Derealization: When the World Feels Unreal

What derealization feels like

People struggle to put it into words. Common descriptions:

• "It's like I'm watching the world through a window or a fog."
• "Everything looks fake, like a movie set or a video game."
• "Familiar places feel strange, as if I've never been here."
• "Colors look washed out or too bright; things look flat or two-dimensional."
• "Objects look too far away, too close, too big or too small."
• "Time seems to slow down or speed up."
• "Sounds seem muffled or distant."

The key feature is that reality testing is intact: you know it is a strange feeling, not that the world has truly changed. That awareness is often what makes it frightening, because people fear they are "going crazy". They are not.

Derealization vs depersonalization

These often occur together and are classed as one disorder:

See depersonalization for the other half.

What causes derealization

Derealization is thought to be the brain dampening emotional processing to protect you during overwhelming stress, like a circuit breaker. Triggers include:

• Anxiety and panic: derealization is a recognized symptom of panic attacks. See panic disorder.
• Severe or prolonged stress, and trauma, especially in childhood. It is common in PTSD.
• Depression.
• Sleep deprivation and exhaustion.
• Cannabis, hallucinogens, ketamine, MDMA and alcohol, during use or afterward. Cannabis is a frequent trigger of persistent episodes in young people.
• Hyperventilation during anxiety, which changes blood carbon dioxide levels.

Medical causes to rule out

Less often, derealization comes from a physical condition:

• Seizures, especially temporal lobe (focal) seizures, which can cause brief déjà vu, unreality, a rising feeling in the stomach, or strange smells. See epilepsy.
• Migraine aura
• Inner ear and balance disorders causing dizziness
• Low blood sugar, thyroid problems
• Medicines, and withdrawal from antidepressants or benzodiazepines

Depersonalization-derealization disorder

The diagnosis is made when episodes are persistent or recurrent, cause significant distress or problems functioning, and are not better explained by drugs, another medical condition or another mental illness. It often starts in the teens or early twenties. Some people have constant symptoms for years, while others have episodes linked to stress. It is one of the dissociative disorders.

How it is assessed

A doctor or mental health professional will ask what the experience is like, when it started, how often it happens, about anxiety, mood, trauma, sleep and substance use. They may examine you and order tests such as blood sugar and thyroid function, and an EEG or brain imaging if seizures or another neurological cause is suspected. Questionnaires such as the Cambridge Depersonalization Scale measure severity.

How to stop derealization

In the moment: grounding techniques

• 5-4-3-2-1: name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell and 1 you can taste.
• Strong sensations: hold an ice cube, splash cold water on your face, or smell something strong such as mint.
• Slow breathing: breathe in for 4 seconds, out for 6 seconds. Avoid fast breathing.
• Name it: remind yourself, "This is derealization. It is an anxiety response. It is not dangerous and it will pass."
• Do something absorbing: talk to someone, play a game, or move your body.

Fighting or constantly checking for the feeling tends to keep it going. Accepting it and redirecting attention often helps it fade.

Longer-term treatment

• Cognitive behavioral therapy (CBT) adapted for depersonalization reduces the fear and checking that keep symptoms going.
• Treating the driver: therapy or medicines for anxiety, panic, depression or PTSD often improve derealization.
• Trauma-focused therapy when trauma is involved.
• Medicines: no medicine is approved specifically for derealization. Some people are helped by SSRIs (for linked anxiety or depression) or by lamotrigine, sometimes combined with an SSRI, under specialist guidance.

Lifestyle

• Avoid cannabis and other recreational drugs.
• Keep regular sleep.
• Limit caffeine and alcohol, which can worsen anxiety.
• Exercise regularly.

Frequently asked questions

What is derealization?

Derealization is a type of dissociation in which the world around you feels unreal, dreamlike, foggy or artificial, while you still know it is real. It is commonly triggered by anxiety, panic, stress, trauma, sleep loss or drugs, and it is usually temporary.

Is derealization dangerous?

The feeling itself is not dangerous and does not cause brain damage or psychosis. It can be very distressing and, when persistent, interfere with daily life. Rarely, it is a sign of a seizure or another medical problem, so a first or unusual episode should be checked.

How long does derealization last?

Episodes linked to panic or stress often last minutes to hours. After drug use, it can last days or weeks. In depersonalization-derealization disorder, symptoms can be continuous for months or years, but treatment helps many people improve.

Can anxiety cause derealization?

Yes. Anxiety is the most common cause. During high anxiety or a panic attack, the brain can dampen how you perceive your surroundings, producing a sense of unreality. Treating the anxiety usually reduces derealization.

Am I going crazy if I have derealization?

No. In derealization, you know your surroundings are real even though they feel strange. That insight is the opposite of psychosis, where people lose touch with reality. The fear of going crazy is very common and can itself keep the anxiety cycle going.