type of dissociative disorder.

Derealization is similar but distinct from depersonalization. The latter involves a feeling of detachment not from your environment, but from your own body, thoughts, or feelings. It’s as if you’re watching what’s happening to yourself as an outsider.

Derealization usually happens in episodes, which means symptoms come and go. During an episode, you might feel as if:

  • You are in a dream or “fog.”
  • A see-through wall or veil is separating you from your surroundings.
  • The world appears lifeless, muted, or fake.
  • Objects or people look “wrong” -- blurry, unnaturally sharp, too big, or too small.
  • Sounds are distorted, too loud, or too soft.
  • Time seems to speed up, slow down, or stand still.

Episodes can end in a few minutes or stretch for months at a time. But even as you feel like you’re going “crazy,” you always recognize that something is off. This is a key difference from psychotic disorders, where you can’t distinguish what’s real and what’s imaginary.

Derealization sometimes can be a symptom of a medical condition. Other times, it can happen on its own, often in reaction to severe trauma or stress.

Health conditions linked to derealization include:

The most common event that can trigger derealization is emotional abuse or neglect at a young age. The experience prompts the child to detach from their surroundings as a way to manage the trauma. Other causes of stress might include:

  • Physical or sexual abuse
  • Witnessing domestic violence
  • Parents or guardians with a severe mental disorder
  • Unexpected death of a loved one
  • PTSD from war or conflict
  • Trauma from an accident or a natural disaster

Future episodes of derealization can be brought on by everyday stressors, including problems at work or in your relationships.

Derealization almost always starts in late childhood or early adulthood. The average age it starts is around 16, and 95% of cases are diagnosed before age 25.

No lab test can diagnose derealization. Your doctor may first try to rule out physical causes. They may use imaging tests such as an MRI, EEG, or an X-ray, or a urine screen to check for toxic chemicals.

If those tests don’t show anything, your doctor will refer you to a mental health expert. They will diagnose you with derealization disorder if you:

  • Have constant or repeated bouts of symptoms
  • Know that what you’re seeing or experiencing is not real
  • Are deeply distressed or your symptoms severely interfere with your life

Many people who have derealization recover fully, sometimes on their own. Others are able learn how to get through episodes calmly.

But if you’ve been enduring it for a long time or if your root cause was very traumatic, you may need professional help. That’s especially true if you also have depression or anxiety that often comes with derealization.

The No. 1 treatment for derealization is psychotherapy. This form of talk therapy teaches you ways to share your experience and strategies to handle your episodes. Your doctor also may prescribe medication, mainly to ease any symptoms of depression or anxiety that come with the disorder.

Through psychotherapy, you may learn how to:

  • Keep yourself from obsessing about unreal experiences.
  • Distract yourself with activities.
  • Ground yourself in reality using your five senses (for example, by playing loud music or holding something very cold).
  • Address negative feelings and figure out the causes of your symptoms.
  • Talk about your feelings using specific words.