Derealization as a Symptom of Anxiety
Yes, derealization is a recognized symptom of anxiety disorders, particularly panic disorder, where it is specifically listed as one of the diagnostic criteria. 1
Understanding Derealization in Anxiety
Derealization refers to feelings of unreality or detachment from one's surroundings, where the external world seems strange, unreal, or distant. This symptom is formally recognized in anxiety disorders in several ways:
Clinical Recognition in Diagnostic Criteria
- Derealization is explicitly listed as one of the 13 symptoms that can occur during panic attacks in the diagnostic criteria for panic disorder 1
- The DSM diagnostic framework includes "derealization (feelings of unreality)" as one of the potential symptoms experienced during panic attacks 2
- Derealization often co-occurs with depersonalization (feeling detached from oneself) in anxiety states 3
Prevalence in Anxiety Disorders
- Derealization symptoms are particularly common in panic disorder patients 4
- In vestibular patients, those with anxiety experience more frequent and severe derealization symptoms compared to those without anxiety 3
- Epidemiological data from the National Comorbidity Survey-Replication shows that clinically significant depersonalization/derealization is more likely to occur in individuals with combined mood and anxiety disturbance 5
Mechanisms and Presentations
Derealization in anxiety may manifest through several mechanisms:
Autonomic arousal: The sympathetic nervous system activation during anxiety states can trigger derealization experiences 6
Cultural factors: How derealization is experienced and reported varies across cultures. For example:
Cognitive aspects: Catastrophic cognitions during anxiety can amplify derealization experiences 2
- Fear of losing control or "going crazy" often accompanies derealization symptoms
- Hypervigilant surveying of one's mental state can intensify the experience
Clinical Implications
Assessment Considerations
- When evaluating anxiety disorders, clinicians should specifically inquire about derealization experiences 6
- The GAD-7 scale is commonly used to assess anxiety severity, with higher scores (15-21) often associated with more severe symptoms that may include derealization 2, 6
- Derealization symptoms may be a marker of illness severity and poor prognosis in anxiety disorders 7
Differential Diagnosis
Derealization can also occur in:
Important distinction: In anxiety disorders, derealization occurs with preserved reality testing, unlike in psychotic disorders 2
Prognostic Significance
Derealization symptoms appear to have independent prognostic significance:
- They represent independent risk factors for the persistence or incidence of elevated symptoms of depression/anxiety 7
- Each point increment on derealization scales is associated with a 21% increase in risk for psychological distress at follow-up 7
- Derealization symptoms are more likely to occur in individuals with multiple comorbid mood and anxiety disorders 5
Treatment Considerations
When derealization is present as part of anxiety:
- Standard anxiety treatments (including SSRIs like sertraline) that are effective for panic disorder may help reduce derealization symptoms 1
- Addressing the underlying anxiety disorder should be the primary treatment focus rather than targeting derealization symptoms in isolation
- Psychoeducation about the nature of derealization as a symptom of anxiety rather than a sign of "going crazy" is important for reducing catastrophic interpretations
Derealization can be a particularly distressing symptom that patients may have difficulty articulating. Recognizing it as a legitimate component of anxiety disorders rather than a separate entity is crucial for proper diagnosis and treatment.