Derealization Treatment (How It Works + Options)

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Practical Psychology

Imagine walking through life feeling constantly detached, as though you’re living in a dream or a movie, with the world around you seeming foggy and unreal. This is the everyday reality for individuals experiencing derealization, a mental health condition that can be disorienting and distressing.

Derealization is a form of dissociation where a person feels disconnected from their surroundings, with the environment appearing distorted, blurry, or unreal, often leading to feelings of panic and discomfort.

This article aims to shed light on derealization, exploring its causes, symptoms, and the various treatment options available, providing hope for those affected by it. By understanding this disorder, individuals can gain insight into managing and overcoming it, paving the way for a balanced and grounded life.

What is Derealization?


Diagnostic Criteria

Diagnosing derealization can be a challenging process due to the overlapping symptoms it shares with other mental health conditions.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a tool mental health professionals use, outlines distinct criteria for identifying derealization.

Individuals experiencing derealization often report feeling separated from their surroundings and perceive the external world as unreal, distorted, or dreamlike. This detachment can cause significant distress, impacting social relationships, work, and daily activities, which is essential for a clinical diagnosis.

The process of diagnosing derealization includes thorough interviews, questionnaires, and, in some cases, psychological testing. Accurate diagnosis is super important as it forms the basis for any treatment plans.

It's also important for healthcare professionals to distinguish derealization from similar disorders to avoid misdiagnosis and ensure appropriate treatment.

Difference from Depersonalization

Derealization and depersonalization, though closely related, are different experiences. While derealization is characterized by an altered perception of the external environment, making the world seem unreal, depersonalization involves feeling estranged from one’s own thoughts, body, and emotions.

Individuals with depersonalization might feel like observers of their lives, leading to a sense of unreality. In clinical settings, it's not uncommon for patients to experience both derealization and depersonalization simultaneously.

When this occurs, a combined diagnosis of Depersonalization/Derealization Disorder is often made, highlighting the connected nature of these dissociative experiences.

Causes and Risk Factors

Biological Factors

Biological factors, including genetics and neurological functioning, are central to understanding derealization.

There is evidence to suggest that individuals with a family history of dissociative disorders are more susceptible to developing derealization, indicating a potential genetic link.

Additionally, changes in brain function and structure have been observed in people experiencing derealization.

Neuroimaging studies have revealed alterations in brain areas associated with perception and stress response, suggesting that neurological factors contribute to the onset and maintenance of this disorder.

Environmental Factors

The environment one is exposed to significantly influences mental health.

For derealization, exposure to high levels of stress, traumatic events, or adverse childhood experiences can trigger the onset of symptoms. These experiences can affect the brain’s stress response system, increasing the likelihood of dissociative symptoms as a coping mechanism.

Understanding the role of environmental factors is crucial in developing effective treatment strategies. Addressing and processing traumatic experiences can be key to alleviating symptoms and reducing the impact of derealization on an individual’s life.

Psychological Stress

Psychological stress is often a precursor to the development of derealization. When individuals encounter prolonged stress, the brain might employ dissociation as a defense mechanism, creating a sense of detachment from the distressing reality.

This detachment, while initially serving as a protective measure, can lead to the chronic experience of derealization if not addressed.

The relationship between stress and derealization underscores the importance of stress management and mental health support in preventing and treating dissociative disorders.

Prevalence and Demographics

Age of Onset

Derealization most commonly first appears during adolescence or early adulthood. This period, marked by numerous changes, transitions, and stressors, can make individuals more vulnerable to developing dissociative symptoms.

However, it’s essential to note that derealization can occur at any age, and individual differences play a significant role in its manifestation.

Early intervention and support are super important in managing symptoms and preventing the progression of the disorder. Recognizing the signs and providing appropriate resources can make a significant difference in the lives of those affected.

Gender Differences

Research on gender differences in derealization presents varied findings. Some studies indicate equal occurrence among males and females, while others suggest that females may be more likely to seek help for dissociative disorders, impacting the observed gender distribution.

Understanding gender differences in the presentation and reporting of derealization is important for tailoring treatment approaches and addressing the unique needs of different populations.

Global Statistics

Experiences of derealization are not uncommon, with studies estimating that up to half of the general population may have encountered at least a short episode of derealization or depersonalization.

However, for a smaller percentage of individuals, these symptoms persist, causing significant distress and impairment in daily life.

Raising awareness of the prevalence of derealization and reducing the stigma associated with it are essential steps towards encouraging affected individuals to seek help and support.

By comprehensively exploring the symptoms, causes, and prevalence of derealization, we can build a solid foundation of understanding this complex condition.

This knowledge serves as a stepping stone to delve deeper into the historical evolution, development of treatments, and future prospects in addressing derealization, providing hope and guidance for those impacted by it.

