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PubMed1997

Feeling unreal: 30 cases of DSM-III-R depersonalization disorder.

OBJECTIVE: In contrast to the recent surge of interest in other dissociative disorders, DSM-III-R depersonalization disorder has not been thoroughly investigated and characterized. The authors systematically elucidated its phenomenology, comorbidity, traumatic antecedents, and treatment history. METHOD: Thirty adult subjects (19 women and 11 men) were consecutively recruited and administered various structured and semistructured interviews as well as the self-rated Dissociative Experiences Scale. An age- and sex-matched normal comparison group was also recruited. RESULTS: The mean age at onset of depersonalization disorder was 16.1 years (SD = 5.2). The illness had a chronic course that was usually continuous but sometimes episodic. Severe distress and high levels of interpersonal impairment were characteristic. Unipolar mood and anxiety disorders were common, but none emerged as specifically related to the depersonalization. A wide variety of personality disorders was manifested; avoidant, borderline, and obsessive-compulsive were most common. Although not highly traumatized, the subjects with depersonalization disorder reported significantly more childhood trauma than the normal comparison subjects. Depersonalization had been typically treatment refractory; only serotonin reuptake inhibitors and, to a lesser extent, benzodiazepines had been of any therapeutic benefit. CONCLUSIONS: This study supports the conceptualization of depersonalization disorder as a distinct disorder with a characteristic course that is independent of mood, anxiety, and personality symptoms. A subtle relationship may exist between childhood trauma and depersonalization disorder that merits further investigation. The disorder appears to be highly treatment refractory, and prospective treatment trials are warranted.

Adolescent↗
PubMed2003

Feeling unreal: a depersonalization disorder update of 117 cases.

BACKGROUND: Despite a surge of interest and literature on depersonalization disorder in recent years, a large series of individuals with the disorder has not been described to date. In this report, we systematically elucidate the phenomenology, precipitants, antecedents, comorbidity, and treatment history in such a series. METHOD: 117 adult subjects with depersonalization disorder (DSM-III-R/DSM-IV criteria) consecutively recruited to a number of depersonalization disorder research studies were administered structured and semistructured diagnostic interviews and the Dissociative Experiences Scale. Data were gathered from 1994 to 2000. RESULTS: The illness had an approximately 1:1 gender ratio with onset around 16 years of age. The course was typically chronic and often continuous. Illness characteristics such as onset, duration, and course were not associated with symptom severity. Mood, anxiety, and personality disorders were frequently comorbid, but none predicted depersonalization severity. The most common immediate precipitants of the disorder were severe stress, depression, panic, marijuana ingestion, and hallucinogen ingestion, and none of these predicted symptom severity. Negative affects, stress, perceived threatening social interaction, and unfamiliar environments were some of the more common factors leading to symptom exacerbation. Conversely, comforting interpersonal interactions, intense emotional or physical stimulation, and relaxation tended to diminish symptom intensity. There were no significant gender differences in the clinical features of the disorder. In this sample, depersonalization tended to be refractory to various medication and psychotherapy treatments. CONCLUSION: The characteristics of depersonalization disorder found in this sample, the largest described to date, are in good accord with previous literature. The study highlights the need for novel therapeutic approaches to treat depersonalization disorder. Novel medication classes, as well as novel psychotherapeutic techniques that build on the reported symptom fluctuation factors, may prove helpful in the future.

Adolescent↗
PubMed1995

Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine.

Sixty-seven subjects, including normal volunteers and patients with obsessive-compulsive disorder, social phobia, and borderline personality disorder, received ratings of depersonalization after double-blind, placebo-controlled challenges with the partial serotonin agonist meta-chlorophenylpiperazine (m-CPP). Challenge with m-CPP induced depersonalization significantly more than did placebo. Subjects who became depersonalized did not differ in age, sex, or diagnosis from those who did not experience depersonalization. There was a significant correlation between the induction of depersonalization and increase in panic, but not nervousness, anxiety, sadness, depression, or drowsiness. This report suggests that serotonergic dysregulation may in part underlie depersonalization.

Adult↗
PubMed1984

Depersonalization in a nonclinical population.

The present study assessed the prevalence and characteristics of depersonalization phenomena in a nonclinical population. Undergraduate students (N = 388) responded to a questionnaire soliciting information regarding the experience of depersonalization, age at onset, number, frequency, duration, and intensity of depersonalization experiences, level of pleasantness/unpleasantness, diminution of experiences with and without professional assistance, and relation of depersonalization to other factors. Of the Ss, 34% reported depersonalization. No significant sex differences were noted but relationships between years of experience of depersonalization and intensity, frequency, and number of experiences were significant.

