Angular Recording Corporation's press release describes the album as featuring:
    "six-foot Japanese Taiko drums, a thirteen piece brass and woodwind en-semble, sub-heavy beats, prepared piano, a children’s choir, Foley recording techniques (including a melon with cream crackers attached struck by a hammer, used to simulate the sound of a human head being smashed), and the ethereal voice of Heather Marlatt from dream-pop group Salem."

Described by songwriter Stephin Merritt as "my folk album", the instrumentation of Realism is largely acoustic, stark in contrast to the band's previous album, Distortion, released in 2008. Merritt said he "thought of the two records as a pair" and considered titling the albums True and False; ultimately, he couldn't decide which title would correspond with which album. The song "The Dada Polka" is the only track to utilize an electric guitar. Merritt also avoided using a traditional drum kit, further separating the sound of Realism from the noise pop of Distortion. Along with Distortion and the 2004 album i, Realism was also recorded without the use of synthesizers, completing the band's "no-synth trilogy".