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'''Derealization''' ('''DR''') is a subtype of [[dissociation]] characterized by a subjective experience where the external [[world]] or [[objective reality]] feels unreal, strange, dreamlike, foggy, artificial, distant, or visually distorted.<ref name="APA_DSM5_DPDR">American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders* (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 302-306.</ref><ref name="Sierra_Berrios_2000">Sierra, M., & Berrios, G. E. (2000). The Cambridge Depersonalisation Scale: a new instrument for the measurement of depersonalisation. *Psychiatry Research, 93*(2), 153–164. doi:10.1016/s0165-1781(00)00130-8</ref><ref name="Murphy_2023">Murphy, R. J. (2023). "Depersonalization/Derealization Disorder and Neural Correlates of Trauma-related Pathology: A Critical Review." *Innovations in Clinical Neuroscience, 20*(1-3): 53–59. PMID: 37122581.</ref> Individuals experiencing derealization often report that their surroundings lack vibrancy, emotional coloring, or depth, sometimes described as looking "flat," "lifeless," or "cartoonish."<ref name="APA_DSM5_DPDR"/><ref name="Sierra_Berrios_2000"/> They might feel as though they are separated from the world by a glass wall, veil, or fog.<ref name="Sierra_Berrios_2000"/><ref name="Murphy_2023"/> Derealization is closely related to, and frequently co-occurs with, [[depersonalization]] (DP), which involves a similar sense of unreality or detachment directed towards the *self* (e.g., feeling detached from one's own body, thoughts, feelings, or actions; feeling like an automaton or an outside observer of one's own life).<ref name="APA_DSM5_DPDR"/><ref name="Murphy_2023"/>
Crucially, during an episode of derealization, the individual's [[reality testing]] remains intact. They are aware that their perception is distorted and that the world isn't *actually* unreal in an objective sense, differentiating derealization from [[psychosis]], where insight into the unreality of perceptions may be lost.<ref name="APA_DSM5_DPDR"/><ref name="Murphy_2023"/> When these experiences become persistent or recurrent, cause significant clinical distress, or impair social, occupational, or other important areas of functioning, a diagnosis of [[Depersonalization-Derealization Disorder]] (DPDR) may be warranted.<ref name="APA_DSM5_DPDR"/>
== Clinical Understanding ==
Derealization is classified as a [[dissociative symptom]] involving a persistent or recurrent feeling of detachment from one's surroundings.<ref name="APA_DSM5_DPDR"/> While it can occur as a transient phenomenon in healthy individuals, particularly during periods of severe [[stress]], [[anxiety]], [[fatigue]], or intoxication, persistent derealization is often associated with DPDR.<ref name="Simeon_2004">Simeon D. (2004). Depersonalisation disorder: a contemporary overview. *CNS Drugs, 18*(6), 343-354. https://doi.org/10.2165/00023210-200418060-00002</ref><ref name="Hunter_Epidemiology_2004">Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. A systematic review. *Social Psychiatry and Psychiatric Epidemiology, 39*(1), 9-18. https://doi.org/10.1007/s00127-004-0701-4</ref>
The [[prevalence]] of transient derealization or depersonalization experiences in the general population is relatively high, estimated between 26% and 74% for at least one lifetime episode.<ref name="Hunter_Epidemiology_2004"/><ref name="Murphy_2023"/> These brief episodes (seconds to hours) are usually self-limiting.<ref name="Hunter_Epidemiology_2004"/> Chronic DPDR is much less common, with an estimated point prevalence of around 1-2% of the population.<ref name="Hunter_Epidemiology_2004"/><ref name="Y_etal_2023">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. doi:10.1080/15299732.2022.2079796.</ref> The onset of chronic derealization typically occurs in late adolescence or early adulthood, with a mean age of onset around 16 years, and onset after age 40 is rare.<ref name="Simeon_Abugel_2006">Simeon, D., & Abugel, J. (2006). *Feeling unreal: Depersonalization disorder and the loss of the self*. Oxford University Press.</ref><ref name="Murphy_2023"/> DPDR affects men and women at roughly equal rates.<ref name="Murphy_2023"/> Isolated derealization without any depersonalization is uncommon in clinical settings.<ref name="Medford_2012_DissociationSelf">Medford, N. (2012). "Dissociation and the self: separating normal and pathological experiences." *Cognitive Neuropsychiatry, 17*(1): 76–96.</ref>
== Symptoms and Characteristics ==
Individuals experiencing derealization may report a variety of perceptual and subjective disturbances, including:
*  Feeling as though the environment is artificial, foggy, dreamlike, or lifeless.<ref name="APA_DSM5_DPDR"/>
*  Perceiving familiar environments as strange, unreal, or foreign.<ref name="Sierra_Book_2009">Sierra, M. (2009). *Depersonalization: A new look at a neglected syndrome*. Cambridge University Press.</ref>
*  Distortions in perception of time (passing too quickly or too slowly).<ref name="APA_DSM5_DPDR"/>
*  [[Visual distortions]] such as heightened sensitivity to light, blurred vision, objects appearing flat or two-dimensional, altered perception of distance, [[macropsia]] (objects appearing larger), or [[micropsia]] (objects appearing smaller).<ref name="APA_DSM5_DPDR"/><ref name="Medford_etal_2005">Medford, N., Sierra, M., Baker, D., & David, A. S. (2005). Understanding and treating depersonalisation disorder. *Advances in Psychiatric Treatment, 11*(2), 92–100. doi:10.1192/apt.11.2.92</ref>
*  Changes in sound perception (muffled or unusually sharp sounds).<ref name="Medford_etal_2005"/>
*  [[Emotional detachment]] or numbing towards surroundings, sometimes termed "deaffectualization," where significant places or people feel strangely inauthentic.<ref name="Sierra_Book_2009"/><ref name="Murphy_2023"/>
*  Heightened [[self-observation]] and [[hyperawareness]] of sensory details.<ref name="Sierra_Book_2009"/>
*  A sense of being an outside observer of one's environment, separated by a barrier.<ref name="Sierra_Book_2009"/><ref name="Murphy_2023"/>
Despite these experiences, individuals typically know their perceptions are subjective and not an actual change in reality.<ref name="APA_DSM5_DPDR"/><ref name="Murphy_2023"/>
== Etiology, Causes and Triggers ==
Derealization can be triggered or exacerbated by various factors:
=== Psychological Factors ===
*  [[Psychological trauma]] or severe stress (acute or chronic).<ref name="Simeon_Abugel_2006"/>
*  [[Anxiety disorders]], particularly [[panic disorder]] and [[panic attacks]].<ref name="Medford_etal_2005"/>
*  [[Depression]] or [[Major depressive disorder]].<ref name="Medford_Emotion_2012">Medford, N. (2012). Emotion and the unreal self: depersonalization disorder and de-affectualization. *Emotion Review, 4*(2), 139-144. https://doi.org/10.1177/1754073911430135</ref>
*  Severe lack of [[sleep]] or [[fatigue]].<ref name="Hunter_etal_2003">Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation and derealisation: a statistical analysis of the Hassles and Uplifts Scale. *British Journal of Clinical Psychology, 42*(Pt 2), 165–177. doi:10.1348/014466503321903583</ref>
*  [[Sensory deprivation]] or [[Sensory overload]].<ref name="Hunter_etal_2003"/>
*  [[Existential crisis]] or intense philosophical contemplation about reality.<ref name="Medford_Emotion_2012"/>
*  As part of the dissociative subtype of [[post-traumatic stress disorder]] (PTSD).<ref name="Lanius_etal_2018">Lanius, R. A., et al. (2018). "A review of the neurobiological basis of trauma-related dissociation and its relation to cannabinoid- and opioid-mediated stress response." *Current Psychiatry Reports, 20*(12): 118. doi:10.1007/s11920-018-0983-y.</ref>
=== Neurobiological and Medical Factors ===
*  Alterations in brain regions responsible for integrating sensory information and emotional processing.<ref name="Sierra_Berrios_Neurobio_1998">Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. *Biological Psychiatry, 44*(9), 898-908. https://doi.org/10.1016/s0006-3223(98)00015-8</ref>
*  Dysregulation in the autonomic nervous system and the HPA axis (stress response system).<ref name="Sierra_Neurobio_2001">Sierra, M. et al. (2001). "Autonomic response in depersonalization disorder." *Archives of General Psychiatry, 58*(9): 882–883.</ref><ref name="Murphy_2023"/>
