Derealization is a dissociative symptom that involves experiencing the external world as strange, unreal, or distant. It is often described as feeling as though one is observing the world through a veil or glass, making surroundings seem foggy, lifeless, or visually distorted. This phenomenon is a common symptom of the broader condition known as dissociative identity disorder (DID) but can also occur as part of other psychiatric conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD). People who experience derealization often report a sense of detachment from their environment, which can be both disorienting and distressing.
The exact causes of derealization are not fully understood, but it is thought to be a coping or defense mechanism triggered by severe stress or trauma. The brain initiates derealization to distance an individual from the full emotional impact of traumatic events by creating a sense of unreality. Neurologically, derealization is believed to involve dysregulation in certain brain areas, including the insula, which helps process emotions and perceptions, and the prefrontal cortex, which deals with cognitive functions and reality testing. This altered brain function disrupts the normal processing of sensory information, leading to the altered perception of reality experienced during derealization.
Diagnosing derealization can be challenging, as it often coexists with other psychiatric disorders, and symptoms can be subjective and difficult to quantify. Typically, healthcare providers will conduct a comprehensive psychological assessment to rule out other potential causes of the symptoms, such as neurological disorders, substance abuse, or other mental health disorders. The Dissociative Experiences Scale (DES) is one tool that may be used to assess the severity and frequency of dissociative symptoms, including derealization. Treatment generally involves psychotherapy, with cognitive-behavioral therapy (CBT) being a common approach to help individuals manage and eventually reduce their symptoms.
Treatment for derealization aims to address both the symptom itself and its underlying causes. In therapy, individuals might work on techniques to ground themselves in reality and improve their emotional regulation. This can involve mindfulness exercises, which help reconnect the person with the present moment and physical sensations. In cases where derealization is linked to trauma, trauma-focused therapies such as Eye Movement Desensitization and Reprocessing (EMDR) can be effective. Medication may also be prescribed to help manage severe symptoms or related conditions, such as anxiety or depression, although there is no specific medication approved solely for the treatment of derealization. Supportive therapy, education about the disorder, and developing a strong therapist-patient relationship are also crucial components of successful treatment outcomes.