History of Derealization

dream within a dream

Evolution of Derealization Diagnosis

Early Descriptions and Case

The term "derealization" has its roots in the 19th century, but it has likely been experienced throughout human history.

The early medical literature contains accounts of individuals describing symptoms remarkably similar to what we now call derealization. These stories, while not labeled as such at the time, highlight the ongoing nature of this condition.

The formal recognition of derealization as a distinct clinical entity occurred gradually.

Early physicians and psychiatrists, such as Pierre Janet in the late 1800s, documented cases, contributing to our initial understanding of this dissociative phenomenon. Their observations paved the way for further research and exploration into the nature of derealization.

Historical Changes in DSM Classification

The evolution of derealization within psychiatric classification systems reflects our growing understanding of this disorder. Initially, derealization and depersonalization were often categorized together under broader classifications of dissociative or neurotic disorders.

The DSM has undergone several revisions, each refining the criteria and classification of derealization.

The most recent edition, DSM-5, recognizes Depersonalization/Derealization Disorder as a distinct diagnosis, reflecting a more detailed understanding and acknowledgement of the uniqueness of these experiences.

Pioneering Researchers and Theories

Pierre Janet

Pierre Janet, a French psychologist, was one of the first to study and document derealization extensively.

Working in the late 19th and early 20th centuries, he explored the relationship between trauma, subconscious mind, and dissociation, laying the groundwork for our modern understanding of derealization.

Janet’s theories emphasized the role of traumatic experiences and psychological stress in the development of dissociative symptoms. He proposed that dissociation served as a defense mechanism, allowing the mind to distance itself from troubling realities, a theory that remains influential in contemporary psychiatry.

Sigmund Freud and Psychoanalytical Approach

Sigmund Freud, the father of psychoanalysis, also contributed to the early understanding of derealization.

While his theories focused primarily on the role of the unconscious mind and internal conflicts, Freud’s exploration of defense mechanisms helped us understand the psychological basis of derealization.

Freud’s psychoanalytical approach highlighted the importance of exploring past experiences and unconscious processes in understanding and treating derealization. This perspective opened avenues for therapeutic interventions, influencing the development of psychotherapy techniques still used today.

Milestones in Treatment Development

Medication Advancements

The 20th century witnessed significant advancements in psychopharmacology, the treatment of mental illnesses with medications, opening new possibilities for treating derealization.

The introduction of antidepressants and anti-anxiety medications provided new tools for managing symptoms, improving the quality of life for many individuals.

Research into the neurological basis of derealization has also led to experimentation with antipsychotic medications, offering additional treatment options. The development and refinement of pharmacological treatments continue to evolve, informed by ongoing research and clinical trials.

Psychotherapy Innovations

Alongside medication advancements, the 20th century also saw the development of various psychotherapy approaches for treating derealization.

Techniques such as Cognitive-Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) emerged, offering promising results for individuals experiencing dissociative disorders. But, they also have their dangers.

These psychotherapy innovations provided new ways to address the underlying psychological factors contributing to derealization.

The emphasis on cognitive restructuring, behavioral interventions, and trauma processing has helped many individuals gain insight, develop coping strategies, and achieve symptom relief.

Conclusion of History

The historical evolution of derealization diagnosis, pioneering research, and treatment development provides a rich backdrop to our current understanding of this complex condition.

By acknowledging the contributions of early researchers and appreciating the advancements in treatment, we gain perspective on the progress made and the possibilities that lie ahead for individuals living with derealization.

Modern Treatment Approaches


Cognitive-Behavioral Therapy (CBT)

CBT stands as one of the most effective treatment approaches for derealization. It focuses on identifying and challenging irrational thoughts and beliefs, helping individuals develop healthier thinking patterns and coping mechanisms.

Therapists work with clients to address distressing thoughts, explore alternative perspectives, and practice grounding techniques to manage symptoms.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a notable psychotherapy technique, particularly for individuals whose derealization is linked to trauma. The therapy involves recalling traumatic memories while receiving bilateral sensory input, such as side-to-side eye movements.

This process can help individuals reprocess traumatic memories, reducing their impact and alleviating derealization symptoms.

Mindfulness and Acceptance-Based Therapies

These therapies teach individuals to observe their thoughts and feelings non-judgmentally and to live in the present moment.

Mindfulness and acceptance-based approaches can be particularly helpful for managing derealization by grounding individuals in the present and reducing anxiety and distress associated with feelings of unreality.

Dialectical Behavior Therapy (DBT)

DBT combines cognitive-behavioral techniques with mindfulness principles. It’s designed to help individuals regulate emotions, tolerate distress, and improve interpersonal relationships.

For those with derealization, DBT can offer tools to manage emotional swings and maintain connections with reality.


Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are commonly prescribed for individuals experiencing derealization, especially when co-occurring with anxiety or depression.

These medications can help regulate mood and reduce anxiety, which may alleviate the intensity and frequency of derealization episodes.


For short-term relief of severe anxiety and distress associated with derealization, benzodiazepines may be prescribed.

However, due to the risk of dependency and tolerance, they are typically not recommended for long-term use in treating derealization.

Antipsychotic Medication

In some cases, low doses of antipsychotic medication may be beneficial for managing severe symptoms of derealization, particularly when other treatments have been ineffective. The use of antipsychotics should be carefully monitored due to potential side effects.

Non-Benzodiazepine Anxiolytics

Medications like buspirone, which are less habit-forming than benzodiazepines, can be effective for managing anxiety symptoms associated with derealization. They may serve as a safer long-term option for some individuals.

Lifestyle Modifications and Coping Strategies

Regular Exercise and Healthy Diet

Adopting a healthy lifestyle, including regular exercise and a balanced diet, can help improve overall mental well-being. Physical activity has been shown to reduce stress and improve mood, which can contribute to managing derealization symptoms.

Adequate Sleep and Stress Management

Ensuring adequate sleep and managing stress are essential for individuals with derealization. Establishing a regular sleep schedule and practicing relaxation techniques like deep breathing and meditation can enhance mental health and reduce symptom frequency.

Building Supportive Relationships

Building and maintaining supportive relationships can be particularly helpful for individuals experiencing derealization. Having a support network provides a sense of connection and reality, which can be grounding for those feeling detached from their surroundings.

Mindfulness and Grounding Techniques

Practicing mindfulness and grounding techniques can help individuals stay connected to the present moment and reality. Techniques such as focused breathing, sensory awareness, and guided imagery can be helpful in managing episodes of derealization.

Conclusion of Treatments

Modern treatment approaches for derealization are diverse and multifaceted, addressing both the psychological and physiological aspects of the condition.

From psychotherapy to medication and lifestyle modifications, individuals living with derealization have a range of options to explore for managing and alleviating their symptoms.

Tailoring treatment to individual needs and preferences is key to fostering recovery and improving quality of life.

Challenges in Treatment and Management

sad dream

Identifying Individual Triggers

Variability of Triggers

Each individual with derealization may have unique triggers that begin episodes. These can range from stress and anxiety to specific environments or sensory stimuli.

Identifying and understanding these triggers is crucial for effective management but can be challenging due to their variability.

Personalized Approach

A personalized approach, involving thorough assessment and individualized treatment planning, is essential to address the specific triggers and needs of each person.

Collaboration between the individual and the treatment team is key to identifying triggers and developing effective coping strategies.

Co-Occurring Disorders

Commonality of Comorbidity

Derealization often does not occur on its own and can be accompanied by other mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD). Having more than one condition is known as "comorbidity."

Addressing co-occurring disorders is integral to successful treatment but adds complexity to the management process.

Holistic Treatment Planning

A holistic approach that addresses all aspects of an individual’s mental health is necessary for effective treatment.

Using various therapies and interventions that target both derealization and any co-occurring conditions can optimize outcomes and support overall well-being.

Stigma and Misunderstanding

Public Perception

Despite growing awareness, derealization remains misunderstood by the general public and, occasionally, by healthcare professionals.

This lack of understanding can lead to stigma, which may deter individuals from seeking help and support.

Educational Initiatives

Increasing education and awareness about derealization among healthcare providers and the wider community is essential to reduce stigma and improve access to appropriate care.

Community outreach, educational campaigns, and professional training can help foster understanding and acceptance.

Obeying Treatment and Accessibility

Challenges in Obeying

Sticking to treatment plans can be challenging for individuals with derealization, especially when symptoms are severe or ongoing.

Motivational strategies, ongoing support, and regular follow-ups are crucial to encourage adherence and monitor progress.

Access to Care

Accessibility to mental health services can be a significant barrier for many.

Efforts to improve access, such as expanding telehealth options and increasing availability of community-based services, are essential to ensure that those in need receive appropriate care.

Conclusion of Challenges

Addressing the challenges in treating and managing derealization is vital to improve the lives of those affected by this condition.

By recognizing individual differences, addressing co-occurring disorders, combating stigma, and enhancing treatment adherence and accessibility, we can build a more supportive and effective mental health landscape for individuals experiencing derealization.

Examples of Derealization Treatments


Case Study 1: Sarah

Sarah, a 30-year-old graphic designer, started experiencing episodes of derealization following a car accident. She described feeling as though the world around her was unreal and dreamlike, which greatly impacted her daily functioning and quality of life.