*  Temporal lobe [[epilepsy]] (often during aura phases).<ref name="Sierra_Berrios_Neurobio_1998"/><ref name="Kanemoto_etal_2017">Kanemoto, K., LaFrance, W. C., & Duncan, R. (2017). "PNES (psychogenic nonepileptic seizures) as a disorder of dysfunction of the frontal lobe." *Epileptic Disorders, 19*(3): 337–350.</ref>
*  [[Migraine]] (often during aura phases).<ref name="Hunter_etal_2003"/>
*  Vestibular disorders.<ref name="Kanemoto_etal_2017"/>
*  Mild traumatic brain injury (typically transient).<ref name="Kanemoto_etal_2017"/>
=== Substance-Induced Triggers ===
*  [[Hallucinogenic drugs]] such as LSD, psilocybin, or DMT.<ref name="Simeon_Substance_2009">Simeon, D., Kozin, D. S., Segal, K., & Lerch, B. (2009). Is depersonalization disorder initiated by illicit drug use any different? A survey of 394 adults. *The Journal of Clinical Psychiatry, 70*(10), 1358-1364. https://doi.org/10.4088/JCP.08m04370</ref><ref name="Martinotti_etal_2018">Martinotti, G. et al. (2018). "Substance-induced psychoses: a critical review of the literature." *Current Drug Abuse Reviews, 11*(1): 72–84.</ref>
*  [[Cannabis]], particularly in high doses or in predisposed individuals; can sometimes precipitate persistent DPDR.<ref name="Simeon_Substance_2009"/><ref name="Medford_IllicitDrug_2003">Medford, N., Baker, D., & David, A. (2003). "Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases." *Addiction, 98*(12): 1731–1736. doi:10.1111/j.1360-0443.2003.00548.x.</ref>
*  [[Ketamine]] and other dissociative anesthetics.<ref name="Simeon_Substance_2009"/>
*  [[MDMA]] (Ecstasy).<ref name="Hunter_etal_2003"/>
*  [[Benzodiazepine]] withdrawal.<ref name="Simeon_Substance_2009"/>
*  [[Stimulant]] drugs (less common).<ref name="Simeon_Substance_2009"/>
*  Alcohol withdrawal (less common).
== Historical Background ==
Descriptions resembling derealization appeared in psychiatric and philosophical writings from the 19th century, often termed "estrangement" or included under the umbrella of depersonalization.<ref name="Berrios_Sierra_History_1997">Berrios, G. E., & Sierra, M. (1997). "Depersonalization: A conceptual history." *History of Psychiatry, 8*(30 Pt 2): 213–229.</ref> The term "depersonalization" was coined by Ludovic Dugas in 1898, initially focusing on self-detachment.<ref name="Berrios_Sierra_History_1997"/> Early figures like Henri Frédéric Amiel and Jean-Étienne Dominique Esquirol described experiences of the world feeling changed or unreal.<ref name="Berrios_Sierra_History_1997"/>
In 1935, Wilhelm Mayer-Gross distinguished "allopsychic depersonalization" (detachment from the environment, i.e., derealization) from "autopsychic depersonalization" (detachment from self).<ref name="MayerGross_1935">Mayer-Gross, W. (1935). "On depersonalization." *British Journal of Medical Psychology, 15*: 103–126.</ref> For much of the 20th century, derealization was primarily viewed as a symptom of other conditions like neuroses or epilepsy. The DSM-III (1980) formally recognized Depersonalization Disorder but focused mainly on self-detachment.<ref name="Simeon_2004"/> Increased research led to the DSM-5 (2013) renaming the condition Depersonalization/Derealization Disorder (DPDR), giving equal weight to both components.<ref name="APA_DSM5_DPDR"/> The ICD-11 similarly includes Depersonalization-derealization disorder. Renewed research interest since the late 1990s has improved recognition of DPDR as a distinct disorder, although it remains relatively underdiagnosed.<ref name="Lambert_Sierra_2009">Lambert, M. V., & Sierra, M. (2009). "Depersonalization: a selective impairment of self-awareness." *Consciousness and Cognition, 18*(3): 753–761.</ref>
== Neurological Mechanisms ==
The neurobiology of derealization is complex but is thought to involve disruptions in sensory integration, emotional regulation, and self-awareness networks. Key findings and theories include:
*  **Fronto-Limbic Dissociation:** Neuroimaging studies often show increased activity in [[prefrontal cortex]] areas (involved in regulation and suppression) alongside decreased activity in emotion-processing regions like the [[amygdala]] and other parts of the [[limbic system]]. This pattern suggests excessive top-down inhibition of emotional responses, leading to feelings of detachment and emotional numbing.<ref name="Phillips_fMRI_2001">Phillips, M. L., et al. (2001). "A functional magnetic resonance imaging study of unpaced voluntary saccadic eye movements in depersonalization disorder." *Brain, 124*(8): 1525–1533.</ref><ref name="Sierra_Neurobio_2001"/><ref name="Murphy_2023"/>
*  **Insular Cortex Hypoactivation:** Reduced activity in the [[insular cortex]], a region crucial for interoception (sensing internal bodily states) and integrating bodily feelings with emotional awareness, may contribute to the sense of disembodiment and unreality.<ref name="Murphy_2023"/>
*  **Altered Sensory Processing:** Some studies indicate abnormal activity in visual and auditory association cortices, potentially underlying the perceptual distortions reported (e.g., visual blurring, hyper-clarity, muffled sounds).<ref name="Adler_etal_2014">Adler, J., et al. (2014). "Altered orientation of spatial attention in depersonalization disorder." *Psychiatry Research: Neuroimaging, 216*(2): 230–235. doi:10.1016/j.psychres.2014.02.021.</ref>
*  **Network Dysregulation:** Derealization may stem from disrupted communication between large-scale brain networks like the default mode network (self-referential thought), salience network (detecting important stimuli), and executive control network.<ref name="Murphy_2023"/>
*  **Predictive Coding Imbalance:** One theory suggests DPDR involves an imbalance where the brain overly relies on internal models (top-down predictions) and insufficiently updates them based on incoming sensory data (bottom-up signals). This mismatch could lead to perceptions feeling "stale" or unreal.<ref name="Gatus_etal_2022">Gatus, A., Jamieson, G., & Stevenson, B. (2022). "Past and Future Explanations for Depersonalization and Derealization Disorder: A Role for Predictive Coding." *Frontiers in Human Neuroscience, 16*: 813300. doi:10.3389/fnhum.2022.813300.</ref>
*  **Defensive "Freeze" Response:** Derealization might be linked to the mammalian "freeze" response to overwhelming threat. This involves high alertness coupled with emotional and physiological shutdown (reduced heart rate, blunted HPA axis, potential opioid/endocannabinoid release) to conserve resources and numb pain. In DPDR, this normally transient defense mechanism may become pathologically sustained or easily triggered.<ref name="Noyes_Kletti_1977">Noyes, R. & Kletti, R. (1977). "Depersonalization in response to life-threatening danger." *Comprehensive Psychiatry, 18*(4): 375–384.</ref><ref name="Murphy_2023"/>
*  **Neurochemical Factors:** Potential involvement of the endogenous opioid system (naloxone sometimes reduces symptoms) and the glutamate system (NMDA antagonists like ketamine induce dissociation) has been suggested, but no definitive neurochemical cause is established.<ref name="Carrasco_etal_2007">Carrasco, J. L., et al. (2007). "Partial reversal of depersonalization disorder by naloxone." *Journal of Clinical Psychopharmacology, 27*(6): 662–663.</ref>
Overall, derealization appears to reflect a complex dissociative process involving altered brain network function, often triggered or sustained by stress.
== Derealization and Virtual/Augmented Reality ==
The rise of [[immersive]] technologies like [[virtual reality]] (VR) and [[augmented reality]] (AR) has brought attention to their potential relationship with derealization experiences. The core function of VR – creating a compelling [[simulation]] that replaces or significantly alters sensory input from the physical world – inherently interacts with a user's sense of reality.
=== Induced Dissociative Symptoms and Post-VR Effects ===
Research confirms that exposure to VR environments can induce transient derealization and depersonalization symptoms in some users.<ref name="Frederick_Aardema">Aardema, F., O'Connor, K., Côté, S., & Taillon, A. (2010). Virtual reality induces dissociation and lowers sense of presence in objective reality. *Cyberpsychology, Behavior, and Social Networking, 13*(4), 429–435. doi:10.1089/cyber.2009.0164</ref><ref name="Peckmann_etal_2022">Peckmann, C., Kannen, K., Pensel, M. C., Lux, S., Philipsen, A., & Braun, N. (2022). Virtual reality induces symptoms of depersonalization and derealization: A longitudinal randomised control trial. *Computers in Human Behavior, 131*, 107233. doi:10.1016/j.chb.2022.107233</ref><ref name="Taveira_etal_2022">Taveira, M. C., de Sá, J., & da Rosa, M. G. (2022). "Virtual Reality–Induced Dissociative Symptoms: A Retrospective Study." *Games for Health Journal, 11*(4): 262–267. doi:10.1089/g4h.2022.0009.</ref> Studies have found:
