When Reality Feels Unreal: Understanding Derealization

As a Licensed Clinical Social Worker, I've seen many individuals grapple with the unsettling sensation that the world around them isn't quite real. This experience, known as derealization, is a form of dissociation where you feel detached from your surroundings, as if you're living in a dream, watching life through a fog, or observing the world from behind a glass wall. While occasional, fleeting moments of feeling "out of it" can happen to anyone, persistent or recurring derealization can be deeply distressing and impact daily life.

It's important to understand that when you experience derealization, you haven't lost touch with reality; you're aware that your perceptions are not typical, which can often lead to increased anxiety and confusion.

What Does Derealization Feel Like?

Derealization can manifest in various ways, making the external world seem:

• Unreal or dreamlike: Like you're in a movie or a play.

• Distant or foggy: Things appear muted, blurry, or lacking vividness.

• Lifeless or artificial: The world seems devoid of emotional coloring or depth.

• Distorted: Objects might appear unusually clear, flat, larger or smaller than they are, or their shapes might seem wrong.

• Sensory distortions: Sounds might seem louder or softer than usual, or other senses might feel altered.

• Time distortions: Time might seem to pass too slowly or too quickly.

These sensations can be accompanied by a feeling of emotional numbness or a reduced emotional response to people and places you normally care about.

What Causes Derealization?

The exact cause of derealization is not fully understood, but it's often linked to the brain's way of coping with overwhelming stress or trauma. Factors that can contribute include:

• Severe stress or trauma: Experiencing or witnessing physical or emotional abuse, domestic violence, accidents, natural disasters, or the sudden death of a loved one can trigger derealization as a protective mechanism.

• Anxiety and Panic Attacks: High levels of anxiety, especially with panic attacks, can precipitate or worsen episodes of derealization.

• Depression: Derealization is frequently co-occurring with depression.

• Other mental health conditions: It can be a symptom of conditions like Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), or certain personality disorders.

• Substance Use: Illicit drug or alcohol use, and even withdrawal from these substances, can induce or exacerbate derealization symptoms.

• Biological and genetic factors: Some individuals may have a predisposition to experiencing dissociative symptoms.

Finding Your Way Back to Reality: Treatment Approaches

The good news is that derealization is a manageable condition, and many people experience significant relief with appropriate support. Treatment primarily focuses on addressing the underlying causes and learning coping strategies.

Psychotherapy (Talk Therapy) is the cornerstone of treatment:

• Cognitive Behavioral Therapy (CBT): This approach helps you identify and challenge the distorted thoughts and beliefs that contribute to derealization, equipping you with practical skills to manage symptoms and reduce anxiety.

• Dialectical Behavioral Therapy (DBT): Particularly helpful for individuals who experience intense emotions or have co-occurring conditions, DBT offers skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to help you navigate overwhelming feelings that might trigger derealization.

• Acceptance and Commitment Therapy (ACT): ACT helps you learn to accept uncomfortable thoughts and feelings rather than fighting them, while committing to actions aligned with your values. This can reduce the distress associated with derealization symptoms and help you engage more fully with your life.

• Trauma-Focused Therapies: If derealization stems from past trauma, approaches like Eye Movement Desensitization and Reprocessing (EMDR) or other trauma-focused interventions can help process and integrate traumatic memories, reducing their dissociative impact.

• Somatic Interventions: These approaches, including Somatic Experiencing and Somatic Awareness, focus on the body's sensations and responses to stress and trauma. By gently guiding attention to physical experiences, somatic work can help you reconnect with your body and the present moment, fostering a sense of grounding and reducing feelings of detachment.

• Internal Family Systems (IFS): IFS views the mind as comprised of various "parts" – some of which might hold trauma or protective behaviors like dissociation. This gentle, non-pathologizing approach helps you understand and heal these parts, allowing for greater internal harmony and reducing the need for dissociative coping mechanisms.

Medication may also be considered: While no specific medication directly treats derealization, your mental health provider might prescribe antidepressants or anti-anxiety medications to address co-occurring conditions like depression or anxiety, which often alleviate derealization symptoms indirectly.

Practical Strategies for Grounding

In moments of derealization, practicing grounding techniques can help you reconnect with the present moment:

• Engage your senses: Focus on what you can see, hear, touch, taste, and smell. For example, hold an ice cube, listen to music, deeply smell a strong scent like mint, or name five things you can see, four things you can feel, three things you can hear, two things you can smell, and one thing you can taste.

• Deep Breathing: As discussed in my previous article, conscious, deep breathing can help regulate your nervous system and bring you back to your body.

• Movement: Light physical activity like walking or stretching can help you feel more connected to your body.

• Talk to someone: Reach out to a trusted friend, family member, or therapist and describe what you're experiencing.

If you are experiencing persistent or distressing feelings of derealization, please know that you are not alone and help is available. Seeking evaluation from a mental health professional can provide clarity, a diagnosis, and a personalized treatment plan to help you regain your sense of reality and well-being.