“Am I dreaming?” How to handle the fear that it’s all been a dream

“Why does my mind feel like it’s in a permanent dream state?”

“What if this is all a dream? How can I know if any of this is real?”

“My dreams are so realistic they feel like memories later.”

If you’ve ever had a similar line of questioning—or a fear that your experience has all been a dream—you’re not alone.

The occasional worry about whether you’re dreaming or experiencing reality is normal—and something that crosses many people’s minds from time to time. Sometimes, however, there’s a mental health condition at play.

Keep reading to understand the phenomenon, and what you can do about it.

If you’re regularly concerned with whether you’re dreaming or fully awake, it can help to check out your symptoms with a professional. Book a free call.

What is dream-reality confusion?

If you’re not sure if you’re dreaming or fully conscious in the present, there’s a name for that: dream-reality confusion (DRC). DRCis defined as “a difficulty or an impossibility to determine whether an event or experience took place during wakefulness or if it was in the content of a dream,” says research in the journal Dreaming.

While anyone can occasionally experience this confusion about what was a dream or reality, the phenomenon is sometimes associated with certain mental health conditions.

How can I tell if I’m dreaming?

There are a few things you can do to answer the question “am I dreaming?” For starters, you can literally pinch yourself. If you’re able to feel the pain, it’s reality.

Then there’s reality testing, which is when you conduct a test to know if you’re sleeping/dreaming or not. You train your brain to recognize the aspects of real life that are consistent, like how many fingers are on your hand. The idea is to do reality testing when you’re fully awake too, so that differences between a dream state and reality are more obvious.

Examples of reality testing:

Mirror checking: Look at yourself in a mirror. Does your reflection look normal?
Observe the time: Are the clocks in your dream displaying strange, impossible times like 45:32? You can also check your watch to see if it’s the same each time you look. If it’s noon, then six o’ clock, then suddenly the clock hands are melting, that’s a sure sign that it’s a dream.
Look down at your hands. Do you have the same amount of fingers you normally do?
Grab a solid object and try to put your hand through it. If you can move through objects—like a ghost in cartoons—you’re dreaming.
Grab a rubber band. Some people wear a hair-tie (or rubber band) on their wrist at all times during real life. If it’s not there, then they know they’re dreaming.

“Am I dreaming?” Mental health conditions that can cause you to ask the question

Borderline personality disorder (BPD)

BPD includes symptoms like extreme mood swings, having intense and unstable relationships, self-harm, and impulsive behavior. But under conditions of extreme stress, people with BPD may also experience dissociation (feeling like they’re not really in their body). Perhaps unsurprisingly, research reveals a significant connection between BPD symptoms and dream content, including DRC.

Post-Traumatic Stress Disorder (PTSD)

PTSD develops from experiencing a traumatic event. It can distort reality, especially during flashbacks or intrusive trauma recollections, leading to a blurred line between past and present, says Nicholas Farrell, a clinical psychologist and Regional Clinical Officer at NOCD. “The intense, vivid memories contribute to a feeling of ‘unreality.’”

Depersonalization/Derealization Disorder

Depersonalization/derealization is a stress-induced phenomenon, and symptoms include skewed or distorted perceptions of reality. It can cause sufferers to feel like they’re seeing themselves from outside their body or that things around them are not real. This sometimes creates a surreal, dreamlike experience leading people to ask, “Is this real or am I dreaming?,” says Farrell.

Major Depressive Disorder with Psychotic Features

Not all types of depression are equal. Severe depression with psychotic features prompts delusions or hallucinations, distorting people’s perception of reality. “The interplay of depressive symptoms and psychosis contributes to a heightened sense of unreality,” says Farrell.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental health disorder that centers around obsessions—a.k.a. intrusive thoughts, images, feelings, sensations or urges that cause you distress—and compulsions, which are mental or physical behaviors done to counteract discomfort. Existential OCD, one subtype of the disorder, is characterized by persistent, distressing thoughts centered around the nature of reality.

