a contemporary overview.
CNS Drugs. 2004;18(6):343-54.
disorder is characterised by prominent depersonalisation and often derealisation,
without clinically notable memory or identity disturbances. The disorder has an
approximately 1 : 1 gender ratio with onset at around 16 years of age. The course
of the disorder is typically long term and often continuous. Mood, anxiety and
personality disorders are often comorbid with depersonalisation disorder but none
predict symptom severity.The most common immediate precipitants of the disorder
are severe stress, depression and panic, and marijuana and hallucinogen ingestion.
Depersonalisation disorder has also been associated with childhood interpersonal
trauma, in particular emotional maltreatment.Neurochemical findings have suggested
possible involvement of serotonergic, endogenous opioid and glutamatergic NMDA
pathways. Brain imaging studies in depersonalisation disorder have revealed widespread
alterations in metabolic activity in the sensory association cortex, as well as
prefrontal hyperactivation and limbic inhibition in response to aversive stimuli.
Depersonalisation disorder has also been associated with autonomic blunting and
hypothalamic-pituitary-adrenal axis dysregulation.To date, treatment recommendations
and guidelines for depersonalisation disorder have not been established. There
are few studies assessing the use of pharmacotherapy in this disorder. Medication
options that have been reported include clomipramine, fluoxetine, lamotrigine
and opioid antagonists. However, it does not appear that any of these agents have
a potent anti-dissociative effect. A variety of psychotherapeutic techniques has
been used to treat depersonalisation disorder (including trauma-focused therapy
and cognitive-behavioural techniques), although again none of these have established
efficacy to date. Overall, novel therapeutic approaches are clearly needed to
help individuals experiencing this refractory disorder. [Abstract]
D, Knutelska M, Nelson D, Guralnik O
a depersonalization disorder update of 117 cases.
Clin Psychiatry. 2003 Sep;64(9):990-7.
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. [Abstract]
EC, Sierra M, David AS
The epidemiology of depersonalisation
and derealisation. A systematic review.
Psychiatr Epidemiol. 2004 Jan;39(1):9-18.
BACKGROUND: Symptoms of depersonalisation
(DP) and derealisation (DR) are increasingly recognised in both clinical and non-clinical
settings, but their importance and underlying pathophysiology is only now being
addressed. METHODS: This paper is a systematic review of the current state of
knowledge about the prevalence of depersonalisation and derealisation using computerised
databases and citation searches. All potential studies were examined and numerical
data included. Three categories of study are reviewed: questionnaire and interview
surveys of selected student and non-clinical samples; population-based community
surveys using standardised diagnostic interviews; and clinical surveys of depersonalisation/derealisation
symptoms occurring within inpatients with psychiatric disorders. In addition,
we present newly analysed data of the prevalence of depersonalisation/derealisation
from five large population-based studies. RESULTS: Epidemiological surveys demonstrate
that transient symptoms of depersonalisation/derealisation in the general population
are common, with a lifetime prevalence rate of between 26 and 74% and between
31 and 66% at the time of a traumatic event. Community surveys employing standardised
diagnostic interviews reveal rates of between 1.2 and 1.7 % for one month prevalence
in a UK sample and a 2.4% current prevalence rate in a Canadian sample. Current
prevalence rates in samples of consecutive inpatient admissions are reported between
1 and 16%, although screening measures employed may have resulted in these being
an underestimate. Prevalence rates in clinical samples of specific psychiatric
disorders vary between 30% of war veterans with PTSD and 60% of those with unipolar
depression. There is a high prevalence within panic disorder with rates varying
from 7.8 to 82.6%. DISCUSSION: DP and DR symptoms are common in normal and psychiatric
populations, but prevalence estimates are hampered by inconsistent definitions
and the use of variable time-frames. Population-based surveys using diagnostic
interviews yield prevalence rates of clinically significant DP/DR in the region
of 1-2%. Surveys of clinical populations in which common screening and assessment
instruments were used also yield consistently high prevalence rates. The use of
reliable diagnostic assessments and rating scales is needed. The relationship
between DP/DR and certain other psychiatric disorders (e. g. panic) suggests possible
common pathophysiological or aetiological factors. [Abstract]
D, Hunter E, Lawrence E, Medford N, Patel M, Senior C, Sierra M, Lambert MV, Phillips
ML, David AS
Depersonalisation disorder: clinical
features of 204 cases.
