Derealization Explained

Medically Reviewed by Shruthi N, MD on August 11, 2024
8 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 1% of people have it often enough for it to become an ongoing issue.

Depersonalization vs. derealization

Derealization is similar but distinct from depersonalization. 

Derealization causes you to feel disconnected from the world around you.

Depersonalization causes you to feel disconnected from your own body, thoughts, and feelings. It’s like you’re watching what’s happening to yourself as an outsider.

It's possible to have feelings of both derealization and depersonalization, or just one or the other. If any of these feelings happen often enough to interfere with your daily life, you may have a condition known as derealization-depersonalization disorder. You might also hear this referred to as dissociation, or a type of dissociative disorder, because you become disconnected from your sense of self.

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

  • You're 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” – for instance, 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.
  • The people around you aren't real. For instance, you might feel like they're robots, even though you know that they're not.

How long does derealization last?

Episodes can last a few hours or stretch for months. If your symptoms linger, they may improve or worsen at times. But even if you feel like you’re going “crazy,” you always recognize that something is off and how you feel isn't normal for you. This is a key difference from psychotic disorders, where you can’t tell 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 issues that are linked to derealization include:

The most common event that can trigger derealization is emotional abuse or neglect at a young age. As a child, you might have learned to detach from the world around you as a way to manage the trauma. Other sources of stress might include:

  • Physical abuse
  • Sexual abuse
  • Witnessing domestic violence
  • A parent or caregiver with a severe mental disorder
  • Unexpected death of a loved one
  • PTSD from war or conflict
  • Trauma from an accident or a natural disaster

Once you experience derealization, an episode can be triggered by smaller, everyday stressors, like an issue at work or in a relationship.

Derealization panic attack

Between 3.3% and 20% of people who live with an anxiety disorder have dissociative symptoms. If you get panic attacks (episodes of intense fear that cause physical effects, like a racing heart and sweating), it's common to feel as if the things around you aren't real. While this can be unsettling, these symptoms won't lead to a serious mental health issue, like psychosis or brain damage.

To manage a panic attack,  you may find it helpful to:

Breathe deeply. Close your eyes and focus on breathing. Inhale slowly through your nose. Then exhale just as slowly out of your mouth.

Tell yourself that this is temporary. You might even remind yourself aloud: "I'm having a panic attack and this will pass."

Focus on the present. This can help you feel more grounded when things around you don't feel real.

Derealization risk factors

Derealization is more likely to happen because of things like:

  • Your personality. For instance, if you tend to avoid stressful situations or find it hard to talk about your feelings.
  • Trauma or extreme stress. Whether it happened to you as a child or as an adult, your brain may be trying to protect you from overwhelming feelings. 
  • Depression. About half of people with depression have derealization or depersonalization.
  • Anxiety

Derealization from drug use is common, too. For instance, it's a well-known side effect of marijuana. But some people keep having episodes months or years after they stop using weed.

You can have symptoms of depersonalization-derealization disorder at any age, although it's most common in teenagers and young adults. Kids and older adults are the least likely to develop it.

Feeling like the world around you suddenly isn't real can feel scary. You may spend a lot of time wondering if you have a severe mental health issue and trying to check your reality. Because the symptoms you're having can feel and sound weird, you may be nervous about telling anyone. But any time you have concerns about your mental health, it's important to get support.

Make an appointment with your doctor if your symptoms:

  • Cause you stress 
  • Make it hard to get through your day
  • Create issues at work, school, or in your relationships
  • Don't go away or keep returning

When you talk to your doctor, try to be as honest as you can about your symptoms. That can help them know how best to help you. 

Derealization test

You might run across online quizzes that say they can diagnose derealization, but there's no written or lab test that can. Your doctor may first try to rule out physical causes of your symptoms. For instance, they may do a physical exam and ask questions about your general health and lifestyle. They could also use imaging tests – such as magnetic resonance imaging (MRI, which uses powerful magnets and radio waves to make detailed pictures of a part of your body), electroencephalogram (EEG, a test that measures electrical activity in your brain), or an X-ray – or a urine screen to get more information and rule out causes like toxic chemicals.

If those tests don’t show anything, your doctor will probably refer you to a mental health expert. You'll talk to them about your symptoms, as well the thoughts and feelings you're having.  

