With derealization, the patient perceives the environment as unreal. The trigger are often emotional stressful situations. For treatment, patients usually receive cognitive behavioral therapy.
What is derealization?
People generally perceive their environment as familiar. Even in a foreign country, at least the way of perception remains familiar. The perceived world therefore appears real and close to the viewer. During derealization, a feeling of alienation and unreality arises in relation to one’s own perception. The perceived world suddenly appears distant, abnormal or alienated.
The environment is universally perceived as alien. Those affected can assign individual details and people, but people, certain objects or the environment itself still appear unfamiliar, distant, unreal, artificial, disproportionate, lifeless or colorless to them. The state of derealization can be brief and momentary, or persistent for different lengths of time.
A perception disorder usually develops from the derealization, which permanently alienates the entire perception and thus the perceived reality of the patient. Some people affected only see veiled, see impressions only weakened or feel great distance between themselves and the environment.
Temporal aspects of experience are also partly affected. In almost all cases, derealization is associated with depersonalization. This means that the condition changes the originally natural feeling of personality. Experience of derealization is an ego disorder that can be traced back to various causes.
Derealization can affect mentally ill as well as mentally healthy people. The changed experience is often triggered by emotionally highly stressful situations that are accompanied by panic, tiredness and exhaustion. Since drugs, medication such as antidepressants and stimulants such as caffeine or nicotine also intervene in the perception system, derealization and depersonalization can be related to the consumption of these substances.
The disturbed perception can also adjust to withdrawal, for example with alcohol or benzodiazepine withdrawal. The physical causes include diseases of the central nervous system, especially epilepsy, migraines and head injuries. In addition, disorders of the vestibular apparatus are among the physically conceivable causes of derealization, for example in the context of labyrinthitis or neuronitis.
In some cases, severe sleep disorders were also causally related to the disorder. In addition to the borderline personality disorder, the main psychological causes include depression. Derealization and depersonalization are just as widespread in the context of schizophrenia or anxiety disorders and panic disorders.
Psychologically caused derealizations usually occur in the context of trauma. The person concerned cannot and does not want to experience the stressful and traumatizing situation as a reality.
Symptoms, ailments & signs
Derealization can be experienced in a number of ways. Some patients feel a general unreality in relation to their environment. Others experience their own perception as if under a cheese dome or through dark sunglasses. The environment or certain parts of the environment appear strange or unfamiliar and unreal to those affected.
Many patients also speak of a robotic, distant, artificial environment. For some sufferers, only the proportion is disturbed. Things look too small or too big, appear colorless or look lifeless. Derealization can lead to an obsession with the idea of not being part of the perceived world.
Especially when combined with depersonalization, patients often experience derealization as frightening and react with panic. In individual cases, the unreal feeling extends to parts of your own body. For example, some patients no longer perceive their own hands as “real” or actually belonging to themselves.
All other symptoms of derealization depend on the primary cause. In the context of schizophrenia, for example, the feeling of involuntary external influence can arise. The patients feel that they are being remotely controlled and experience not only the environment, but also themselves like a robot.
According to ICD-10, several criteria must be met when diagnosing derealization. The environment must appear strange, unreal, lifeless or otherwise artificial to the patient. The person concerned also accepts that the changed perception is not due to a direct cause in the environment and describes a subjectively spontaneous change in perception.
In addition to the insight into the illness, the person concerned must show awareness that his perceptual experience is not a toxic state of confusion or an epileptic state of illness. Disturbances such as metamorphopsia, hallucination, illusion or delusional misunderstanding of reality are to be considered as differential diagnoses. The prognosis depends on the individual case.
As a rule, derealization mainly leads to mental disorders that can have serious consequences for the patient. In the worst case, thoughts of suicide or even suicide occur. Immediate medical treatment is therefore necessary in the event of a derealization.
In most cases, the entire environment feels strange to the patient, although he can recognize and assign all people and facts in life. This can lead to depression and other mental disorders. Often there is tiredness, headache and dizziness. Sleep disorders are also not uncommon and reduce the quality of life enormously.
Often times, patients don’t care about other people’s feelings, making them appear cold and numb. This can have a negative impact on friendships and social contacts.
The derealization can be treated by talking to a psychologist. As a rule, insight into the disease occurs very quickly, so that the treatment can be successful and the person concerned see a psychologist himself.
In some cases, derealization can result from abuse of alcohol and other drugs. This also damages the body physically. Withdrawal is necessary to combat derealization. Various serious complications can arise for the body from drug abuse.
When should you go to the doctor?
A doctor’s visit is necessary if there are changes in perception that are classified as abnormal in everyday life. If the environment is perceived as strange or alien, this is considered unusual and should be investigated. The sensations can be sporadic, temporary, or continuous. With all possibilities of occurrence, a doctor is needed. In many cases, due to the mental disorder, the person concerned does not realize that he should seek medical help.
