Mental-Cognitive Symptoms

Derealization - A Scary Anxiety Symptom

  • Derealization is the feeling as though the reality around you is altered.
  • It is a common symptom of severe anxiety, especially within specific anxiety disorders.
  • Scientists have many theories about why de-realization occurs.
  • There are small strategies that you can implement to “bring you back” to reality during an episode.
  • Treating the specific type of anxiety you are experiencing should stop periods of de-realization.
Micah Abraham, BSc

Written by

Micah Abraham, BSc

Last updated January 17, 2023

Derealization - A Scary Anxiety Symptom

Derealization is a feeling of detachment from your external surroundings and a common anxiety symptom. When someone experiences derealization anxiety, they may feel as though something is off in reality and the world around them is essentially crashing. In some cases, this may cause the world to feel "unreal," as though something is not quite right in the world around them.

If derealization happens to you, it may feel like you’re going crazy. It has a way of doing that. However, you’re not alone. Of those who experience trauma, up to 66% will confront derealization.

Derealization can be one of many frightening anxiety symptoms. But how are the two linked? And what can you do about derealization? Find out below.

What Is Derealization?

According to the Diagnostic and Statistical Manual (DSM-5), derealization is “experiences of unreality or detachment with respect to surroundings.”

Derealization has various tell-tale psychological symptoms, including:

  • A dream-like state
  • Feeling detached from reality
  • Out-of-body sensation
  • Feeling like you have an emotional detachment from reality
  • Seeing a distorted or colorless reality
  • Distortion in time perception
  • The world seems fake
  • Sound distortion

The American Psychiatric Association (APA) states that depersonalization/derealization disorder is one of three types of dissociative disorders. The other two are:

  1. Dissociative identity disorder
  2. Dissociative amnesia

Often, the term “depersonalization disorder” is used interchangeably with derealization. However, APA describes a distinction between the two.

  • Depersonalization: Unreality/detachment from your mind, body, or soul. Out-of-body experiences are common with depersonalization - you may feel like you’re watching yourself from another standpoint.
  • Derealization: Unreality/detachment to your surroundings. Feeling that things and people are fake or distorted is characteristic of derealization.

So, what is the relationship between anxiety and derealization? Let’s discuss the link.

Anxiety and Derealization: What’s the Link?

Derealization is a common anxiety disorder symptom. Many people who have healthy levels of anxiety may never experience this phenomenon. However, the incidence of derealization is far more common as anxiety persists, becoming chronic.

Therefore, if people suffer from anxiety disorders like social anxiety disorder, generalized anxiety disorder, or OCD, they're at a greater risk of derealization.

Your derealization may span for just a few minutes, or it may last for months. However, unlike personality disorders, with derealization, the individual senses something isn’t quite right with their perception of the world - they have some awareness that it’s inaccurate. For this reason, derealization can be highly distressing.

However, derealization isn’t always due to anxiety. Other factors may also be involved.

Other Causes of Derealization

The American Psychiatric Association states that derealization may arise for several reasons. Namely, from other medical conditions and trauma. Evidence also suggests that mental illness may play a role. Let’s look at each of these in turn.

#1 Untreated Medical Condition

Anxiety isn’t the only reason why people experience derealization. In fact, the phenomenon is linked to various medical health conditions, including:

  • Drug abuse
  • Depression
  • Dementia
  • Seizures
  • Amnesia and other dissociative disorders
  • Schizophrenia

Therefore, it’s essential to seek your doctor’s medical expertise, as they will be able to provide medical advice, diagnosis, or treatment.

#2 Trauma

As stated earlier, roughly 66% of traumatized people experience derealization in their lifetime. Experts suggest that derealization may occur as a reaction to severe trauma, such as war and child abuse. Derealization may, therefore, act as a defense mechanism against further harm.

Some refer to dissociative disorders such as derealization as an “airbag,” cushioning the blow of threatening situations that may lead to stress, trauma, or panic. 

#3 Depression

In a recent systematic review, researchers found that around 50% of participants with depression experienced derealization disorder. This was compared to:

  • 1.8 - 5.9% of substance abuse
  • 3.3 - 20.2% in anxiety
  • 3.7 - 20.4% in other dissociative conditions
  • 16.3% of people with schizophrenia
  • 17% of individuals with borderline personality disorder

This suggests that those with a diagnosis such as depression are at a higher risk of developing derealization disorder, and perhaps, vice versa.

