Why Does Everything Seem So Surreal After Brain Injury?

Question: 

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?

Answer: 

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.

Posted on BrainLine May 22, 2013

Emilie Godwin

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.

Comments

Thank you. My daughter (17) just recently had a door hit the back of her head last week. Just the corner caught the back of her head as it swung closed.
A year prior she was thrown ftom a horse and had only pain. No nausea a little dizziness but sge was fine.
After this recent injury she started feeling disconnected and neither of us had any idea this happens. Still worried but more at ease now.

About 3 months ago I suffered a concussion only about a month and a half after having another concussion. I'm 18 years old and have had 6 concussions in my life and 4 of those are in the past year and a half. The symptoms from the 5 previous concussions were all the same with a headache, some nausea, and maybe some dizziness. However, my last concussion was a lot different. As soon as I got hit in the head, I had a lot of ringing in my ears and had confusion and shortly after, the derealization began to start. I had very bad anxiety trying to dealing with this from that day until around 2 months later. I was desperately searching the internet searching for other people who had this feeling and if it would go away when I came upon this thread. Reading these comments made my anxiety so much worse because I was reading these stories about how their derealization hadn't gone away for years and were still dealing with it and I never thought I would return back to normal. I just want anyone that comes upon this thread with a similar story to mine or anyone with derealization to know that IT CAN go away. For me it took around 2 and a half months for it to really go away. The brain is a slow healing organ and it does not go away instantly like I was and I'm sure you are hoping for. It takes time. I know all you want to do is just stay and inside and not move or go anywhere but BELIEVE ME after a certain amount of time resting, go outside and do things. It's very scary I know because everything feels unreal or like a dream, but you have to do your best to try and push through it. The more you do this the better it's gonna help you. You CAN get better and I know it's very hard to believe that you will, but there are plenty or people out there including myself who have gotten better out there and returned to normal. And for the people who have commented on this thread and have had derealization for years, I have the upmost and tremendous respect for you. It feels like a nightmare every second of every single day and the fact that you all go out and live your lives or even if you don't is incredible. This was by far one of the hardest or the hardest thing I have ever gone through in my life both emotionally and physically. I know how difficult it is to really explain to people how it feels and it's impossible for someone to really understand how it feels unless they have gone through it themselves. So again, the fact that you all choose to go out and live your lives with this is ridiculously brave. I just want to help people that come to this thread understand that their lives aren't over and that there is hope. If anyone ever wants someone to talk to about this or how they are feeling feel free to email me at adam9129129@gmail.com. DONT LOSE HOPE.

I have exactly this, depersonalisation and decentralisation.
I must be in a smaller catergory because I simply do not feel stress.
My focal area of my brain took a hit in a car accident and I suffered a Diffuse Axional Injury and maybe a hypoxia injury. Witnesses said they approached the car and they thought I was dead and after sometime let out a gasp and then they heard me breath. I was out for 40minutes.
A guy described this issue like being stuck in a 70s martial arts movie where the video is grainy and the audio is dubbed and not synced.
I thought this was a spot on description. One of my ears has a really high scratching sound and the my vision also got damaged which most likely explains for a lot of the DP and DC.
I'm basically tired all the time.
Regards Chris/ Australia

Interesting article and thanks for sharing, Emilie. It reminds me that I felt in a "dream-like" state for years after my accident over 50 years ago- "floating up in the sky", wondering what was real that and I could do ANYTHING!!

Regards craig

www.traumaticbraininjury.wordpress.com​

www.headbraininjury.wordpress.com, etc

PPS

“You’re not disabled (limited) by your disabilities, you are able (enabled) by your abilities.”
 

I am writing a book, on my TBI, which led to anoxia and coma, and so much of my recovery was RECOVERING MY EGO. The ego, I've learned, is so important for us to function on this plane. It separates us from others, it gives us an identity, it's what kids don't have yet. And this funny feeling you're describing.....it might be like what I fett when awakening from coma and for years after - that I wasn't a separate me, I was connected to everything. (I was like a little child.) 

I can't wait to get my book out, the journals I kept during my 20 year recovery. RECOVERY OF MY EGO. In that was held my memories, my gut feelings, etc. It's like your brain work has to be connected a your person, in order to make it work for you. And that identity, is your precious ego. So many Eastern thinkers say get past your ego. Absolutely not! (but that's another discussion topic.)

