In derealization, the patient perceives the environment as unreal. The trigger is often emotionally stressful situations. For treatment, patients usually receive cognitive behavioral therapy.
What is derealization?
People usually perceive their environment as familiar. Even in a foreign environment, at least the way they perceive it remains familiar. The perceived world therefore seems real and close to the observer. In derealization, a feeling of strangeness and unreality towards one’s own perception sets in. The perceived world suddenly seems distant, abnormal, or alienated. The environment is thus universally perceived as alien. The affected person may be able to relate individual details and people, but people, certain objects, or the environment itself still seem unfamiliar, distant, unreal, artificial, disproportionate, lifeless, or colorless. The state of derealization can be brief and momentary, or persistent for varying lengths of time. Derealization usually develops into a perceptual disorder that permanently alienates all perception per se and thus the patient’s perceived reality. Some affected persons see only in a veiled way, recognize impressions only in a weakened way or feel a great distance between themselves and the environment. In some cases, temporal aspects of experience are also affected. In almost all cases derealization is associated with depersonalization. This means that the condition changes the originally natural personality feeling. Derealization experience is an ego disorder that can be due to various causes.
Causes
Derealization can affect mentally ill individuals as well as mentally healthy individuals. Often, the altered experience is triggered by emotionally high-stress situations that are accompanied by panic, fatigue, and exhaustion. Since drugs, medications such as antidepressants, and stimulants such as caffeine or nicotine also interfere with the perceptual apparatus, derealization and depersonalization may be related to the use of these substances. The disturbed perception can also occur during withdrawal, for example, during alcohol withdrawal or benzodiazepine withdrawal. Physical causes are diseases of the central nervous system, especially epilepsy, migraine or head injuries. In addition, disorders of the vestibular apparatus are among the physically conceivable causes of derealization, for example in the context of labyrinthitis or neuronitis. In some cases, severe sleep disturbances have also been causally related to the disorder. Psychological causes include borderline personality disorder and, above all, depression. Equally common is derealization and depersonalization in the context of schizophrenia or anxiety disorders and panic disorders. Psychologically induced derealizations usually occur in the context of trauma. The affected person cannot and does not want to experience the stressful and traumatizing situation as reality.
Symptoms, complaints, and signs
Derealization can be experienced in a variety of ways. Some patients experience a general unreality toward their environment. Others experience their own perceptions as if they are under a cheese cover or as if they are looking through dark sunglasses. The environment or certain parts of the environment seem strange or unfamiliar and unreal to those affected. Many patients also speak of a robotic, distant, artificial environment. In some affected persons, only the proportion is disturbed. Things seem too small or clearly too large, appear colorless or seem lifeless. Derealisaton can develop into an obsession with the thought of not being a part of the perceived world. Especially when combined with depersonalization, patients often experience derealization as frightening and react with panic. In individual cases, the unreal sensation extends to parts of the patient’s own body. For example, some patients no longer perceive their own hands as “real” or actually belonging to themselves. All other symptoms of derealization depend on the primary cause. In the context of schizophrenia, for example, there may be a feeling of involuntary influence from outside. Patients feel remotely controlled and thus experience not only the environment but also themselves robotically.
Diagnosis
According to ICD-10, several criteria must be met for a diagnosis of derealization.The environment must seem strange, unreal, lifeless, or otherwise artificial to the patient. The affected person also accepts that the altered perception is not due to a direct cause of the environment and describes a subjectively spontaneous change of perception. Furthermore, in addition to illness insight, the affected person must demonstrate awareness that his perceptual experience is not a toxic confusional state or epileptic disease state. Differential diagnoses to consider include disorders such as metamorphopsia, hallucination, illusion, or delusional recognition of reality. Prognosis depends on the individual case.
Complications
Usually, derealization results primarily in psychological disturbances that can have serious consequences for the patient. In the worst case, there are suicidal thoughts or even suicide . Therefore, in case of derealization, immediate medical treatment is necessary. In most cases the complete environment feels strange to the patient, although he can recognize and relate to all people and facts of life. This can lead to depression and other mental disorders. Often there is fatigue, headaches and dizziness. Sleep disturbances are also not uncommon and reduce the quality of life enormously. Patients are often not interested in the feelings of other people, so that they come across as cold and uncaring. This can have a negative effect on friendships and social contacts. Derealization can be treated by talking to a psychologist. Usually, insight about the disorder occurs very quickly, so that treatment can be successful and the affected person himself sees a psychologist. In some cases, derealization can result from the abuse of alcohol and other drugs. This also physically damages the body. In this case, withdrawal is necessary to combat derealization. Various serious complications can arise for the body due to the abuse of drugs.
When should you go to the doctor?
