What is Derealisation?

Understanding Derealisation

Derealisation is a dissociative experience where the world around you feels unreal, dreamlike, or somehow “off.” It’s as if you’re looking at the world through a fog, a glass barrier, or like you’re watching everything happen in a movie rather than experiencing it directly (Sierra & David, 2011).

People experiencing derealisation often describe feeling like they’re living in a bubble, separated from the world around them. Colours might seem muted or too bright, sounds might feel distant or distorted, and familiar places can feel strange and foreign. Despite these feelings, people with derealisation typically maintain awareness that these perceptions aren’t actually real—they know intellectually that the world hasn’t changed, even though it feels completely different (Hunter et al., 2003).

Derealisation is one of the most common dissociative experiences, and while it can be frightening when it first occurs, it’s important to understand that it’s a protective mechanism your brain uses when feeling overwhelmed. It’s not a sign of “going crazy” or losing touch with reality in a psychotic sense (Simeon & Abugel, 2006).

This experience exists on a spectrum from mild, brief episodes that many people experience occasionally to more persistent, distressing symptoms that may indicate a dissociative disorder. Understanding derealisation can help reduce the fear and confusion that often accompany these experiences.

What Derealisation Feels Like

Common Descriptions

People experiencing derealisation often struggle to put their experiences into words because the feelings are so unusual. Here are some common descriptions (Steinberg & Schnall, 2000):

Visual Distortions:

• “Everything looks flat, like a photograph or painting”
• “The world seems covered in a haze or fog”
• “Colours appear dull and washed out, or sometimes too bright”
• “Things look smaller or larger than they should”
• “Familiar places look strange and unfamiliar”
• “It’s like looking at the world through glass or a veil”

Spatial and Dimensional Changes:

• “Distances seem wrong—things appear closer or farther than they are”
• “Rooms feel bigger or smaller than usual”
• “I feel like I’m in a fishbowl or bubble”
• “Everything seems two-dimensional rather than three-dimensional”
• “The world feels tilted or somehow ‘off'”

Temporal Distortions:

• “Time feels slowed down or sped up”
• “Moments feel like they last forever”
• “Everything feels frozen in time”
• “It’s like living in slow motion”

Familiarity Issues:

• “My own home feels like a strange place”
• “People I know well seem like strangers”
• “Nothing feels real or genuine”
• “Everything feels artificial or staged”

Emotional Responses to Derealisation

The emotional experience of derealisation varies among individuals:

Fear and Anxiety: Many people feel frightened when derealisation first occurs, worrying about their mental health

Confusion: Feeling puzzled about what’s happening and why the world seems different

Loneliness: Feeling isolated and cut off from others and the world

Numbness: Sometimes accompanied by emotional flatness or inability to feel

Curiosity: Some people find the experience strange but interesting rather than distressing

Types and Variations of Derealisation

Acute vs. Chronic Derealisation

Acute Derealisation:

• Sudden onset, often triggered by specific stressors
• May last minutes to hours
• Often more intense but shorter duration
• May be accompanied by panic or anxiety
• Can occur as isolated episodes

Chronic Derealisation:

• Persistent, ongoing experiences
• May last weeks, months, or years
• Often less intense but more constant
• May become the person’s “normal” way of experiencing the world
• Often associated with trauma history or other mental health conditions

Episodic vs. Persistent Patterns

Episodic Derealisation:

• Comes and goes in distinct episodes
• Clear beginning and end to experiences
• May have identifiable triggers
• Person feels “normal” between episodes
• More common in stress-related derealisation

Persistent Derealisation:

• Continuous experience with little relief
• May fluctuate in intensity but rarely completely absent
• Often associated with trauma or dissociative disorders
• Can become the person’s baseline experience
• May require professional treatment

Severity Levels

Mild Derealisation:

• Subtle sense that things aren’t quite right
• May be dismissed as tiredness or stress
• Doesn’t significantly interfere with functioning
• Often brief and self-resolving