I had 3 aneurysms, 2 CVAs/strokes, craniotomy and part cerebellum removal. I live this exactly. I felt so alone not hearing about anyone with these affects. I'm so sorry you all have gone through this as well.

I am thirteen, and suffered a traumatic brain injury at age 11. No one saw me get it but some classmates, so my parents thought I just hit my head and got a bloody nose. Instead, I was sprinting on a new gym floor, and tripped over someone, and hit my head hard. I don't remember after that, for I had lost consciousness. I rolled and hit my head 3 times. (I know this from classmates later telling me). No doctor could see anything wrong, but I know it was a bad concussion because I had intense confusion after that and could not walk straight for days. Plus, I did not know my way around the school, and happened to gain new musical ability. To this day, I do not feel normal, everything feels so surreal. It is obvious that it won't get better from that after 2 1/2 years from the concussion. Thank you for is article so much. I have finally found some answers to why I feel this way.

I can't find the words of appreciation and relief I feel find your site.  I'm in my early sixties and have battled mental illness my entire life, however, at the age of eleven I suffered a head injury that went untreated. A change in my personality/behavior was noted, by teachers and some family members, but nothing was ever done beyond that. I've always had episodes of this feeling of being unhinged or as if I was watching a movie, and always disconnected to what I was seeing. It has been very unnerving and troublesome, I've been misdiagnosed as bi-polar, and now I'm wondering about the diagnoses of clinical depression? I found your site and your experience and others FITS to a tee exactly what happens when I have 'episodes' and now I have something I feel I can explore.  What REALLY as helped me finding you is knowing I'm not "crazy" that this experience is felt by others, it's a real thing.  SO, thank you for sharing what I know is a difficult situation to put out there, bless you and I'll keep exploring.  <3

Hope this helps someone. It can be very bad in the initial stages of recovery. In my first 3 conscience and remembered days, I seriously didn't believe I was in a real hospital even though I had significant physical injuries, as well as a serious concussion. I thought that someone was playing an elaborate practical joke on me, that the hospital room, nurses, doctors, and my physical injuries were all being faked somehow. If you have experienced anything like this after a concussion, you're not crazy. It was because of the brain injury.

It is all too true! It is hard to find work in any skilled profession that accommodates a short work day or less days in a week for those of us with a TBI. Society & the USA economy is built on a 40 hour work week.

If you read this, remember, you are not alone ¡¡¡¡¡¡

Yeah, is true the world and the reality change in seconds and violently, the only thing we can do is adapt to survive and maybe become in something better than we are before.

We are Survivors and extreme strong people that can charge this cross, we can with this.

Best regards from Chile. sorry for my poor English

Wow! I tried to explain this to family and friends after my TBI in 2002! It has diminished through the years especially when I am in nature! Thanks

Relief to have those feelings validated and know that others experience the exact same feelings! Fortunately, I no longer feel like I did when it seemed as though my head wasn't connected to the rest of me.

Thank You for this it is such a comfort to know why. 

So well written. Many people dismiss the after days of a TBI as "nothing notable" because it takes time and reflection to notice that things have gone different.  

It is good 15 years later to have someone finally explain it! theres been a need for a site like this for so long. Thank you to everyone involved.

It is all too true. What is hard is surviving in a world that does not understand, validate and/or accommodate us. Society views 40 hour work week as the norm. Unless you work for yourself, it is difficult at best to find livable-wage employment that allows resting periods to make it through a day. No benefits or health insurance unless we buy them ourselves. Do we eat or have health insurance? Social Security Disability is denied to so many of us even with a lawyer. Many who do get SSD find it hard to make it on 800 month; many do not get much. It is like society does not even see us tho we exist. It's a hard world to survive and navigate on our own but many of us do somehow.

Exactly, after TBI I feel the same:(

I don't know what I want to say; but I understand.

This site has helped me so much, thank you! I have both PTSD and a TBI and many symptoms seem to overlap which is frustrating but knowing i'm not alone or completely  off my rocker helps.
 

I have MS...mostly in my brain & this is exactly how I feel! Thank you do much for this....the MS Society has nothing on it and the only info I could find was about dissociative disorder (psychiatric). I know others with MS feel this well as well...what a Godsend this page is!
This is so very true! ! I wish more people in my life would read this it's so me....
I can relate to some of this! TBI in 12-27-2007

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