The loss of reality is a symptom that can accompany a variety of organic and psychological diseases, and in some cases may have reasons of non-pathological nature. Therefore, determining the actual cause is necessary to initiate effective treatment.
What is loss of reality?
In medical and psychological terms, the term loss of reality refers to a mental state in which affected individuals can no longer grasp their situation as it corresponds to the facts or as the majority of their peers would. The perception of events and objects is disturbed to such an extent that those affected find themselves in a kind of individual parallel world. This can lead to delusions, hearing voices, excessive overestimation of oneself or underestimation of one’s own abilities. In extreme cases, a loss of reality can lead to sufferers endangering themselves or others. The loss of adequate perception of reality can be limited to individual dimensions, for example as a temporal loss of reality. In this, affected individuals no longer have awareness of a temporal continuum.
Causes
There are multiple possible causes of a loss of reality, and these can be psychological or organic in nature. Very often, reality loss is associated with psychosis, but there are a number of other possible triggers. For example, reality loss occurs in various personality disorders, depressions, and especially in schizophrenia. The symptom is psychiatrically or neurologically relevant in dementia and strokes, among others. Furthermore, organically related causes include metabolic disorders, encephalopathy, brain injuries (for example, traumatic brain injury), cachexia (pathological weight loss), gradual starvation, and dehydration (lack of fluids). Lesser-known causes such as permanent light deprivation can also lead to loss of reality, as can traumatizing experiences, shock, and severe exhaustion. Alcohol and drug abuse also account for a not insignificant part of the causes. For example, long-term alcohol abuse can lead to severe amnesic psychosyndrome (Korsakow syndrome). Abuse of cannabis, in turn, can lead to psychosis and associated loss of reality. Finally, in some cases, the use of certain medications can also cause a distorted perception of reality.
Diseases with this symptom
- Psychosis
- Dissocial personality disorder
- Dementia
- Stroke
- Paranoia
- Narcissism
- Alzheimer’s disease
- Paranoid schizophrenia
- Metabolic disorder
- Cachexia
- Dissociative identity disorder
- Munchausen Syndrome
- Schizophrenia
- Encephalopathy
- Concussion
Diagnosis and course
Since loss of reality is only a symptom, the diagnosis finding will focus on determining the underlying causes. Only when organic causes have been ruled out should mental illness be considered. For example, if typical symptoms such as loss of reality occur in the course of psychosis, the treating physician will conduct blood and urine tests after taking a medical history and performing a general health check. This is done to rule out substance abuse, inflammation or metabolic disorders. Further neurological tests can provide information as to whether the person concerned suffers from epilepsy or multiple sclerosis – diseases in which psychoses can also occur. If no organic cause for the loss of reality can be determined in this way, there is a high probability that a mental disorder underlies the psychotic episode. Schizophrenia is the most common cause of psychosis. However, other mental illnesses or disorders may also be behind it, such as severe depression or bipolar disorder, in which cases the term affective psychosis is used. Therefore, the exact diagnosis of the causative mental disorder is indispensable. This is established by means of psychological testing procedures and by a psychiatrist.
Complications
A loss of reality almost always occurs in the context of psychosis and has several complications. One example of when a loss of reality occurs is in schizophrenia. Affected individuals tend to use drugs more often. In addition, affected individuals are often addicted to nicotine. Furthermore, increased aggressive behavior is observed in schizophrenics, increasing the risk of injury not only to the affected person but also to the immediate environment. In addition, most patients have hallucinations and delusions. Antipsychotics prescribed for schizophrenia have characteristic side effects such as elevation of blood sugar, weight gain, and a Parkinsonian-like appearance such as a muscular rigidity (rigor) and muscle tremors (tremor). In general, mentally ill people are not accepted by society, so they become socially isolated. This can lead to depression. Depression in itself can also alter one’s relationship to reality. Affected people tend to consume a lot of alcohol or even drugs. Chronic alcohol abuse can lead to damage of the liver. This leads via a fatty liver to liver cirrhosis, which can end in liver cancer. Liver cirrhosis favors the development of edema and coagulation disorders. Furthermore, depressives usually suffer from anxiety and obsessive-compulsive disorders, so that they no longer dare to go outside and the symptomatology is worsened by this. In the worst cases, thoughts of suicide occur in the affected person.
When should one go to the doctor?
