Derealization: Difference between revisions

{{see also|Terms|Non-technical Terms]]

[[Derealization]] ('''DR''') is a form of [[dissociation]] in which the **external world feels unreal, dream-like, foggy, artificial, distant, or visually distorted**.<ref name="DSM5">American Psychiatric Association. (2013). ''Diagnostic and Statistical Manual of Mental Disorders'' (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>  Although surroundings may appear “flat,” “cartoonish,” or “as if seen through glass,” **reality-testing remains intact**: the sufferer knows the environment itself has not actually changed. Derealization often co-occurs with [[depersonalization]] (detachment from one’s self); persistent or recurrent episodes of either — when clinically distressing — are diagnosed as [[Depersonalization/Derealization Disorder]] (DPDR).<ref name="Simeon2004">Simeon, D. (2004). Depersonalisation disorder: a contemporary overview. ''CNS Drugs'', 18 (6), 343-354. https://doi.org/10.2165/00023210-200418060-00002</ref>

* **Core symptoms** include a sense that people or objects are artificial, colour-less, two-dimensional, or remote; time may seem sped up or slowed; familiar places can appear strangely foreign.<ref name="Hunter2004">Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. ''Social Psychiatry & Psychiatric Epidemiology'', 39 (1), 9-18. https://doi.org/10.1007/s00127-004-0701-4</ref>

* **Prevalence.** Transient DR/DP episodes occur in **26-74 %** of the general population, but chronic DPDR affects roughly **1-2 %**.<ref name="Hunter2004" /><ref>Y, J., Millman, L. S., David, A. S., & Hunter, E. (2023). The prevalence of depersonalization-derealization disorder: a systematic review. ''Journal of Trauma & Dissociation'', 24 (1), 8-41. https://doi.org/10.1080/15299732.2022.2079796</ref>

| Cognitive || Feeling “in a film,” heightened [[self-observation]], doubts about the reality of memories

: Cannabis, hallucinogens (e.g., LSD, psilocybin), [[ketamine]], MDMA, stimulant intoxication, or benzodiazepine withdrawal can precipitate DR.<ref>Simeon, D., Kozin, D., Segal, K., & Lerch, B. (2009). Is depersonalization disorder initiated by illicit drug use any different? ''Journal of Clinical Psychiatry'', 70 (10), 1358-1364.</ref>

Neuro-imaging studies reveal a **fronto-limbic “decoupling”**: hyper-activation of pre-frontal regions suppresses limbic emotional circuits, yielding detachment from affective salience.<ref>Sierra, M. & David, A. S. (2011). Depersonalization: a selective impairment of self-awareness. ''Consciousness & Cognition'', 20 (1), 99-108.</ref>  Reduced insular activity may underlie impaired [[interoception]], while alterations in visual association cortices correlate with perceptual distortions.<ref>Adler, J. et al. (2014). Altered orientation of spatial attention in DPDR. ''Psychiatry Research: Neuroimaging'', 216 (2), 230-235.</ref>

Immersive [[virtual reality]] (VR) and [[augmented reality]] (AR) deliberately alter multisensory input, raising concern that they may **induce transient or persistent DR/DP symptoms**.

A pivotal study from the Fernand-Seguin Research Center reported significant increases in DR/DP and reduced sense of [[presence]] after VR exposure.<ref name="Aardema2010">Aardema, F., O'Connor, K., Côté, S., & Taillon, A. (2010). Virtual reality induces dissociation and lowers sense of presence in objective reality. ''Cyberpsychology, Behavior, & Social Networking'', 13 (4), 429-435. https://doi.org/10.1089/cyber.2009.0164</ref>  More recent RCTs and surveys confirm that **VR can acutely elevate DR scores**, yet effects typically resolve within minutes to hours and rarely persist.<ref>Braun, N. et al. (2022). Virtual reality induces depersonalization and derealization: a longitudinal RCT. ''Computers in Human Behavior'', 131, 107233.</ref><ref>Barreda-Ángeles, M., & Hartmann, T. (2023). Experiences of DP/DR among users of VR applications: a cross-sectional survey. ''Cyberpsychology, Behavior, & Social Networking'', 26 (1), 22-27.</ref>

* High '''immersion / presence shift''', producing a temporary imbalance favouring virtual over physical cues.<ref>Slater, M., & Sanchez-Vives, M. V. (2016). Enhancing our lives with immersive VR. ''Frontiers in Robotics & AI'', 3, 74.</ref>

* **Session design:** build-in breaks every 20–30 min; gradual onboarding for new users.   

* **Grounding techniques:** post-VR mindfulness, tactile engagement, or brief exercise help re-establish physical-world presence.   

* **User warnings:** advise individuals with DPDR, severe [[anxiety]], or trauma histories to proceed cautiously.<ref name="Madary2016" />   

* **Clinical monitoring:** therapists using VR exposure should screen for dissociative side-effects.<ref>Maples-Keller, J. L. et al. (2017). The use of VR in treatment of anxiety & psychiatric disorders. ''Harvard Review of Psychiatry'', 25 (3), 103-113.</ref>

Paradoxically, controlled VR has been investigated to **treat** dissociative conditions — e.g., reality-discrimination training or interoceptive biofeedback to enhance bodily awareness.<ref>Opriş, D. et al. (2012). VR exposure therapy in anxiety disorders: a meta-analysis. ''Depression & Anxiety'', 29 (2), 85-93.</ref>