Moderate Derealisation:

• Clear sense of unreality or detachment
• Noticeable impact on daily activities
• May cause distress or concern
• Can interfere with concentration or performance

Severe Derealisation:

• Overwhelming sense of unreality
• Significant functional impairment
• High levels of distress
• May be accompanied by other dissociative symptoms

Causes and Triggers of Derealisation

Trauma-Related Causes

Derealisation often develops as a protective response to overwhelming experiences (Briere & Scott, 2015):

Childhood Trauma:

• Physical, sexual, or emotional abuse
• Severe neglect or abandonment
• Witnessing domestic violence
• Medical trauma or repeated hospitalisations
• Loss of caregiver or significant disruption

Adult Trauma:

• Accidents or natural disasters
• Physical or sexual assault
• Combat exposure
• Medical emergencies or serious illness
• Sudden loss or bereavement

Complex Trauma:

• Repeated, ongoing traumatic experiences
• Captivity or imprisonment
• Human trafficking
• Cult involvement
• Domestic violence relationships

Stress-Related Triggers

Even without major trauma, derealisation can be triggered by significant stress:

Life Transitions:

• Starting college or new job
• Marriage, divorce, or relationship changes
• Moving to new locations
• Financial difficulties
• Health problems

Acute Stressors:

• Exams or performance pressure
• Conflict with family or friends
• Work-related stress
• Legal problems
• Major decisions

Medical and Substance-Related Causes

Various medical conditions and substances can trigger derealisation:

Medical Conditions:

• Epilepsy or seizure disorders
• Migraine headaches
• Inner ear problems
• Thyroid disorders
• Sleep deprivation

Medications:

• Antidepressants (especially when starting or stopping)
• Anti-anxiety medications
• Antihistamines
• Some blood pressure medications
• Steroids

Substances:

• Marijuana (particularly high-THC varieties)
• Alcohol (during intoxication or withdrawal)
• Hallucinogens
• Dissociative drugs (ketamine, PCP)
• Caffeine (in high doses)

Panic and Anxiety Triggers

Derealisation commonly occurs during panic attacks or severe anxiety (Baker et al., 2003):

Panic-Induced Derealisation:

• Often occurs during peak panic symptoms
• May persist after other panic symptoms subside
• Can create fear of future panic attacks
• May become a specific phobia (fear of derealisation)

Anxiety-Related Patterns:

• Hyperventilation can trigger derealisation
• Anticipatory anxiety about derealisation can trigger episodes
• Social anxiety situations may precipitate symptoms
• Performance anxiety can lead to derealisation

The Neuroscience of Derealisation

Brain Regions Involved

Research has identified specific brain areas involved in derealisation experiences (Simeon et al., 2000):

Prefrontal Cortex:

• Involved in self-awareness and reality monitoring
• May become hyperactive during derealisation
• Responsible for the “observer” quality of the experience

Temporal-Parietal Junction:

• Integrates sensory information to create sense of reality
• Disruption may contribute to feelings of unreality
• Important for spatial and temporal processing

Insula:

• Processes bodily sensations and emotional awareness
• May show reduced activity during derealisation
• Important for sense of embodied presence in the world

Visual Processing Areas:

• May show altered activity leading to visual distortions
• Can affect perception of depth, colour, and familiarity
• Connected to the “flat” or “unreal” visual quality

Neurotransmitter Systems

Several brain chemicals are involved in derealisation:

GABA (Gamma-Aminobutyric Acid):

• The brain’s primary calming neurotransmitter
• Deficiency may contribute to derealisation
• Target of some medications used for treatment

Glutamate:

• Excitatory neurotransmitter involved in perception
• NMDA receptors may be affected in derealisation
• Some dissociative drugs work by blocking these receptors

Serotonin:

• Affects mood and perception
• Imbalances may contribute to derealisation symptoms
• Target of some antidepressant medications