  1. Treatment Approach
    Sarah was introduced to a combination of Cognitive-Behavioral Therapy (CBT) and medication. The therapy focused on identifying and challenging her irrational thoughts and beliefs, while SSRIs were prescribed to regulate her mood and reduce anxiety.
  2. Outcome
    Over several months, Sarah reported a decrease in the frequency and intensity of her derealization episodes. The personalized approach helped her develop healthier thinking patterns, manage anxiety, and regain a sense of reality and control.

Case Study 2: Alex

Alex, a 22-year-old college student, developed derealization symptoms in response to high academic and social pressures. For Alex, episodes would manifest through a profound sense of disconnection from his environment and peers.

  1. Treatment Approach
    Alex engaged in Dialectical Behavior Therapy (DBT) to regulate emotions and improve interpersonal relationships. Additionally, he adopted lifestyle modifications, including regular exercise and mindfulness practices, to manage stress.
  2. Outcome
    With consistent therapy and lifestyle changes, Alex experienced significant improvement. He learned to handle academic pressures more effectively and felt more connected to his surroundings and peers.

Case Study 3: Emily

Emily, a 40-year-old teacher, had lived with untreated derealization for several years, stemming from childhood trauma. The condition manifested in her adult life during stressful periods, making her feel detached and alienated.

  1. Treatment Approach
    Emily underwent Eye Movement Desensitization and Reprocessing (EMDR) to address the underlying trauma contributing to her derealization. Simultaneously, she was prescribed a low dose of an antipsychotic medication to manage severe symptoms.
  2. Outcome
    The combination of EMDR and medication enabled Emily to reprocess traumatic memories and alleviate the intensity of her derealization symptoms. Over time, she reported feeling more grounded and present in her daily life.

Case Study 4: Michael

Michael, a 50-year-old engineer, experienced chronic derealization, accompanied by severe anxiety. His work and relationships were significantly affected, as he struggled to maintain a connection with reality.

  1. Treatment Approach
    Michael’s treatment included a combination of benzodiazepines for short-term relief of anxiety and distress, alongside Mindfulness and Acceptance-Based Therapies to anchor him in the present and reduce distress.
  2. Outcome
    Through medication and therapy, Michael gained tools to manage his anxiety and derealization. He reported a renewed sense of engagement with his environment and relationships, leading to an improved quality of life.

Conclusion of Case Studies

These case studies illustrate the diversity of derealization experiences and the need for personalized treatment approaches. Each individual faced unique challenges but found relief through a combination of therapy, medication, and lifestyle changes. The positive outcomes highlight the potential for recovery and underscore the importance of early intervention and tailored treatment strategies in managing derealization.

Future Directions in Research and Treatment

Advances in Neuroscience

Neuroimaging Studies

Ongoing neuroimaging studies continue to unravel the brain’s intricacies and how alterations in brain structure and function contribute to derealization.

These discoveries can inform the development of novel treatments and interventions, targeting the neurological underpinnings of the disorder.


Advances in neuropharmacology hold promise for refining medication treatments for derealization.

New drugs, acting on specific neurotransmitter systems implicated in derealization, are being researched and developed, aiming to provide more effective and personalized treatment options.

Integrative and Holistic Approaches

Mind-Body Connection

Exploring the mind-body connection and integrating physical and mental health care can offer innovative approaches to treating derealization.

Practices such as yoga, meditation, and biofeedback are gaining recognition for their potential to enhance well-being and alleviate dissociative symptoms.

Personalized and Precision Medicine

The move towards personalized and precision medicine in psychiatry allows for treatments tailored to the individual’s genetic, biological, and psychological makeup.

This personalized approach can optimize treatment efficacy and minimize adverse effects, offering a more targeted and effective strategy for managing derealization.

Technological Innovations

Virtual Reality (VR) and Biofeedback

The application of technology, such as VR and biofeedback, in mental health treatment opens up new avenues for therapy. These tools can offer immersive and interactive experiences, aiding in exposure therapy, relaxation training, and real-time monitoring of physiological responses.

Telehealth and Online Resources

The expansion of telehealth and online mental health resources increases accessibility to care and support.

These platforms can provide remote therapy, peer support, and educational materials, reaching individuals who might otherwise face barriers to accessing mental health services.


Derealization, while a challenging and often misunderstood condition, is gradually coming into the light with advancements in research, treatment, and public awareness.

The strides made in understanding this disorder, from the pioneering work of early researchers to modern-day innovations, reflect a trajectory of progress and hope.

By continuing to explore new frontiers in neuroscience, embracing holistic and integrative approaches, and leveraging technological innovations, we can look forward to a future where derealization is effectively understood, treated, and perhaps, prevented.

Reference this article:

Practical Psychology. (2023, September). Derealization Treatment (How It Works + Options). Retrieved from

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