am i going mad
No — and here is what that rests on, rather than reassurance.
Through the whole thing you know the world is real. That is exactly why it’s frightening: you can see perfectly well that the kitchen is the kitchen, and it still looks like a set. In psychosis that gap is missing; what seems true is simply taken as true. Clinicians call this intact reality testing, and it is one of the things that separates derealisation from psychotic states. If the fear of madness itself has become the main thing and holds without the unreality, it has its own piece, along with the signs that mean see someone.
Put less formally: someone searching "am I going mad" at three in the morning rarely is — for exactly that reason.
how common is this
Common enough that you are nowhere near alone in it.
A systematic review pulling together surveys across several decades found that transient episodes of derealisation or depersonalisation are reported at some point in life by somewhere between a quarter and three-quarters of people. That spread is enormous, and the authors say so themselves — different studies ask different questions over different time windows. But the conclusion survives the spread: having felt this once is ordinary rather than rare.
The persistent version — months of it, getting in the way of living — is a different matter. A 2023 review across twenty-three studies puts it at about one per cent of the general population. Something like a fiftyfold gap between "that happened to me once" and "this is a disorder".
One more figure worth having. Among people with anxiety disorders the persistent version is found in three to twenty per cent, against one in the general population. Passing episodes in panic disorder are recorded in eight per cent of patients in some studies and eighty in others: they counted differently. Even the lower bound there is several times the ordinary rate — the link to anxiety shows.
what to do in the moment
The job is to give your body something to hold. Talking yourself round doesn’t work, because there is nothing to correct — you already know the world is real.
None of this needs a room to yourself — derealisation hits hardest on a bus or halfway down a supermarket aisle.
- Brace against something. Sitting: back to a wall, feet flat. Standing: weight spread across both feet, a hand on a rail or a wall. Your body needs the message that it is somewhere.
- Hold something cold. Keys, a bottle out of your bag, a glass of water. A sharp sensation in the hand cuts through the glass better than argument.
- Slow the out-breath. In through the nose, out through the mouth twice as long. If your breathing had sped up, start here and the rest gets easier.
- Name five things out loud. The mug, the handrail, the scratch on the table. Out loud beats silently — it brings your voice and your hearing in. In company, a whisper does it, or just the shape of the words: the throat still works.
- Move. At home: walk the room, wash your face, put a palm flat on the wall. In public, go smaller: fists closed and opened, weight shifted foot to foot, keys turned over in your fingers. Moving returns the sense of having a body faster than sitting and monitoring it.
It usually eases within minutes. Sometimes a tail of it hangs about for half an hour or so. That is how it ends: slowly.
And if the list didn’t work, that says nothing about you — for some people the episode simply runs its course and stops on its own.
If it arrived at the peak of panic, then panic is the thing to work with — the order of operations is in panic attack, or, if it’s the middle of the night, panic attack at night.
what sets it off
There’s no single agreed explanation, but the circumstances are well described. Usually several of them stack.
The peak of anxiety or panic. The most common setting by far. Unreality sits in the description of a panic attack alongside the racing heart and the tight chest, and it is often the part that frightens people most.
Breathing that has run away. Breathe fast and deep and the carbon dioxide in your blood drops, the vessels in the brain narrow, and you get dizziness, poor focus and precisely this sense of unreality. It is a long-described effect of hyperventilation: in laboratory work three minutes of that kind of breathing is enough to bring on a crop of symptoms. Which gives a practical rule: if you’ve been breathing hard for the last few minutes, start with the exhale. More in can’t breathe properly.
Lost sleep. After a night without any, this turns up often and usually means very little — though it frightens just as much.
A long stretch of strain. Exams, a court date, a move, a month at full tilt. Derealisation often arrives a week after the worst day, once things have supposedly calmed down.
Something that already happened. After violence, an accident, a loss, derealisation is more common than in any other group and it stays longer. Here it is part of the response to what happened, and it’s addressed as part of that, with someone who knows trauma.
Substances. Cannabis is the one people name most often here; for a lot of them the first episode starts there. An alcohol rebound the morning after does it too — that one has its own piece, hangover anxiety.
The list has something in common: a nervous system running past what it can process. Many researchers read derealisation as something like an emergency setting — a way of turning the volume down when there is too much of it. What makes that idea useful isn’t its elegance; it’s what follows from it. The overload passes, and the setting switches off.
the loop that makes it stick
This is the important part, and it explains why one person forgets the episode by the next day and another is still in it months later.