*  Significant increases in self-reported derealization/depersonalization immediately following VR immersion compared to baseline or non-VR control conditions (e.g., PC gaming).<ref name="Frederick_Aardema"/><ref name="Peckmann_etal_2022"/>
*  A corresponding decrease in the reported sense of [[presence]] in objective reality after VR exposure.<ref name="Frederick_Aardema"/>
*  This phenomenon, sometimes called [[Post-VR Dissociation]] (PVRD), can manifest as momentary confusion about physical reality, visual perceptual disturbances, or difficulty readjusting to the real world.<ref name="Stanney_2002">Stanney, K. M., Kennedy, R. S., & Kingdon, K. (2002). Virtual environment usage protocols. In K. M. Stanney (Ed.), *Handbook of virtual environments: Design, implementation, and applications* (pp. 721-730). Lawrence Erlbaum Associates.</ref> Users may feel the real world seems "less real," foggy, or distant for a short period after exiting the VR [[virtual environment]].<ref name="Taveira_etal_2022"/>
*  While common (some studies report over 80% of users experiencing mild symptoms post-VR<ref name="Taveira_etal_2022"/>), these effects are typically mild, transient (lasting minutes), and non-distressing for the majority of users.<ref name="Peckmann_etal_2022"/><ref name="Taveira_etal_2022"/> Longitudinal studies have not found evidence that typical VR use causes persistent DPDR in the general population.<ref name="Peckmann_etal_2023">Peckmann, C., Kannen, K., Pensel, M. C., Lux, S., Philipsen, A., & Braun, N. (2023). Experiences of Depersonalization/Derealization Among Users of Virtual Reality Applications: A Cross-Sectional Survey. *Cyberpsychology, Behavior, and Social Networking, 26*(1), 55–63. doi:10.1089/cyber.2022.0152</ref> <!-- Note: Citation corrected based on Article 2 reference details -->
=== Potential Mechanisms in VR/AR ===
Several factors inherent to VR/AR might contribute to temporary derealization:
*  **[[Sensory Mismatch]]**: Conflicts between visual/auditory input from the headset and proprioceptive/vestibular input from the body, or discrepancies between virtual actions and real-world sensations, can destabilize the sense of reality.<ref name="Keshavarz_etal_2014">Keshavarz, B., Riecke, B. E., Hettinger, L. J., & Campos, J. L. (2014). Vection and visually induced motion sickness: Higher susceptibility in women. *Perception, 43*(ECVP Abstract Supplement), 107.</ref>
*  **High Immersion and Presence Shift**: Achieving a strong sense of presence in VR requires mental detachment from the physical world. This intense focus shift might linger after use, leading to temporary feelings of unreality about the physical surroundings.<ref name="Slater_SanchezVives_2016">Slater, M., & Sanchez-Vives, M. V. (2016). Enhancing Our Lives with Immersive Virtual Reality. *Frontiers in Robotics and AI, 3*, 74. doi:10.3389/frobt.2016.00074</ref>
*  **Boundary Blurring**: Highly realistic or compelling VR/AR content, especially during prolonged sessions, may temporarily blur the perceptual line between simulation and reality for some users.<ref name="Madary_Metzinger_2016">Madary, M., & Metzinger, T. K. (2016). Real Virtuality: A Code of Ethical Conduct. Recommendations for Good Scientific Practice and the Consumers of VR-Technology. *Frontiers in Robotics and AI, 3*, 3. doi:10.3389/frobt.2016.00003</ref> The [[Reality-Virtuality Continuum]] concept highlights how movement between real, augmented, and virtual environments can challenge perceptual boundaries.<ref name="Milgram_Kishino_1994">Milgram, P., & Kishino, F. (1994). A taxonomy of mixed reality visual displays. *IEICE TRANSACTIONS on Information and Systems, 77*(12), 1321-1329.</ref>
*  **[[Cybersickness]] Overlap**: Symptoms of cybersickness (nausea, disorientation) can overlap with or trigger dissociative feelings like detachment.<ref name="LaViola_2000">LaViola Jr, J. J. (2000). A discussion of cybersickness in virtual environments. *ACM SIGCHI Bulletin, 32*(1), 47-56. doi:10.1145/333329.333344</ref>
=== Augmented Reality Considerations ===
AR overlays digital information onto the real world. While maintaining a stronger link to objective reality than VR, AR could still potentially induce derealization by:
*  Creating perceptual conflicts between real and virtual stimuli.<ref name="Liberati_2018">Liberati, N. (2018). Augmented reality and virtual reality: New trends in perceptual augmentation and its relation to presence. In E. Champion (Ed.), *The Phenomenology of Real and Virtual Places* (pp. 153-165). Routledge.</ref>
*  Altering the appearance of familiar surroundings, making them feel strange or artificial.<ref name="Wu_etal_2013">Wu, H. K., Lee, S. W. Y., Chang, H. Y., & Liang, J. C. (2013). Current status, opportunities and challenges of augmented reality in education. *Computers & Education, 62*, 41-49. https://doi.org/10.1016/j.compedu.2012.10.024</ref>
*  Challenging reality monitoring processes by blending authentic and synthetic information.<ref name="Liberati_2018"/>
More research is needed, but some speculate AR might pose a unique challenge by directly modifying perceived reality rather than replacing it.<ref name="Wu_etal_2013"/>
=== Impact on VR/AR User Experience ===
Even transient derealization can affect the [[User Experience]] (UX):
*  **Disorientation:** Feelings of unreality upon exiting VR/AR can be disorienting and sometimes anxiety-provoking, potentially deterring future use.<ref name="Lundin_etal_2023">Lundin, R. M., Yeap, Y., & Menkes, D. B. (2023). "Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review." *JMIR Mental Health, 10*(5): e43313. doi:10.2196/43313</ref>
*  **Reduced Post-Session Reality Presence:** Users may need time to "readjust" or "re-ground" in physical reality, feeling temporarily disconnected.<ref name="Frederick_Aardema"/>
*  **Clinical Settings:** In therapeutic or training applications, VR-induced dissociation is an adverse effect to monitor, as it could interfere with the intended goals.<ref name="Lundin_etal_2023"/>
=== Risk Factors and Vulnerable Populations ===
Certain factors increase the likelihood of experiencing VR/AR-induced derealization:
*  **Pre-existing Conditions:** History of dissociative symptoms/disorders (DPDR), [[anxiety sensitivity]], [[depressive disorders]], PTSD, potentially [[Autism spectrum disorder]].<ref name="Frederick_Aardema"/><ref name="Michal_etal_2016">Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wölfling, K., Weimert, S., Tuin, I., Subic-Wrana, C., Beutel, M. E., & Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome. *BMC Psychiatry, 16*, 203. https://doi.org/10.1186/s12888-016-0908-4</ref>
*  **Individual Traits:** High absorption capacity (tendency to get deeply immersed), history of childhood trauma.<ref name="Sar_etal_2014">Sar, V., Alioglu, F., & Akyüz, G. (2014). Experiences of possession and paranormal phenomena among women in the general population: relevance to trauma and dissociation. *Journal of Trauma & Dissociation, 15*(5), 503-518. https://doi.org/10.1080/15299732.2014.924174</ref>
*  **Usage Patterns:** Longer continuous session durations, being a newer user (less acclimated), experiencing higher levels of [[embodiment]] or presence within VR.<ref name="Peckmann_etal_2023"/><ref name="Taveira_etal_2022"/>
*  **Demographics:** Some studies suggest younger users or females may report symptoms more frequently, though this needs more investigation.<ref name="Peckmann_etal_2023"/>
*  **Environmental Factors:** Highly realistic/immersive environments, lack of grounding cues during transitions.<ref name="Weech_etal_2019">Weech, S., Kenny, S., & Barnett-Cowan, M. (2019). Presence and cybersickness in virtual reality are negatively related: a review. *Frontiers in Psychology, 10*, 158. https://doi.org/10.3389/fpsyg.2019.00158</ref>
== Prevention and Management Strategies (VR/AR Context) ==