Adolescent↗
PubMed2001

The phenomenological stability of depersonalization: comparing the old with the new.

The view that depersonalization is a stable syndrome became well established during the first half of the 20th century. Current operational definitions restrict depersonalization to the experience of unreality. This is likely to neglect clinical features of potential neurobiological relevance. By using the year 1946 as the dividing line, 200 cases of depersonalization disorder reported in the medical literature since 1898 were divided into two historical groups (1 and 2). The groups were then compared in terms of 18 phenomenological variables with a sample of 45 prospective cases of DSM-IV depersonalization disorder (group 3 or gold standard). Groups 1 and 2 differed in terms of their symptom profile, but the highest frequency that symptoms achieved in either group did not differ from the rates identified in group 3. A core of (invariable) symptoms, including emotional numbing, visual derealization, and altered body experience, was present throughout. These high rates of spontaneous reporting in all three groups may be explained by the fact that they all are accompanied by specific distress. With the exception of heightened self-observation and altered time experiencing, all other symptoms were significantly lower in group 2. The results suggest that the phenomenology of depersonalization has remained stable over the last 100 years. Our study found differences in frequency for some symptoms, but these are likely to have resulted from reporting biases, themselves governed by changing theoretical views. Clinical descriptions became poorer as the present is approached. This cannot be solely explained on the basis of empirical progress, and it is likely that theoretical biases also play a role. Because the neurobiological relevance of the symptoms of depersonalization remains unknown, it makes sense to continue collecting as many symptoms as possible, thereby avoiding both biased selection or premature closure.

Adult↗
PubMed1986

Depersonalization in early adolescence.

Depersonalization is a comparatively rare disease in the psychiatric field. Particularly, its occurrence in early adolescence or even before seems to be quite uncommon. We have observed 120 cases of depersonalization, of which only 16 cases had their onset before the age of 15. Among them, we will present here 6 cases for which a detailed observation was available. It is very difficult for these minors to put their feeling into verbal expressions because the experience of depersonalization is a "negative symptom." Adult patients can explain metaphorically how they feel. However, children can use only similes. Therefore, in the case of depersonalization, children have more difficulty in expressing their feeling than adults. This might cause to clinically overlook depersonalization in children. Even in our observation of the cases reported here, we found after a while that their complaints actually meant experiences of depersonalization, although their explanations were at first obscure. These 6 cases showed common personality traits that they are passive in interpersonal relationship and that they easily become frustrated or hold a sense of inferiority even at trifles.

Adolescent↗
PubMed1986

Depersonalization and agoraphobia associated with marijuana use.

This paper examines the role of uncontrolled depersonalization associated with marijuana use in the development of agoraphobia. Cases of six people are described, all of whom reported first experiencing depersonalization while using marijuana, and subsequently experiencing depersonalization while not using the drug. A fear of this 'uncontrolled' depersonalization resulted in considerable anticipatory anxiety and panic attacks. Patients ultimately presented for treatment of agoraphobia. A temporal relationship between marijuana use, uncontrolled depersonalization, panic attacks and agoraphobia does not imply causality. Comparison of these cases with other agoraphobia clinic patients provides tentative evidence for a difference between the two types of patients. There were no systematic patterns of stressors in the cases prior to the onset of symptoms. Data obtained before and after treatment indicated the cases were slightly more severe than clinic patients. Males and females were represented equally in the cases, whereas there was a higher incidence of females in the clinic patients. The cases' age of onset was younger than that of the clinic patients. Our standard cognitive-behavioural treatment programme required modification to account for the intensity of the fear of depersonalization in the cases.

Adult↗
PubMed1999

Depersonalization, fantasies, and coping behavior in clinical context.

The main purpose of the present study was to determine the relation between specific dissociative experiences (depersonalization, fantasies) and self-reported coping behavior in a clinical (depression, anxiety, schizophrenia) and nonclinical sample (normal adults). Dissociative experiences were assessed with the Questionnaire of Experiences of Dissociation (QED) of Riley (1988) and coping behavior with the Stress-Process Questionnaire (SPQ; Janke, Erdmann, & Boucsein, 1985). A factor analysis of the QED items revealed a two-factor extraction: Factor 1 "depersonalization" and Factor 2 "fantasies/daydreams." The clinical group scored higher on the QED factor "depersonalization" and had more passive forms of coping behavior (resignation, social isolation, self-compassion, self-blame) than the normal adults. Similar correlation patterns were found for both groups: The QED factor "depersonalization" correlated highly with the coping behaviors "resignation," "social isolation," "self-blame," "self-compassion," and "rumination." No correlation between Factor 2 "fantasies/daydreams" and the coping behavior was found. Finally, correlations between depersonalization, trait anxiety, and personal need for structure were reported.

