Derealization and Anxiety: Why the World Feels Unreal

You are talking to someone, driving a familiar route, or sitting in a room you know well. And suddenly everything feels strange.

Things may look slightly off, dreamlike, distant, foggy, or like a scene from a film. Colors may seem faded, and sounds may feel muffled or distant. Familiar places may suddenly seem unfamiliar. Even though you are physically present, you may feel strangely disconnected from your surroundings.

This experience is called derealization, and it is more common than many people realize, particularly among people who experience anxiety. It can be frightening, especially the first time it happens. Understanding what derealization is, what causes it, and what to do about it can make it much less overwhelming.

Key Takeaways

• Derealization (a feeling that your surroundings are unreal, dreamlike, or altered) is a dissociative symptom often associated with anxiety disorders and panic attacks. 

• Anxiety and panic can trigger derealization through stress-related changes in breathing, nervous system activation, and sensory processing. 

• Derealization is not the same as a sign of psychosis or losing touch with reality.

• Treating the underlying anxiety often reduces derealization episodes significantly.  Grounding techniques can help manage your response in the moment, and therapy and medication can help address the underlying anxiety.

What Is Derealization?

Derealization is a type of dissociative experience in which the external world feels unreal, detached, or distorted. It is classified in the DSM-5 alongside depersonalization (feeling detached from oneself) as depersonalization/derealization disorder when it occurs persistently and causes significant distress. However, short-term derealization is often more common. 

Some people describe the experience as:

• Feeling like they’re in a dream

• Seeing the world through fog or glass

• Feeling emotionally disconnected from their environment

• Noticing that familiar places suddenly feel strange or unfamiliar

A comprehensive review suggested that 70% of all people experience at least one episode of depersonalization or derealization in their lifetime. This often happens during moments of extreme stress, sleep deprivation, or intense anxiety.

Derealization usually exists on a spectrum. Brief and mild episodes typically lasting a few seconds or minutes are often considered part of the normal human experience. But when episodes become frequent, prolonged, distressing, and interfere with daily life, they may warrant professional evaluation. 

How Anxiety Causes Derealization

Derealization is closely connected to the body’s stress response. When anxiety or panic activates the fight-or-flight response, several physical changes can affect perception and awareness: 

• Rapid breathing or hyperventilation  can alter carbon dioxide levels in the blood, contributing to lightheadedness and perceptual changes

• Adrenaline and stress hormones can temporarily alter sensory processing in ways that can feel very strange

• The brain may activate a dissociative response as a protective mechanism. This may create an emotional and perceptual distance from the experience, and can feel overwhelming

For many people, derealization becomes especially distressing because the experience itself becomes frightening and triggers more anxiety. This can create a feedback loop that goes from anxiety to derealization to fear about derealization and more anxiety. 

Understanding that this cycle is anxiety-related and not dangerous in itself is often the first step toward breaking it and reducing fear.

What Derealization Feels Like

People describe derealization in different ways, but common experiences include:

• The world looks flat, two-dimensional, or like a movie set rather than real life

• Colors appear washed out, too vivid, or somehow wrong

• Objects seem the wrong size, or closer or farther away than they should be

• Sounds feel muffled, echoing, or strangely distant

• Familiar places feel unfamiliar or dreamlike

• A sense of a glass wall or fog existing between you and the world around you

Although these experiences can feel strange, people experiencing them generally remain aware that the sensation is internal and temporary. 

Is Derealization a Sign of Psychosis?

Usually, no. 

One of the most common fears people have during derealization is that they’re losing touch with reality. However,  derealization is different from psychosis. 

In psychosis, people may hold false beliefs about reality or perceive things that are not there. In derealization, the person usually knows that their experience is distorted. They can maintain full awareness that while something feels strange, reality itself has not changed. 

According to the Cleveland Clinic, this awareness is what sets derealization apart from psychosis. If you are experiencing derealization, it is important to note that it is more commonly associated with anxiety, panic, trauma, and dissociation. 

Managing Derealization in the Moment

Grounding techniques for dissociation can help redirect attention to the present moment and reduce the intensity of derealization symptoms. 

