Derealization

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Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. [1] Described as "Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless or visually distorted") in the DSM-5, it is a dissociative symptom that may appear in moments of severe stress. [2] [3]

Contents

Derealization is a subjective experience pertaining to a person's perception of the outside world, while depersonalization is a related symptom characterized by dissociation towards one's own body and mental processes. The two are commonly experienced in conjunction with one another, but are also known to occur independently. [4]

Chronic derealization is fairly rare, and may be caused by occipital–temporal dysfunction. [5] Experiencing derealization for long periods of time or having recurring episodes can be indicative of many psychological disorders, and can cause significant distress. However, temporary derealization symptoms are commonly experienced by the general population a few times throughout their lives, with a lifetime prevalence of up to 26–74% and a prevalence of 31–66% at the time of a traumatic event. [6]

Derealization is linked to childhood trauma, with the severity of derealization correlating directly with the reported severity of childhood maltreatment experienced by individuals. [7]

Description

The experience of derealization can be described as an immaterial substance that separates a person from the outside world, such as a sensory fog, pane of glass, or veil. It may feel as if the person is viewing their immediate surroundings through VR glasses, through glass, or on a movie screen. Individuals may report that what they see lacks vividness and emotional coloring. [8] Emotional response to visual recognition of loved ones may be significantly reduced. Feelings of déjà vu or jamais vu are common. One may not even be sure whether what one perceives is in fact reality or not. The world as perceived by the individual may feel as if it were going through a dolly zoom effect. Such perceptual abnormalities may also extend to the senses of hearing, taste, and smell. An important differentiation between hallucination and derealization is that an individual does not hear, see, or experience things that are not real or visible during derealization, rather, one experiences their immediate surroundings as distant or dreamlike. During this state of altered perception, the individual is aware of the subjective nature of the feeling. [9]

The degree of familiarity one has with their surroundings is among one's sensory and psychological identity, memory foundation and history when experiencing a place. When persons are in a state of derealization, they block this identifying foundation from recall. This "blocking effect" creates a discrepancy of correlation between one's perception of one's surroundings during a derealization episode, and what that same individual would perceive in the absence of a derealization episode.

Frequently, derealization occurs in the context of constant worrying or "intrusive thoughts" that one finds hard to switch off. In such cases it can build unnoticed along with the underlying anxiety attached to these disturbing thoughts, and be recognized only in the aftermath of a realization of crisis, often a panic attack, subsequently seeming difficult or impossible to ignore. This type of anxiety can be crippling to the affected and may lead to avoidant behavior. Those who experience this phenomenon may feel concern over the cause of their derealization. It is often difficult to accept that such a disturbing symptom is simply a result of anxiety, and the individual may often think that the cause must be something more serious. This can, in turn, cause more anxiety and worsen the derealization. Derealization also has been shown to interfere with the learning process, with cognitive impairments demonstrated in immediate recall and visuospatial deficits. [10] This can be best understood as the individual feeling as if they see the events in third person. [11]

Causes

Derealization can accompany the neurological conditions of epilepsy (particularly temporal lobe epilepsy), migraine, and mild TBI (head injury). [12] There is a similarity between visual hypo-emotionality, a reduced emotional response to viewed objects, and derealization. This suggests a disruption of the process by which perception becomes emotionally colored. This qualitative change in the experiencing of perception may lead to reports of anything viewed being unreal or detached. [5]

The instances of recurring or chronic derealization among those who have experienced extreme trauma and/or have post-traumatic stress (PTSD) have been studied closely in many scientific studies, whose results indicate a strong link between the disorders, with a disproportionate amount of post traumatic stress patients reporting recurring feelings of derealization and depersonalization (up to 30% of those with the condition) in comparison to the general populace (only around 2%), [13] especially in those who experienced the trauma in childhood. Many possibilities have been suggested by various psychologists to help explain these findings, the most widely accepted including that experiencing trauma can cause individuals to distance themselves from their surroundings and perception, with the aim of subsequently distancing themselves from the trauma and (especially in the case of depersonalisation) their emotional response to it. This could be either as a deliberate coping mechanism or an involuntary, reflexive response depending on circumstance. [14] This possibly not only increases the risk of experiencing problems with derealization and its corresponding disorder, but with all relevant dissociative disorders. In the case of childhood trauma, not only are children more likely to be susceptible to such a response as they are less able to implement more healthy strategies to deal with the emotional implications of experiencing trauma, there is also a lot of evidence that shows trauma can have a substantial detrimental effect on learning and development, especially since those who experience trauma in childhood are far less likely to have received adequate parenting. [14] These are factors proven to increase susceptibility to maladaptive psychological conditions, which of course includes dissociative disorders and subsequently derealization symptoms.

