Derealization

Derealization is a dissociative symptom in which the external world feels unreal, distant, or distorted. People may describe objects or surroundings as artificial, dreamlike, hazy, or unfamiliar. Sensations such as time distortion or a sense of automaticity can accompany these experiences. Reality testing—the awareness that perceptions are real—typically remains intact. When derealization is persistent and impairing, it can form part of depersonalization-derealization disorder.

Derealization can occur transiently in the context of stress, anxiety, depression, post-traumatic stress disorder, sleep deprivation, or medical illness. It may be induced by substances (for example, cannabis, hallucinogens, alcohol withdrawal) or neurological conditions (such as migraines or temporal lobe epilepsy). It is a feature of various psychiatric disorders and can appear with dissociative disorders. Many people experience brief episodes; persistent or recurrent symptoms are much less common.

Diagnosis is clinical, based on history and examination. In depersonalization-derealization disorder, individuals experience recurrent or persistent derealization (with or without depersonalization) that causes distress or impairment, while reality testing remains intact. The symptoms are not better explained by another medical condition or substance use.

Treatment emphasizes the underlying condition and symptom management. Psychotherapy, particularly cognitive-behavioral approaches, grounding techniques, and stress-reduction strategies, is central. Treatment of coexisting anxiety or mood disorders with appropriate medications may help, though there is no specific pharmacological agent approved for derealization. Many episodes lessen over time, and some patients improve with psychotherapy and coping strategies; others experience intermittent or persistent symptoms requiring ongoing support.