Norepinephrine:

• Stress hormone and neurotransmitter
• Elevated levels during stress may trigger derealisation
• Involved in fight-or-flight responses

Protective Brain Function

Derealisation appears to be a sophisticated protective mechanism:

• Emotional Buffering: Creates distance from overwhelming emotional experiences
• Cognitive Protection: Prevents complete psychological overwhelm during trauma
• Survival Mechanism: Allows continued functioning during extreme stress
• Adaptive Response: May have evolutionary advantages in certain situations

Derealisation vs. Related Experiences

Derealisation vs. Depersonalisation

While often occurring together, these are distinct experiences:

Derealisation (External Focus):

• World feels unreal or strange
• Environment seems dreamlike or artificial
• Focus on external surroundings
• “The world doesn’t feel real”

Depersonalisation (Internal Focus):

• Self feels unreal or strange
• Feeling detached from your own body or mind
• Focus on internal experience
• “I don’t feel real”

Derealisation vs. Psychosis

Important distinctions for diagnosis and treatment:

Derealisation:

• Knows feelings of unreality aren’t actually real
• Maintains reality testing
• Insight into the unusual nature of experience
• Can often respond to grounding techniques

Psychosis:

• Believes altered perceptions are real
• Impaired reality testing
• Lacks insight into unusual experiences
• Requires different treatment approaches

Derealisation vs. Anxiety

While they can co-occur, they have different primary features:

Anxiety:

• Primary emotion is fear or worry
• Physical activation (racing heart, sweating)
• Thoughts focus on perceived threats
• Usually responds to anxiety management techniques

Derealisation:

• Primary experience is unreality or detachment
• May have physical symptoms but they’re secondary
• Thoughts focus on the strangeness of perception
• Better responds to grounding and dissociation-specific techniques

Impact on Daily Life

Academic and Work Performance

Derealisation can significantly affect cognitive functioning:

Concentration Difficulties:

• Hard to focus when the world feels unreal
• Attention may be drawn to the unusual perceptual experiences
• Academic or work performance may decline
• May appear distracted or “spacey” to others

Memory Problems:

• Difficulty forming new memories during episodes
• Events during derealisation may feel “unreal” in memory
• May have trouble remembering what happened during episodes
• Can affect learning and retention

Decision-Making:

• May feel uncertain about choices when reality feels questionable
• Difficulty trusting perceptions and judgements
• May avoid important decisions during episodes
• Can lead to procrastination or avoidance

Relationships and Social Functioning

Derealisation can create challenges in relationships:

Social Disconnection:

• May feel cut off from others during episodes
• Difficulty engaging in conversations or activities
• Others may seem strange or unfamiliar
• May withdraw from social situations

Communication Challenges:

• Difficulty explaining experiences to others
• May seem distant or disengaged
• Others may not understand the experience
• Can lead to misunderstandings or conflict

Intimacy Issues:

• Physical and emotional intimacy may feel strange
• Partner may feel shut out or rejected
• May avoid close relationships due to symptoms
• Can affect romantic and family relationships

Safety Considerations

Derealisation can create safety concerns in certain situations:

Driving and Transportation:

• Visual distortions can affect depth perception
• May feel disconnected from the act of driving
• Important to avoid driving during severe episodes
• Consider alternative transportation when symptomatic

Other Activities:

• Operating machinery or tools
• Caring for children during episodes
• Activities requiring precise judgement or coordination
• Sports or physical activities where awareness is crucial

Coping Strategies and Grounding Techniques

Immediate Grounding Techniques

When experiencing derealisation, these techniques can help reconnect with reality:

5-4-3-2-1 Grounding:

• 5 things you can see
• 4 things you can touch
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

Physical Grounding:

• Hold ice cubes or splash cold water on face
• Press feet firmly into the ground
• Touch different textures (rough, smooth, soft)
• Squeeze and release muscle groups
• Focus on physical sensations

Cognitive Grounding:

