"Everything feels unreal": Derealization and Anxiety.

Have you ever had the experience of feeling like things are unreal? Like, you’re in your experience, living your life, doing your thing, but it just feels like a dream?

Called depersonalization (feeling like your self is unreal) or derealization (feeling like the world is unreal), it can be a jarring, unsettling experience. And it not unusual for people who are struggling with severe anxiety and panic attacks.

To clarify, when we talk about depersonalization/derealization, we are talking not talking about an abstract philosophical idea (such as solipsism), a metaphysical insight (such as Zen’s kensho), or a firmly held and acted-upon belief (such as occurs in a psychotic or drug-addled experience).  Rather, this is just a feeling, a sensory experience. You feel like the world is fake and disconnected from you, even though you don’t actually believe this to be the case.

Derealization (I’ll use this term to encompass depersonalization, for brevity’s sake) has been a recognized psychological phenomenon for decades. It is unusual, but not exactly rare; in a 2000 study of 1008 randomly-chosen people, nearly one in four reported having experienced it at some point.

Sometimes, you can simulate this feeling of unreality (in a mild sense) by hyperventilating, by standing up too quickly, or by staring at something (like a chain link fence) for a very long time. You can also bring it on (intentionally or otherwise) by using recreational drugs such as marijuana and hallucinogens.  In any case, derealization feels, well, weird. And when it occurs spontaneously and for no apparent reason, it can cause considerable anxiety and fear.

If you experience derealization, and you try to understand it by Googling it (assuming you even happen to know the word for it), you might come across some things that scare you. You might read that derealization is a feature of psychiatric conditions such as panic disorder, posttraumatic stress disorder (PTSD), and psychosis. You might also read about derealization disorder, which is a chronic experience of derealization. Or, you might read about how it is associated with neurological conditions such as epilepsy, traumatic brain injury, and migraines.

All of that sounds pretty scary. But it really shouldn't. Because even though these conditions can include derealization as a symptom, derealization neither causes nor indicates these conditions. It’s like how coughing can be a symptom of emphysema, but you shouldn’t assume that your cough means you have emphysema. Statistically speaking, a cough probably just means you have a cold, and derealization probably just means you have anxiety.

However, as is usually the case with anxiety disorders, the problem is not the anxiety itself, but the interpretation of the anxiety. If you experience derealization, you might start to think things like...

  • “I’m losing my grip on reality”

  • “I have brain damage”

  • “This will last forever”

  • “I’m not in control of myself”

In my experience, none of those beliefs have ever been valid for any of my clients. However, they can become part of the Panic Cycle, and serve to further amplify anxiety and panic. Because you’re worried about derealization, you become hypersensitive to it, so you think it’s happening more frequently, which makes you more anxious, which leads to more derealization, and so on and so on.

When this is the case, we address it in therapy like we would any other physiological experience that triggers a panic attack. We identify and counter the problematic beliefs, and we practice experiencing it mindfully, without judgment or reaction. We try to understand what else may be feeding the preoccupation with this experience. And often, once derealization is no longer experienced as threatening, its significance fades, and it becomes a non-issue.