A London research group that has worked on this for years proposed the following. The symptom itself is passing. It turns chronic when it gets read catastrophically: I’m losing my mind, something is wrong with my brain, I will never be myself again. That thought raises the anxiety, the anxiety deepens the derealisation, the derealisation confirms the thought, and the circle closes.
After that it is held up by things people do with the best of intentions. Checking, ten times a day, whether it still feels unreal. Watching their own sensations closely. Avoiding the place where it happened. Every check keeps attention pinned to the symptom and blocks the one experience that would contradict the fear.
This is a model rather than a proven mechanism: the authors put it forward as a working frame for therapy. But it has a property that matters more than proof — what to do falls straight out of it. Check less, go back to the places you stopped going, and know the sensation is safe; that knowledge is exactly what the loop is missing.
If the part you recognise is a thought winding itself up, the machinery is the same one in how to stop overthinking.
derealisation and depersonalisation
They’re usually named together because they usually arrive together, but they are different sensations.
Derealisation is about the world outside. It looks flat, staged, behind glass. A familiar street looks like a photograph of a familiar street.
Depersonalisation is about you. Your hands look borrowed, your voice sounds like a recording, feelings arrive muffled. Some people describe watching themselves from the corner of the room. If the muffling is the main thing and it holds on its own, without the world looking unreal, that may be a different state: can't feel emotions.
The classifications treat them as one diagnosis — depersonalisation-derealisation disorder. For what to do in the moment the distinction doesn’t matter.
when something else is behind it
A one-off episode after panic, a bad week or a night without sleep calls for breathing and sleep. It’s worth getting seen if any of the following fits.
- It has lasted weeks, or returns nearly every day, and you’re arranging life around it.
- It started after a blow to the head, a faint, or alongside neurological signs — numbness, double vision, weakness in an arm or leg. Then a neurologist first: some conditions produce a similar feeling and want ruling out.
- The episodes are short and identical each time — arriving out of nowhere without anxiety, lasting under a minute, and repeating in the same shape: the same odd smell or taste, the same sense of having been here before, a pause other people notice. That is one for a neurologist.
- There are gaps in your memory. Not "drove home on autopilot" — chunks of time that aren’t there.
- It comes with heavy low mood, or with thoughts of hurting yourself. That one is urgent and separate; numbers are below.
The encouraging part: this is treatable, usually with cognitive behavioural therapy — the same school the explanation above came from. It means a psychiatrist or a therapist.
If the anxiety sits underneath everything without episodes, constant anxiety covers where to start.
short answers
Is derealisation the start of schizophrenia?
No — different conditions. The confusion comes from the fact that derealisation occurs in schizophrenia too, but there it sits alongside other symptoms rather than on its own. The distinction above is the one that matters: here you know the world is real, and that is what hurts.
Is it spelled derealization or derealisation?
Both — the z is American, the s is British. Same thing.
How long does it last?
An episode during panic: minutes, occasionally up to an hour. After a sleepless night it can hold all day and lift with sleep. Once it’s measured in weeks, it’s a question for a professional.
Why is it worst in supermarkets and on the underground?
Movement, light, noise, and nothing for the eyes to rest on. Your brain gets a stream it can’t process right now. Standing against a wall, holding a rail and narrowing your view to one point all help.
I feel it all the time but my life is normal. Is that bad?
The sensation itself is no more dangerous in year five than it was on day one. What it does do is quietly narrow things — you get used to it and stop noticing what you have stopped doing. So it is worth mentioning to someone even without anything getting worse; it responds to treatment, and it usually turns out to have cost more than it looked like. If it is new or getting stronger, go sooner.
Does medication help?
There’s no drug for derealisation as such. What gets treated is whatever it rests on — an anxiety disorder, depression, panic. That’s a conversation with a doctor rather than a choice at the pharmacy.
What if it started with cannabis?
That’s a common way in. For many it clears once the substance is out of their life — for some in days, for others longer. If it runs past a month, see someone, and say what you took: it changes the plan, not how they’ll look at you.
What should I do if someone I’m with has this right now?
Don’t argue that things are real; they know. Sit with them, talk normally, put something cold in their hands, breathe alongside them. How to be there through an attack is in helping someone through a panic attack.