Today, a frightening number of people suffer from a partial loss of reality. The reason is that each person creates his or her own reality through opinions, prejudices or false perceptions. In this case, no doctor can help the affected person. Possibly, however, a psychologist can be a helpful address, especially if the affected person suffers from his loss of reality. Neurotics, borderline patients and narcissists suffer from a personality disorder. As a result, a more or less severe loss of reality can occur. This can also be assumed in schizophrenia or psychosis. In many cases, drug therapies are indicated. In other cases, an increasing loss of reality may be cause for the greatest concern. The loss of reality may occur as a result of long-term alcoholism. Without withdrawal therapy, it can be difficult to connect with the real world. However, loss of reality may also indicate increasing destruction of brain cells due to strokes, lesions or plaques. Increasing loss of reality may indicate dementia or Alzheimer’s disease. In this case, a visit to the doctor is essential, because the patient must be treated professionally. A loss of reality can also result from taking some medications. Preparations such as Pramid, Pramipexol or Oprymea are known to cause confusion or increasing loss of reality. In this case, a visit to the doctor is essential. The drug may need to be exchanged for another.
Treatment and therapy
The treatment of a loss of reality is carried out according to the underlying disease or the cause. For example, if the loss of reality occurs as a concomitant of dehydration, elimination of the fluid deficiency is sufficient. Likewise, the symptom dissipates relatively quickly when a drug causative for it is discontinued. In other cases, where there is an underlying organic disease, drug treatment may be necessary. This applies, for example, to dementia, strokes, encephalopathies and various inflammatory diseases that can attack the nervous system or brain. Medications can also be used for psychological causes of loss of reality. For example, the administration of neuroleptics has proven particularly effective in the treatment of psychoses. These are part of the standard therapy for schizophrenia sufferers, although anxiety-relieving drugs may also be administered to those affected. The psychotropic drugs are taken over a long period of time, and in some cases patients are dependent on such medication for the rest of their lives. The same applies to all other mental disorders and diseases. In the case of depression, antidepressants are used to alleviate the symptoms; in the case of other disorders, the administration of mood stabilizers can be helpful. If the loss of reality has a psychological cause, psychotherapy is indicated in most cases in addition to medication.Occupational therapy and sociotherapeutic measures such as assisted living and a protected workplace are also recommended, especially for schizophrenia patients. Psychological care is also required if the symptoms are alcohol- or drug-induced. In these cases, it is not uncommon for the focus to be on addictive behavior, which must be treated and ideally overcome.
Outlook and prognosis
The outlook and prognosis for a loss of reality cannot be universally predicted. They depend very strongly on the psychological and the physical condition of the affected person and can develop to different degrees. The personal environment also contributes relatively much to the development of the loss of reality. In most cases the treatment is carried out by a psychologist. Often, ordinary everyday life is no longer possible for the affected person, so they are dependent on outside help. In some cases, the loss of reality is so severe that the affected person can hurt themselves or other people. In these cases, they are treated in a closed institution. Medication is also used in the treatment. Often the abuse of drugs leads to loss of reality, so here the body will remain permanently damaged. Therefore, whether the treatment is successful also strongly depends on the medical history of the person concerned. In addition to mental disorders, patients with loss of reality also complain of metabolic disorders, lack of fluids and sleep disorders. Traumatic outcomes are also often the trigger for the loss of reality. These results are discussed and evaluated with a psychologist. However, whether treatment will lead to success cannot be universally predicted.
Prevention
Some risk factors for reality loss are relatively easy to prevent, provided an addiction is not already present. This is especially true of alcohol and drug abuse, which at best should be avoided altogether. Excessive stress, interpersonal conflicts and noise pollution should also possibly be avoided in order to prevent states of exhaustion. A generally healthy and balanced lifestyle can also help to reduce the risk of psychological stress and the loss of reality that may be triggered by it.
Here’s what you can do yourself
There is almost no self-help method for reality loss. In most cases, a psychologist must be consulted in any case for treatment of this symptom. Not infrequently, therefore, patients must also be admitted to a closed clinic. If the loss of reality takes place due to an excessive intake of alcohol or other drugs, these drugs must be discontinued immediately in any case. Smoking can also promote the loss of reality and should be discontinued. In many cases, it is not possible for the patient to stop the drug in question. This is where self-help groups can be helpful. In any case, self-admission to a psychiatric hospital is also possible to treat the loss of reality. Often, the loss of reality comes from stress. Therefore, all possible situations in which stress or conflicts can arise should be avoided. This limits the daily life, but helps enormously against the symptom. If the loss of reality occurs due to medication, this should be discontinued or replaced by other medication. Above all, friends and family must pay attention to the patient and, if necessary, force him or her to seek treatment.