Br J Psychiatry. 2003 May;182428-33.
Depersonalisation disorder is a poorly understood and underresearched syndrome.
AIMS: To carry out a large and comprehensive clinical and psychopathological survey
of a series of patients who made contact with a research clinic. METHOD: A total
of 204 consecutive eligible referrals were included: 124 had a full psychiatric
examination using items of the Present State Examination to define depersonalisation/derealisation
and 80 had either a telephone interview (n=22) or filled out a number of self-report
questionnaires. Cases assessed were diagnosed according to DSM-IV criteria. RESULTS:
The mean age of onset was 22.8 years; early onset was associated with greater
severity. There was a slight male preponderance. The disorder tended to be chronic
and persistent. Seventy-one per cent met DSM-IV criteria for primary depersonalisation
disorder. Depersonalisation symptom scores correlated with both anxiety and depression
and a past history of these disorders was commonly reported. 'Dissociative amnesia'
was not prominent. CONCLUSIONS: Depersonalisation disorder is a recognisable clinical
entity but appears to have significant comorbidity with anxiety and depression.
Research into its aetiology and treatment is warranted. [Abstract]
O, Claudon P, Colin V, Svatos J, Thiébaut E
of dissociative disorders and depersonalization in a sample of young adult French
Encephale. 2001 Nov-Dec;27(6):559-69.
by several researches about dissociative disorders, the authors study differences
established on the nosographic register, through a quantitative study and a psychodynamic
argumentation in a sample of french population. From the utilisation of the Dissociative
Experiences Scale (DES) created by Bernstein E and Putnam FW (1986), which is
an excellent screening tool for dissociative disorders and constructed on DSM
II diagnostic criterions, the authors will show the interest of a psychodynamic
analysis of dissociative disorders, in the face of the diagnostic difficulty in
relation to several approaches of this concept. This difficulty is studied giving
the background to dissociative disorders and depersonalization. Ionescu (1999)
shows that between 1890 and 1910 dissociation represents one of major themes of
psychology, psychopathology and psychiatry. Then, this interest about dissociation
decreases and will be almost non-existent in the middle of the twentieth century.
The interest for dissociative disorder will grow in the eighties with north-american
studies about multiple personality disorders. Until 1980, dissociative disorders
exist in DSM II as a list of symptoms included into hysterical neurosis, among
the conversive disorders. In 1980, the publication of DSM III replaces the notion
of hysteria with the notion of dissociative disorder. In this way, we can see
on the one hand somatoform disorders quarterly corresponding to the ancient version
of conversive hysteria, and on the other hand dissociative disorders characterized
by a perturbation of consciousness, memory, identity or perception of environment.
In 1994, The DSM IV delete the notion of hysteria and neurosis and keeps only
the notion of dissociative disorders. They include now the five following categories:
dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative
identity disorder, dissociative disorder not otherwise specified (including derealization).
Depersonalization disorders consist of "persistent or recurrent episodes
of depersonalization characterized by a feeling of detachment or estrangement
from one's self. The individual may feel like an automation or like he or she
is living in a dream or movie" (DSM IV). Depersonalization disorder cannot
be diagnosed if it is part of schizophrenia, panic disorder, acute stress disorder
or dissociative identity disorder. Various depressive disorders, hypocondriasis
or obsessive-compulsive disorders can accompany depersonalization disorder. The
first purpose of this study will search the frequency of dissociative disorders
and depersonalization in a sample of normal population. Further, the inclusion
of depersonalization amongst dissociative disorders seems not so evident: depersonalization
belongs to self-consciousness disorder in french psychiatry. This fact seems more
logical insofar as dissociative disorders have all together a memory and consciousness
perturbation, and this perturbation is missing from depersonalization's feeling.
The second purpose will be to clarify and specify the particularity of depersonalization
among dissociative diorders, from the psychopathological point of view. METHODOLOGY:
The sample (n = 248) is made up of french young adults aged 17 to 30 (mean age
= 20, SD = 15 and 24% is male population). Subjects were streamming from universities.