Derealization and the Brain

Derealization is incredibly complex. While the underpinnings of derealization are unknown by researchers, neuroscientific research highlights various brain regions that may be involved.

Peer-reviewed studies suggest that some regions of the brain may disconnect when depersonalization occurs. Namely, the cortico-limbic system (including the amygdala), anterior cingulate cortex, and prefrontal structures. These areas have involvement in integrating emotion with cognition, empathy, and impulse control, respectively.

Furthermore, there appears to be more activity than usual in brain areas associated with attention, arousal modulation, and cognitive control. This makes sense, as experts suggest that derealization and other psychiatric disorders likely require high levels of psychological control.

Therefore, during intense periods of anxiety (as occurs with panic attacks and panic disorder), the mind seems to tune the world out to temporarily eliminate thinking about the anxiety-inducing stimuli.

Since the mind keeps working during this ‘tune out,' the world becomes a place that feels unreal. Those who experience derealization will usually find it occurs at the peak of an anxiety attack, along with other anxiety symptoms.

What Derealization Feels Like

For those who have not personally experienced derealization, it may help to imagine being transported into a place you do not recognize or understand. In this place, you cannot seem to follow what's going on or make sense of the world around you. Your brain's failure to process the information being taken in by your sense (sight, sound, etc.) results in even the most familiar places looking unfamiliar and strange.

There's no denying that this experience is profoundly unusual and a frightening occurrence. It can often feel like you're not really in the environment surrounding you or that the world around you is unreal. You may feel like you're watching something going on with no understanding of what it is or that the world is a dream that you aren't able to escape. In some cases, derealization may occur alongside experiencing depersonalization, making it feel like you're watching yourself.

Other anxiety symptoms may make the feeling of derealization worse. During a severe stress response such as an anxiety attack, your pupils dilate, which can cause distorted vision. Your muscles may also weaken, making you feel lighter. There are countless ways that your anxiety symptoms may interact and potentially exacerbate one another. You can learn more in our article on physical anxiety symptoms.

How to Stop Derealization

Derealization - when it comes from anxiety - is not considered dangerous. It generally goes away on its own and only comes during periods of intense anxiety symptoms. If your derealization is so persistent that it's altering your sense of reality, or if it lasts for a long period of time, you should contact a doctor immediately.


Medical and mental health professionals generally agree that mindfulness is the best way to stop derealization. Mindfulness is the act of becoming more aware of your own body and the present moment.

You can complete mindfulness in a variety of ways, but the easiest way is to simply get yourself to perform an action and focus as much as possible on that action in order to get yourself back into the world.

For example:

  • Touch something warm or cold. Focus on the warmth or cold.
  • Pinch yourself so that you feel how real you are.
  • Try to find a single object and start identifying what it is and what you know about it.
  • Count something in the room. Identify what they are.
  • Utilize your senses in any way possible.

Consider starting with the following exercise, and see if this helps with the derealization:

  • The moment you feel as though you may be experiencing de-realization, go through the 5 senses with your surroundings.
  • Start with taste. It helps to keep a mint with you. Place the mint in your mouth and focus on the flavor. Try to place the mint on all corners of your tongue.
  • Next is your sense of smell. You can either smell the mint carton or smell it in your surroundings and try to identify the source of each smell.
  • Next is touch. Try touching what's around you and slowly feel the textures. Explore more than one texture.
  • Next is hearing. Listen for what's around you and identify the sounds.
  • Finally, sight. Now that you've gone through the other 4 senses, look for things out in the distance and identify what they are, count them, or otherwise immerse your vision.

It may be helpful to meditate or perform these exercises even when you're not experiencing derealization to practice utilizing your senses to experience what is “real.”

Evidence demonstrates that mindfulness reduces anxiety symptoms, and hence makes derealization less likely to occur.


Deep Breathing

Another effective method for snapping out of derealization (and preventing it altogether!) is deep breathing exercises. When you become stressed, this sets off your fight-or-flight response, triggering a range of physical symptoms. If you can calm your nervous system, you can reduce the risk of entering a dream-like state such as derealization.

There are various deep breathing exercises you can try. Check out our article on deep breathing exercises for anxiety to find out more.

Remember, derealization is an anxiety symptom. It doesn't mean you're psychotic, nor does it mean anything is wrong with your mind. As such, part of overcoming derealization is simply to wait it out, then address your anxiety symptoms in order to make sure you don't experience that intense level of anxiety again. 

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

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Where can I go to learn more about Jacobson’s relaxation technique and other similar methods?

– Anonymous patient


You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process.

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