Understanding Derealization - Dr. Samantha Torres, MD

PATIENT EDUCATION • NOVEMBER 2003

Understanding Derealization:
When the World Feels Unreal

By Samantha Torres, M.D.
Board-Certified Neuropsychiatrist

>> What is Derealization?

Derealization is a dissociative experience in which the external world feels unreal, dreamlike, or somehow different from normal. People experiencing derealization often describe feeling as though they're watching their surroundings through a fog, a pane of glass, or as if they're in a movie.

While deeply unsettling, derealization is more common than many people realize. Brief episodes can occur in response to stress, fatigue, or sleep deprivation and are generally not cause for concern. However, when derealization becomes persistent or significantly interferes with daily functioning, professional evaluation is warranted.

Key Points:
• Derealization involves a persistent or recurrent feeling that the world around you is unreal
• It often co-occurs with depersonalization (feeling detached from oneself)
• Episodes can be brief or chronic, mild or severely impairing
• Effective treatments are available

>> Common Symptoms

People with derealization may experience:

Feeling that surroundings are unreal, dreamlike, or artificial
Visual distortions—objects may appear blurry, unusually sharp, or the wrong size
Sounds may seem muffled or unusually loud
Time may feel like it's speeding up or slowing down
Familiar places feel strange or unfamiliar
Emotional numbness or detachment from surroundings
Feeling like you're viewing the world through a glass barrier

Important: People experiencing derealization typically retain insight—they know that their perceptions are unusual, even while the experience feels very real. This distinguishes derealization from certain psychotic experiences.

>> Causes and Risk Factors

Derealization can arise from various causes:

Category	Causes
Psychological Factors	• Severe stress or anxiety • Trauma, particularly childhood trauma • Depression • Panic disorder • Post-traumatic stress disorder (PTSD)
Medical Conditions	• Seizure disorders, particularly temporal lobe epilepsy • Migraine with aura • Sleep disorders • Vestibular dysfunction
Substance-Related	• Cannabis use • Hallucinogens • Alcohol withdrawal • Certain medications

>> Treatment Approaches

Treatment depends on the underlying cause and severity of symptoms:

Psychotherapy
Cognitive-behavioral therapy (CBT) and other psychotherapeutic approaches can help patients understand and manage their symptoms. Specific techniques may include grounding exercises, cognitive restructuring, and stress management.

Medication
While no medication is specifically approved for derealization, certain medications may help when symptoms occur alongside depression, anxiety, or other treatable conditions. Medication decisions should be individualized based on comprehensive evaluation.

Addressing Underlying Conditions
When derealization is secondary to another condition (such as anxiety, PTSD, or a medical issue), treating the primary problem often leads to improvement in derealization symptoms.

>> When to Seek Professional Help

Consider scheduling an evaluation if you experience:

Derealization episodes that are frequent or prolonged
Symptoms that significantly interfere with work, relationships, or daily activities
Associated symptoms such as severe anxiety, depression, or thoughts of self-harm
Uncertainty about whether your experiences are derealization or something else

Ready to Discuss Your Symptoms?

Dr. Torres specializes in consciousness disorders including derealization and depersonalization. Schedule a consultation to discuss your experiences and explore treatment options.

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<< Back to All Articles

>> Related Articles

CISD Research Paper

Treatment-Resistant Depression

Sleep Paralysis

Early Psychosis Intervention

>> Contact Info

Address:
3050 Medical Center Dr.
Suite 602
San Francisco, CA 94143

Phone:
(909) 390-0003

Email:
appointments@
drtorresmd.info

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