Some neurophysiological studies have noted disturbances arising from the frontal-temporal cortex, which could explain the correlation found between derealization symptoms and temporal lobe disorders. This is further supported by reports of people with frontal lobe epilepsy, with those with epilepsy of the dorsal premotor cortex reporting symptoms of depersonalization, while those with temporal lobe epilepsy reported experiencing derealization symptoms. [15] This implies that malfunction of these specific brain regions may be the cause of these dissociative symptoms, or at the very least that these brain regions are heavily involved.

Derealization is a common psychosomatic symptom seen in various anxiety disorders, especially hypochondria. [16] However, derealization is presently regarded as a separate psychological issue due to its presence as a symptom within several pathologies.

Derealization and dissociative symptoms have been linked by some studies to various physiological and psychological differences in individuals and their environments. It was remarked that labile sleep-wake cycles (labile meaning more easily roused) with some distinct changes in sleep, such as dream-like states, hypnogogic, hypnopompic hallucinations, night-terrors and other disorders related to sleep could possibly be causative or improve symptoms to a degree. [17] Derealization can also be a symptom of severe sleep disorders and mental disorders like depersonalization disorder, borderline personality disorder, bipolar disorder, schizophrenia, dissociative identity disorder, and other mental conditions. [18]

Cannabis, [19] psychedelics, dissociatives, antidepressants, caffeine, nitrous oxide, albuterol, and nicotine can all produce feelings of derealization, or sensations mimicking them, [20] particularly when taken in excess. It can also result from alcohol withdrawal or benzodiazepine withdrawal. [21] Tramadol withdrawal can also cause feelings of derealization, often alongside psychotic symptoms such as anxiety, paranoia and hallucinations. [22]

Interoceptive exposure exercises have been used in research settings as a means to induce derealization, as well as the related phenomenon depersonalization, in people who are sensitive to high levels of anxiety. Exercises with documented successes include timed intervals of hyperventilation or staring at a mirror, dot, or spiral. [23]

Derealization, as a concept, is referenced in the 2021 comedy special by Bo Burnham called Bo Burnham: Inside ; specifically, it is mentioned in the song "That Funny Feeling". [24]

The protagonist of the 2017 video game Night in the Woods - Mae Borowski - is implied to experience derealization, seeing objects and people as "just shapes" and "just lines someone wrote".

See also

Related Research Articles

<span class="mw-page-title-main">Hallucination</span> Perception that only seems real

A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

<span class="mw-page-title-main">Alice in Wonderland syndrome</span> Neurological disorder that distorts perception of objects size and distance

Alice in Wonderland Syndrome (AIWS), also known as Todd's Syndrome or Dysmetropsia, is a neurological disorder that distorts perception. People with this syndrome may experience distortions in their visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they are. Distortion may also occur for senses other than vision.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization, which involves a sense of detachment from the external world rather than from oneself.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.

Acute stress reaction (ASR), also known as psychological shock, mental shock, or simply shock, and acute stress disorder (ASD), is a psychological response to a terrifying, traumatic, or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

<span class="mw-page-title-main">Hallucinogen persisting perception disorder</span> Medical condition

Hallucinogen persisting perception disorder (HPPD) is a non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs, including but not limited to psychedelics, dissociatives, entactogens, tetrahydrocannabinol (THC), and SSRIs. Despite being designated as a hallucinogen-specific disorder, the specific contributory role of psychedelic drugs is unknown.

Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.

Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.

Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings either verbally or nonverbally, especially when talking about issues that would normally be expected to engage emotions. In this condition, expressive gestures are rare and there is little animation in facial expression or vocal inflection. Additionally, reduced affect can be symptomatic of autism, schizophrenia, depression, post-traumatic stress disorder, depersonalization derealization disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental and behavioral disorder generally occurring in response to complex traumas.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Mystical psychosis is a term coined by Arthur J. Deikman in the early 1970s to characterize first-person accounts of psychotic experiences that are strikingly similar to reports of mystical experiences.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Other specified dissociative disorder (OSDD) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder, and the reasons why the previous diagnoses were not met are specified. "Unspecified dissociative disorder" is given when the clinician does not give a reason. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as "Other dissociative and conversion disorders". Under the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was known as "Dissociative disorder not otherwise specified" (DDNOS).

The Multiscale Dissociation Inventory (MDI) is a comprehensive, self-administered, multiscale instrument developed by Paul F. Dell. It is designed to assess the domain of dissociative phenomena. The MDI measures 14 major facets of pathological dissociation and uses 23 scales to diagnose dissociative disorders.

References

  1. ↑ American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN   0-89042-024-6.
  2. ↑ "Diagnostic and Statistical Manual of Mental Disorders | Psychiatry Online". DSM Library. doi:10.1176/appi.books.9780890425596 . Retrieved 2024-11-21.
  3. ↑ "Depersonalization-derealization disorder - Symptoms and causes". Mayo Clinic . Archived from the original on 2017-10-08. Retrieved 2019-10-10.
  4. ↑ "Depersonalization/Derealization Disorder - Psychiatric Disorders". MSD Manual Professional Edition. Archived from the original on 2020-11-11. Retrieved 2021-02-07.
  5. 1 2 Sierra M, Lopera F, Lambert MV, Phillips ML, David AS (2002). "Separating depersonalisation and derealisation: the relevance of the "lesion method"". J. Neurol. Neurosurg. Psychiatry. 72 (4): 530–2. doi:10.1136/jnnp.72.4.530. PMC   1737835 . PMID   11909918.
  6. ↑ Hunter EC, Sierra M, David AS (2004). "The epidemiology of depersonalization and derealisation". Social Psychiatry and Psychiatric Epidemiology. 39 (1): 9–18. doi:10.1007/s00127-004-0701-4. PMID   15022041. S2CID   31285190.
  7. ↑ Daniels, Judith K.; Timmerman, Marieke E.; Spitzer, Carsten; Lampe, Astrid (2024-12-31). "Differential constellations of dissociative symptoms and their association with childhood trauma – a latent profile analysis". European Journal of Psychotraumatology. 15 (1). doi:10.1080/20008066.2024.2348345. ISSN   2000-8066.
  8. ↑ "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)". The SAGE Encyclopedia of Abnormal and Clinical Psychology. Thousand Oaks, California: SAGE Publications, Inc. 2017. doi:10.4135/9781483365817.n433. ISBN   9781483365831. Archived from the original on 2024-01-26. Retrieved 2022-09-28.
  9. ↑ Graux, Jérôme; Lemoine, Maël; El Hage, Wissam; Camus, Vincent (2012). "From Depersonalization to Hallucination". Psychopathology. 45 (1): 42–52. doi:10.1159/000325911. ISSN   0254-4962.
