What causes derealization
Pro Research Analysisby 
Searched over 200M research papers
Causes of Derealization: An Overview
Derealization is a dissociative disorder characterized by experiencing one's surroundings as unreal or dreamlike. This condition often co-occurs with depersonalization, where individuals feel detached from their own body or self. Understanding the causes of derealization is crucial for effective diagnosis and treatment. This article synthesizes findings from multiple research studies to elucidate the various factors contributing to derealization.
Neuropsychological and Neuroanatomical Factors
Malfunction of the Frontal Cortex
Research indicates that neuropsychological and neuroanatomical abnormalities can contribute to derealization. Specifically, a malfunction in the left frontal and prefrontal cortex has been linked to deficits in working memory, which may produce symptoms of derealization and depersonalization 1. This suggests that cognitive-neurofunctional alterations play a significant role in the manifestation of these symptoms.
Pharmacological Triggers
Drug-Induced Derealization
Certain medications have been implicated in the onset of derealization episodes. For instance, reboxetine, a selective norepinephrine reuptake inhibitor, has been reported to induce derealization in patients treated for major depressive episodes. The symptoms typically remit after discontinuation of the drug, suggesting a possible role of the serotonin system in the pathophysiology of derealization 2. Similarly, dextroamphetamine, commonly used to treat ADHD, has been associated with derealization symptoms in some patients, which also subside upon switching medications 10.
Vestibular and Sensory Mismatches
Distorted Vestibular Signals
Studies have shown that distorted vestibular signals can provoke derealization symptoms. For example, unilateral centrifugation in healthy subjects has been found to induce feelings of unreality, such as the sensation that the body feels strange or that time passes very slowly. These symptoms are thought to arise from a mismatch between vestibular signals and other sensory inputs, creating a misleading frame of reference 3.
Emotional and Psychological Factors
Circumplex Model of Emotion
The circumplex model of emotion, which categorizes emotions based on valence and arousal, has been used to understand the emotional precipitators of derealization. Research suggests that both positive and negative emotions, when experienced at high levels of arousal, can trigger derealization episodes. This highlights the multidimensional nature of the disorder and underscores the importance of emotional states in its onset 4.
Psychiatric and Neurological Conditions
Comorbid Psychiatric Disorders
Derealization is frequently observed in individuals with various psychiatric disorders, including depression, anxiety, and PTSD. Epidemiological studies reveal high prevalence rates of derealization in these populations, suggesting common pathophysiological or etiological factors 5. Additionally, derealization-like symptoms have been reported in the context of epilepsy, further indicating a neurological basis for the disorder 7.
Autonomic Suppression
Fronto-Limbic Mechanisms
Research involving autonomic responses to simulated body threats has shown that individuals predisposed to derealization exhibit distinct patterns of autonomic suppression. Specifically, threats delivered to others correlate with derealization-like experiences, implicating a fronto-limbic autonomic suppression mechanism in the disorder 6.
Conclusion
Derealization is a complex disorder with multifaceted causes, including neuropsychological abnormalities, pharmacological triggers, sensory mismatches, emotional states, and comorbid psychiatric and neurological conditions. Understanding these diverse factors is essential for developing effective treatments and improving patient outcomes. Further research is needed to explore these mechanisms in greater depth and to identify potential therapeutic interventions.
Sources and full results
Most relevant research papers on this topic
Neuropsychological and Pet Study of Depersonalization and Derealization: A Single Case Report
A malfunction of the left frontal and prefrontal cortex may cause deficits in working memory, leading to some of the symptoms of depersonalization and derealization disorder.
Case ReportDepersonalization-derealization syndrome induced by reboxetine.
Reboxetine can induce depersonalization and derealization episodes, potentially due to noradrenaline-induced serotonin liberation of Raphe neurons.
Case ReportDerealization during utricular stimulation.
Unilateral centrifugation in healthy subjects can provoke depersonalization/derealization symptoms, suggesting distorted vestibular signals may create a misleading frame of reference leading to 'unreal' perceptions.
Non-RCTThe Circumplex Structure of Depersonalization/Derealization
Depersonalization and derealization precipitators are significantly influenced by valence and arousal dimensions, indicating the multidimensional nature of these emotions.
Literature ReviewThe epidemiology of depersonalisation and derealisation
Depersonalisation and derealisation symptoms are common in both normal and psychiatric populations, with prevalence estimates ranging from 1 to 2% in the general population.
Systematic Review
Highly CitedThe depersonalized brain: New evidence supporting a distinction between depersonalization and derealization from discrete patterns of autonomic suppression observed in a non-clinical sample
Autonomic suppression in response to self-threats correlates with trait-based depersonalization experiences, while suppression for others' threats correlates with trait-based derealization-like experiences.
Non-RCTDepersonalization‐ and derealization‐like phenomena of epileptic origin
Depersonalization and derealization-like symptoms may occur in epileptic patients, indicating a potential link between epilepsy and psychiatric disorders like depression and anxiety.
Rigorous JournalThe Treatment of Depersonalization-Derealization Disorder: A Systematic Review
A combination of pharmacotherapies, neuromodulation, and psychotherapies can effectively treat depersonalization-derealization disorder, but more high-quality research is needed.
Systematic ReviewRealizing Derealization
Derealization may be more of a philosophical view of life rather than a mental disorder, as it involves experiencing one's surroundings as unreal as if living in an elaborate dream.
2321 – Derealization Due To Dextroamphetamine: a Rare Side Effect Which Could Cause Premature Discontinuation Of Treatment
Dextroamphetamine may cause rare cases of derealization in children with ADHD, potentially leading to premature discontinuation of treatment.
Case ReportRigorous Journal