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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↗
PubMedDate not supplied

Depersonalization and basic symptoms in schizophrenia.

The purpose of this study is to examine the classic psychopathologic notion of depersonalization in the light of the Basic Symptom paradigm. A sample of 57 chronic schizophrenics was cross-sectionally assessed with the Bonn Scale for the Assessment of Basic Symptoms (BSABS) and contextually with specific scales testing positive, negative, depressive and alexithymic dimensions. In order to categorize depersonalized vs. nondepersonalized patients three specific BSABS items explicitly identifying the allo-/auto-/somatopsychic domains of depersonalization were used, according to the wernickian threefold definition. Depersonalized schizophrenics showed a semiological profile that was distinct from that of nondepersonalized schizophrenics (as regards basic, positive, depressive symptoms and alexithymia); patients with multiple co-occurring forms of depersonalization revealed higher levels of cognitive disturbance, lowering of stress threshold and greater alexithymia. Clinical and research implications are discussed.

Adult↗
PubMed2006

[The psychopathology of depersonalization].

In his classic overview, Mayer-Gross indicated two clinical features of depersonalization to be taken as starting points for future investigation: excessive difficulty in describing it and its relatively rare appearance in organic disorders. Neither characteristic has so far been discussed sufficiently in psychopathology and neurobiology. In this article, we examine the language aspect of depersonalization by comparisons with aphasia, in which the two objects of study described by Mayer-Gross, speech and organic disorders, intertwine. Concerning amnestic aphasia, Gelb and Goldstein insist that an object cannot be grasped as a generally understood fact using a categorical attitude but only experienced subjectively in its this-ness with a concrete attitude. The particular experience of depersonalization is the reverse of that in amnestic aphasia, as the relation of the depersonalized patient to this-ness is disturbed but an ideal view of the generality remains.

Anomia↗
PubMed1999

Alcohol-induced depersonalization.

BACKGROUND: A case of alcohol-induced depersonalization disorder is presented. The subject had experienced several depersonalization states following the consumption of alcohol rather than from a psychogenic etiology, and the episodes were transient, not chronic. METHODS: Three quantitative EEG (QEEG) studies were performed on the subject, one during the index depersonalization episode and two subsequent studies when the subject was clinically asymptomatic. RESULTS: Slow wave activity (relative theta power) was significantly increased when symptomatic. This slowing was still present over the occiput 3 days after the symptoms had remitted but was absent 17 days after symptoms had ameliorated. CONCLUSIONS: The time course of EEG slowing suggests a metabolic encephalopathy, a condition which likely contributes to the manifestations of depersonalization syndrome.

Adult↗
PubMed2001

Development of a depersonalization severity scale.

Our aim was to develop a clinician-rated scale assessing depersonalization severity for use in clinical trials of Depersonalization Disorder and trauma-related disorders in general. The 6-item Depersonalization Severity Scale (DSS) was administered to 63 participants with DSM-IV Depersonalization Disorder as diagnosed by the SCID-D, and its psychometric properties were examined. The sensitivity of the DSS and of the Dissociative Experiences Scale (DES) to treatment change was assessed in blinded, controlled settings. Individual items were widely distributed across the severity range. Interrater reliability was excellent and internal consistency was moderate. The DSS had high convergent and discriminant validity and was sensitive to treatment change. The DES was also sensitive to treatment change. We recommend piloting the DSS in future treatment trials of trauma-spectrum disorders.

Adult↗
PubMed2000

Depersonalization in cyberspace.

We explored the possibility of carrying out clinical research on the Internet. To do so, we compared psychometric and demographic variables between two groups of sufferers of depersonalization disorder, one recruited via the Internet, the other from outpatients attending the Depersonalization Research Unit. No differences were found in demographics or features of depersonalization. Those seen in the clinic were, however, significantly more depressed. We then explored the answers to several questions posted on a depersonalization bulletin board by a second group of Internet users. Useful information on symptoms, precipitants, and treatment was gained. It is concluded that the Internet could become a valuable tool in clinical psychiatric research.

Adult↗
PubMed2005

An open trial of naltrexone in the treatment of depersonalization disorder.

Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a pervasive subjective sense of unreality and detachment with intact reality testing. Two recent controlled medication trials, one with lamotrigine and one with fluoxetine, failed to show efficacy. There is some evidence for dysregulation of endogenous opioid systems in depersonalization, and a few studies have suggested that opioid antagonists may have efficacy in the treatment of dissociation and depersonalization symptoms. In this prospective open treatment trial, 14 subjects were recruited and treated with naltrexone for 6 weeks to a maximum dose of 100 mg/d (first 7 subjects) or 10 weeks to a maximum dose of 250 mg/d (next 7 subjects). Mean naltrexone dose was 120 mg/d. There was an average 30% reduction of symptoms with treatment, as measured by 3 validated dissociation scales. Three patients were very much improved, and 1 patient was much improved with naltrexone treatment. These findings are potentially promising in a highly treatment-refractory disorder for which no treatment guidelines exist and warrant a randomized controlled trial.

Adult↗
PubMedDate not supplied

[Depersonalization: from disorder to the symptom].

In contrast with the growing interest in dissociative disorders over the last few years, depersonalization continues to be very scarcely approached. There is no agreement among clinicians regarding the concept of depersonalization, and little is known about its etiology, epidemiology and treatment. This paper has two main aims: first, review the literature on this pathology focusing on nosological, historical, psychophysiological and treatment aspects, and second, explore the incidence of the depersonalization symptom in other psychiatric conditions, in particular in panic disorder. The Medline database over the last 5 years has been used for these purposes, and lack of studies on this subject has been found, especially regarding therapeutic issues. Some of the most relevant findings suggest that depersonalization, when associated to panic disorder, could correspond to the most severe forms of this disorder.