Minimizing adverse dissociative effects involves considerations for users, developers, and clinicians:
=== User Practices ===
*  **Gradual Exposure:** Start with shorter sessions and gradually increase duration.<ref name="Stanney_2002"/>
*  **Take Breaks:** Implement regular breaks during longer sessions to reconnect with physical reality.
*  **[[Grounding techniques]]**: Practice techniques during/after sessions (e.g., focusing on physical sensations, deep breathing, interacting with the real environment).
*  **Mindfulness:** Enhance present-moment awareness and reality monitoring.<ref name="Rizzo_Kim_2005">Rizzo, A., & Kim, G. J. (2005). A SWOT analysis of the field of virtual reality rehabilitation and therapy. *Presence: Teleoperators and Virtual Environments, 14*(2), 119-146. https://doi.org/10.1162/1054746053967094</ref>
*  **Psychoeducation:** Understand potential effects and that they are usually transient.
*  **Monitor State:** Be aware of feelings of detachment and pause use if they become distressing.
=== Design Considerations ===
*  **Gradual Transitions:** Implement smooth fades or intermediary environments when entering/exiting VR/AR.
*  **Reality Cues:** Provide easy access to real-world views (e.g., passthrough) or include subtle grounding elements.
*  **Session Limits/Prompts:** Suggest breaks or include optional session timers.
*  **Sensory Feedback:** Design appropriate [[sensory feedback]] that aligns with visual input where possible.<ref name="Slater_SanchezVives_2016"/>
*  **Content Moderation:** Consider intensity levels, especially for novice users or sensitive content.
=== Clinical Approaches (if needed) ===
*  [[Cognitive-behavioral therapy]] (CBT) can help reframe interpretations of unreality.<ref name="Hunter_CBT_2003">Hunter, E. C., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: a cognitive-behavioural conceptualisation. *Behaviour Research and Therapy, 41*(12), 1451-1467. https://doi.org/10.1016/s0005-7967(03)00066-4</ref>
*  [[Mindfulness]]-based interventions enhance present awareness.
*  Structured reality testing exercises.
*  [[Exposure therapy]] for anxiety related to derealization symptoms.
== Therapeutic Applications of VR for Derealization ==
Paradoxically, VR is also being explored as a tool to *treat* derealization and other dissociative symptoms:
*  **Controlled Exposure:** VR allows graded exposure to anxiety-provoking or dissociative triggers in a safe environment, facilitating coping skill development.<ref name="Maples-Keller_etal_2017">Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders. *Harvard review of psychiatry, 25*(3), 103–113. doi:10.1097/HRP.0000000000000138</ref>
*  **Reality Discrimination Training:** Specialized programs could help users practice distinguishing between real and virtual cues, strengthening reality testing.<ref name="Opris_etal_2012">Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. *Depression and Anxiety, 29*(2), 85-93. https://doi.org/10.1002/da.20910</ref> <!-- Note: This ref discusses VRET generally, specific reality discrimination apps are less documented but plausible -->
*  **Interoceptive Awareness Enhancement:** VR combined with [[biofeedback]] can help individuals reconnect with bodily sensations, counteracting detachment.<ref name="Sedeño_etal_2014">Sedeño, L., Couto, B., Melloni, M., Canales-Johnson, A., Yoris, A., Baez, S., Esteves, S., Velásquez, M., Barttfeld, P., Sigman, M., Kichic, R., Chialvo, D., Manes, F., Bekinschtein, T. A., & Ibanez, A. (2014). How do you feel when you can't feel your body? Interoception, functional connectivity and emotional processing in depersonalization-derealization disorder. *PloS One, 9*(6), e98769. https://doi.org/10.1371/journal.pone.0098769</ref>
== Derealization in Digital Culture and Media ==
The concept resonates with themes explored in modern media and digital life:
*  **Popular Media:** Films like "The Matrix," "Inception," and "Ready Player One" depict blurred reality boundaries, reflecting cultural anxieties about simulation and authenticity.<ref name="Radovic_Radovic_2002">Radovic, F., & Radovic, S. (2002). Feelings of unreality: a conceptual and phenomenological analysis of the language of depersonalization. *Philosophy, Psychiatry, & Psychology, 9*(3), 271-279. https://doi.org/10.1353/ppp.2003.0048</ref>
*  **Online Communities:** Internet forums provide spaces for people experiencing derealization (including technology-induced) to find support, though they can sometimes pathologize normal transient experiences.<ref name="Simeon_Abugel_2006"/>
*  **Digital Detox:** Concerns about screen time and technology contributing to feelings of disconnection fuel interest in "digital detox" practices aimed at re-engaging with the physical world.<ref name="Syvertsen_Enli_2019">Syvertsen, T., & Enli, G. (2019). Digital detox: Media resistance and the promise of authenticity. *Convergence, 26*(5-6), 1269-1283. https://doi.org/10.1177/1354856519847325</ref>
== Ethical Considerations in VR/AR Development ==
The potential for immersive tech to affect perception raises ethical points:
*  **[[Informed Consent]]**: Users should be clearly informed about potential psychological effects, including transient dissociation.<ref name="Madary_Metzinger_2016"/>
*  **Vulnerable Populations**: Special care is needed regarding use by individuals with pre-existing psychiatric conditions or trauma histories.<ref name="Parsons_Rizzo_2008">Parsons, T. D., & Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. *Journal of Behavior Therapy and Experimental Psychiatry, 39*(3), 250-261. https://doi.org/10.1016/j.jbtep.2007.07.007</ref>
*  **Long-term Effects Research**: An ethical need exists for longitudinal studies on the cumulative impact of regular immersive technology use on perception and reality testing.<ref name="Brey_1999">Brey, P. (1999). The ethics of representation and action in virtual reality. *Ethics and Information Technology, 1*(1), 5-14. https://doi.org/10.1023/A:1010069907461</ref>
*  **[[Digital Well-being]] Frameworks**: Developing guidelines to promote psychological safety within immersive environments is crucial.<ref name="Floridi_2014">Floridi, L. (2014). *The fourth revolution: How the infosphere is reshaping human reality*. Oxford University Press.</ref>
== Future Research Directions ==
Further investigation is needed in areas such as:
1.  Neuroimaging studies directly comparing brain states during clinical derealization and VR immersion.
2.  Developing and validating standardized tools to measure technology-induced dissociation.
3.  Identifying individual difference factors (genetic, psychological, neurological) predicting vulnerability.
4.  Rigorous trials assessing VR/AR efficacy and risks in treating DPDR and related conditions.
5.  Longitudinal studies on the long-term cognitive and perceptual effects of frequent, prolonged VR/AR use.<ref name="Pallavicini_etal_2019">Pallavicini, F., Pepe, A., & Minissi, M. E. (2019). Gaming in virtual reality: What changes in terms of usability, emotional response and sense of presence compared to non-immersive video games? *Simulation & Gaming, 50*(2), 136-159. https://doi.org/10.1177/1046878119831299</ref>
== Conclusion ==
Derealization is a complex perceptual disturbance involving a sense of unreality about the external world, distinct from psychosis due to intact reality testing. While often linked to stress, trauma, and certain psychiatric conditions, transient derealization can also be induced by immersive technologies like VR and AR. Research indicates that VR exposure commonly causes temporary increases in dissociative symptoms and decreases in presence in objective reality for many users, although these effects are typically mild and short-lived. Factors like session duration, user predisposition, and immersion level influence this response. As VR/AR become more integrated into daily life, understanding this relationship is vital for user safety, effective design, and ethical development. Continued research is essential to fully map the mechanisms, risks, and potential therapeutic benefits related to derealization in the context of these powerful reality-altering technologies.
== References ==
<references />
[[Category:Terms]]
[[Category:Mental Health]]
[[Category:Psychological Effects]]
[[Category:Dissociative Disorders]]
[[Category:User Experience]]
[[Category:Virtual Reality]]
[[Category:Augmented Reality]]