• Name the current date, time, and location
• Describe your surroundings in detail
• Count backwards from 100
• Recite familiar facts about yourself
• Use logical self-talk: “This feeling will pass”

Sensory Techniques:

• Listen to familiar music
• Look at photos of loved ones
• Smell something strong (peppermint, coffee)
• Chew gum or eat something with strong flavour
• Use essential oils or familiar scents

Long-Term Management Strategies

Regular Grounding Practice:

• Practice grounding techniques daily, not just during episodes
• Develop a routine that includes grounding exercises
• Keep a grounding toolkit readily available
• Learn to recognise early warning signs

Stress Management:

• Identify and manage stress triggers
• Develop healthy coping mechanisms
• Practice relaxation techniques regularly
• Maintain good sleep hygiene

Lifestyle Modifications:

• Regular exercise and physical activity
• Balanced nutrition and regular meals
• Limit caffeine and alcohol
• Avoid recreational drugs, especially marijuana

Support Systems:

• Educate family and friends about derealisation
• Join support groups or online communities
• Maintain social connections despite symptoms
• Consider professional counselling or therapy

When to Seek Professional Help

Consider professional support if derealisation:

• Persists for weeks or months
• Significantly interferes with daily functioning
• Causes severe distress or anxiety
• Is accompanied by other concerning symptoms
• Doesn’t respond to self-help strategies
• Affects work, school, or relationships

Treatment Approaches

Therapeutic Interventions

Several therapeutic approaches can be effective for derealisation:

Cognitive Behavioural Therapy (CBT):

• Helps identify and change thought patterns that worsen symptoms
• Teaches coping strategies and grounding techniques
• Addresses anxiety that often accompanies derealisation
• Provides psychoeducation about the condition

Mindfulness-Based Approaches:

• Teaches present-moment awareness
• Can help reconnect with immediate experience
• Reduces anxiety about derealisation symptoms
• Builds tolerance for unusual sensations

Trauma-Focused Therapy:

• Addresses underlying traumatic experiences
• May include EMDR, trauma-focused CBT, or somatic approaches
• Helps process and integrate traumatic memories
• Can reduce trauma-related triggers for derealisation

Acceptance and Commitment Therapy (ACT):

• Focuses on accepting derealisation experiences without struggle
• Teaches psychological flexibility
• Emphasises values-based living despite symptoms
• Can reduce distress about having symptoms

Medication Options

While no medications are specifically approved for derealisation, some may help:

Antidepressants:

• SSRIs may help with associated anxiety and depression
• Can take several weeks to show effects
• May initially worsen symptoms before improving
• Require careful monitoring

Anti-Anxiety Medications:

• May provide short-term relief for acute episodes
• Benzodiazepines should be used cautiously
• Can be helpful for panic-related derealisation
• Not recommended for long-term use

Other Medications:

• Some anticonvulsants may help
• Atypical antipsychotics in very low doses
• Medications targeting specific symptoms
• Often used off-label with careful monitoring

Complementary Approaches

Some people find additional benefit from:

Yoga and Movement:

• Helps reconnect with the body
• Reduces stress and anxiety
• Provides grounding through physical awareness
• Can be adapted for individual needs

Creative Therapies:

• Art, music, or writing therapy
• Helps express difficult experiences
• Can provide alternative ways to process emotions
• May help with integration of experiences

Meditation and Spirituality:

• Can provide sense of connection and meaning
• Some practices may need modification for dissociation
• Important to work with trauma-informed teachers
• Focus on grounding rather than transcendent states

Simplified Version for Difficult Moments: Derealisation is when the world around you feels unreal, dreamlike, or strange. It’s your brain’s way of protecting you from feeling overwhelmed. While it can be scary, it’s not dangerous and will pass. Grounding techniques like noticing what you can see, hear, and touch can help you feel more connected to reality.

