Derealization
Encyclopedia
Derealization is an alteration in the perception or experience of the external world so that it seems unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional coloring and depth. It is a dissociative
symptom of many conditions, such as psychiatric and neurological disorders, and not a standalone disorder. It is also a transient side effect of acute drug intoxication, sleep deprivation
, and stress.
Derealization is a subjective experience of unreality of the outside world, while depersonalization
is unreality in one's sense of self. Although most authors currently regard derealization (surroundings) and depersonalization (self) as independent constructs, many do not want to separate derealization from depersonalization. The main reason for this is nosological, because these symptoms often co-occur, but there is another, more philosophical reason: the idea that the phenomenological experience of self, others, and world is one continuous whole. Thus, feelings of unreality may blend in and the person may puzzle over deciding whether it is the self or the world that feels unreal to them.
Chronic derealization may be caused by occipital
–temporal
dysfunction. These symptoms are common in the population, with a lifetime prevalence
of up to 74% and between 31 and 66% at the time of a traumatic event
.
or jamais vu
are common. Familiar places may look alien, bizarre, and surreal. The world as perceived by the individual may feel like it is going through a dolly zoom
effect. Such perceptual abnormalities may also extend to the senses of hearing, taste, and smell. Because degree of familiarity is itself among one's sensory and psychological data when experiencing a place, the process of derealization, by blocking identification with one's surroundings, itself contributes to the difference between one's perception of one's surroundings under derealization and what one's perception would be in the absence of derealization. For this reason, the more familiar a place normally seems, the more unfamiliar it seems when a person is experiencing derealization.
Frequently, derealization occurs in the context of constant worrying or 'intrusive thoughts
' that people find hard to switch off. In such cases it can build unnoticed along with the underlying anxiety
attached to these disturbing thoughts, and be recognized only in the aftermath of a realization of crisis, often a panic attack
, subsequently seeming difficult or impossible to ignore. This type of anxiety can be crippling to the affected and may lead to avoidant behavior. Those who experience this phenomenon may feel concern over the cause of their derealization. It is often difficult to accept that such a disturbing symptom is simply a result of anxiety, and the individual may often think that the cause must be something more serious. This can, in turn, cause more anxiety and worsen the derealization.
People suffering from derealization have described feeling as if the world external to them were something in a TV show or movie, or as if they were viewing it through a TV screen. This, and other similar feelings attendant to derealization, can cause a sensation of alienation and distance between the person suffering from derealization and others around them.
(particularly temporal lobe epilepsy
), migraine
, and mild head injury
. There is a similarity between visual hypo-emotionality, a reduced emotional response to viewed objects, and derealization. This suggests a disruption of the process by which perception
becomes emotionally coloured. This qualitative change in the experiencing of perception may lead to reports of anything viewed being unreal or detached.
Derealization can also manifest as an indirect result of certain vestibular disorders such as labyrinthitis
and vestibular neuronitis
. This is thought to result from the experience of anxiety precipitated by the functional disparity that arises between the ability to reconcile external stimuli relative to motion and equilibrioception
that are compromised by vestibular dysfunction with the internal perceptions and expectations regarding the physical environment.
An alternative explanation holds that a possible effect of vestibular dysfunction includes responses in the form of the modulation of noradrenergic and serotonergic activity due to a misattribution of vestibular symptoms to the presence of imminent physical danger resulting in the experience of anxiety or panic, which subsequently generate feelings of derealization.
Cannabis
, psychedelics, dissociatives, antidepressant
s, caffeine
, nitrous oxide
, and nicotine
can all produce feelings resembling derealization, particularly when taken in excess. It can also result from alcohol withdrawal or benzodiazepine withdrawal.
Derealization can also be a symptom of severe sleep disorder
s, and mental disorders like depersonalization disorder
, borderline personality disorder
, bipolar disorder
, schizophrenia
, and anxiety disorder
s.
Interoceptive exposure
can be used as a means to induce derealization, as well as the related phenomenon depersonalization.
