I survived a TBI in May 2010. Since that time everything feels surreal. It is as if I am 2-3 steps removed from everything that’s happening. Can you explain this?
Following a traumatic brain injury, many people experience both their inner and outer worlds quite differently than they did before. There are a number of reasons for this. First, changes to the brain commonly impact a person’s memory, attention, concentration, problem-solving abilities, and reasoning skills. These changes can alter the way a person makes sense of or interacts with the world around them, resulting in very different thought processes and behaviors than the person may have had before the injury.
Changes to the parts of the brain that control either visual or auditory processing can also result in a person experiencing the world quite differently than they did before. When the brain receives information either by looking at something (visual input) or by listening to sounds (auditory input), the brain must de-code this information and make sense of it. When the parts of the brain that have this job are injured, people can have a difficult time accurately interpreting what they see or hear.
Finally, stress levels are substantially heightened for most people with TBI. Whether stress comes from the difficulty of having had a traumatic experience, from the challenge of living with changes to one’s abilities, from the emotional changes that can accompany brain injury, or from a combination of these factors, stress levels are likely to be high. Prolonged, intense stress "• especially when accompanied by trauma "• can have a significant impact on the way in which the brain functions. Survivors struggling to manage stress levels may notice further difficulty processing information or making meaning of themselves and their world.
Some people with brain injury may also experience what doctors refer to as depersonalization (DP) and/or derealization (DR). Depersonalization describes the experience of feeling like you are removed from yourself or as if you are in a dream. Derealization is the sensation that the world around you is unreal or is profoundly and grotesquely changed. Often, DP and DR occur at the same time. The majority of people who note frequent bouts with DP/DR have experienced some type of significant trauma. DP/DR can also occur as a result of injuries or illnesses which impact neurological functioning. Although there is still much to learn with respect to why some people experience DP/DR following a traumatic brain injury, the experience may be more common than was previously thought. In fact, in one study, as many as half of the patients with TBI reported experiencing at least occasional instances of DP/DR¹,². It appears that people with TBI may be more likely to experience DP/DR when they also meet the criteria for a diagnosis of Post-Traumatic Stress Disorder (PTSD).
If you frequently have the sensation that either you or the world around you is unreal and/or dreamlike, speak to your doctor about this. Your physician may be able to prescribe a medication regimen that could help to reduce these symptoms. Additionally, consider seeing a counselor about ways to reduce the significant stressors in your life. The counselor can also help by providing support and encouragement to assist you in coping with times when you experience DP/DR. Combining stress reduction, professional support, and a comprehensive wellness and medication management plan is the most effective approach to regaining a sense of stability and security in yourself and your world.
- Grigsby J, Kaye K: Incidence and correlates of depersonalization following head trauma. Brain Inj 1993; 7:507–513.
- Lambert, M, Sierra, M, Phillips, M, David, A: The spectrum of organic depersonalization: A review plus four new cases. J Neuropsych Clin N 2002; 14:141-154.
Emilie Godwin, PhD, LPC, MFT is a faculty member and licensed clinician at Virginia Commonwealth University, with a specialty focus on couples and family counseling after brain injury. Currently, she serves as the Family Support Program Coordinator for the VCU TBI Model System projects.