Common approaches that may help include:

• Using the 5-4-3-2-1 grounding exercise: Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste

• Holding something cold, textured, or strongly sensory, like a cold glass of water or an ice cube

• Slowing your breathing deliberately and extending the exhale to counteract rapid breathing

• Move your body: walk, stamp your feet, or do a few jumping jacks to reconnect with physical sensation

The goal with these techniques is not to force the sensation away immediately, but to help reduce the cycle of fear and reconnect with the present environment. 

Treatment for Anxiety-Related Derealization

Treating the underlying anxiety is usually the most effective and lasting approach.. 

Therapy

Cognitive-behavioral therapy (CBT) is one of the most evidence-based treatments for anxiety disorders and panic symptoms. It can help people:

• Disrupt the thought patterns

• Reduce the intense and fearful interpretations of derealization

• Address avoidance behaviors

• Improve coping strategies during anxiety episodes

. A review found that CBT was effective across a range of anxiety conditions.

Medications

For some people, medications used to treat anxiety disorders can reduce the frequency and intensity of derealization episodes. These may include:

• Selective-Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Read more about how these non-addictive anxiety medications work and what to expect from treatment. However, medication decisions should always be discussed with a licensed healthcare provider first. 

Derealization, Trauma, and Dissociation

Derealization is also commonly associated with trauma and dissociation.

In overwhelming situations, the brain may create emotional or perceptual distance from what’s happening as a protective response.

This is one of the reasons derealization can occur as a symptom of PTSD or trauma, even outside of panic attacks.

Sleep deprivation, substance use (including cannabis), certain medications, and medical conditions affecting the brain can also contribute to derealization.  A thorough evaluation can help rule out these contributing factors and identify the underlying trigger. 

For people experiencing derealization as a symptom of trauma,  treatments such as Eye Movement Desensitization and Reprocessing (EMDR) or trauma-focused CBT may help.

Understanding how anxiety affects the nervous system can help reduce fear around the experience itself. With grounding strategies, therapy, and treatment for underlying anxiety, many people see significant improvement in both the frequency and intensity of derealization episodes over time.

When to Seek Help

Derealization can feel deeply unsettling, especially when it happens unexpectedly. But for many people, it is a stress- and anxiety-related response rather than a sign of something dangerous.

Occasional derealization during periods of high stress or sleep deprivation is also relatively common. It generally does not require professional intervention. However, it may help to seek professional support if symptoms are:

• Frequent or persistent

• Causing significant distress

• Interfering with your ability to drive, work, or function in daily life

• Occurring alongside panic attacks, trauma symptoms, or severe anxiety

A psychiatrist or therapist can help determine what may be contributing to the symptoms and recommend appropriate treatment. 

Book a virtual appointment with our board-certified psychiatric providers now and get personalized support for anxiety, panic symptoms, derealization, and dissociation.

Medical Disclaimer

This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be the same for another.

Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you’re experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider. 

In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.

Sources

1. Wilkhoo, H. S., Islam, A. W., Reji, F., Sanghvi, L., Potdar, R., & Solanki, S. (2024). Depersonalization-Derealization Disorder: Etiological Mechanism, Diagnosis and Management. Discoveries (Craiova, Romania), 12(2), e190. https://doi.org/10.15190/d.2024.09 

2. National Institute of Mental Health. (December 2024). Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders 

3. American Psychiatric Association. DSM-5. https://www.psychiatry.org/psychiatrists/practice/dsm 

4. Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin Cleveland Clinic. (29 September, 2023). Depersonalization-Derealization Disorder. https://my.clevelandclinic.org/health/diseases/9791-depersonalization-derealization-disorder 

5. NIMH. Panic Disorder. https://www.nimh.nih.gov/health/statistics/panic-disorder 

6. Sierra, M., & David, A. S. (2011). Depersonalization: a selective impairment of self-awareness. Consciousness and cognition, 20(1), 99–108. https://doi.org/10.1016/j.concog.2010.10.018 

7. NIMH.  (December 2024). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

8. American Psychiatric Association. (June 2023). What Are Anxiety Disorders? https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders