Around 50% of all adults have experienced derealization — feelings of unreality or detachment from the world — at least once. Severe stress and other traumatic situations can trigger episodes of derealization. For some people, symptoms cause only minor problems, while others may require professional, medical intervention.
Not everyone who experiences an episode of derealization has a psychiatric disorder. Only about 2% of people meet the level of criteria noted in the DSM-5 for a diagnosis of derealization disorder. Most people who experience derealization feel an alteration in their perception that makes their external surroundings appear unreal or strange. These episodes may last a few hours or continue for days, weeks, or even months.
In 2013, the American Psychiatric Association (APA) merged two disorders, depersonalization disorder and derealization disorder, into one: depersonalization-derealization disorder. The APA identified it as one of three types of dissociative disorders, conditions that lead to a disconnection between a person’s sense of self and their thoughts, feelings, memories, and actions.
Both conditions lead to experiences of unreality and detachment. Depersonalization causes a person to feel like they are an observer of their own thoughts, emotions, sensations, body, or actions, and they may feel disconnected from their memories. Derealization results in detachment from the validity of their surroundings. They feel like they are walking around in a fog.
Physical or emotional abuse, neglect, or having a mentally ill parent or caregiver are childhood experiences that can later result in derealization episodes or a disorder. Traumatic experiences during childhood, such as the unexpected death of a loved one or witnessing domestic violence, can later trigger these types of responses as a teenager or young adult.
An intense or stressful event usually triggers the sudden onset of derealization episodes. Although the episodes may be brief, they cause immense distress. A variety of stressors can have this effect, once, a few times, or chronically:
A person experiencing a derealization episode may feel like they are living in a dream or movie. They may perceive their surroundings as blurry, artificial, colorless, or distorted. Some people report a heightened awareness of their surroundings, while others feel unfamiliar with places they have been many times. Distortions of time and distance as well as of objects’ shapes and sizes are also possible. Transient derealization is common, where symptoms appear briefly, then go away.
Persistent or recurring derealization episodes may indicate a derealization disorder. Such disorders rarely occur in children or older adults. They usually begin in the mid-to-late teens or early adulthood and seldom after 40. Some people experience both depersonalization and derealization episodes simultaneously. Researchers believe that in addition to environmental factors, biological factors such as a seizure disorder may play a role.
Derealization disorder often appears in people who have avoidant, borderline, or obsessive-compulsive personality disorders. Researchers found that people with a high clinical risk for psychosis may experience derealization and depersonalization symptoms as well. However, there is no evidence of the opposite — people who experience derealization symptoms do not appear to be at a higher risk for schizophrenia or other serious mental health illnesses.
Both depersonalization and derealization are common psychiatric symptoms. According to the DSM-5, a person must have persistent or recurring episodes of derealization to receive a diagnosis of derealization disorder. The individual must also be aware that these experiences are not real. Additionally, the physician will determine if the symptoms are causing significant social or occupational impairment or distress. An MRI, EEG, and urine toxicology tests can rule out other causes.
Most people fully recover from derealization episodes or disorders. However, individuals often avoid seeking treatment for their symptoms, causing them to last longer. Some studies show that a diagnosis alone is enough to reduce symptoms because it helps relieve anxieties resulting from the uncertainty of the issue. There is no known medication for treating depersonalization/derealization disorder. Psychotherapy is the primary treatment.
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