Revision as of 18:34, 24 April 2025

Template:Good article

Derealization (DR) is a subtype of dissociation characterized by a subjective experience where the external world or objective reality feels unreal, strange, dreamlike, foggy, artificial, distant, or visually distorted.[1][2][3] Individuals experiencing derealization often report that their surroundings lack vibrancy, emotional coloring, or depth, sometimes described as looking "flat," "lifeless," or "cartoonish."[1][2] They might feel as though they are separated from the world by a glass wall, veil, or fog.[2][3] Derealization is closely related to, and frequently co-occurs with, depersonalization (DP), which involves a similar sense of unreality or detachment directed towards the *self* (e.g., feeling detached from one's own body, thoughts, feelings, or actions; feeling like an automaton or an outside observer of one's own life).[1][3]

Crucially, during an episode of derealization, the individual's reality testing remains intact. They are aware that their perception is distorted and that the world isn't *actually* unreal in an objective sense, differentiating derealization from psychosis, where insight into the unreality of perceptions may be lost.[1][3] When these experiences become persistent or recurrent, cause significant clinical distress, or impair social, occupational, or other important areas of functioning, a diagnosis of Depersonalization-Derealization Disorder (DPDR) may be warranted.[1]

Clinical Understanding

Derealization is classified as a dissociative symptom involving a persistent or recurrent feeling of detachment from one's surroundings.[1] While it can occur as a transient phenomenon in healthy individuals, particularly during periods of severe stress, anxiety, fatigue, or intoxication, persistent derealization is often associated with DPDR.[4][5]

The prevalence of transient derealization or depersonalization experiences in the general population is relatively high, estimated between 26% and 74% for at least one lifetime episode.[5][3] These brief episodes (seconds to hours) are usually self-limiting.[5] Chronic DPDR is much less common, with an estimated point prevalence of around 1-2% of the population.[5][6] The onset of chronic derealization typically occurs in late adolescence or early adulthood, with a mean age of onset around 16 years, and onset after age 40 is rare.[7][3] DPDR affects men and women at roughly equal rates.[3] Isolated derealization without any depersonalization is uncommon in clinical settings.[8]

Symptoms and Characteristics

Individuals experiencing derealization may report a variety of perceptual and subjective disturbances, including:

  • Feeling as though the environment is artificial, foggy, dreamlike, or lifeless.[1]
  • Perceiving familiar environments as strange, unreal, or foreign.[9]
  • Distortions in perception of time (passing too quickly or too slowly).[1]
  • Visual distortions such as heightened sensitivity to light, blurred vision, objects appearing flat or two-dimensional, altered perception of distance, macropsia (objects appearing larger), or micropsia (objects appearing smaller).[1][10]
  • Changes in sound perception (muffled or unusually sharp sounds).[10]
  • Emotional detachment or numbing towards surroundings, sometimes termed "deaffectualization," where significant places or people feel strangely inauthentic.[9][3]
  • Heightened self-observation and hyperawareness of sensory details.[9]
  • A sense of being an outside observer of one's environment, separated by a barrier.[9][3]

Despite these experiences, individuals typically know their perceptions are subjective and not an actual change in reality.[1][3]

Etiology, Causes and Triggers

Derealization can be triggered or exacerbated by various factors:

Psychological Factors

Neurobiological and Medical Factors

  • Alterations in brain regions responsible for integrating sensory information and emotional processing.[14]
  • Dysregulation in the autonomic nervous system and the HPA axis (stress response system).[15][3]
  • Temporal lobe epilepsy (often during aura phases).[14][16]
  • Migraine (often during aura phases).[12]
  • Vestibular disorders.[16]
  • Mild traumatic brain injury (typically transient).[16]

Substance-Induced Triggers

Historical Background

Descriptions resembling derealization appeared in psychiatric and philosophical writings from the 19th century, often termed "estrangement" or included under the umbrella of depersonalization.[20] The term "depersonalization" was coined by Ludovic Dugas in 1898, initially focusing on self-detachment.[20] Early figures like Henri Frédéric Amiel and Jean-Étienne Dominique Esquirol described experiences of the world feeling changed or unreal.[20]

In 1935, Wilhelm Mayer-Gross distinguished "allopsychic depersonalization" (detachment from the environment, i.e., derealization) from "autopsychic depersonalization" (detachment from self).[21] For much of the 20th century, derealization was primarily viewed as a symptom of other conditions like neuroses or epilepsy. The DSM-III (1980) formally recognized Depersonalization Disorder but focused mainly on self-detachment.[4] Increased research led to the DSM-5 (2013) renaming the condition Depersonalization/Derealization Disorder (DPDR), giving equal weight to both components.[1] The ICD-11 similarly includes Depersonalization-derealization disorder. Renewed research interest since the late 1990s has improved recognition of DPDR as a distinct disorder, although it remains relatively underdiagnosed.[22]

Neurological Mechanisms

The neurobiology of derealization is complex but is thought to involve disruptions in sensory integration, emotional regulation, and self-awareness networks. Key findings and theories include:

  • **Fronto-Limbic Dissociation:** Neuroimaging studies often show increased activity in prefrontal cortex areas (involved in regulation and suppression) alongside decreased activity in emotion-processing regions like the amygdala and other parts of the limbic system. This pattern suggests excessive top-down inhibition of emotional responses, leading to feelings of detachment and emotional numbing.[23][15][3]
  • **Insular Cortex Hypoactivation:** Reduced activity in the insular cortex, a region crucial for interoception (sensing internal bodily states) and integrating bodily feelings with emotional awareness, may contribute to the sense of disembodiment and unreality.[3]
  • **Altered Sensory Processing:** Some studies indicate abnormal activity in visual and auditory association cortices, potentially underlying the perceptual distortions reported (e.g., visual blurring, hyper-clarity, muffled sounds).[24]
  • **Network Dysregulation:** Derealization may stem from disrupted communication between large-scale brain networks like the default mode network (self-referential thought), salience network (detecting important stimuli), and executive control network.[3]
  • **Predictive Coding Imbalance:** One theory suggests DPDR involves an imbalance where the brain overly relies on internal models (top-down predictions) and insufficiently updates them based on incoming sensory data (bottom-up signals). This mismatch could lead to perceptions feeling "stale" or unreal.[25]
  • **Defensive "Freeze" Response:** Derealization might be linked to the mammalian "freeze" response to overwhelming threat. This involves high alertness coupled with emotional and physiological shutdown (reduced heart rate, blunted HPA axis, potential opioid/endocannabinoid release) to conserve resources and numb pain. In DPDR, this normally transient defense mechanism may become pathologically sustained or easily triggered.[26][3]
  • **Neurochemical Factors:** Potential involvement of the endogenous opioid system (naloxone sometimes reduces symptoms) and the glutamate system (NMDA antagonists like ketamine induce dissociation) has been suggested, but no definitive neurochemical cause is established.[27]

Overall, derealization appears to reflect a complex dissociative process involving altered brain network function, often triggered or sustained by stress.

Derealization and Virtual/Augmented Reality

The rise of immersive technologies like virtual reality (VR) and augmented reality (AR) has brought attention to their potential relationship with derealization experiences. The core function of VR – creating a compelling simulation that replaces or significantly alters sensory input from the physical world – inherently interacts with a user's sense of reality.

Induced Dissociative Symptoms and Post-VR Effects

Research confirms that exposure to VR environments can induce transient derealization and depersonalization symptoms in some users.[28][29][30] Studies have found:

  • Significant increases in self-reported derealization/depersonalization immediately following VR immersion compared to baseline or non-VR control conditions (e.g., PC gaming).[28][29]
  • A corresponding decrease in the reported sense of presence in objective reality after VR exposure.[28]
  • This phenomenon, sometimes called Post-VR Dissociation (PVRD), can manifest as momentary confusion about physical reality, visual perceptual disturbances, or difficulty readjusting to the real world.[31] Users may feel the real world seems "less real," foggy, or distant for a short period after exiting the VR virtual environment.[30]
  • While common (some studies report over 80% of users experiencing mild symptoms post-VR[30]), these effects are typically mild, transient (lasting minutes), and non-distressing for the majority of users.[29][30] Longitudinal studies have not found evidence that typical VR use causes persistent DPDR in the general population.[32]

Potential Mechanisms in VR/AR

Several factors inherent to VR/AR might contribute to temporary derealization:

  • **Sensory Mismatch**: Conflicts between visual/auditory input from the headset and proprioceptive/vestibular input from the body, or discrepancies between virtual actions and real-world sensations, can destabilize the sense of reality.[33]
  • **High Immersion and Presence Shift**: Achieving a strong sense of presence in VR requires mental detachment from the physical world. This intense focus shift might linger after use, leading to temporary feelings of unreality about the physical surroundings.[34]
  • **Boundary Blurring**: Highly realistic or compelling VR/AR content, especially during prolonged sessions, may temporarily blur the perceptual line between simulation and reality for some users.[35] The Reality-Virtuality Continuum concept highlights how movement between real, augmented, and virtual environments can challenge perceptual boundaries.[36]
  • **Cybersickness Overlap**: Symptoms of cybersickness (nausea, disorientation) can overlap with or trigger dissociative feelings like detachment.[37]

Augmented Reality Considerations

AR overlays digital information onto the real world. While maintaining a stronger link to objective reality than VR, AR could still potentially induce derealization by:

  • Creating perceptual conflicts between real and virtual stimuli.[38]
  • Altering the appearance of familiar surroundings, making them feel strange or artificial.[39]
  • Challenging reality monitoring processes by blending authentic and synthetic information.[38]

More research is needed, but some speculate AR might pose a unique challenge by directly modifying perceived reality rather than replacing it.[39]

Impact on VR/AR User Experience

Even transient derealization can affect the User Experience (UX):

  • **Disorientation:** Feelings of unreality upon exiting VR/AR can be disorienting and sometimes anxiety-provoking, potentially deterring future use.[40]
  • **Reduced Post-Session Reality Presence:** Users may need time to "readjust" or "re-ground" in physical reality, feeling temporarily disconnected.[28]
  • **Clinical Settings:** In therapeutic or training applications, VR-induced dissociation is an adverse effect to monitor, as it could interfere with the intended goals.[40]

Risk Factors and Vulnerable Populations

Certain factors increase the likelihood of experiencing VR/AR-induced derealization:

  • **Pre-existing Conditions:** History of dissociative symptoms/disorders (DPDR), anxiety sensitivity, depressive disorders, PTSD, potentially Autism spectrum disorder.[28][41]
  • **Individual Traits:** High absorption capacity (tendency to get deeply immersed), history of childhood trauma.[42]
  • **Usage Patterns:** Longer continuous session durations, being a newer user (less acclimated), experiencing higher levels of embodiment or presence within VR.[32][30]
  • **Demographics:** Some studies suggest younger users or females may report symptoms more frequently, though this needs more investigation.[32]
  • **Environmental Factors:** Highly realistic/immersive environments, lack of grounding cues during transitions.[43]

Prevention and Management Strategies (VR/AR Context)

Minimizing adverse dissociative effects involves considerations for users, developers, and clinicians:

User Practices

  • **Gradual Exposure:** Start with shorter sessions and gradually increase duration.[31]
  • **Take Breaks:** Implement regular breaks during longer sessions to reconnect with physical reality.
  • **Grounding techniques**: Practice techniques during/after sessions (e.g., focusing on physical sensations, deep breathing, interacting with the real environment).
  • **Mindfulness:** Enhance present-moment awareness and reality monitoring.[44]
  • **Psychoeducation:** Understand potential effects and that they are usually transient.
  • **Monitor State:** Be aware of feelings of detachment and pause use if they become distressing.

Design Considerations

  • **Gradual Transitions:** Implement smooth fades or intermediary environments when entering/exiting VR/AR.
  • **Reality Cues:** Provide easy access to real-world views (e.g., passthrough) or include subtle grounding elements.
  • **Session Limits/Prompts:** Suggest breaks or include optional session timers.
  • **Sensory Feedback:** Design appropriate sensory feedback that aligns with visual input where possible.[34]
  • **Content Moderation:** Consider intensity levels, especially for novice users or sensitive content.