The screening tool which was used is the Dissociative Experiences Scale, a 28-item
patient questionnaire regarding various dissociative symptoms. The subject is
asked to indicate the percentage of time, to the nearest 5%, that particular symptom
is experienced. The score is made by adding the various percentages and finding
a mean that is expressed in numbers from 0 to 100. Normal scores are in the range
of 5 to 15 in american adults. RESULTS: The utilization of principal component
analysis (PCA) with varimax rotation is justified by the will to compare this
study with American's studies. The mean score obtained is 17.44%, and 13.3% of
the scores exceed a psychiatric threshold at 30%. The descriptive analysis shows
that the component 1 (PCA without varimax rotation) represents 33.02% of total
explained variance. This result demonstrates that the structure of the DES is
based on one concept, the same as the american population, it is the concept of
dissociation. The Principal Component Analysis with varimax rotation of the DES
ratings yielded a tree-factor solution: imaginative absorption (F1), depersonalization-derealization
(F2) and dissociative amnesia (F3). Mean score for each factor is respectively:
F1 = 21.56%, F2 = 13.95%, F3 = 11.04%. DES reliability was studied through computation
of Cronbach's coefficient (0.92). The PCA with varimax rotation brings to the
fore a full dissociative disorder without any trouble of memory and consciousness.
This fact questions again once more the link between hysteria and dissociative
disorders. There is here a clinical distinction between depersonalization-derealization
and other dissociative disorders. Indeed, the absence of significant alteration
of memory and conscience is specific of depersonalization and derealization in
this study. CONCLUSION: Finally, this study concurs with DSM IV dissociative criterions.
At last, one factor of PCA is composed by the association of depersonalization
and derealization, in contradiction with DSM IV definition. This result shows
that, into the french population, we cannot divide the two concepts. [Abstract]
D, Guralnik O, Schmeidler J, Sirof B, Knutelska M
role of childhood interpersonal trauma in depersonalization disorder.
J Psychiatry. 2001 Jul;158(7):1027-33.
OBJECTIVE: In contrast to trauma's relationship
with the other dissociative disorders, the relationship of trauma to depersonalization
disorder is unknown. The purpose of this study was to systematically investigate
the role of childhood interpersonal trauma in depersonalization disorder. METHOD:
Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison
subjects who were free of lifetime axis I and II disorders and of comparable age
and gender were administered the Dissociative Experiences Scale and the Childhood
Trauma Interview, which measures separation or loss, physical neglect, emotional
abuse, physical abuse, witnessing of violence, and sexual abuse. RESULTS: Childhood
interpersonal trauma as a whole was highly predictive of both a diagnosis of depersonalization
disorder and of scores denoting dissociation, pathological dissociation, and depersonalization.
Emotional abuse, both in total score and in maximum severity, emerged as the most
significant predictor both of a diagnosis of depersonalization disorder and of
scores denoting depersonalization but not of general dissociation scores, which
were better predicted by combined emotional and sexual abuse. The majority of
the perpetrators of emotional abuse were either or both parents. Although different
types of trauma were modestly correlated, only a few of these relationships were
statistically significant, underscoring the importance of comprehensively considering
different types of trauma in research studies. CONCLUSIONS: Childhood interpersonal
trauma and, in particular, emotional abuse may play a role in the pathogenesis
of depersonalization disorder. Compared to other types of childhood trauma, emotional
maltreatment is a relatively neglected entity in psychiatric research and merits
more attention. [Abstract]
D, Gross S, Guralnik O, Stein DJ, Schmeidler J, Hollander E
unreal: 30 cases of DSM-III-R depersonalization disorder.
J Psychiatry. 1997 Aug;154(8):1107-13.
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. [Abstract]
VG, Steiner H
Trauma and dissociation in delinquent
J Am Acad Child Adolesc Psychiatry.
OBJECTIVES: To assess history of trauma and dissociation
in a group of juvenile delinquents and to assess how adolescents would respond
to a structured interview for dissociative symptoms. METHOD: Sixty-four adolescents
in juvenile probation hall participated in 2 investigational sessions in 1996-1997.
For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response
Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory.
For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured
Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). RESULTS: In this
sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history
of traumatic events. There were significant positive correlations between CTI
and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative
symptoms were endorsed, but depersonalization was the most common experience.
There was a lack of congruence between the different methods of assessing dissociation.