Adaptation, Psychological↗
PubMed1978

Review of the relationship between obsession and depersonalization.

Depersonalization is discussed and a brief outline of the primary symptoms is presented. The relationship between obsessionalism and depersonalization is reviewed in the literature, and subsequent similarities are presented. The intellectual obsessive depersonalization syndrome is postulated as a variant, and also as an exposition of what might occur in many other cases of depersonalization. Finally, a picture is presented which takes into account a strong component of obsessionalism in both the etiology and course of depersonalization.

Anxiety↗
PubMed2000

Feeling unreal: cognitive processes in depersonalization.

OBJECTIVE: Depersonalization disorder is characterized by a detachment from one's sense of self and one's surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. METHOD: Fifteen patients with depersonalization disorder were compared to 15 matched normal comparison subjects on a comprehensive neuropsychological test battery that assessed cognitive function. RESULTS: The subjects with depersonalization disorder showed a distinct cognitive profile. They performed significantly worse than the comparison subjects on certain measures of attention, short-term visual and verbal memory, and spatial reasoning within the context of comparable intellectual abilities. CONCLUSIONS: The authors propose that depersonalization involves alterations in the attentional and perceptual systems, specifically in the ability to effortfully control the focus of attention. These early encoding deficits are hypothesized to have a deleterious effect on the short-term memory system; they manifest as deficits in the ability to take in new information but not in the ability to conceptualize and manipulate previously encoded information.

Adult↗
PubMed2001

The relationship of akathisia with suicidality and depersonalization among patients with schizophrenia.

An association of suicidality and depersonalization with akathisia has been reported, but it is not clear whether these phenomena are specific to akathisia or are nonspecific manifestations of distress. The authors used the Barnes Akathisia Rating Scale, Brief Psychiatric Rating Scale, and Hamilton Rating Scale for Depression (Ham-D) to examine the relationships between suicidality, depersonalization, dysphoria, and akathisia in 68 patients with schizophrenia or schizophreniform disorder. Akathisia was associated with higher scores on the Ham-D ratings of suicidality, depersonalization, and agitation. In a logistic regression model, depressive mood and subjective awareness of akathisia appeared to be the only predictors of suicidality and depersonalization, respectively. These findings support the association between akathisia and both suicidality and depersonalization. However, these symptoms appear to be nonspecific responses to accompanying depressive mood and the subjective awareness of the akathisia syndrome, respectively.

Adult↗
PubMed2001

Effect of naloxone therapy on depersonalization: a pilot study.

To test the hypothesis of the role for the opioid system in the pathogenesis of depersonalization, the effect of naloxone (an opioid receptor blocker) on the symptoms and corticosteroids secretion was studied in patients with depersonalization syndrome. Fourteen depersonalization patients were treated with naloxone: 11 patients received single doses (1.6 or 4 mg i.v.) and three others received multiple infusions, with the maximal dosage being 10 mg, and the effect of naloxone on symptom severity was determined. In eight patients, the cortisol, cortisone and corticosterone content in the blood plasma was determined prior to and after the 4 mg naloxone infusion. A reversed-phase microcolumn high-performance liquid chromatography with ultraviolet detection was applied for assessment of glucocorticoids. In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization.

Adult↗
PubMed2003

A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder.

There is evidence to support the view that glutamate hyperactivity might be relevant to the neurobiology of depersonalization. We tested the efficacy of lamotrigine, which reduces glutamate release, as a treatment for patients with depersonalization disorder. A double-blind, placebo-controlled, cross-over design was used to evaluate 12 weeks of treatment of lamotrigine. Subjects comprised nine patients with DSM-IV depersonalization disorder. Changes on the Cambridge Depersonalization Scale and the Present State Examination depersonalization/derealization items were compared across the two cross-over periods. Lamotrigine was not significantly superior to placebo. None of the nine patients was deemed a responder to the lamotrigine arm of the cross-over. Lamotrigine does not seem to be useful as a sole medication in the treatment of depersonalization disorder.

Adult↗
PubMed1997

Depersonalization: a conceptual history.

