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PubMed1987

The psychotherapeutic treatment of depersonalization disorder.

A psychotherapeutic approach to the treatment of depersonalization disorder is presented. The treatment process enables the patient to drop dissociation as a defense against overly vigorous scrutiny of a "self," which is felt to be inadequate when compared to highly demanding standards set by parents. When feelings of worthlessness and helplessness are "transferred" back to original sources of childhood trauma, the patient is then taught how to handle conflict without needing to dissociate from the stress as overpowering and literally depersonalizing the threat.

Adult↗
PubMed1979

Defensive and arrested developmental aspects of death anxiety, hypochondriasis and depersonalization.

The theoretical distinction between psychopathology based on intrapsychic conflict and psychopathology rooted in a developmental arrest is applied to an analysis of death anxiety, hypochondriasis and depersonalization. The defensive functions of these states are contrasted with instances in which they are symptomatic of interferences with the consolidation of a structurally cohesive and temporally stable self representation. Clinical material is presented to demonstrate that, in their arrested developmental aspects, death anxiety, hypochondriasis and depersonalization are closely related to one another along a continuum of narcissistic decompensation and signal varying degrees or stages of self-fragmentation.

Anxiety↗
PubMed1978

The role of attention in depersonalization.

Episodes of depersonalization function to keep disturbing preconscious thoughts from becoming conscious. The symptom is conceptualized as a compromise between the wish to be "only dreaming" and the need to maintain a waking state in contact with perceptual reality. Restriction of attention is identified as the central mechanism by which the compromise is effected. On this basis an explanation for the alteration in the sense of reality is suggested. Material from a case is given to support these ideas. The author speculates that early efforts to deal with traumatic experience at a time when the distinction between sleeping and waking states is not secure may lead to the symptom choice of depersonalization.

Adult↗
PubMed1980

Mania occurring during treatment for depersonalization: a report of two cases.

Severe depersonalization at times constitutes a chronic and disabling syndrome for which there is no generally established etiology or treatment. Two cases in which young female patients with severe depersonalization became floridly manic in response to stimulant and antidepressant drug treatment are reported, and the clinical and theoretical implications of these phenomena are discussed.

Adolescent↗
PubMed1994

The experimental induction of depersonalization and derealization in panic disorder and nonanxious subjects.

The present study evaluated the efficacy of three tasks in inducing depersonalization (DP) and derealization (DR) in three different groups: (a) panic disorder patients who report these symptoms while panicking (PD + DD; n = 10); (b) panic disorder patients never experiencing these symptoms during panic attacks (PD; n = 10); and (c) nonanxious controls (NC; n = 10). Clinical features of the PD+DD and PD Ss were compared as well. Relative to PD Ss, PD + DD Ss evidenced higher levels of depression, trait anxiety, more fear of panic, and had a briefer duration of their disorder. A substantial proportion of NC Ss reported past DP and DR experiences. DP and DR induction procedures were the following: staring at a dot on the wall, staring in a mirror, and silent repetition of one's name. Results indicated two tasks (mirror and dot) successfully elicited these sensations above baseline levels with DP reported more frequently and intensely than DR for all Ss. The PD + DD Ss evidenced greater baseline-to-task increases in DP and DR relative to the other two groups and exhibited a differential fear response, particularly on the dot task, with 30% of these Ss intentionally distracting themselves or terminating the induction.

Adult↗
PubMed2006

Emotional memory in depersonalization disorder: a functional MRI study.

This study examines emotional memory effects in primary depersonalization disorder (DPD). A core complaint of DPD sufferers is the dulling of emotional responses, and previous work has shown that, in response to aversive stimuli, DPD patients do not show activation of brain regions involved in normal emotional processing. We hypothesized that DPD sufferers would not show the normal emotional enhancement of memory, and that they would not show activation of brain regions concerned with emotional processing during encoding and recognition of emotional verbal material. Using fMRI, 10 DPD patients were compared with an age-matched healthy control group while performing a test of emotional verbal memory, comprising one encoding and two recognition memory tasks. DPD patients showed significantly enhanced recognition for overtly emotive words, but did not show enhancement of memory for neutral words encoded in an emotive context. In addition, patients did not show activation of emotional processing areas during encoding, and exhibited no substantial difference in their neural responses to emotional and neutral material in the encoding and emotional word recognition tasks. This study provides further evidence that patients with DPD do not process emotionally salient material in the same way as healthy controls, in accordance with their subjective descriptions of reduced or absent emotional responses.

Adult↗
PubMedDate not supplied

[Depersonalization, social phobia and shame].

