Derealization is the sensation of feeling detached from your surroundings. During an episode, the world may seem dream-like, unreal, distant, or distorted. It is considered a form of dissociation, meaning a temporary disconnection between your body, thoughts, and sense of self .[1]
Mild or brief derealization episodes are common—research shows that 26% to 74% of people experience them at least once in their lifetime. These short episodes may occur due to stress, anxiety, fatigue, changes in sleep, or substance use. However, long-lasting or chronic derealization is more often linked to trauma or underlying health conditions. [1]
Intense or ongoing episodes can greatly impact daily life, making it difficult to feel present or connected. Learning coping strategies and seeking therapy can help manage symptoms and support recovery. [2]
Symptoms
Derealization episodes may last minutes to hours; chronic cases can continue for days, weeks, or months [3] [1]. Common experiences include feeling like:[4][5][1]
- Your surroundings are unreal, distant, or unfamiliar
- You are viewing the world through fog or glass
- Time is distorted (e.g., minutes feel like an hour)
- Your memory is unclear or disrupted
- Sounds seem muffled or lights appear too bright
- The environment is shifting or visually distorted
Chronic derealization can also lead to anxiety, difficulty functioning at work or school, and disconnection from others.
Causes
Short-term derealization may be triggered by:
- Stress or anxiety
- Fatigue or jet lag
- Sleep changes
- Alcohol or marijuana use
Long-term derealization may result from:
- Trauma (e.g., abuse, accidents, natural disasters, violence)
- Mental health conditions, such as dissociative disorders
- Neurological conditions, such as seizures, migraines, traumatic brain injury, or cerebrovascular disease
Diagnosis
While mild episodes can be self-recognized, persistent symptoms should be evaluated by a healthcare provider. Diagnosis may include reviewing your medical history, lifestyle habits, and symptoms, along with physical exams or brain imaging to rule out neurological issues. Mental health professionals may use tools such as:
- Dissociative Experiences Scale (DES-II)
- Multidimensional Inventory of Dissociation
- SCID-D (Structured Clinical Interview for DSM-5 Dissociative Disorders)
Treatment
Treatment aims to help you:
- Learn grounding techniques
- Process possible traumatic experiences
- Develop coping skills for triggers
There is no specific medication for derealization, but treatment of related anxiety or depression can help. Psychotherapy is the main approach, including:
- Psychodynamic therapy
- Cognitive behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Eye movement desensitization and reprocessing (EMDR)
Prevention
Derealization cannot always be prevented, but symptoms may be reduced by:
- Limiting alcohol and drug use
- Maintaining healthy sleep habits
- Managing stress through exercise or journaling
- Practicing mindfulness
- Seeking support from loved ones and healthcare providers
Preventing childhood trauma and supporting trauma survivors also reduces the likelihood of chronic dissociative symptoms. Strategies include economic support for families, accessible childcare, mentoring programs, and public awareness on signs of child abuse.
Complications
Although common, derealization can also indicate a dissociative disorder or accompany other mental health conditions such as borderline personality disorder (BPD), obsessive-compulsive disorder (OCD), major depression, PTSD, or panic disorder. Frequent or long-lasting episodes should be evaluated by a healthcare professional.
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