Cognition Disorders↗
PubMed1990

Depersonalization syndrome--a report of 9 cases.

Depersonalization is defined and the clinical characteristics of 9 patients presenting with Depersonalization Syndrome are discussed. The cases comprise 5 males and 4 females with an age range of 15-47 years, of which two-thirds presented with an acute onset of symptoms. The diagnosis is made on the patients' own descriptions of their symptoms. Criteria laid out by Ackner and ICD-9 are closely adhered to. The findings of the study are compared with those of Shorvon's 66 cases and similarities are found. Depersonalization symptoms described by Mayer-Gross are reviewed. That depersonalization itself appears to have an affective aspect and a somatic aspect is noted, and an explanation for both aspects is attempted. The resistance to various treatment is confirmed.

Adolescent↗
PubMed1985

[Clinical features of stages in the development of depersonalization in adolescence and young adulthood].

Using clinico-psychopathological methods, the author examined 44 adolescents and youths suffering from slowly progressive schizophrenia and the syndrome of depersonalization. Four stages of the formation of depersonalization were identified: vital, allopsychic, somatopsychis and autopsychic. The correlations of the leading depersonalizational and related affective and neurosis-like disorders were considered at each stage. It was shown that each stage was predominantly characterized by disturbances of the same level of the development of self-consciousness and psyche and that the clinical picture of the syndromokinesis tended to parallel the time-course from disturbances of ontogenetic early forms of self-consciousness to more advanced forms. The author outlines possible clinico--ontogenetic correlations of stages of depersonalization and levels of self-consciousness and psyche with regard to the most prevalent taxonomies of depersonalization.

Adolescent↗
PubMed1995

Depersonalization disorder and self-injurious behavior.

Depersonalization is a subjective sense of unreality regarding various aspects of the self, experienced as disconnectedness from one's own body, mentations, feelings, or actions. When episodes of depersonalization are recurrent or persistent and lead to distress or dysfunction, the diagnosis of depersonalization disorder is made. Certain similarities in phenomenology, comorbidity, neurochemistry, and treatment response suggest a relationship to the obsessive-compulsive spectrum. However, depersonalization is a very poorly studied condition, and any conclusions must be viewed tentatively. Self-injurious behaviors are defined as intentionally self-inflicted bodily injuries without lethal intent. Basic categories are briefly described. Subsequently, the phenomenology and biology of both impulsive and compulsive self-injurious behaviors, and their relationship to the obsessive-compulsive spectrum, are discussed.

Adolescent↗
PubMed1993

[Depersonalization as a developmental disorder of self-consciousness].

The comparison of psychopathological and age characteristics of depersonalization was made for 114 schizophrenic patients. It has been concluded that depersonalization syndrome may be viewed as a developmental or dysontogenetic disorder of self-consciousness. In the majority of the cases depersonalization arises in adolescence which is the most critical period in the development of self-consciousness. Typical psychopathological features of depersonalization correspond to typical features of puberty identity crisis.

Adolescent↗
PubMedDate not supplied

[Depersonalization in panic disorders].

Several studies which focus on the clinical study of the panic disorder have shown its clinical variety, subject to individual variations and which, up to a certain point, may justify a different response to the treatment used. In this sense, but focused on the presence of the depersonalization symptom we have directed our study to see if depersonalization is associated to socio-demographic characteristics, clinical and or personality traits which allow us to differentiate two sub-types of this disorder. Twenty-eight patients with panic disorder completed a structured interview which included a list of symptoms from the Structured Clinical Interview for DSM-III -Upjohn version, together with impairment in social or occupational functions. Fisher's Exact Test and Student's T test were used to analyse the results and showed for depersonalization an earlier onset (p < 0.05) and a more important impairment (p = 0.0021). Thus, the most important conclusion we have reached is an association between depersonalization, an earlier onset of the panic disorder and a more important impairment.

Adolescent↗
PubMed1998

[Depersonalization experiences in adolescents].

OBJECTIVES: The present study examined how widespread experiences of depersonalization are in adolescence and how they are connected to self-esteem and self-awareness. METHODS: We tested 352 adolescents aged 12 to 16 years by means of standardized questionnaires. RESULTS: The results show: (1) that the majority of adolescents has had few experiences of depersonalization. (2) We observed clear sex differences in the course of age. Among female adolescents the number of experiences of depersonalization increased with age, whereas among male adolescents the number began to decrease in mid-adolescence. (3) Adolescents whose experiences of depersonalization are intense do not differ from their counterparts in the study with regard to self-esteem; however, their sense of self-awareness is heightened. The results are discussed in respect to the formation of identity in adolescence.

Adolescent↗
PubMed1998

[Depersonalization syndrome after acquired brain damage. Overview based on 3 case reports and the literature and discussion of etiological models].

Depersonalization after brain damage is still only rarely reported and poorly understood. We describe three patients between the ages of 21 and 25 who experienced depersonalization and derealization for periods of 6 weeks to 4 months, two after traumatic brain injury, the third after surgical and radiation treatment of a pineocytoma. Each one believed to be living in a nightmare and thought about committing suicide in order to wake up. One patient developed symptoms as described in Cotard delusion. Aspects of neuroanatomy, psychodynamics, and anthropology are discussed with reference to the literature. Frontal and temporal lesions seem only to play a facilitating role but not to be a necessary condition. There is evidence for additional influence of psychological and premorbid personality factors. Summarizing the current state of information we consider depersonalization with the experience of being in a dream or being dead as a heuristic reaction to brain damage. Similar models have already been discussed in neuropsychological disorders as for instance reduplicative paramnesias, neglect, and anosognosia.

Adult↗