Derealization
Overview
While the phrase is déjà vu describes the sensation of experiencing the present situation in the past, and has been “already seen.”[1] Conversely, jamais vu is used when an individual perceives a familiar situation as if they have never confronted it or seen it with "new eyes".[2] Similarly to jamais vu, derealization refers to a shift in an individual's perception of the world, making it seem different from its usual appearance or feeling.[3] For example, imagine someone gazing out of their office window where they have seen the same skyline for a decade. if a person were experiencing derealization, the familiar view would suddenly take on a muffled quality, leaving them with a sense of disconnection.
Causes
While derealization symptoms are often associated with depression, anxiety, and acute trauma resulting from motor accidents, instances of abuse and imprisonment can also lead to derealization.[4] Additionally, Heydrich et al. (2019) found isolated case reports and small case series that also documented associations between derealization symptoms and epilepsy.[5] According to Murphy (2023), earlier research has primarily concentrated on specific brain regions associated with the sensation of derealization.[6] These regions play a role in adaptive stress responses through defense mechanisms that involve autonomic functions, the hypothalamic-pituitary-adrenal (HPA) axis, and various interconnected neural circuits.[7]
Other neurological conditions (e.g., migraines and mild traumatic brain injuries) have been recognized as potential catalysts for derealization.[8] Additionally, derealization can manifest as a secondary symptom in the context of other psychiatric disorders, such as borderline personality disorder (BPD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD).[9] As per the findings by Madden and Einhorn (2018), depersonalization symptoms induced by cannabis have been studied in the literature for several years.[10] While not everyone who uses cannabis will encounter derealization, those who do experience it will typically have the onset of cannabis-induced derealization symptoms peak around 30 minutes after consumption and will dissipate within 120 minutes of drug exposure.[11] Individuals with a prior history of anxiety disorders, including panic disorders or social phobia, are at a heightened risk of experiencing symptoms induced by cannabis.[12]
Symptoms
Derealization symptoms include:[13]
Familiar people and places seem surreal.
The environment appears distorted and lacks vibrancy.
Three-dimensional objects and settings appear flat.
Recent experiences feel as if they transpired in the distant past.
An altered sense of distance, size, and shape for objects, creating an unrealistic perspective.
Feels like the ground is shifting while walking.[14]
Regarding psychological disorders, Schlax et al. (2020) conducted a study to see if depersonalization and derealization could be markers of disease severity and poor prognosis.[15] The study revealed that 8.7% of participants were troubled by derealization symptoms at baseline and that these participants faced an increased risk of elevated symptoms of depression and anxiety.[16]
Treatment
Psychotherapy plays a pivotal role in a comprehensive treatment approach for derealization and similar trauma-related disorders. When an individual is going through a challenging period with frequent dissociations, support interventions, like crisis management and coping strategies, are highly recommended.[17] During times when symptoms are milder, psychodynamic therapy, which encourages self-reflection and self-evaluation, is a valuable approach.[18] According to Gentile (2014), patients who undergo treatment interventions addressing their trauma-related symptoms are at a greater likelihood of improved functioning and reduced residual symptoms.[19] Additional treatment may include the use of medications, such as antidepressants.[20]
If you suspect you are experiencing derealization from stress, trauma or anxiety disorder, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for additional guidance and support
Contributed by: Kelly Valentin
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 Cleary, A. M., & Brown, A. S. (2021). The deja vu experience. Essays in Cognitive Psychology.
2 O’Connor, A. R., Wells, C., & Moulin, C. J. A. (2021). Déjà vu and other dissociative states in memory. https://doi.org/10.1080/09658211.2021.191119
3 APA Dictionary of Psychology. (n.d.). https://dictionary.apa.org/derealization
4 Gentile, J. P. (n.d.). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/
5 Heydrich, L., Marillier, G., Evans, N. J., Seeck, M., & Blanke, O. (2019). Depersonalization‐ and derealization‐like phenomena of epileptic origin. Annals of Clinical and Translational Neurology, https://doi.org/10.1002/acn3.50870
6 Ibid.
7 Murphy, R. J. (2023, March 1). Depersonalization/Derealization Disorder and Neural correlates of Trauma-related Pathology: A Critical review. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132272/
8 Ibid.
9 Lambert, M., Sierra, M., Phillips, M. L., & David, A. S. (2002). The spectrum of organic depersonalization. Journal of Neuropsychiatry and Clinical Neurosciences. https://doi.org/10.1176/jnp.14.2.141
10 Murphy (2023)
11 Madden, S. P., & Einhorn, P. M. (2018). Cannabis-Induced Depersonalization-Derealization Disorder. The American Journal of Psychiatry Residents’ Journal. https://doi.org/10.1176/appi.ajp-rj.2018.130202
12 Ibid.
13 Ibid.
14 Sang, F. Y. P., Jáuregui‐Renaud, K., Green, D., Bronstein, A. M., & Gresty, M. A. (2006). Depersonalisation/derealisation symptoms in vestibular disease. Journal of Neurology, Neurosurgery, and Psychiatry. https://doi.org/10.1136/jnnp.2005.075473
15 Sang et al., (2006)
16 Schlax, J., Wiltink, J., Beutel, M. E., Münzel, T., Pfeiffer, N., Wild, P. S., Blettner, M., Kerahrodi, J. G., & Michal, M. (2020). Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2020.04.018
17 Ibid.
18 Gentile, J. P. (n.d.). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/
19 Ibid.
20 Domino, F. J., & Baldor, R. A. (2012). The 5-Minute Clinical Consult 2012.