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Depersonalization and meditation.

From a review of the literature on meditation and depersonalization and interviews conducted with six meditators, this study concludes that: 1) meditation can cause depersonalization and derealization; 2) the meanings in the mind of the meditator regarding the experience of depersonalization will determine to a great extent whether anxiety is present as part of the experience; 3) there need not be any significant anxiety or impairment in social or occupational functioning as a result of depersonalization; 4) a depersonalized state can become an apparently permanent mode of functioning; 5) patients with Depersonalization Disorder may be treated through a process of symbolic healing--that is, changing the meanings associated with depersonalization in the mind of the patient, thereby reducing anxiety and functional impairment; 6) panic/anxiety may be caused by depersonalization if catastrophic interpretations of depersonalization are present.

Adaptation, Psychological

[Clinical characteristics of vital depersonalization in schizophrenia].

Vital depersonalization was observed in 59 out of 76 schizophrenic patients with the prevalence of depersonalization. Three interrelated components of vital depersonalization were distinguished. The main depersonalization component proper was manifested by the experience of estrangement and unreality of the feeling of existence ("self"). The second, affective one, was marked by vital fear and anxiety. The third one involved common sense disorders and was characterized by vital bodily sensations. Vital depersonalization had all the principal signs of depersonalization. However, it differed from the allo-, somato- and autotypes of depersonalization in disorders of the vital level: similarity to physical sensations, pain and vagueness. Vital depersonalization may be viewed as pathology of the first level of selfawareness--selfsence of awareness of vital ego or of body perception.

Adolescent

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

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

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

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

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

Left hemispheric activation in depersonalization disorder: a case report.

Depersonalization disorder is classified in DSM-III-R (APA 1987) as a dissociative disorder characterized by altered perception or experience of the self. To date, there are no known reports of the neurobiological features of this disorder. We report clinical and biological correlates in a patient with depersonalization disorder previously unresponsive to a variety of anticonvulsant, monoamine oxidase inhibitor, and tricyclic antidepressant trials, but for whom fluoxetine partially reduced depersonalization symptoms, but not associated anxiety and depression. Neurophysiological, neuroanatomical and neuropsychological findings revealed left hemispheric frontal-temporal activation and decreased left caudate perfusion. These findings suggest a similarity to the neuropsychiatric data reported in obsessive-compulsive disorder patients.

Adult

Self-induced depersonalization syndrome.

The author reports two cases in which depersonalization occurred during the waking consciousness of individuals who had engaged in meditative techniques designed to alter consciousness. Psychiatrists should be aware of this phenomenon, as the number organizations in the "consciousness movement" is increasing, and should ask people manifesting depersonalization about any involvement in activities leading to altered states of consciousness. In some cases it might be appropriate to refer such patients to responsible groups that teach altered consciousness by meditation as an egosyntonic desirable state. The author cautions against the use of phenothiazines in cases where depersonalization is a prominent feature.

Adult

The significance of depersonalization in the life and writings of Joseph Conrad.

Through reference to his letters and fiction, this paper attempts to demonstrate how Conrad made use of depersonalization in order to cope with the childhood loss of his parents and to avoid, whenever possible, psychotic regression. Genetic and dynamic aspects of depersonalization are noted along with the relationship between dream and depersonalization.

Depersonalization

Depersonalization in accident victims and psychiatric patients.

A transient depersonalization syndrome was identified in nearly one third of persons exposed to life-threatening danger (accident victims) and close to 40% of a group of hospitalized psychiatric patients. Although the syndrome was similar in these populations, mental clouding developed more commonly among patients and alertness was more prominent among accident victims. Anxiety was significantly associated with the development of depersonalization among psychiatric patients and was almost certainly a factor in its appearance among accident victims. The findings suggest that this syndrome is a specific response to extreme danger or its associated anxiety.

Accidents, Traffic

Depersonalization in a 16-year-old boy.

A prolonged period of depersonalization resolved in this 16-year-old boy with only supportive therapy. Reasons for the depersonalization and withholding of other treatment are discussed. Observations are shared of the very intriguing phenomenon of derealization and allied conditions, psychiatric syndromes which are appearing with increasing frequency among so-called "normal adolescents" who indulge in drugs or other experiences which alter the state of consciousness, and among adolescents who survive disasters or harrowing experiences.

Adult

Imaginary companions, fantasy twins, mirror dreams and depersonalization.

Illustrative case material is presented to demonstrate genetic linkages between the presence of imaginary companions or fantasy twins and extensive mirror play in childhood and early adolescence, and the appearance of mirror dreams and depersonalization in later adolescence and adulthood. The defensive splitting of the self-representations observable in these phenomena is viewed as a means of warding off castration anxiety and anxiety about object loss, anxieties which arise because of conflicts primarily centering on intense aggressive drive derivative wishes. Formulations about depersonalization are discussed.

Adult

[Depersonalization and déjà vu experiences: prevalences in nonclinical samples].

According to the relevant psychological and psychiatric literature, depersonalization and déjà vu experiences are usually viewed as symptoms of severe psychiatric or neurological disorders, especially in schizophrenia, depression and epilepsy. Studies of these phenomena in non-clinical populations are rate. In this article we present the results of several epidemiological investigations. On the basis of survey and interview research, quantitative and qualitative aspects of both phenomena were assessed, as well as the relations with personality variables like emotionality. The results indicate prevalence rates up to 80 percent in non-clinical populations. Based on epidemiological considerations, the question of differentiation between clinical and non-clinical forms of depersonalization and déjà vu is discussed.

Adolescent

[Study of pain sensitivity based on the indicators of electro- odontometry in patients with depersonalization and depressive disorders].

Electroodontometry was used to examine the pain threshold and sensation threshold in patients with depersonalization, endogenous depression and in mentally healthy test subjects. The strongest differences in the thresholds were found on the anterior teeth. The patients with depersonalization manifested a considerable rise of the sensation threshold and to an ever greater degree of the pain threshold. In patients suffering from endogenous depression, both thresholds were decreased and coincided almost completely. It is likely that this fact is associated with a relatively higher incidence of the painful syndrome in patients suffering from depression.

Adolescent

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

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

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