CONCLUSIONS: This study provides support for an early link between history of
trauma and dissociation. Adolescents were able to answer questions from a structured
interview assessing dissociation. [Abstract]
MV, Senior C, Phillips ML, Sierra M, Hunter E, David AS
imagery and depersonalisation.
Twenty-eight people diagnosed with depersonalisation
disorder (DD) were assessed using self-report measures of imagery ability in relation
to a range of symptoms and in comparison with age- and sex-matched controls. It
was found that symptoms of depersonalisation as well as other dissociative symptoms
and depressed mood correlated with impaired ability to generate visual images.
This was particularly evident with images pertaining to the self and other people
as opposed to objects. A subgroup of 10 patients was tested on a neuropsychological
battery of visual perception tests and found to be unimpaired compared with normal
controls and patients with obsessive compulsive disorder, despite subjective impairments
in imagery and high symptom scores. The findings add further weight to the distinctions
made between imagery and perceptual processes. [Abstract]
O, Schmeidler J, Simeon D
Feeling unreal: cognitive
processes in depersonalization.
Am J Psychiatry.
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. [Abstract]
H, Abiru T, Domon Y
[Two types of depersonalization--reconsideration
from a descriptive-phenomenological view point]
Shinkeigaku Zasshi. 2001;103(5):411-25.
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. [Abstract]
D, Guralnik O, Knutelska M, Schmeidler J
factors associated with dissociation: temperament, defenses, and cognitive schemata.
J Psychiatry. 2002 Mar;159(3):489-91.
OBJECTIVE: The purpose of this study
was to investigate temperamental, psychodynamic, and cognitive factors associated
with dissociation. METHOD: Fifty-three subjects with DSM-IV-defined depersonalization
disorder and 22 healthy comparison subjects were administered the Dissociative
Experiences Scale, the Tridimensional Personality Questionnaire, the Defense Style
Questionnaire, and the Schema Questionnaire. RESULTS: Subjects with depersonalization
disorder demonstrated significantly greater harm-avoidant temperament, immature
defenses, and over-connection and disconnection cognitive schemata than comparison
subjects. Within the group of subjects with depersonalization disorder, dissociation
scores significantly correlated with the same variables. CONCLUSIONS: Particular
personality factors may render individuals more vulnerable to dissociative symptoms.
Risk factors associated with dissociative disorders merit further study. [Abstract]
BT, Nuller IuL, Ustimova IN, Andreev BV
pain sensitivity based on the indicators of electro- odontometry in patients with
depersonalization and depressive disorders]
Psikhiatr Im S S Korsakova. 1990;90(10):81-2.
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. [Abstract]
R, Sirof B, Simeon D, Guralnick O
Role of fantasy
proneness, imaginative involvement, and psychological absorption in depersonalization
J Nerv Ment Dis. 2004 Jan;192(1):69-71.
GE, Sierra M
Depersonalization: a conceptual history.
Psychiatry. 1997 Jun;8(30 pt 2):213-29.
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
M, Berrios GE
The phenomenological stability of depersonalization:
comparing the old with the new.
J Nerv Ment Dis.
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. [Abstract]
MV, Senior C, Phillips ML, David AS
J Nerv Ment Dis. 2000 Nov;188(11):764-71.
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. [Abstract]
D, Knutelska M, Nelson D, Guralnik O, Schmeidler J
of the pathological dissociation taxon in depersonalization disorder.
Nerv Ment Dis. 2003 Nov;191(11):738-44.
In recent years, the pathologic dissociation
taxon developed by Waller, Putnam, and Carlson (Psychological Methods 1:300-321,
1996) from a Dissociative Identity Disorder (DID) sample has been increasingly
used in studies of dissociation in general. However, the taxon's convergence with
dissociative diagnoses other than DID, as well as the taxon's central premise
that pathologic dissociation is a categorical rather than a dimensional construct,
remain areas of exploration. This report examines the applicability of the pathologic
dissociation taxon to Depersonalization Disorder (DPD). The Dissociative Experiences
Scale was administered to 100 consecutively recruited DPD subjects diagnosed by
semistructured clinical interview and by the SCID-D. Taxon membership probability
was calculated using the recommended SAS scoring program. Approximately 2/3 of
subjects (N = 64) had a very high probability (>.80) of belonging to the taxon,
while 1/3 of subjects had a very low probability (<.10) of belonging to the
taxon. A taxon cutoff score of 13 yielded an 81% sensitivity in detecting the
presence of DPD. The modest convergence between taxonic membership and clinical
dissociative disorder diagnosis suggests that the taxon may have important limitations
in its use, at least when applied to DPD in its current form. As previously, we
continue to recommend a low taxon cutoff score (13) for the sensitive detection
of depersonalization disorder. The inference that pathologic dissociation is a
unitary and categorical entity is also discussed. [Abstract]
M, Berrios GE
The Cambridge Depersonalization Scale:
a new instrument for the measurement of depersonalization.