Associations between depersonalization (DP) and social phobia (SP) were described in the early scientific literature. This connection, however, has not yet been considered in the recent empirical literature and clinical trials on SP. The aim of this study is to examine these associations. In a sample of 100 consecutive inpatients we compare 45 patients with pathological DP to 55 patients without pathological DP with respect to comorbidity and the degree of social anxieties assessed with the SOCIAL INTERACTION ANXIETY SCALE (SIAS) and with the SOCIAL PHOBIA SCALE (SPS) and the extent of shame assessed with the INTERNALIZED SHAME SCALE (ISS). Social phobia was significantly more prevalent in the patients with pathological DP. Furthermore, the patients with pathological DP showed a significantly larger extent of social anxieties (SIAS, SPS) and shame (ISS). The results may be considered as a preliminary empirical support of the assumed associations and thus warrant an enhanced consideration of DP in therapy and research of social anxiety disorders.

Depersonalization↗
PubMed1997

Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics.

The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. Sixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, 1987) criteria participated in the study. Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed.

Adolescent↗
PubMed2005

Depersonalization and social anxiety.

Although the literature on depersonalization (DP) indicates links between DP and anxiety disorders, there has been no systematic investigation of the association of DP with social anxiety. The present study explores a hypothesized connection between DP and social anxiety by using correlative and regression analyses in a sample of 116 psychotherapy inpatients, 54 outpatients with epilepsy, and 31 nonpatients. Corresponding to our hypothesis, we found a connection of medium to large effect size between DP and social fears exceeding the impact of general psychopathologic symptom severity both for the psychotherapy patients and the nonpatients. The association of social anxiety with DP merits further research. A general consideration of DP in clinical and neurobiological trials on anxiety disorders like social phobia is warranted.

Adolescent↗
PubMed1978

On depersonalization in adolescence: a consideration from the viewpoints on habituation and 'identity'.

Depersonalization occurs in many psychiatric states but its origins are unknown. It is suggested that feelings of unreality may be unusually common in adolescents. Certain speculations are offered concerning the genesis of a sense of unreality. The neurophysiological mechanisms governing the perception of 'familiar' or 'strange' are seen to be the key to this experience. They involve the matching of events in the outer world against inner organizations of previous experience. These mechanisms are likely to be disturbed through epilepsy or other disorders of the temporal lobe, in which abnormal perceptions of strangeness and familiarity are frequently found. It is suggested that the matching process extends to include social situations, and that where an individual's identity is undeveloped or fragmented a sense of strangeness may result. The concept of identity is briefly discussed in order to distinguish it from 'self' and 'ego', and to intimate its possible fragmentation in adolescence. Finally, some reference is made to management and, in particular, to the use of the peer group.

Adolescent↗
PubMed2002

Changes of P300 elicited during a Working Memory test in Individuals with depersonalization-derealization experiences.

BACKGROUND/AIM: The P300 component of Event-Related Potentials (ERPs) is related to fundamental aspects of cognitive functions, such as Working Memory (WM) and attention allocation. Deficits in these domains have been implicated in the pathophysiology of depersonalization-derealization (DD). The present study focused on the P300 elicited during a WM test in transient DD experiences. METHODS: Fifteen subjects with transient DD experiences were matched for age, sex and educational level to an equal number of healthy controls. Both groups were submitted to a computerized version of the digit span Wechsler batteries. P300 was measured during the anticipatory period of this test. All participants completed the Dixon self-rating questionnaire. RESULTS: In relation to the control group, the subjects with transient DD experiences showed significantly decreased amplitudes of P300 at central posterior brain areas. Concerning memory performance, the groups did not differ significantly. CONCLUSIONS: These findings may indicate that subjects with transient DD experiences manifest altered aspects of information processing, as reflected by P300 amplitudes elicited during a WM test. Additionally, P300 might serve as a valuable investigative tool for a more comprehensive understanding of the neurobiological substrate of DD.

Adult↗
PubMed2007

Pain response in depersonalization: a functional imaging study using hypnosis in healthy subjects.

BACKGROUND: Depersonalization (DP) is characterized by persistent or recurrent episodes of detachment from one's self with reduced pain perception being a common feature. Alterations in the body schema similar to the cortico-limbic disconnection syndrome of pain asymbolia are suggested to be responsible for DP. In this study we used hypnosis to induce DP in healthy subjects and to examine neural patterns of pain perception in the state of DP by means of functional magnetic resonance imaging (fMRI). METHODS: Pain perception was investigated in 7 healthy subjects with high susceptibility to hypnosis in three different mental states: waking state (N-W), hypnotic relaxation (H-R) and hypnotic DP (H-DP). Pain was induced with electrical stimulation to the median nerve at the right wrist. fMRI measurements were performed during all states. RESULTS: Nociceptive stimuli led to an activation of the well described pain network including somatosensory and insular regions and the cerebellum. Activation was markedly reduced in the contralateral somatosensory cortex, parietal cortex (Brodmann area 40, BA40), prefrontal cortex (BA9), putamen and the ipsilateral amygdala during H-DP. Subjects also reported a significant decrease in pain intensity from N-W to H-DP. CONCLUSION: Pain response during H-DP was reduced in sensory and affective pain-related areas, reflecting the diminished intensity of the perceived pain. Moreover, a network of cortical and subcortical areas that have been implicated in the perception of the own body was less responsive during DP, which might point to a specific neural mechanism underlying the 'out-of-body' experience. Although the small number of subjects does not allow a generalization of our findings, H-DP seems to be a promising tool for the investigation of psychological and biological mechanisms of self-inflicted injuries as well as the mind-body interplay within the realm of psychosomatic disorders.