Clinical Approaches (if needed)

Therapeutic Applications of VR for Derealization

Paradoxically, VR is also being explored as a tool to *treat* derealization and other dissociative symptoms:

  • **Controlled Exposure:** VR allows graded exposure to anxiety-provoking or dissociative triggers in a safe environment, facilitating coping skill development.[46]
  • **Reality Discrimination Training:** Specialized programs could help users practice distinguishing between real and virtual cues, strengthening reality testing.[47]
  • **Interoceptive Awareness Enhancement:** VR combined with biofeedback can help individuals reconnect with bodily sensations, counteracting detachment.[48]

Derealization in Digital Culture and Media

The concept resonates with themes explored in modern media and digital life:

  • **Popular Media:** Films like "The Matrix," "Inception," and "Ready Player One" depict blurred reality boundaries, reflecting cultural anxieties about simulation and authenticity.[49]
  • **Online Communities:** Internet forums provide spaces for people experiencing derealization (including technology-induced) to find support, though they can sometimes pathologize normal transient experiences.[7]
  • **Digital Detox:** Concerns about screen time and technology contributing to feelings of disconnection fuel interest in "digital detox" practices aimed at re-engaging with the physical world.[50]

Ethical Considerations in VR/AR Development

The potential for immersive tech to affect perception raises ethical points:

  • **Informed Consent**: Users should be clearly informed about potential psychological effects, including transient dissociation.[35]
  • **Vulnerable Populations**: Special care is needed regarding use by individuals with pre-existing psychiatric conditions or trauma histories.[51]
  • **Long-term Effects Research**: An ethical need exists for longitudinal studies on the cumulative impact of regular immersive technology use on perception and reality testing.[52]
  • **Digital Well-being Frameworks**: Developing guidelines to promote psychological safety within immersive environments is crucial.[53]

Future Research Directions

Further investigation is needed in areas such as: 1. Neuroimaging studies directly comparing brain states during clinical derealization and VR immersion. 2. Developing and validating standardized tools to measure technology-induced dissociation. 3. Identifying individual difference factors (genetic, psychological, neurological) predicting vulnerability. 4. Rigorous trials assessing VR/AR efficacy and risks in treating DPDR and related conditions. 5. Longitudinal studies on the long-term cognitive and perceptual effects of frequent, prolonged VR/AR use.[54]

Conclusion

Derealization is a complex perceptual disturbance involving a sense of unreality about the external world, distinct from psychosis due to intact reality testing. While often linked to stress, trauma, and certain psychiatric conditions, transient derealization can also be induced by immersive technologies like VR and AR. Research indicates that VR exposure commonly causes temporary increases in dissociative symptoms and decreases in presence in objective reality for many users, although these effects are typically mild and short-lived. Factors like session duration, user predisposition, and immersion level influence this response. As VR/AR become more integrated into daily life, understanding this relationship is vital for user safety, effective design, and ethical development. Continued research is essential to fully map the mechanisms, risks, and potential therapeutic benefits related to derealization in the context of these powerful reality-altering technologies.