They may also assess you for conditions like:

  • OCD
  • PTSD
  • Personality disorders

To be diagnosed with derealization disorder,  you'll have to meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association.

That includes:

  • Having constant or repeated bouts of symptoms
  • Knowing that what you’re seeing or experiencing is not real
  • Feeling deeply distressed by your symptoms or that they severely interfere with your life

Many people who have derealization recover fully, sometimes on their own. You can also learn how to manage episodes when they happen. Either way, you may find support from a mental health expert to be really helpful. That’s especially true if you also live with depression or anxiety.

The gold-standard treatment for derealization is talk therapy. A mental health professional like a counselor or psychologist can help you:

  • Learn more about derealization
  • Keep yourself from obsessing about unreal experiences
  • 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
  • Get better at dealing with stress
  • Explore and improve your mental health

Some kinds of therapy that can improve derealization symptoms include:

Cognitive behavioral therapy (CBT), which can help you understand how your thoughts affect your actions and how to unlearn negative thought patterns. You'll set goals and learn skills.

Psychodynamic therapy explores your past experiences, and how they influence you today. Because you'll be talking a lot about yourself, it's important to find a therapist you trust and connect with.

Eye movement desensitization reprocessing (EMDR) is a newer therapy that helps you process past traumas by moving your eyes a very specific way. Many clinical trials have shown it to be effective in treating derealization.

There's no drug that can prevent or stop derealization, but if you've been diagnosed with another mental health condition, your doctor may prescribe a treatment to manage those symptoms. That could include:

  • Anti-anxiety medication
  • Antidepressants
  • Mood stabilizers, which can treat conditions like bipolar disorder and borderline personality disorder
  • Antipsychotic medications, which help treat conditions like schizophrenia and mania

Experts are still learning about derealization. Because much more still needs to be understood, it may take some time to lessen your symptoms, or for you to learn how to better manage them when they come up. Here's what can help:

Follow your treatment plan. That means keeping therapist and doctor appointments, and taking any prescribed medication. 

Ask questions. The more you understand about derealization, the less unsettling it may start to feel. Ask your doctor for handouts, or to help you find more information.

Reach out to others for support. You might tell loved ones or close friends what you're going through. You could also ask your doctor or therapist to help you find a support group.

Avoid drugs and alcohol. Any substance you take could trigger derealization or make any medication less effective. If you need help to quit, ask your doctor.

Go easy on yourself. Stressing may make your symptoms worse. Find ways to relax and soothe yourself when your symptoms feel intense – for instance, meditation or deep breathing.

After starting treatment, many people see their symptoms improve within a few months.

When you feel disconnected from the world around you, it can be really hard to get through your day. Derealization can lead to:

  • Anxiety
  • Depression
  • Feelings of hopelessness
  • Issues with focus and memory
  • Problems at work, school, or at home
  • Tension with family and friends

Treatment can make a big difference, but it can take time. If you feel like you might hurt yourself or someone else, get help right away. You can:

Derealization is a mental health condition that causes you to feel detached from the world or like the things and people around you may not be real. Because it's an ongoing condition, treatment is important. Different types of talk therapy, and sometimes medication, can help you better manage episodes when they happen.

How can I get out of a derealization episode?

There's no switch you can flip to "turn off" any type of dissociation. But therapy can help you get better at staying calm when it happens. One strategy is trying to ground yourself in the present moment. Some ways to do that include:

  • Holding an object tightly in your hands
  • Touching the ground
  • Wrapping yourself up in a blanket
  • Paying attention to the sounds you hear around you
  • Listening to music you like
  • Smelling a familiar or comforting smell
  • Becoming more aware of your body (clenching your fists, clapping, etc.) 

How does a person with depersonalization act?

Someone who's going through this type of dissociation feels detached from themselves. They could:

  • Not recognize themselves in a mirror
  • Feel like they're floating above their body
  • Worry that their arms and legs aren't the right shape
  • Be numb to their senses (what they taste, touch, see, hear, or smell)
  • Have a hard time responding to the world around them
  • Feel like their memories are not their own

If someone you care about is having an episode of depersonalization or derealization, it can be challenging to know how to support them. They may not be able to put what they're going through into words or act like their usual selves. You can try to ask what they need, and listen if they want to talk. If they have techniques in place to help them manage episodes, you can offer to help them do those. If you can, make a plan ahead of time of who to call for extra support.