The sensation of feeling persistently “high,” “spacey,” or “unreal” when you have not consumed any substances is a deeply unsettling experience. This feeling is often described as brain fog, lightheadedness, or a dream-like detachment. It is a symptom complex, not a single diagnosis. It can manifest as depersonalization (feeling disconnected from your own self and body) or derealization (the sense that the world around you seems strange or artificial). Although frightening, these symptoms are often the result of underlying physiological or psychological processes that warrant professional investigation.
Psychological Causes: The Role of Derealization and Anxiety
One of the most common non-substance-related causes of feeling unreal is dissociation, a psychological defense mechanism. This manifests as depersonalization, the feeling of observing your life from outside your body, or derealization, the sense that your surroundings are distorted or fake. These dissociative symptoms are frequently triggered by intense stress, chronic anxiety, or panic attacks. The brain initiates this detachment as a protective measure to buffer itself from overwhelming emotional pain or fear.
When severe anxiety or stress activates the body’s “fight-or-flight” response, it causes rapid physiological changes. A common result is hyperventilation, which alters the balance of oxygen and carbon dioxide in the blood. This shift temporarily reduces blood flow to the head, creating the physical sensation of lightheadedness or a “spaced-out” feeling. The brain interprets this physical symptom as confirmation that something is wrong, which fuels the anxiety and traps the individual in a self-perpetuating cycle of fear and detachment.
Issues With Balance and Vestibular Processing
The feeling of being “off-balance” or “floaty” often has a physical origin in the vestibular system, the balance mechanism located in the inner ear. This system works closely with your eyes and brain to maintain spatial orientation and posture. When communication within this network is disrupted, it can produce chronic dizziness, unsteadiness, and a sensation similar to being perpetually in motion.
Persistent Postural-Perceptual Dizziness (PPPD)
PPPD is a frequent cause of chronic, non-spinning dizziness that can feel like being high or fuzzy. It typically begins after an acute event, such as a severe migraine, a panic attack, or a viral inner ear infection, but the symptoms persist for months. Instead of fully recovering, the brain adopts a maladaptive strategy, relying excessively on visual input rather than internal vestibular signals to maintain balance. This over-reliance on sight makes symptoms worse in visually busy environments, such as grocery stores or when exposed to complex patterns.
Vestibular Migraine
Another common culprit is the Vestibular Migraine, a neurological disorder that can cause episodes of vertigo and profound dizziness without a severe headache. These attacks can include lightheadedness, unsteadiness, and a feeling of rocking or swaying, often described as being on a boat. Vestibular migraines are triggered by factors common to classic migraines, including stress, hormonal changes, and lack of sleep. The resulting feeling of unreality can last anywhere from minutes to several days.
Metabolic and Systemic Health Contributors
The brain is highly sensitive to changes in the body’s internal chemistry, and several systemic health issues can create a persistent feeling of cognitive fog or lightheadedness.
One measurable cause is low blood sugar, or hypoglycemia, which starves the brain of its primary fuel, glucose. Symptoms often include dizziness, impaired concentration, nervousness, and confusion, which collectively mimic the detached feeling. This can occur in individuals with diabetes or those who have long gaps between meals.
Thyroid dysfunction also significantly impacts systemic health and mental clarity. An underactive thyroid, or hypothyroidism, slows down metabolism and can lead to fatigue, cognitive changes, balance problems, and vertigo. Furthermore, chronic dehydration or conditions leading to low blood pressure can decrease blood volume. This prevents sufficient blood flow from reaching the brain, resulting in lightheadedness and a foggy mental state that can feel like a constant disconnect from reality.
Necessary Steps for Diagnosis and Treatment
Because the symptom of feeling “high” or “unreal” has such diverse origins, the diagnostic process begins with a comprehensive medical evaluation to rule out physical causes. Initial steps involve general blood work to check for metabolic issues like thyroid imbalance, anemia, and blood glucose irregularities. A detailed symptom journal is also beneficial, as it helps track triggers and patterns. If a vestibular issue is suspected, a specialist may order tests like a Videonystagmography (VNG) to assess inner ear function.
Treatment is specifically targeted to the identified cause. For psychological origins like DPDR, psychotherapy, such as Cognitive Behavioral Therapy (CBT), is often utilized. Vestibular disorders like PPPD are typically managed with specialized physical therapy, which helps retrain the brain to correctly process balance information. Metabolic issues are addressed through dietary changes, hydration management, or medication to correct hormonal or chemical imbalances.