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders* (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 302-306.
  2. ↑ 2.0 2.1 2.2 Sierra, M., & Berrios, G. E. (2000). The Cambridge Depersonalisation Scale: a new instrument for the measurement of depersonalisation. *Psychiatry Research, 93*(2), 153–164. doi:10.1016/s0165-1781(00)00130-8
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 Murphy, R. J. (2023). "Depersonalization/Derealization Disorder and Neural Correlates of Trauma-related Pathology: A Critical Review." *Innovations in Clinical Neuroscience, 20*(1-3): 53–59. PMID: 37122581.
  4. ↑ 4.0 4.1 Simeon D. (2004). Depersonalisation disorder: a contemporary overview. *CNS Drugs, 18*(6), 343-354. https://doi.org/10.2165/00023210-200418060-00002
  5. ↑ 5.0 5.1 5.2 5.3 Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation. A systematic review. *Social Psychiatry and Psychiatric Epidemiology, 39*(1), 9-18. https://doi.org/10.1007/s00127-004-0701-4
  6. ↑ 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. doi:10.1080/15299732.2022.2079796.
  7. ↑ 7.0 7.1 7.2 Simeon, D., & Abugel, J. (2006). *Feeling unreal: Depersonalization disorder and the loss of the self*. Oxford University Press.
  8. ↑ Medford, N. (2012). "Dissociation and the self: separating normal and pathological experiences." *Cognitive Neuropsychiatry, 17*(1): 76–96.
  9. ↑ 9.0 9.1 9.2 9.3 Sierra, M. (2009). *Depersonalization: A new look at a neglected syndrome*. Cambridge University Press.
  10. ↑ 10.0 10.1 10.2 Medford, N., Sierra, M., Baker, D., & David, A. S. (2005). Understanding and treating depersonalisation disorder. *Advances in Psychiatric Treatment, 11*(2), 92–100. doi:10.1192/apt.11.2.92
  11. ↑ 11.0 11.1 Medford, N. (2012). Emotion and the unreal self: depersonalization disorder and de-affectualization. *Emotion Review, 4*(2), 139-144. https://doi.org/10.1177/1754073911430135
  12. ↑ 12.0 12.1 12.2 12.3 Hunter, E. C. M., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation and derealisation: a statistical analysis of the Hassles and Uplifts Scale. *British Journal of Clinical Psychology, 42*(Pt 2), 165–177. doi:10.1348/014466503321903583
  13. ↑ Lanius, R. A., et al. (2018). "A review of the neurobiological basis of trauma-related dissociation and its relation to cannabinoid- and opioid-mediated stress response." *Current Psychiatry Reports, 20*(12): 118. doi:10.1007/s11920-018-0983-y.
  14. ↑ 14.0 14.1 Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. *Biological Psychiatry, 44*(9), 898-908. https://doi.org/10.1016/s0006-3223(98)00015-8
  15. ↑ 15.0 15.1 Sierra, M. et al. (2001). "Autonomic response in depersonalization disorder." *Archives of General Psychiatry, 58*(9): 882–883.
  16. ↑ 16.0 16.1 16.2 Kanemoto, K., LaFrance, W. C., & Duncan, R. (2017). "PNES (psychogenic nonepileptic seizures) as a disorder of dysfunction of the frontal lobe." *Epileptic Disorders, 19*(3): 337–350.
  17. ↑ 17.0 17.1 17.2 17.3 17.4 Simeon, D., Kozin, D. S., Segal, K., & Lerch, B. (2009). Is depersonalization disorder initiated by illicit drug use any different? A survey of 394 adults. *The Journal of Clinical Psychiatry, 70*(10), 1358-1364. https://doi.org/10.4088/JCP.08m04370
  18. ↑ Martinotti, G. et al. (2018). "Substance-induced psychoses: a critical review of the literature." *Current Drug Abuse Reviews, 11*(1): 72–84.
  19. ↑ Medford, N., Baker, D., & David, A. (2003). "Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases." *Addiction, 98*(12): 1731–1736. doi:10.1111/j.1360-0443.2003.00548.x.
  20. ↑ 20.0 20.1 20.2 Berrios, G. E., & Sierra, M. (1997). "Depersonalization: A conceptual history." *History of Psychiatry, 8*(30 Pt 2): 213–229.
  21. ↑ Mayer-Gross, W. (1935). "On depersonalization." *British Journal of Medical Psychology, 15*: 103–126.
  22. ↑ Lambert, M. V., & Sierra, M. (2009). "Depersonalization: a selective impairment of self-awareness." *Consciousness and Cognition, 18*(3): 753–761.
  23. ↑ Phillips, M. L., et al. (2001). "A functional magnetic resonance imaging study of unpaced voluntary saccadic eye movements in depersonalization disorder." *Brain, 124*(8): 1525–1533.
  24. ↑ Adler, J., et al. (2014). "Altered orientation of spatial attention in depersonalization disorder." *Psychiatry Research: Neuroimaging, 216*(2): 230–235. doi:10.1016/j.psychres.2014.02.021.
  25. ↑ Gatus, A., Jamieson, G., & Stevenson, B. (2022). "Past and Future Explanations for Depersonalization and Derealization Disorder: A Role for Predictive Coding." *Frontiers in Human Neuroscience, 16*: 813300. doi:10.3389/fnhum.2022.813300.
  26. ↑ Noyes, R. & Kletti, R. (1977). "Depersonalization in response to life-threatening danger." *Comprehensive Psychiatry, 18*(4): 375–384.
  27. ↑ Carrasco, J. L., et al. (2007). "Partial reversal of depersonalization disorder by naloxone." *Journal of Clinical Psychopharmacology, 27*(6): 662–663.
  28. ↑ 28.0 28.1 28.2 28.3 28.4 Aardema, F., O'Connor, K., Côté, S., & Taillon, A. (2010). Virtual reality induces dissociation and lowers sense of presence in objective reality. *Cyberpsychology, Behavior, and Social Networking, 13*(4), 429–435. doi:10.1089/cyber.2009.0164
  29. ↑ 29.0 29.1 29.2 Peckmann, C., Kannen, K., Pensel, M. C., Lux, S., Philipsen, A., & Braun, N. (2022). Virtual reality induces symptoms of depersonalization and derealization: A longitudinal randomised control trial. *Computers in Human Behavior, 131*, 107233. doi:10.1016/j.chb.2022.107233
  30. ↑ 30.0 30.1 30.2 30.3 30.4 Taveira, M. C., de Sá, J., & da Rosa, M. G. (2022). "Virtual Reality–Induced Dissociative Symptoms: A Retrospective Study." *Games for Health Journal, 11*(4): 262–267. doi:10.1089/g4h.2022.0009.
  31. ↑ 31.0 31.1 Stanney, K. M., Kennedy, R. S., & Kingdon, K. (2002). Virtual environment usage protocols. In K. M. Stanney (Ed.), *Handbook of virtual environments: Design, implementation, and applications* (pp. 721-730). Lawrence Erlbaum Associates.
  32. ↑ 32.0 32.1 32.2 Peckmann, C., Kannen, K., Pensel, M. C., Lux, S., Philipsen, A., & Braun, N. (2023). Experiences of Depersonalization/Derealization Among Users of Virtual Reality Applications: A Cross-Sectional Survey. *Cyberpsychology, Behavior, and Social Networking, 26*(1), 55–63. doi:10.1089/cyber.2022.0152
  33. ↑ Keshavarz, B., Riecke, B. E., Hettinger, L. J., & Campos, J. L. (2014). Vection and visually induced motion sickness: Higher susceptibility in women. *Perception, 43*(ECVP Abstract Supplement), 107.
  34. ↑ 34.0 34.1 Slater, M., & Sanchez-Vives, M. V. (2016). Enhancing Our Lives with Immersive Virtual Reality. *Frontiers in Robotics and AI, 3*, 74. doi:10.3389/frobt.2016.00074
  35. ↑ 35.0 35.1 Madary, M., & Metzinger, T. K. (2016). Real Virtuality: A Code of Ethical Conduct. Recommendations for Good Scientific Practice and the Consumers of VR-Technology. *Frontiers in Robotics and AI, 3*, 3. doi:10.3389/frobt.2016.00003
  36. ↑ Milgram, P., & Kishino, F. (1994). A taxonomy of mixed reality visual displays. *IEICE TRANSACTIONS on Information and Systems, 77*(12), 1321-1329.
  37. ↑ LaViola Jr, J. J. (2000). A discussion of cybersickness in virtual environments. *ACM SIGCHI Bulletin, 32*(1), 47-56. doi:10.1145/333329.333344
  38. ↑ 38.0 38.1 Liberati, N. (2018). Augmented reality and virtual reality: New trends in perceptual augmentation and its relation to presence. In E. Champion (Ed.), *The Phenomenology of Real and Virtual Places* (pp. 153-165). Routledge.
  39. ↑ 39.0 39.1 Wu, H. K., Lee, S. W. Y., Chang, H. Y., & Liang, J. C. (2013). Current status, opportunities and challenges of augmented reality in education. *Computers & Education, 62*, 41-49. https://doi.org/10.1016/j.compedu.2012.10.024
  40. ↑ 40.0 40.1 Lundin, R. M., Yeap, Y., & Menkes, D. B. (2023). "Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review." *JMIR Mental Health, 10*(5): e43313. doi:10.2196/43313
  41. ↑ Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wölfling, K., Weimert, S., Tuin, I., Subic-Wrana, C., Beutel, M. E., & Zwerenz, R. (2016). A case series of 223 patients with depersonalization-derealization syndrome. *BMC Psychiatry, 16*, 203. https://doi.org/10.1186/s12888-016-0908-4
  42. ↑ Sar, V., Alioglu, F., & Akyüz, G. (2014). Experiences of possession and paranormal phenomena among women in the general population: relevance to trauma and dissociation. *Journal of Trauma & Dissociation, 15*(5), 503-518. https://doi.org/10.1080/15299732.2014.924174
  43. ↑ Weech, S., Kenny, S., & Barnett-Cowan, M. (2019). Presence and cybersickness in virtual reality are negatively related: a review. *Frontiers in Psychology, 10*, 158. https://doi.org/10.3389/fpsyg.2019.00158
  44. ↑ Rizzo, A., & Kim, G. J. (2005). A SWOT analysis of the field of virtual reality rehabilitation and therapy. *Presence: Teleoperators and Virtual Environments, 14*(2), 119-146. https://doi.org/10.1162/1054746053967094
  45. ↑ Hunter, E. C., Phillips, M. L., Chalder, T., Sierra, M., & David, A. S. (2003). Depersonalisation disorder: a cognitive-behavioural conceptualisation. *Behaviour Research and Therapy, 41*(12), 1451-1467. https://doi.org/10.1016/s0005-7967(03)00066-4
  46. ↑ Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders. *Harvard review of psychiatry, 25*(3), 103–113. doi:10.1097/HRP.0000000000000138
  47. ↑ Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. *Depression and Anxiety, 29*(2), 85-93. https://doi.org/10.1002/da.20910
  48. ↑ Sedeño, L., Couto, B., Melloni, M., Canales-Johnson, A., Yoris, A., Baez, S., Esteves, S., Velásquez, M., Barttfeld, P., Sigman, M., Kichic, R., Chialvo, D., Manes, F., Bekinschtein, T. A., & Ibanez, A. (2014). How do you feel when you can't feel your body? Interoception, functional connectivity and emotional processing in depersonalization-derealization disorder. *PloS One, 9*(6), e98769. https://doi.org/10.1371/journal.pone.0098769
  49. ↑ Radovic, F., & Radovic, S. (2002). Feelings of unreality: a conceptual and phenomenological analysis of the language of depersonalization. *Philosophy, Psychiatry, & Psychology, 9*(3), 271-279. https://doi.org/10.1353/ppp.2003.0048
  50. ↑ Syvertsen, T., & Enli, G. (2019). Digital detox: Media resistance and the promise of authenticity. *Convergence, 26*(5-6), 1269-1283. https://doi.org/10.1177/1354856519847325
  51. ↑ Parsons, T. D., & Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. *Journal of Behavior Therapy and Experimental Psychiatry, 39*(3), 250-261. https://doi.org/10.1016/j.jbtep.2007.07.007
  52. ↑ Brey, P. (1999). The ethics of representation and action in virtual reality. *Ethics and Information Technology, 1*(1), 5-14. https://doi.org/10.1023/A:1010069907461
  53. ↑ Floridi, L. (2014). *The fourth revolution: How the infosphere is reshaping human reality*. Oxford University Press.
  54. ↑ Pallavicini, F., Pepe, A., & Minissi, M. E. (2019). Gaming in virtual reality: What changes in terms of usability, emotional response and sense of presence compared to non-immersive video games? *Simulation & Gaming, 50*(2), 136-159. https://doi.org/10.1177/1046878119831299
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