More about OCD and the fear that you might be dreaming

“It’s common for people with Existential OCD to worry about whether something that is happening is a simulation, dream, or hallucination,” says April Kilduff, MA, LPCC, LCPC, LMHC, LPC, a licensed therapist and Clinical Trainer at NOCD. They may even fear that life itself is nothing more than a dream.

These may be interesting philosophical questions and the subject of an interesting debate for people without OCD. But for people with the disorder, the attempt to answer these questions is not a matter of curiosity. It’s distress-inducing and often debilitating. The intrusive thoughts can be deeply unsettling, leading people to engage in compulsions in order to reduce their anxiety, find “true” answers to their worries, or feel certain about the nature of their reality.

The resulting compulsions are likely invisible to others, and often involve prolonged rumination and efforts to answer unanswerable questions. “You have a strong need to figure things out, and feel as if your concerns will plague your life if you don’t get to the answers,” Kilduff explains. Which is why you may find that you get lost for hours contemplating whether you’re having a dream, or what reality even means.

Dream vs. reality themes don’t just appear in Existential OCD. For instance, NOCD therapist Tracie Zinman-Ibrahim, LMFT, CST, often works with patients who have False Memory OCD and wonder about whether or not they did something that they can’t remember. They ruminate on the possibility and then spiral into “‘Was that a dream, or did that really happen?” Ibrahim says.

If you relate to any of the obsessions and compulsions below, and these thoughts and mental actions take up more than an hour per day and cause you significant distress, then it’s a good idea to see an OCD specialist for an evaluation.

Common obsessions in OCD:

“What if I’m stuck in a dream and can’t get out?”
Excessively thinking about whether past memories happened in real life
Worries about lucid dreaming
“If this is a dream, what if I never wake up?”
Fears about losing your mind or becoming delusional
“Does anything I do matter if this isn’t reality?”
“How can I be certain that this is real life?”

Common compulsions in OCD:

Rumination: A form of overthinking where you chew over the same thought again and again, often in an attempt to work out a definitive answer.
Mental review of an experience you had to try to determine if it was a dream or reality. (“Did that phone call with my mom actually happen or not?”)
Reassurance-seeking: For instance, asking loved ones if this experience is real life.
Deep, extensive research into the nature or reality of dreams.
Avoidance of situations because you’re not sure if they’re real or not.
Physical checks to see if you are dreaming. (“If I can lift my leg on demand, then I’m not in a dream.”)

What can I do about the fear that I might be in a dream?

If it’s happening once in a while, it’s OK to shrug it off, especially if it’s not troubling you. But if you’re regularly obsessing over the question, “Am I dreaming?,” and causing distress, then it’s time to seek professional help. That might be a mental health practitioner, such as a psychologist or licensed therapist, or your primary care provider—especially if you’re taking medications that can impact your memory, such as zolpidem (Ambien) or have other cognitive concerns related to one of the mental health conditions mentioned above.

That said, if you suspect your dream fears might be related to OCD specifically, then it’s critical to know that the treatment for OCD is unlike the treatment for most other mental health conditions.

The gold-standard treatment for OCD (and all of its subtypes, including Existential OCD and False Memory OCD) is Exposure and Response Prevention (ERP).

ERP involves facing what makes you anxious—like the question of whether life is a dream—a little bit at a time, and learning that you can tolerate discomfort or anxiety that arises, says Ibrahim. ERP teaches you to respond without compulsions—so you’re not endlessly ruminating or seeking reassurance—and over time, the thoughts that cause so much distress lose their power over you.

Creating a worst-case scenario script: If your life really is all a dream, how do you think that will play out in a negative way for you?
Practicing saying a statement like this may or may not be a dream.
Experiencing life. Kilduff says that she encourages clients to go ahead and live their life as they otherwise would. “You can’t put decisions on hold until you figure out if it’s reality,” she says. “It’s a type of exposure to say let’s go ahead and make plans rather than avoiding your life.”

While the idea of confronting your OCD dream fears may sound scary, know that your therapist will be there with you every step of the way. They can individualize your treatment to help you feel comfortable with the process, while still gently pushing you to overcome your fears. Above all, know that you don’t have to live in fear and worry forever—help is out there.