Many can relate to a passing feeling of disconnection or detachment every so often, but if you've suddenly found yourself in a constant state of detachment, experiencing visual distortions, or perhaps even avoiding mirrors, you may have derealization disorder.
"A depressing and debilitating condition, derealization essentially involves a person feeling, and being completely aware of, a disconnection between their mind and body," said Dr. Kathryn Smerling, a psychotherapist.
Derealization makes someone feel like they're in a perpetual dreamlike state, disassociating from themselves, their surroundings, or both. "It's an emotional roller coaster of a disorder, as it interferes with one's day-to-day life and makes one feel like there's an actual veil or impossible barrier between you and reality," Dr. Smerling said. Things that you're used to seeing and being surrounded by can all of a sudden seem foggy or not real. You may have a sense like you're "not all there" or might be having persistent out-of-body experiences.
"People with depersonalization/derealization disorder experience regular and persistent episodes of depersonalization and/or derealization," said Kinsey McManus, MA, MSW, client services direction at the National Alliance on Mental Illness-NYC Metro (NAMI-NYC Metro).
"Depersonalization can include experiences of unreality, detachment, or feeling like an outside observer of internal thoughts, feelings, and sensations or actions," McManus said. Someone experiencing depersonalization may express that they have feelings but can't feel them, that they are no one, or that their head feels filled with cotton. While depersonalization is specific to a person's internal world and sense of self, derealization has to do with a person's connection to their surroundings. "People experiencing derealization may report feeling like they are walking around in a dream, that life seems fake or colorless, or that their vision is distorting what they are seeing (e.g., having a widened or narrowed field of vision, or seeing in the outside world as two-dimensional or exaggerated three-dimensional)," McManus said.
Many people with this disorder have difficulty explaining their symptoms, and they may be particularly fearful that they have irreversible brain damage. They may report that time seems to be moving too fast or too slow. "Someone may also be obsessed with whether or not they really exist or ask a lot of questions about how someone else may see things in their physical environment, in order to check their own perceptions," McManus said.
It is important to note that depersonalization and derealization are not psychotic symptoms like those for people who experience schizophrenia. "A hallmark of this disorder is that people are able to evaluate their experiences against real life," McManus said. For example, knowing that they are experiencing a distorted perception of time.
Temporary depersonalization or derealization symptoms lasting hours to days are common. "About 50 percent of all adults will experience one episode of depersonalization or derealization in their life. Only about two percent of the population will actually experience symptoms that meet the definition of the disorder," McManus said, adding that depersonalization/derealization affects men and women equally.
Symptoms of this disorder are highly distressing. However, it can be difficult for others to appreciate this because the nature of the disorder leads people to appear emotionless and robotic. This disconnection to life can lead to great challenges interpersonally and professionally.
Diagnosis and Treatment
Derealization can be caused by certain hallucinogens or cannabis but can also commonly be the result of acute stress or significant past trauma. People disassociate when they're living in extreme fear. If they're feeling overwhelmed or as if things are getting too much to handle, derealization can result. "They become robotic, disconnected from their emotions, and unable to feel awareness of their own bodies. It's complete turmoil, and the worst fact is the individual is completely aware of what's happening — they're not tuned out — they know something's wrong.
If you believe you struggle with derealization disorder, the best thing to do would be to see a psychotherapist. Talk therapy would be the sole option as there are no medications for this disorder," Dr. Smerling said.