Dissociation
Dissociation is an altered state of consciousness characterized by partial or complete disruption of the normal integration of a person’s normal conscious or psychological functioning. Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from...
symptom of many conditions, such as psychiatric and neurological disorders, and not a standalone disorder. It is also a transient side effect of acute drug intoxication, sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
, and stress.
Derealization is a subjective experience of unreality of the outside world, while depersonalization
Depersonalization
Depersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...
is unreality in one's sense of self. Although most authors currently regard derealization (surroundings) and depersonalization (self) as independent constructs, many do not want to separate derealization from depersonalization. The main reason for this is nosological, because these symptoms often co-occur, but there is another, more philosophical reason: the idea that the phenomenological experience of self, others, and world is one continuous whole. Thus, feelings of unreality may blend in and the person may puzzle over deciding whether it is the self or the world that feels unreal to them.
Chronic derealization may be caused by occipital
Occipital lobe
The occipital lobe is the visual processing center of the mammalian brain containing most of the anatomical region of the visual cortex. The primary visual cortex is Brodmann area 17, commonly called V1...
–temporal
Temporal lobe
The temporal lobe is a region of the cerebral cortex that is located beneath the Sylvian fissure on both cerebral hemispheres of the mammalian brain....
dysfunction. These symptoms are common in the population, with a lifetime prevalence
Prevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
of up to 74% and between 31 and 66% at the time of a traumatic event
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
.
Description
The detachment of realization can be described as an immaterial substance that separates a person from the outside world, such as a sensory fog, a pane of glass, or a veil. Individuals may complain that what they see lacks vividness and emotional coloring. Emotional response to visual recognition of loved ones may be significantly reduced. Feelings of déjà vuDéjà vu
Déjà vu is the experience of feeling sure that one has already witnessed or experienced a current situation, even though the exact circumstances of the prior encounter are uncertain and were perhaps imagined...
or jamais vu
Jamais vu
In psychology, jamais vu is the phenomenon of experiencing a situation that one recognises but that nonetheless seems very unfamiliar.-Linguistics:...
are common. Familiar places may look alien, bizarre, and surreal. The world as perceived by the individual may feel like it is going through a dolly zoom
Dolly zoom
The dolly zoom is an unsettling in-camera effect that appears to undermine normal visual perception. It is part of many cinematic techniques used in filmmaking and television production....
effect. Such perceptual abnormalities may also extend to the senses of hearing, taste, and smell. Because degree of familiarity is itself among one's sensory and psychological data when experiencing a place, the process of derealization, by blocking identification with one's surroundings, itself contributes to the difference between one's perception of one's surroundings under derealization and what one's perception would be in the absence of derealization. For this reason, the more familiar a place normally seems, the more unfamiliar it seems when a person is experiencing derealization.
Frequently, derealization occurs in the context of constant worrying or 'intrusive thoughts
Intrusive thoughts
Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate. Most people experience these thoughts...
' that people find hard to switch off. In such cases it can build unnoticed along with the underlying anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
attached to these disturbing thoughts, and be recognized only in the aftermath of a realization of crisis, often a panic attack
Panic attack
Panic attacks are periods of intense fear or apprehension that are of sudden onset and of relatively brief duration. Panic attacks usually begin abruptly, reach a peak within 10 minutes, and subside over the next several hours...
, subsequently seeming difficult or impossible to ignore. This type of anxiety can be crippling to the affected and may lead to avoidant behavior. Those who experience this phenomenon may feel concern over the cause of their derealization. It is often difficult to accept that such a disturbing symptom is simply a result of anxiety, and the individual may often think that the cause must be something more serious. This can, in turn, cause more anxiety and worsen the derealization.
People suffering from derealization have described feeling as if the world external to them were something in a TV show or movie, or as if they were viewing it through a TV screen. This, and other similar feelings attendant to derealization, can cause a sensation of alienation and distance between the person suffering from derealization and others around them.
Causes
Derealization can accompany the neurological conditions of epilepsyEpilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
(particularly temporal lobe epilepsy
Temporal lobe epilepsy
Temporal lobe epilepsy a.k.a. Psychomotor epilepsy, is a form of focal epilepsy, a chronic neurological condition characterized by recurrent seizures. Over 40 types of epilepsies are known. They fall into two main categories: partial-onset epilepsies and generalized-onset epilepsies...
), migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, and mild head injury
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....
. There is a similarity between visual hypo-emotionality, a reduced emotional response to viewed objects, and derealization. This suggests a disruption of the process by which perception
Perception
Perception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...
becomes emotionally coloured. This qualitative change in the experiencing of perception may lead to reports of anything viewed being unreal or detached.
Derealization can also manifest as an indirect result of certain vestibular disorders such as labyrinthitis
Labyrinthitis
Labyrinthitis is an inflammation of the inner ear, and a form of unilateral vestibular dysfunction. It derives its name from the labyrinths that house the vestibular system . Labyrinthitis can cause balance disorders....
and vestibular neuronitis
Vestibular neuronitis
Vestibular neuronitis, also called Vestibular neuritis, can be a paroxysmal, single attack of vertigo, a series of attacks, or a persistent condition which diminishes over three to six weeks. It is a type of unilateral vestibular dysfunction and may be associated with nausea, vomiting, and...
. This is thought to result from the experience of anxiety precipitated by the functional disparity that arises between the ability to reconcile external stimuli relative to motion and equilibrioception
Equilibrioception
Equilibrioception or sense of balance is one of the physiological senses. It helps prevent humans and animals from falling over when walking or standing still. Balance is the result of a number of body systems working together: the eyes , ears and the body's sense of where it is in space ideally...
that are compromised by vestibular dysfunction with the internal perceptions and expectations regarding the physical environment.
An alternative explanation holds that a possible effect of vestibular dysfunction includes responses in the form of the modulation of noradrenergic and serotonergic activity due to a misattribution of vestibular symptoms to the presence of imminent physical danger resulting in the experience of anxiety or panic, which subsequently generate feelings of derealization.
Cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
, psychedelics, dissociatives, antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s, caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, nitrous oxide
Nitrous oxide
Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic...
, and nicotine
Nicotine
Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
can all produce feelings resembling derealization, particularly when taken in excess. It can also result from alcohol withdrawal or benzodiazepine withdrawal.
Derealization can also be a symptom of severe sleep disorder
Sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...
s, and mental disorders like depersonalization disorder
Depersonalization disorder
Depersonalization disorder is a dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization. Diagnostic criteria include persistent or recurrent experiences of feeling detached from one's mental processes or body...
, borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
, bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
, schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, and anxiety disorder
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
s.
Interoceptive exposure
Interoceptive exposure
Interoceptive exposure is a behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and can be contrasted with in vivo exposure, which...
can be used as a means to induce derealization, as well as the related phenomenon depersonalization.
See also
- DepersonalizationDepersonalizationDepersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...
- Temporal lobe epilepsyTemporal lobe epilepsyTemporal lobe epilepsy a.k.a. Psychomotor epilepsy, is a form of focal epilepsy, a chronic neurological condition characterized by recurrent seizures. Over 40 types of epilepsies are known. They fall into two main categories: partial-onset epilepsies and generalized-onset epilepsies...
- Post-traumatic stress disorderPost-traumatic stress disorderPosttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...
- Dissociative disordersDissociative disordersDissociative disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. See also dissociation. People with dissociative disorders are able to escape from reality involuntarily...
- Existential crisisExistential crisisAn existential crisis is a stage of development at which an individual questions the very foundations of his or her life: whether his or her life has any meaning, purpose or value...
- Mystical psychosisMystical psychosisMystical psychosis is a term coined by Arthur J. Deikman in the early 1970’s to characterize first-person accounts of psychotic experiences that are strikingly similar to reports of mystical experiences...
- Fugue stateFugue stateA fugue state, formally dissociative fugue or psychogenic fugue , is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality...
- RealityRealityIn philosophy, reality is the state of things as they actually exist, rather than as they may appear or might be imagined. In a wider definition, reality includes everything that is and has been, whether or not it is observable or comprehensible...