  10. ↑ Guralnik, Orna; Giesbrecht, Timo; Knutelska, Margaret; Sirroff, Beth; Simeon, Daphne (December 2007). "Cognitive Functioning in Depersonalization Disorder". The Journal of Nervous and Mental Disease. 195 (12): 983–8. doi:10.1097/NMD.0b013e31815c19cd. ISSN   0022-3018. PMID   18091191. S2CID   35238079.
  11. ↑ Spiegel, David; Cardeña, Etzel (1991). "Disintegrated experience: The dissociative disorders revisited". Journal of Abnormal Psychology . 100 (3): 366–378. doi:10.1037/0021-843X.100.3.366. ISSN   1939-1846. PMID   1918616.
  12. ↑ Lambert MV, Sierra M, Phillips ML, David AS (2002). "The spectrum of organic depersonalization: a review plus four new cases". The Journal of Neuropsychiatry and Clinical Neurosciences. 14 (2): 141–54. doi:10.1176/appi.neuropsych.14.2.141. PMID   11983788.
  13. ↑ "Altered Circuits May Cause 'Out-Of-Body' Symptoms in Some People with PTSD". Brain & Behavior Research Foundation. 2015-05-01. Archived from the original on 2021-06-13. Retrieved 2021-02-07.
  14. 1 2 Choi, Kristen R.; Seng, Julia S.; Briggs, Ernestine C.; Munro-Kramer, Michelle L.; Graham-Bermann, Sandra A.; Lee, Robert C.; Ford, Julian D. (December 2017). "The Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) Among Adolescents: Co-Occurring PTSD, Depersonalization/Derealization, and Other Dissociation Symptoms". Journal of the American Academy of Child and Adolescent Psychiatry. 56 (12): 1062–1072. doi:10.1016/j.jaac.2017.09.425. ISSN   0890-8567. PMC   5726572 . PMID   29173740.
  15. ↑ Heydrich, Lukas; Marillier, Guillaume; Evans, Nathan; Seeck, Margitta; Blanke, Olaf (2019-08-22). "Depersonalization- and derealization-like phenomena of epileptic origin". Annals of Clinical and Translational Neurology. 6 (9): 1739–1747. doi:10.1002/acn3.50870. ISSN   2328-9503. PMC   6764488 . PMID   31437864.
  16. ↑ Simon, NM; Pollack, MH; Tuby, KS; Stern, TA. (June 1998). "Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety". Annals of Clinical Psychiatry . 10 (2): 75–80. doi:10.3109/10401239809147746. PMID   9669539.
  17. ↑ Lynn, Lillienfeld (2008). "Challenging Conventional Wisdom- Socio-cognitive Framework for DID & Dissociative Disorders" (PDF). Current Directions in Psychological Science. Archived (PDF) from the original on 2021-02-24. Retrieved 2019-09-08– via Sage.
  18. ↑ Simeon D, Knutelska M, Nelson D, Guralnik O (September 2003). "Feeling unreal: a depersonalization disorder update of 117 cases". Journal of Clinical Psychiatry . 64 (9): 990–7. doi:10.4088/JCP.v64n0903. PMID   14628973.
  19. ↑ Johnson BA (February 1990). "Psychopharmacological effects of cannabis". Br J Hosp Med. 43 (2): 114–6, 118–20, 122. PMID   2178712.
  20. ↑ "Depersonalization-derealization disorder - Symptoms and causes". Mayo Clinic. Archived from the original on 2017-10-08. Retrieved 2021-02-07.
  21. ↑ Mintzer MZ; Stoller KB; Griffiths RR (November 1999). "A controlled study of flumazenil-precipitated withdrawal in chronic low-dose benzodiazepine users". Psychopharmacology . 147 (2): 200–9. doi:10.1007/s002130051161. PMID   10591888. S2CID   35666163.
  22. ↑ Sidana, Ajeet; Domun, Ira; Arora, Prinka (2019). "Tramadol withdrawal psychosis". Indian Journal of Psychiatry . 61 (6): 655–656. doi: 10.4103/psychiatry.IndianJPsychiatry_11_19 . ISSN   0019-5545. PMC   6862981 . PMID   31896879.
  23. ↑ Lickel J, Nelson E, Lickel AH, Deacon B (2008). "Interoceptive Exposure Exercises for Evoking Depersonalization and Derealization: A Pilot Study". Journal of Cognitive Psychotherapy . 22 (4): 321–330. doi:10.1891/0889-8391.22.4.321. S2CID   12746427. Archived from the original on 2021-03-07. Retrieved 2020-11-19.
  24. ↑ That Funny Feeling -- Bo Burnham (from "Inside"), archived from the original on 2021-12-20, retrieved 2022-05-22
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