Derealization is the perception that the external world is unreal, or being detached from your surroundings. This is sometimes distinguished from depersonalization, where you feel yourself as unreal, or you are detached from yourself. However, depersonalization and derealization are difficult to separate, as someone with derealization may question whether or not their feelings of unreality are directed at the external world or directed at himself/herself. When you have derealization, you do not see the world as you used to. You may see the world as if you are in a fog; in a daze. You may perceive previously familiar objects, places or people as unfamiliar, strange, or alien. You may also have perceptual disturbances, where you see things out of proportion, and this can be quite unnerving. In derealization, a person may feel like they are watching the world external to them as if in a movie. So others become alienated to the person who views them as if in a movie.
Derealization is frequently a dissociative symptom, where you disconnect from your environment in response to trauma or anxiety-provoking stimuli. For people with a history of exposure to trauma and post traumatic stress disorder, they use derealization to disconnect from their environment, which may be triggering the anxiety associated with the trauma. It could be that the person lost a loved one in a car accident, and that person happened to return to the scene of the accident…in order to prevent severe anxiety or a panic attack from erupting, the person utilizes derealization to dissociate oneself from the environmental trigger. So in this way, derealization may be a defence mechanism, which is protective and spares the sufferer from further anxiety symptoms. However, if derealization is utilized repeatedly, then it becomes a safety behavior and leads to avoidance, which serves to make the underlying anxiety worse.
People also use derealization to disconnect from the anxiety associated with constant worrying or intrusive thoughts. Again, this is only temporary relief, but if utilized repeatedly, derealization leads to safety behaviors and avoidance, worsening the underlying anxiety. In addition to anxiety disorders, derealization is present in other psychiatric disorders such as depersonalization/derealization disorder, dissociative identity disorder, psychotic disorders, and major depressive disorder (American Psychiatric Association, 2013).
In addition to representing dissociation associated with psychiatric illness, derealization can also be a symptom of an underlying medical illness. Seizure disorder (particularly temporal lobe epilepsy), migraines, vestibular disorders and drug intoxication (such as cannabis and hallucinogens) can present with derealization. It is important to rule out medical causes of derealization with a visit to your doctor. For more information and help on derealization and anxiety, read my book on anxiety, Anxiety Protocol.