A visit to the doctor is necessary when there are changes in perception that are not considered normal in everyday life. If the environment is perceived as strange or alienated, this is considered unusual and should be investigated. Sensations may be sporadic, transient, or continuous. A physician is needed for all possibilities of occurrence. In many cases, due to the mental disorder, there is a lack of awareness on the part of the sufferer that they should seek medical attention. For this reason, the duty of care of people in the close environment is important. They should seek conversation with the affected person and find out about the symptoms. Subsequently, the assistance of a doctor is often requested due to the initiative of the family. Concern for a loved one is warranted as soon as he or she suffers from substance abuse or appears lifeless. In order to avoid misunderstandings and to understand the behavior and emotions of the affected person, it is necessary that all persons involved are fully informed about the disease by a physician. If the relatives need support in processing the events due to the psychological burden, they should seek therapeutic help. If the affected person himself is able to realize a boundary between himself and the environment, he should consult a physician.
Treatment and therapy
Treated in a small nonrandomized, noncontrolled trial of the use of cognitive behavioral therapy. This is especially true for anxiety-influenced derealization states. Concomitant symptomatic anxiety and depression are brought to resolution as much as possible during therapy. The cause of a traumatizing situation is ideally resolved and reoccupied. The anxiety experience of altered perception results in persistent panic, obsessive introspection, and avoidant behavior. The cognitive-behavioral therapy approach to treatment therefore seeks to provide the patient with an opportunity to reevaluate the depersonalization and derealization experience so that the appearance of threat is lost. In the past, re-evaluating the perception as “normal” has shown positive effects on patients’ recovery. In some cases, neuromodulation is used concomitantly, such as electroconvulsive therapy and transcranial magnetic stimulation. Drug therapies are also used in some cases.The main drugs available for depersonalization are glutamate modulators, opioid antagonists, benzodiazepines, neuroleptics and stimulants. However, the drugs usually do not resolve the underlying cause. In the case of neurogenic causes, causative therapy is additionally given as far as possible.
Outlook and prognosis
The prognosis of derealization has an unfavorable outlook for recovery in a primary syndrome. The course is chronic-persistent in these patients. In addition, the patient’s risk of suicide is significantly increased. For all other sufferers, the prognostic outlook must be evaluated on an individual basis. Approximately half of all adolescents suffer from temporary derealization during the period of adolescence when stressful conditions are severe. As soon as the stress levels decrease or a way of dealing with the situation is learned, these patients normally experience a regression of symptoms. The spontaneous recovery is permanent and does not require medical care. If other mental disorders are present, the prospect of recovery worsens. Especially in the case of personality or affective disorders, the chances of recovery decrease. Therapies often last for several years. In some cases, there is no cure. In psychotherapy, patients learn to live with the symptomatology. Derealization is integrated into everyday life and leads to relief for the patient. Avoiding stress and maintaining a basic optimistic attitude improves the prognosis of the sufferer. Healthy coping with the obstacles of everyday life and good management of life crises also help in strengthening well-being and reducing symptoms.
Prevention
Because emotionally stressful situations occur in everyone’s life, derealization cannot be prevented in such situations in a way that promises success. Derealization and depersonalization are actually a protection of the organism especially in stressful situations.
Aftercare
In most cases, no special possibilities and measures of an aftercare are available to the patient in case of a derealization. Therefore, the affected person is primarily dependent on a very early diagnosis and treatment of the disease to prevent further complications and discomfort. A direct and causal treatment of this disease is usually not possible, since its cause is unknown. Therefore, the measures of an aftercare are also only very limited or not possible at all. Treatment is carried out with the help of medication and through psychological treatment. The patient should pay attention to the correct dosage of the medication and contact a doctor in case of doubt. The help and support of friends or family can also be very useful in preventing further upsets. The relatives should familiarize themselves with derealization and learn to understand the disease, even if they cannot live through it directly. Contact with other sufferers of derealization can also be very useful in this process. In severe cases, relatives can also persuade the sufferer to undergo treatment in a closed institution. In most cases, the disease does not reduce the patient’s life expectancy.
What you can do yourself
Derealization, with an alienated perception of the environment, can significantly reduce the quality of life of those affected. At the heart of the disorder derealization is a dissociatively disrupted experience of self. To alleviate the suffering of the disorder, strategies are recommended that bring the attention of the affected person into the here-and-now. Especially with stimulation of the sensory organs, which can be seen as a short-term means of relief, the gap between the patient and his reality experience can be minimized. Perfumes are often used to stimulate the sense of smell, while spicy foods such as mustard, chili peppers, and even sour foods such as lemons are used to stimulate the sense of taste. If you want to irritate your hearing, you can clap your hands loudly, listen to stimulating music or be in a noisy environment. Pain stimuli that can be self-inflicted in small doses have a positive effect on the experience of sufferers. Sufferers should always have sensory experiences in everyday life that they can experience without a need for detachment.Sensual experiences can take place in the form of touch as well as by listening to pleasant music or by taking relaxing baths with fragrant bath essences. Even the conscious, mindful consumption of delicious food can be perceived by the affected person as a beneficial experience and can be a great help in derealization disorder.
