Mental health issues can be complex and challenging to understand. One concept that comes up frequently is “breaks from reality” – but what does this actually mean? In this article, we’ll explore what constitutes a break from reality, what the signs and symptoms may be, and how these experiences can impact someone’s life.
What is a break from reality?
A break from reality refers to a disruption in a person’s perception or experience of the world around them. It signifies a disconnect between the way things objectively exist, and the way someone subjectively perceives them. Breaks from reality can vary dramatically in severity, from mild distortions to complete detachment from consensual reality.
Some examples of breaks from reality include:
- Hallucinations – seeing, hearing, feeling, tasting or smelling things that aren’t actually there
- Delusions – fixed, false beliefs that are held despite evidence to the contrary
- Disorganized thinking – incoherent or illogical thought patterns
- Catatonia – lack of movement, activity or responsiveness
- Derealization – feeling detached from one’s surroundings, like reality is somehow unreal
Breaks from reality appear in mental health conditions like schizophrenia, bipolar disorder, major depressive disorder with psychotic features, and drug-induced psychosis. They can also occur in neurological conditions like dementia. In some cases, physical factors like lack of sleep, sensory deprivation, or high fever can also play a role.
What are the signs and symptoms?
There is a wide spectrum when it comes to the possible signs and symptoms of a break from reality. Here are some common ones to look out for:
- Hallucinations – seeing, hearing, tasting, feeling or smelling things that others do not experience. Auditory hallucinations like hearing voices are most common.
- Delusions – firmly holding false beliefs despite contrary evidence. Paranoid delusions are common, like beliefs about persecution, conspiracy, or guilt over imagined transgressions.
- Disorganized speech or behavior – rambling or nonsensical speech patterns. Behaving in ways that seem bizarre or unpredictable.
- Catatonia – lack of movement, activity, reactivity or speech.
- Thought disorder – disjointed and incoherent thinking. Jumping between topics erratically.
- Derealization – feeling detached from reality, as if things or people are somehow unreal. The external world seems foggy or dreamlike.
Often, these symptoms lead the individual to behave in ways that don’t align with social norms or expectations. Their perceptions, interpretations and reactions may be very different from those around them.
What’s the impact?
Experiencing a break from reality can be extremely disruptive to a person’s life. Depending on the severity, it may make day-to-day living and functioning very difficult. Some of the potential impacts include:
- Withdrawing socially and isolation
- Difficulty with work, school or relationships
- Self-care and hygiene may deteriorate
- Trouble understanding or communicating clearly
- Apathy, lack of motivation or energy
- Mood changes – like depression or euphoria
- Fear, anxiety, anger surrounding delusional beliefs
- High risk of self-harm or suicidal ideation
- Stigma surrounding mental health issues
Additionally, breaks from reality can be frightening or confusing for the affected individual. They may have difficulty determining what is real versus imagined, or be unable to control disturbing thoughts, urges and sensations.
Support from loved ones is crucial, but professional treatment is often needed as well. Medications, psychotherapy, social support and hospitalization in severe cases can help manage symptoms and work towards recovery.
Examples and case studies
Looking at specific examples can help illustrate what different types of breaks from reality look and feel like on an individual level.
Schizophrenia
Schizophrenia is one of the most well-known conditions involving detachment from reality. Positive symptoms like delusions and hallucinations are common. Consider this hypothetical case study:
Joan, a 32-year old woman was diagnosed with schizophrenia five years ago. She hears imaginary voices that narrate her daily activities and make critical comments about her. Joan also believes she is married to a famous musician she has never met, and that the government has implanted tracking devices in her body.
Sometimes Joan has disorganized speech, switching randomly between topics mid-sentence. Other times she sits frozen and unresponsive, seemingly unaware of her surroundings. She insists the voices and delusions are completely real and becomes agitated if others suggest otherwise.
Joan has difficulty holding a steady job. She often neglects basic self-care, isolating herself in her apartment for days at a time. Her lack of insight means she doesn’t think treatment is necessary despite her psychiatrist’s recommendations.
