The feeling of being “out of it,” foggy, or unreal, often described as constantly feeling “high” without having consumed any substances, is a confusing and unsettling experience. This persistent sensation of detachment is a recognized phenomenon that can be extremely distressing and interfere with daily life. This feeling is a genuine alteration in perception that demands attention. This article explores the potential causes and triggers behind this state.
Understanding the Sensation: Depersonalization and Derealization
The sensation falls under the clinical umbrella of dissociation, specifically known as depersonalization and derealization. Depersonalization is the feeling of being detached from yourself, as if you are observing your own thoughts, feelings, or body from the outside. People often describe feeling emotionally numb or like a robot.
Derealization is a detachment from your surroundings, where the external world appears distorted, foggy, or dreamlike. Objects might seem the wrong size or color, or time may feel like it is speeding up or slowing down. In both depersonalization and derealization, reality testing remains intact, meaning the individual knows their perceptions are not real, which often increases anxiety.
Psychological and Stress-Related Factors
The most common triggers for these dissociative states are intense psychological stressors, including severe anxiety and panic attacks. When the brain senses an overwhelming threat, the nervous system initiates a protective mechanism to “check out” of the situation. This adaptive response numbs the mind to emotional or sensory input perceived as overwhelming.
Chronic, unmanaged stress, such as burnout or long-term emotional strain, can also lead to this persistent feeling of unreality. The hypothalamic-pituitary-adrenal (HPA) axis, which regulates the body’s stress response, can become dysregulated, altering neurochemical balances. This continuous activation may lead to an altered baseline state where the brain remains in a low-level dissociative mode.
A history of trauma, particularly early childhood emotional abuse or neglect, is strongly linked to the development of dissociative symptoms. Dissociation can become a learned coping mechanism that resurfaces under current stress, even years later. The emotional numbness and detachment provide a psychological distance from painful emotions, but this can manifest as a constant sense of being disconnected.
Physical Conditions and Neurological Triggers
The feeling of being perpetually “high” or disconnected can originate from non-psychiatric medical conditions that affect brain function and perception. Metabolic issues, such as hypoglycemia (low blood sugar), can trigger neurological symptoms that mimic intoxication or lightheadedness. This disruption to the brain’s primary fuel source can lead to altered consciousness and a feeling of unreality.
Disorders affecting the vestibular system, which controls balance and spatial orientation in the inner ear, are another source of these sensations. When the inner ear is impaired, the brain receives incorrect signals about where the body is in space, which can translate into a feeling of detachment from one’s surroundings. Certain types of migraines, particularly vestibular migraines or those with aura, are also known to cause transient perceptual disturbances that include feelings of derealization.
In rare cases, conditions like temporal lobe epilepsy or transient ischemic attacks can induce perceptual alterations that resemble a chemical high. These neurological events cause brief electrical disturbances in the brain regions responsible for processing reality and self-awareness. Since these physical causes require specific medical intervention, they must be properly evaluated.
Medications and Substance After-Effects
The introduction or discontinuation of certain prescribed medications can sometimes produce feelings of detachment as a side effect. Drugs that affect the central nervous system, such as some selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medications, and even non-psychiatric drugs like some antibiotics, have been reported to cause depersonalization symptoms. This is often due to the drug’s effect on neurotransmitter systems, such as serotonin, which are involved in mood and perception.
For individuals with a history of substance use, lingering effects can persist even after sobriety is established. Post-acute withdrawal syndrome (PAWS) is a set of persistent symptoms that can include cognitive fog and derealization, continuing long after the acute withdrawal phase. Substances like cannabis, hallucinogens, and ketamine are known to acutely trigger depersonalization and derealization episodes, and for some, these episodes may become chronic.
Steps for Diagnosis and Management
If you are experiencing persistent feelings of unreality, the first step should be a consultation with a primary care physician to rule out physical causes. The doctor will likely conduct a physical exam and may order lab tests to check for metabolic issues or endocrine dysfunction. Be prepared to discuss your full medical history, including any medications you are taking, to identify potential physiological triggers.
Keeping a detailed journal of when the symptoms occur, their duration, and any accompanying factors, such as specific foods or levels of stress, can be incredibly helpful for diagnosis. If physical causes are ruled out, a referral to a mental health specialist, such as a psychologist or psychiatrist, is the next step for a thorough mental health evaluation. Psychotherapy, especially cognitive behavioral therapy (CBT), is a common and effective treatment that helps patients understand the causes and learn techniques to manage the symptoms.
During episodes, immediate management often involves grounding techniques, which are simple actions designed to reconnect you with the present moment and your physical body. These techniques might include holding a piece of ice, focusing intently on a strong scent, or firmly pressing your feet into the floor. While no single medication is proven to treat this detachment directly, drugs may be prescribed to address underlying conditions like anxiety or depression that often accompany these sensations.