As with other clinical phenomena, the historical analysis of the term, concepts and behaviours involved in the construction of 'depersonalization' should provide researchers with an essential frame for its empirical study. Before the term was coined in 1898, and under a variety of names, behaviours typical of 'depersonalization' were reported by Esquirol, Zeller, Billod, and Griesinger. The word 'depersonnalisation, derived from a usage in Amiel's Journal intime, was first used in a technical sense by Ludovic Dugas. The new disorder has since been explained as resulting from pathological changes in the sensory system, memory, affect, body image and self-experience. During the 1930s, evolutionary views became popular, particularly in the work of Mayer-Gross. The unclear conceptual boundaries of depersonalization still invite confusion and often enough fragments of what used to be its core-behaviour are used to diagnose the disorder. Depersonalization has of late become subsumed under the dissociative disorders. The definitional instability of the latter, however, has caused further complications to the study of depersonalization. It is recommended that the term is used to refer only to the original core-behaviour as this has shown adequate stability.

Depersonalization↗
PubMed1992

Toward the clarification of the construct of depersonalization and its association with affective and cognitive dysfunctions.

Little consensus or systematic research exists regarding the symptoms that constitute depersonalization and its association with affective and perceptual dysfunctions. A scale was constructed to measure depersonalization experiences reported in the literature and four items representing psychotic symptoms. Five factors representing different types of depersonalization emerged: Inauthenticity, Self-Negation, Self-Objectification, Derealization, and Body Detachment. Based on the factors, scales were constructed; these scales have internal consistency ranging from .78 to .84. Each of these factor scales was factorially distinguishable from psychosis and correlated between .48 and .58 with the Jackson and Messick (1972) Feelings of Unreality Scale, suggesting divergent and convergent validity. Inauthenticity, the most frequent and pervasive form of depersonalization experience, was best predicted by a cognitive style featuring intense, critical examination of self and others. In contrast, Self-Objectification was best predicted by thought disorganization and perceptual distortion and was experienced somewhat infrequently by relatively few subjects. All forms of depersonalization were associated with depression, except Inauthenticity.

Adult↗
PubMed2001

[Two types of depersonalization--reconsideration from a descriptive-phenomenological view point].

The term depersonalization has been vaguely used in clinical contexts and there is confusion over its nosological positioning. Although the syndrome has been assigned a niche of its own in the European psychiatric taxonomy, the American's Diagnostic and Statistical Manual of Mental Disorders (DSM-III, IV) labeled it under the term Dissociative Disorder. The latter, which does not agree with the classical theory of Janet, seems to have no basis on traditional psychopathology and is not derived from any dissociative theories. In this paper the descriptive characteristics of depersonalization are discussed with regard to the features of "observing self" and the relationship between experiences and selves, according to which the authors distinguish two types of depersonalization: an "excessive-self-reflecting type" and an "absorbed-in-experience type". Whereas the former coinsides with the typical depersonalization neurosis, in which excessive self-reflection plays an important role in reducing the sense of reality, in the latter over-absorption in some situations leads the patient to construct a wall to block out reality. We suggest that in making a distinction between these two types, the psychopathology of depersonalization will be better clarified.

Adult↗
PubMed1990

Treatment of depersonalization with serotonin reuptake blockers.

Eight patients with depersonalization disorder or with depersonalization symptoms in association with obsessive-compulsive and panic disorders were treated with serotonin reuptake blockers. There was clinical overlap of depersonalization disorder with obsessive-compulsive disorder, and the co-occurrence of obsessive-compulsive and panic features with depersonalization in these patients was associated with a favorable treatment outcome. The chronicity of illness and lack of prior response to a variety of treatments in these patients highlights the positive outcome with this treatment. In addition, issues are raised regarding the current hierarchical exclusion of depersonalization disorder in the presence of obsessive-compulsive and panic disorders.

Adolescent↗
PubMed1977

Impotence, frigidity and depersonalization.

A review of important psychoanalytic literature in the perplexing area of depersonalization focuses primarily on its phenomenology and genesis. Case material from two patients elucidates a relatively neglected, specific substate. These two analyses center about prominent complaints of impotence and frigidity which are seen as equivalents of, or screens for, underlying depersonalization. Only by understanding and working through the genesis of the masked depersonalization could these sexual dysfunctions be adequately treated. Depersonalization was also manifest outside the sexual sphere, but its presence there led to a more thorough elucidation of its etiology, in which actual childhood observations of the primal scene were of paramount importance. A comprehensive description of depersonalization phenomenology is offered which considers this state as a compromise formulation with contributions from each structure of the mental apparatus. Normal and pathological determinants of the sesation of a split within the self into observing and participating aspects are described, as is the genesis of feelings of alienation and estrangement.

Adult↗