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Derealization

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See also: Terms and 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.[1] 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).[2]

Clinical definition and overview

  • 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.[3]
  • Prevalence. Transient DR/DP episodes occur in 26-74 % of the general population, but chronic DPDR affects roughly 1-2 %.[3][4]

Symptoms and characteristics

Domain Examples
Perceptual The world seems foggy, muted, too sharp, macropsia/micropsia, muted or echoing sounds
Cognitive Feeling "in a film", heightened self-observation, doubts about the reality of memories
Affective Emotional numbing (“de-affectualisation”), blunted responses to normally salient stimuli

Etiology and triggers

Psychological
Acute stress, panic attacks, trauma, severe sleep deprivation, or sensory overload.[5]
Neurobiological
Abnormal fronto-limbic connectivity; hypo-activity of the amygdala and insula; disturbances in predictive-coding networks.[6]
Substance-related
Cannabis, hallucinogens (for example LSD, psilocybin), ketamine, MDMA, stimulant intoxication, or benzodiazepine withdrawal can precipitate DR.[7]

Neurological mechanisms

Neuro-imaging studies reveal a fronto-limbic "decoupling": hyper-activation of pre-frontal regions suppresses limbic emotional circuits, yielding detachment from affective salience.[8] Reduced insular activity may underlie impaired interoception, while alterations in visual association cortices correlate with perceptual distortions.[9]

Derealization and immersive technology (VR/AR)

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

Induced dissociative symptoms

A pivotal study from the Fernand-Seguin Research Center reported significant increases in DR/DP and reduced sense of presence after VR exposure.[10] More recent RCTs and surveys confirm that VR can acutely elevate DR scores, yet effects typically resolve within minutes to hours and rarely persist.[11][12]

Proposed mechanisms

  • Sensory conflict between visual and vestibular/proprioceptive inputs.[13]
  • High immersion / presence shift, producing a temporary imbalance favouring virtual over physical cues.[14]
  • Boundary blurring when hyper-realistic graphics or prolonged sessions weaken reality markers.[15]

Risk factors

Factor Evidence
High baseline dissociation Greater symptom spike post-VR in high-trait individuals.[10]
New users / long sessions Larger DR reports among novices and marathon users.[16]
High embodiment Feeling “inside” an avatar predicts stronger after-effects.[17]

Prevention and management strategies

  • 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.[15]
  • Clinical monitoring: therapists using VR exposure should screen for dissociative side-effects.[18]

Therapeutic applications

Paradoxically, controlled VR has been investigated to treat dissociative conditions, for example reality, discrimination training or interoceptive biofeedback to enhance bodily awareness.[19]

Ethical considerations

Developers and researchers are urged to supply informed consent, protect vulnerable users, and pursue longitudinal studies on cumulative exposure.[15][20]

Historical background

Derealization-like phenomena have been documented since the 19th century; Mayer-Gross (1935) distinguished “allopsychic depersonalization” (unreality of environment) from “autopsychic” depersonalization (unreality of self).[21] DSM-III (1980) first codified Depersonalization Disorder; DSM-5 renamed it DPDR to equalize derealization.[1]

Future research directions

  1. Neuro-imaging comparing spontaneous DR episodes with VR-induced DR
  2. Standardized assessment tools for technology-induced dissociation
  3. Longitudinal studies on heavy VR/AR users
  4. Tailored VR therapeutics balancing presence and grounding
  5. Predictive-coding models of derealization across clinical and technological contexts

References

  1. ↑ 1.0 1.1 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. ↑ Simeon, D. (2004). Depersonalisation disorder: a contemporary overview. CNS Drugs, 18 (6), 343-354. https://doi.org/10.2165/00023210-200418060-00002
  3. ↑ 3.0 3.1 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
  4. ↑ 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
  5. ↑ Medford, N., Sierra, M., Baker, D., & David, A. S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11 (2), 92-100. https://doi.org/10.1192/apt.11.2.92
  6. ↑ Gatus, A., Jamieson, G., & Stevenson, B. (2022). Past and future explanations for DPDR: a role for predictive coding. Frontiers in Human Neuroscience, 16, 813300.
  7. ↑ 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.
  8. ↑ Sierra, M. & David, A. S. (2011). Depersonalization: a selective impairment of self-awareness. Consciousness & Cognition, 20 (1), 99-108.
  9. ↑ Adler, J. et al. (2014). Altered orientation of spatial attention in DPDR. Psychiatry Research: Neuroimaging, 216 (2), 230-235.
  10. ↑ 10.0 10.1 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
  11. ↑ Braun, N. et al. (2022). Virtual reality induces depersonalization and derealization: a longitudinal RCT. Computers in Human Behavior, 131, 107233.
  12. ↑ 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.
  13. ↑ Keshavarz, B. et al. (2014). Vection and motion sickness: higher susceptibility in women. Perception, 43 (ECVP Suppl.), 107.
  14. ↑ Slater, M., & Sanchez-Vives, M. V. (2016). Enhancing our lives with immersive VR. Frontiers in Robotics & AI, 3, 74.
  15. ↑ 15.0 15.1 15.2 Madary, M., & Metzinger, T. (2016). Real virtuality: a code of ethical conduct. Frontiers in Robotics & AI, 3, 3.
  16. ↑ Barreda-Ángeles & Hartmann (2023).
  17. ↑ Peckmann, C. et al. (2023). Experiences of DP/DR among VR gamers. Cyberpsychology, Behavior, & Social Networking, 26 (1), 55-63.
  18. ↑ 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.
  19. ↑ Opriş, D. et al. (2012). VR exposure therapy in anxiety disorders: a meta-analysis. Depression & Anxiety, 29 (2), 85-93.
  20. ↑ Brey, P. (1999). The ethics of representation and action in virtual reality. Ethics & Information Technology, 1 (1), 5-14.
  21. ↑ Mayer-Gross, W. (1935). On depersonalization. British Journal of Medical Psychology, 15, 103-126.
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