Psychosis
Psychotic symptoms like hallucinations and delusions can also occur in bipolar disorder, severe depression or as a side effect of drug use. Consider this example:
James, a 27-year old corporate lawyer, experiences episodes of psychotic mania during his bipolar upswings. He begins feeling invincible and believes he has divine powers with an epic destiny. James impulsively quits his job, writes nonsensical formulaic codes he believes will change the world, and delivers rambling sermons on the street corner.
During these states, James sleeps very little but feels hyper-energized. He hears voices encouraging his grandiose delusions and also sees visions of his “future kingdom”. His speech is rapid, loud, and disorganized, punctuated by laughter or angry outbursts.
While productive at times, these prolonged hyper-manic states inevitably end in crisis – arrest, hospitalization, or complete burnout from exhaustion. James’ periods of psychosis put his career, finances and relationships at risk.
Delirium
Delirium can cause acute confusion, attention and awareness problems that represent a change from baseline cognition. It is common in neurological disorders like dementia, as well as post-surgery. Consider this example:
Clara, a 68-year old widow, was hospitalized for a broken hip after a fall at home. After surgery, she became delirious – probably as a combined result of the hip fracture, anesthesia side effects, change in environment, and pre-existing but undiagnosed Alzheimer’s disease.
Clara was agitated and fearful, seemingly unable to recognize where she was or communicate clearly. She shouted angrily at hospital staff and tried to remove her IV lines. She became paranoid, insisting her children were trying to poison her.
These hallucinations and delusions represented a sharp departure from Clara’s normal mental status. Tracking her vitals and oxygen levels, adjusting medications, and placing Clara’s bed near a window helped resolve the delirium within a few days. But the dramatic episode indicated an underlying dementia problem requiring further evaluation.
Treatment options
The appropriate treatment for a break from reality depends on the underlying cause and severity of symptoms. Some key options may include:
Medication
Medications like antipsychotics and mood stabilizers can help relieve psychotic symptoms like delusions, hallucinations, paranoia and disordered thinking. Drugs are carefully chosen based on diagnosis, symptom profile and side effects risk.
Psychotherapy
Talk therapy approaches like cognitive behavioral therapy (CBT) can provide coping strategies for symptoms, improve insight, and track progress. For high psychosis risks, preventative therapy teaches how to recognize early warning signs.
Social and community support
Support groups, home aids, case workers and workshop programs provide social connection and rehab living skills. They aid functional recovery and complement medical treatment.
Hospitalization
For acute risks like suicide, aggression or inability to care for oneself, a psychiatric hospital stay may be required to stabilize symptoms in a secure environment.
| Treatment | Description | Benefits |
|---|---|---|
| Medication | Drugs like antipsychotics and mood stabilizers | Can quickly improve psychotic symptoms like delusions, hallucinations, paranoia, disordered thoughts |
| Psychotherapy | Cognitive behavioral therapy (CBT) or psychoeducation | Develops coping skills, increases insight, tracks progress |
| Community support | Support groups, home aids, case workers | Provides social connection, develops real-world living skills |
| Hospitalization | Inpatient admission for stabilization | Controls dangerous symptoms in a secure environment |
Prevention
While psychotic breaks cannot always be prevented entirely, certain strategies can reduce risk or minimize severity:
- Staying physically, mentally, emotionally and socially active
- Reducing substance use including alcohol, drugs, and even excessive caffeine
- Managing stress through relaxation, mindfulness, therapy, social support
- Establishing regular sleep-wake cycles
- Monitoring moods for lows or highs; keeping mood charts
- Identifying early warning signs like growing paranoia
- Having a crisis plan if warning signs escalate
- Avoiding triggering factors like sensory deprivation
- Taking medications reliably if prescribed
A combination of healthy lifestyle habits, self-monitoring, social support and prompt treatment aid stability and functioning.
Conclusion
Breaks from reality encompass a wide spectrum – from subtle distortions to complete psychotic breaks with the real world. Hallucinations, delusions, confused thinking and catatonia are common symptoms. Such experiences can be tremendously disruptive, but many different treatment options exist. With proper care, fulfilling lives are possible despite chronic mental health conditions. Increased awareness, along with continuous support for those affected, can go a long way in managing symptoms successfully and preventing major deteriorations.