Derealization: Symptoms, causes, impact, and treatments

Reviewed by Robert Bogenberger, PhD

Written by

therapist.com team

Last updated: 06/30/2025

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What is derealization?

Derealization is a feeling where the world around you seems unreal or strange. It changes how you see your surroundings.¹

While it can happen by itself, it often shows up with depersonalization, which makes you feel like you’re watching yourself from outside your body. Both are types of dissociation where you feel detached from reality.²

Short, mild episodes of derealization are fairly normal and don’t usually mean there’s a serious problem.³ But when these feelings last a long time or start to affect your daily life, they might be a sign of depersonalization-derealization disorder (DDD or DPDR).⁴ DPDR affects around 1% of people, with more cases in teens and young adults.⁵

Derealization symptoms

Derealization involves feeling like your environment is somehow unreal or changed. Common symptoms include:⁶

• Feeling that familiar places seem strange or unfamiliar
• Seeing the world as dreamlike, foggy, or lifeless
• Having vision changes, like seeing things darker or blurrier
• Feeling emotionally cut off from your surroundings
• Wondering if you’re dreaming
• Testing reality (like pinching yourself)

These symptoms can happen on their own or along with other conditions like anxiety and depression.⁷ When derealization is part of DPDR, symptoms can be more severe.

A person with DPDR may have trouble recognizing themselves in mirrors, lose feeling in parts of their body, feel like everyday events aren’t real, or have memory problems that make familiar people seem like strangers.⁸

If you’re experiencing these symptoms regularly or they’re causing distress in your life, it’s important to reach out to a mental health professional. They can help determine whether you’re dealing with occasional derealization or a more persistent condition that requires treatment.

What does derealization feel like?

People often struggle to explain what derealization feels like. In a rare case of derealization without depersonalization, a patient described feeling that people and places around him were so unreal that he had to pinch himself to check if he was dreaming.⁹ He also touched hot or cold objects and smelled different things to test his surroundings. His feelings of unreality were only about the world around him, not about himself.

More often, derealization happens together with depersonalization, meaning people feel dissociated from both their surroundings and themselves. One patient with DPDR described feeling like they were watching their life from outside themselves, being physically present but emotionally absent.¹⁰ They also felt alone because no one understood what they were going through.

Research has found that during derealization and depersonalization, the brain areas that help us understand ourselves and process our environment don’t work together properly.¹¹ This may explain why people with DPDR feel disconnected—the parts of the brain that help them feel connected to reality aren’t communicating as they should.

How long does derealization last?

Derealization can last for different amounts of time:

• Short episodes typically last from hours to days in people with DPDR.¹² These can be triggered by fatigue or stress.
• Ongoing or repeated symptoms can last for months or even years in some cases of DPDR.¹³

Between 26% and 74% of people experience short-term derealization symptoms at some point in their lives.¹⁴ But if the symptoms are strong, persistent, or impact your daily life, you should consult a medical or mental health professional.

What causes derealization?

Researchers don’t yet fully understand what causes derealization, but several common triggers have been identified for DPDR:¹⁵

• Traumatic events: Trauma, especially in childhood, can be a trigger as the brain tries to protect itself.
• Childhood anxiety: Early anxiety experiences are often triggers for later derealization episodes.
• Intense stress: Severe stress, depression, and panic attacks can all cause derealization experiences.
• Brain chemistry and structure: People with DPDR sometimes have differences in brain structure that may contribute to symptoms, though more research is needed.
• Substance use: Psychoactive substances including cannabis, hallucinogens, and even alcohol can trigger episodes.
• Physical factors: Not enough sleep, feeling very tired, and even traveling to new places can cause short periods of derealization.¹⁶

The impact of derealization on well-being

Derealization can greatly affect a person’s well-being. Research shows that derealization and depersonalization are linked to both depression and anxiety symptoms.¹⁷ They are risk factors for both developing and continuing the conditions.

When derealization and depersonalization last a long time, as is the case with DPDR, they can cause:¹⁸

• Problems with daily activities, work, and relationships
• Fatigue and insomnia
• Trouble concentrating and remembering things
• Emotional numbness that affects memories and imagination
• Trouble responding to emotional situations

Derealization and depersonalization often happen along with anxiety and other mental health conditions. This may make treatment more complicated and possibly make the experience worse.

Derealization diagnosis and treatment options

Derealization is not a standalone, diagnosable disorder. However, it’s a recognized symptom of several mental health conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Additionally, someone who suffers from derealization alone may still meet the criteria for depersonalization-derealization disorder. To diagnose DPDR, clinicians typically use interviews and assessment tools like the Cambridge Depersonalization Scale (CDS).¹⁹

Treatment options for derealization, especially when it’s part of DPDR, include:

Therapy: Cognitive behavioral therapy (CBT) has shown promising results for treating the disorder, but more research with larger samples is needed.²⁰ Dialectical behavior therapy (DBT) may also help because it teaches emotional regulation and stress management.²¹

Medication: When derealization happens with anxiety or depression, medicines like SSRIs or SNRIs might be prescribed.²² However, long-lasting episodes doesn’t usually respond well to medication alone.²³

Tips for managing derealization

While professional help is important for ongoing symptoms, several self-help strategies can help manage derealization:

Grounding techniques can help reconnect you to reality.²⁴ Try:

• Focusing on physical sensations. Touch different textures, hold something cold or warm, or splash water on your face.
• Using your senses. Try naming five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.
• Moving your body by walking, stretching, or doing gentle exercise to feel connected again.

Lifestyle approaches that support mental health include:²⁵

• Keeping a regular sleep schedule
• Practicing stress-reduction like deep breathing and meditation
• Avoiding substances that can trigger derealization, including alcohol, caffeine, and recreational drugs
• Eating well and staying hydrated

There’s no one perfect fit for treatment of all cases of DPDR. But many patients find their symptoms improve or even fade away with personalized treatment.²⁶ People who get help early and stick with treatment tend to do better, especially when other mental health conditions are also treated.

If you’re struggling, remember that you’re not alone and help is available. Visit our therapist directory to find a mental health professional who specializes in assessing and treating dissociative disorders.