For this reason, the duty of care of people in the immediate vicinity is important. You should talk to the person concerned and find out about the symptoms. Subsequently, assistance from a doctor is often requested on the initiative of the family. Concern for a loved one is justified as soon as they are suffering from substance abuse or appear lifeless. In order to avoid misunderstandings and to understand the behavior and emotions of the person concerned, it is necessary that all persons involved obtain comprehensive information from a doctor about the disease.
If the relatives need support in dealing with the events because of the psychological burden they have, they should seek therapeutic help. If the person concerned is able to realize a boundary between himself and the environment, he should consult a doctor.
Treatment & Therapy
Treated in a small, non-randomized, uncontrolled study on the use of cognitive behavioral therapy. This is especially true for fear-influenced derealization states. Accompanying symptomatic fears and depression are resolved as far as possible during therapy. The cause of a traumatizing situation is ideally resolved and reoccupied.
The fear of the altered perception results in persistent panic, compulsive introspection and avoidant behavior. The cognitive-behavioral treatment approach therefore aims to give the patient an opportunity to reassess the experience of depersonalization and derealization, so that the appearance of the threatening is lost.
The reassessment of perception as “normal” has shown positive effects on patient recovery in the past. In some cases, neuromodulation is also used, for example electroconvulsive therapy and transcranial magnetic stimulation. Drug therapies are also used in some cases.
Glutamate modulators, opioid antagonists, benzodiazepines, neuroleptics and stimulants are primarily available as preparations for depersonalization. However, the medication usually does not resolve the root cause. In the case of neurogenic causes, causal therapy is also used as far as possible.
Outlook & forecast
In the case of a primary syndrome, the prognosis of derealization has an unfavorable prospect of cure. The course in these patients is chronic and persistent. In addition, the patient’s risk of suicide is significantly higher.
For all other patients, the prognosis perspective must be assessed individually. About half of all adolescents suffer from temporary derealization during adolescence under high stress conditions. As soon as the stress drops or how to deal with the situation has been learned, symptoms usually regress in these patients. The spontaneous healing is permanent and does not require medical care.
If there are other mental illnesses, the prospect of a cure worsens. The chances of recovery decrease, especially in the case of personality or mood disorders. Therapy often lasts for several years. In some cases there is no healing. In psychotherapy, patients learn to live with the symptoms.
The derealization is integrated into everyday life and leads to relief for the patient. Avoiding stress and maintaining an optimistic attitude improves the patient’s prognosis. A healthy way of coping with everyday obstacles and dealing well with life crises also help to strengthen well-being and reduce symptoms.
Since emotionally stressful situations occur in every life, derealization in such situations cannot be prevented in a promising way. The derealization and depersonalization are actually a protection of the organism, especially in stressful situations.
In most cases, there are no special follow-up options or measures available to the patient in the event of a derealization. The person concerned is therefore primarily dependent on a very early diagnosis and treatment of the disease so that there are no further complications and complaints. A direct and causal treatment of this disease is usually not possible because its cause is not known.
For this reason, follow-up care measures are only possible to a very limited extent or not at all. Treatment is carried out with the help of medication and psychological treatment. The patient should pay attention to the correct dosage of the medication and, if in doubt, contact a doctor. The help and support of friends or your own family can also be very useful in order to prevent further upsets.
The relatives should familiarize themselves with the derealization and learn to understand the disease, even if they cannot live through it directly. Contact with other people affected by the derealization can also be very useful. In serious cases, the relatives can persuade the person concerned to seek treatment in a closed institution. In most cases, the disease does not reduce the patient’s life expectancy.
You can do that yourself
The derealization with an alienated perception of the environment can significantly reduce the quality of life of those affected. The focus of the disorder derealization is a dissociatively interrupted self-experience. In order to alleviate the suffering of the disorder, strategies are recommended that bring the affected person’s attention to the here-and-now.
Especially with an irritation of the sensory organs, which can be seen as a short-term means of relief, the gap between the patient and his experience of reality can be minimized. Perfumes are often used to stimulate the sense of smell, while spicy foods such as mustard, chilli peppers and sour foods such as lemons are used to stimulate the sense of taste. Those who want to stimulate their hearing can clap their hands loudly, listen to stimulating music or stay in a noisy environment. Pain stimuli, which you can inflict on yourself in small doses, have a positive effect on the experience of those affected.
Those affected should repeatedly have sensual experiences in everyday life that they can experience without the need for separation. Sensual experiences can take place in the form of touching as well as by listening to pleasant music or by relaxing baths with fragrant bath essences. Conscious, mindful consumption of delicious food can also be perceived as a beneficial experience by those affected and can be of great help in the event of a derealization disorder.