Why the World Feels Unreal: Derealization Explained in Plain Language

What Derealization Is, in Plain Language

People describe derealization in different ways: “like I’m watching a movie,” “the world is behind glass or in a fog,” “everything looks like a stage set,” “sounds are muffled and colors are faded,” “a familiar street seems foreign.” Objects may seem flat, too bright, or distorted in size, and time may seem to flow strangely. At the same time, the person knows perfectly well where they are and understands that the world has not changed, and it is precisely this mismatch that frightens them most.

Derealization is a dissociative experience. Dissociation is the way the mind “switches off” part of perception when overloaded in order to reduce the intensity of emotions. In acute danger this can be useful: the person acts as if on autopilot and does not panic. But when the mechanism kicks in during ordinary anxiety or becomes constant, it starts causing fear in its own right and gets in the way of life.

How Derealization Differs From Depersonalization

Derealization concerns the perception of the outside world, while depersonalization concerns the perception of oneself. In depersonalization, a person feels detached from their body, thoughts, and emotions: as if they are watching themselves from the outside, their hands seem to belong to someone else, their voice sounds unfamiliar, their emotions are dulled, and their actions feel mechanical. These states very often occur together, which is why ICD-11 and DSM-5 combine them into a single disorder.

Importantly, insight is preserved in both states: the person understands that it is their perception that has changed, not the world or themselves. This is what distinguishes derealization and depersonalization from psychotic disorders, in which a person is convinced that their unusual experiences are real. Many people fear that derealization is the first step toward schizophrenia, but on its own it is not such a sign.

Why the World Feels Unreal: The Main Causes

A great many people experience brief episodes of derealization at least once in their lives, for example after a sleepless night, at a moment of intense fright, or during a flight with a change of time zones. This is not an illness. Persistent or frequently recurring derealization is usually linked to one of the following factors, and finding the cause is the doctor’s main task at the first consultation.

Derealization After Substance Use

A separate and common story is persistent derealization that begins after using cannabis or other psychoactive substances, sometimes after a single use. The state can last for weeks or months and be accompanied by severe anxiety. The most important things here are to stop using substances completely and to see a specialist, rather than trying to “override” the feeling with other substances.

• Anxiety disorders and panic attacks, the most common cause
• Prolonged stress, emotional burnout, or acute psychological trauma
• Depression, especially with marked anxiety
• Chronic sleep deprivation, exhaustion, or an abrupt change in routine
• Use of cannabis, hallucinogens, or alcohol and their after-effects
• Neurological causes: migraine and some forms of epilepsy
• Physical conditions: heart rhythm disorders, hypoglycemia, or thyroid problems

Is Derealization Dangerous?

Derealization on its own does not damage the brain and does not turn into psychosis. However, it is very unpleasant and causes marked anxiety and fear of losing control. The person starts constantly checking their perception, listening to their sensations, and searching for information online, and the more attention is paid to the symptom, the more persistent it becomes. This creates a vicious circle: anxiety causes derealization, and derealization causes new anxiety.

It is important to see a doctor not because derealization itself is dangerous, but because it may be caused by a condition that needs treatment: an anxiety disorder, depression, the after-effects of substance use, or, less often, a neurological problem. Derealization deserves particular attention if it comes with memory gaps, seizures, a severe headache, or speech problems, or if it appeared after a head injury.

How to Help Yourself With Derealization

The main principle is not to fight the symptom or keep checking it. Remind yourself that this is a feeling linked to overload and anxiety; it is unpleasant but safe, and it passes. Shift your attention to concrete things outside yourself: name five objects around you out loud, touch objects with different textures, splash your face with cool water, or do something that requires concentration. These “grounding” techniques help bring back a sense of presence.

In the long term, regular sleep, physical activity, cutting down on caffeine, completely avoiding alcohol and any psychoactive substances, and limiting time on symptom forums all help. If derealization is linked to panic attacks or an anxiety disorder, working on the anxiety through cognitive behavioral therapy and, if necessary, medication usually reduces the derealization as well.

How Depersonalization-Derealization Disorder Is Treated

The disorder is diagnosed when episodes of depersonalization or derealization are persistent or recurrent, cause marked distress, and disrupt life, and other causes have been ruled out. Assessment begins with a detailed conversation: the doctor asks when and how the symptoms began and about links with stress, substances, and sleep, and whether there is anxiety or depression. If needed, the doctor orders an examination by a neurologist or lab tests.

The main treatment is psychotherapy, above all cognitive behavioral therapy, aimed at reducing anxiety, stopping the constant checking of symptoms, and changing catastrophic interpretations. There is no medication specifically “for derealization,” but the doctor may prescribe treatment for co-occurring anxiety or depression. An online consultation at Psychiatry Online lets you discuss your symptoms with a psychiatrist anonymously and get a plan, without fear of not being “understood.”

When to see a doctor

• The feeling that the world or you yourself are unreal lasts several days in a row or keeps coming back
• Derealization comes with panic attacks, constant anxiety, or low mood
• The state appeared after using cannabis or other substances and is not going away
• Because of the symptoms, you have started avoiding going out, work, or socializing
• You cannot shake the fear of going crazy and keep checking your perception
• Besides derealization, there are memory gaps, seizures, a severe headache, or a head injury

Questions and answers

Reviewed by

Pavel Kornilov, MDPsychiatrist

Depression, anxiety disorders, OCD, bipolar disorder; online medication selection and adjustment.