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General overview

Déjà vu is defined as a situation where a person has the sensation that an event, that is currently being experienced, has been experienced in the past.

Researchers have described this experience as an anomaly of memory which results in the impression that an experience is being recalled. 

Déjà vu can be a physiological experience in healthy people, but it can also be a pathological issue which is usually associated with temporal lobe epilepsy

When déjà vu experiences are frequent and/or prolonged as well as associated with other symptoms such as hallucinations, then this may indicate the presence of psychiatric or other neurological conditions

Derealisation disorder

This is a psychiatric condition which is characterized by a patient experiencing or perceiving the external world in an unreal manner. Patients say that it seems as if they are looking at the world or environment through a hazy fog or partition or even as if they are looking at it through a 3rd person perspective (like being in a dream). The usual description of this environment is that it lacks emotional colour and depth.

These patients can experience déjà vu or even jamais vu (the feeling that familiar places or people are foreign to the person). The perception which is experienced isn't only visual but also involves the senses of taste, hearing and smell.

Derealisation commonly occurs when the patient experiences persistent worrying or is having intrusive thoughts which are difficult to control. This then leads to increased anxiety and the derealisation is usually only noticed after the patient experiences a situation such as a panic attack. This then results in the patient becoming concerned over the derealisation they are experiencing, and this then makes them even more anxious as they believe that anxiety is not the main cause of the derealisation.

A vicious cycle then develops where the anxiety worsens which in turns worsens the experienced derealisation. This can then result in difficulty to focus on tasks or remembering things, interference with work or other routine activities and it can cause problems in the relationships with friends and family.

The causes of derealisation can include the following issues: 

  • Temporal lobe epilepsy.
  • Occipital-temporal dysfunction.
  • Migraine.
  • Head injuries.
  • Severe physical or emotional stressors.
  • Growing up with a parent who is significantly mentally ill.
  • Childhood trauma, such as experiencing verbal or emotional abuse.
  • Suicide or unexpected death of a close family member or friend.
  • Vestibular neuritis.
  • Labyrinthitis.
  • Excessive use of substances and medications such as marijuana, psychedelics, antidepressants, nitrous oxide, nicotine, caffeine and albuterol. 
  • Alcohol or benzodiazepine withdrawal.
  • It can occur as a symptom of conditions such as severe sleep disorders, borderline personality disorder, anxiety disorders, schizophrenia, bipolar mood disorder, depersonalisation disorder and dissociative identity disorders.
Managing the symptoms of derealisation would then entail excluding and managing the above-mentioned conditions and/or situations. Patients would need to be seen by their primary care physicians to be evaluated and then referred accordingly for further management and treatment. Psychiatric issues can be managed with oral antidepressants and psychological counseling.

 

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