Living with Derealisation

Building Understanding and Acceptance

Learning to live with derealisation often involves:

Education and Knowledge:

• Understanding what derealisation is and isn’t
• Learning about the brain science behind the experience
• Recognising it as a protective mechanism
• Reducing self-blame and shame

Developing Self-Compassion:

• Treating yourself with kindness during episodes
• Recognising that derealisation is not your fault
• Avoiding self-criticism about having symptoms
• Celebrating small victories in management

Finding Meaning:

• Some people find derealisation gives them unique perspectives
• May develop increased empathy for others’ struggles
• Can lead to deeper appreciation for present moments
• Might inspire helping others with similar experiences

Communication with Others

Helping others understand your experience:

Explaining Derealisation:

• Use simple, concrete descriptions
• Compare to experiences others might relate to
• Explain that you’re not “crazy” or losing touch with reality
• Share resources or articles that explain the condition

Setting Boundaries:

• Let others know what’s helpful and what isn’t
• Ask for patience during difficult episodes
• Communicate your needs clearly
• Educate about what derealisation looks and feels like

Building Support:

• Identify people who are understanding and supportive
• Consider joining support groups or online communities
• Share coping strategies that work for you
• Ask for specific types of help when needed

Hope and Recovery

Many people with derealisation experience significant improvement:

Recovery is Possible:

• Symptoms often decrease with appropriate treatment
• Many people learn to manage symptoms effectively
• Quality of life can improve significantly
• Some people recover completely

Growth Through Challenge:

• Many develop strong coping skills
• Increased self-awareness and emotional intelligence
• Deeper connections with others who understand
• Greater appreciation for wellness and stability

Grounding Exercise for Now

Take a moment to ground yourself after reading about derealisation. Look around and name three objects you can see. Touch something nearby and notice its texture. Take three deep breaths and remind yourself: you are here, you are real, and your experiences are valid. If you’re experiencing derealisation right now, remember that it will pass, and you are safe.

Frequently Asked Questions

Recommended Reading

For Understanding Derealisation:

• “Feeling Unreal: Depersonalization Disorder and the Loss of the Self” by Daphne Simeon – Expert guide to derealisation and depersonalisation
• “The Stranger in the Mirror” by Marlene Steinberg – Comprehensive understanding of dissociative experiences
• “Overcoming Depersonalization and Feelings of Unreality” by Anthony David – Practical guide to understanding and managing symptoms

For Coping and Recovery:

• “Coping with Trauma-Related Dissociation” by Suzette Boon, Kathy Steele, and Onno van der Hart – Practical skills for managing dissociative symptoms
• “The Body Keeps the Score” by Bessel van der Kolk – Understanding trauma’s impact including dissociative responses
• “Complex PTSD: From Surviving to Thriving” by Pete Walker – Healing approaches for trauma-related symptoms

References

1. Baker, D., Hunter, E., Lawrence, E., Medford, N., Patel, M., Senior, C., … & David, A. S. (2003). Depersonalisation disorder: Clinical features of 204 cases. British Journal of Psychiatry, 182(5), 428-433.

2. Briere, J., & Scott, C. (2015). Principles of Trauma Therapy. Sage Publications.

3. Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation: A systematic review. Social Psychiatry and Psychiatric Epidemiology, 39(1), 9-18.

4. Sierra, M., & David, A. S. (2011). Depersonalization: A selective impairment of self-awareness. Consciousness and Cognition, 20(1), 99-108.

5. Simeon, D., & Abugel, J. (2006). Feeling Unreal: Depersonalization Disorder and the Loss of the Self. Oxford University Press.

6. Simeon, D., Guralnik, O., Hazlett, E. A., Spiegel-Cohen, J., Hollander, E., & Buchsbaum, M. S. (2000). Feeling unreal: A PET study of depersonalization disorder. American Journal of Psychiatry, 157(11), 1782-1788.

7. Steinberg, M., & Schnall, M. (2000). The Stranger in the Mirror. HarperCollins.