Adult↗
PubMed1977

Depersonalization and temporal disintegration in acute mental illness.

The authors assessed the relationship between depersonalization (defined by self-estrangement and body image diffusion) and temporal disintegration (impaired goal-directedness and temporal indistinction) in 37 acutely ill hospitalized psychiatric patients. Substantial correlations were found between these two phenomena, confirming previous work. The finding that body image diffusion is positively correlated with temporal disintegration suggests that distortions of personal space accompany distortions of personal time.

Acute Disease↗
PubMed1978

Severe depersonalization treated by behavior therapy.

The author reports the use of behavior therapy in the treatment of two cases of severe intractable depersonalization. Outcome criteria included full psychiatric assessment, patients' self-ratings, and psychometric test scores. Treatment by flooding was highly effective in one case, and associated obsessive symptoms and anticipatory anxiety were substantially decreased in the other. Behavioral techniques may prove especially helpful in cases in which anticipatory anxiety, phobic avoidance, and obsessive perseveration are exacerbating features.

Adult↗
PubMed2004

[Assessment of the depersonalization-derealization syndrome using the German version of the Dissociative Experiences Scale].

OBJECTIVES: The goal of this study is to investigate the applicability of the German adaptation of the Dissociative Experiences Scale, the "Fragebogen zu dissoziativen Symptomen (FDS)", for research on depersonalization (DP) and derealization (DR), and to elucidate the phenomenology of DP / DR. METHODS: 101 consecutively recruited inpatients were diagnosed with the German version of the Structured Clinical Interview for DSM-IV Dissociative Disorders for depersonalization/derealization. Furthermore, the FDS and the SCL-90-R were administered. RESULTS: 47 of 101 Patients were diagnosed with pathological DP / DR. The mean score of the DES scale of the FDS was 32.00 +/- 15.52. A cut-off score of 17.5 for the DES scale of the FDS yielded a 83.0 % sensitivity and 77.8 % specificity. Depressive disorders, anxiety disorders and trauma-associated disorders were the most common comorbidity. CONCLUSIONS: The findings are comparable to the Anglo-American samples. The FDS was found to be quite effective for screening of DP / DR. The three-factor solution of the FDS was not well supported in this sample.

Adult↗
PubMed1989

Depersonalization, vertigo and Ménière's disease.

Ménière's disease is generally accepted to be a consequence of distention of the endolymphatic sac of the inner ear. Although the exact etiology is unclear, there is a body of research suggesting that Ménière's disease is of psychosomatic origin. While we do not intend to review the literature exhaustively, we briefly review several frequently cited studies. Even though this literature is so severely flawed that no solid conclusions may be drawn from it, certain questions about the psychological aspect of this disorder continue to surface. Our limited access to patients with vertigo has not allowed us to undertake a carefully designed study. However, in clinical practice we have noted that many persons who complain of vertigo (whether due to Ménière's disease or other causes) also report symptoms of depersonalization and derealization. In this paper we present the cases of two women with Ménière's disease who also experienced concurrent feelings of unreality. It appears likely that feelings of unreality may occur regularly in association with syndromes causing vertigo, presumably as a consequence of vestibular dysfunction. We argue that emotional disturbances previously identified as predisposing causes of Ménière's disease are more likely effects of the disease. Although the discussion of two uncontrolled cases can do little to help solve nagging questions about a psychosomatic component to this disorder, we believe it may suggest a different perspective from which to investigate these complex phenomena.

Adult↗
PubMedDate not supplied

[Estrangement in psychopathology: depersonalization, derealization, disorders of the self?].

The history of estrangement as a clinical object is very recent and concrete. It is negatively defined through the following syndromes: depersonalization, derealization and disturbances of the self. The limits that are established for its definition are very lax and unsuitable. The models that have been applied to these phenomena are explained in this paper: the model of the psychology of faculties, the model of the self-awareness as a reflective structure and the model of the consciousness as a passive synthesis. The authors propose to recover estrangement as a primary experience and to concentrate on the concepts of subject and person's re-examination.

Depersonalization↗