Res. 2000 Mar 6;93(2):153-64.
Existing self-rating scales to measure depersonalization
either show dubious face validity or fail to address the phenomenological complexity
of depersonalization. Based on a comprehensive study of the phenomenology of this
condition, a new self-rating depersonalization questionnaire was constructed.
The Cambridge Depersonalization Scale is meant to capture the frequency and duration
of depersonalization symptoms over the 'last 6 months'. It has been tested on
a sample of 35 patients with DSM-IV depersonalization disorder, 22 with anxiety
disorders, and 20 with temporal lobe epilepsy. Scores were compared against clinical
diagnoses (gold standard) and correlated with the depersonalization subscale of
the Dissociation Experiences Scale (DES). The scale was able to differentiate
patients with DSM-IV depersonalization disorder from the other groups, and showed
specific correlations with the depersonalization subscale of the DES (r=0.80;
P=0.0007). The scale also showed high internal consistency and good reliability
(Cronbach alpha and split-half reliability were 0.89 and 0.92, respectively).
The instrument can, therefore, be considered as valid and reliable, and can be
profitably used in both clinical and neurobiological research. [Abstract]
D, Guralnik O, Schmeidler J
Development of a depersonalization
J Trauma Stress. 2001 Apr;14(2):341-9.
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. [Abstract]
MV, Senior C, Fewtrell WD, Phillips ML, David AS
and secondary depersonalisation disorder: a psychometric study.
Affect Disord. 2001 Mar;63(1-3):249-56.
INTRODUCTION: Depersonalisation may
be part of a symptom-complex, a primary or a secondary disorder. Optimal methods
of measurement and diagnosis have not been established. METHODS: We assessed 42
patients with primary or secondary depersonalisation, plus psychiatric and non-psychiatric
controls using a variety of self-report questionnaire scales including the Beck
depression and anxiety Inventories, and one developed by the authors (the Fewtrell
Depersonalisation Scale (FDS)). The correlations between the scales and measures
of anxiety and depression were calculated, as were sensitivity and specificity
against an operational case definition. RESULTS: All the scales were highly correlated.
All could distinguish depersonalisation cases from the rest but none could distinguish
between primary and secondary depersonalisation disorder. Anxiety and especially
depression were correlated with depersonalisation symptoms. The FDS had high sensitivity
(85.7%) and specificity (92.3%) which compared favourably with other instruments.
Patients with both derealisation and depersonalisation scored the highest on the
FDS. DISCUSSION: Depersonalisation disorder comprises a measurable cluster of
symptoms which may be quantified with the help of self-report scales. Primary
and secondary forms overlap, with depressed mood a frequent feature. [Abstract]
BJ, Swinson RP
Instrument to assess depersonalization-derealization
in panic disorder.
Depress Anxiety. 2002;15(4):172-5.
is a long history of scholarly interest on depersonalization-derealization (DD)
and its role in clinical anxiety, but there is a paucity of appropriate assessment
instruments available. Our objective was to develop and evaluate a self-report
measure of DD for use with clinically anxious patients. Panic disorder patients
(n=169) were surveyed about DD experiences and provided data on a new item pool
for psychometric development. DD episodes were common and a 28-item Depersonalization-Derealization
Inventory was found to possess good reliability and validity. DD appears to be
prevalent and clinically relevant in panic disorder. Continued study of DD is
warranted and may be facilitated by the availability of a suitable instrument
with promising psychometric properties. A 12-item version of the instrument may
be appropriate as a brief screen. [Abstract]
Simeon D, Guralnik O, Hazlett EA, Spiegel-Cohen
J, Hollander E, Buchsbaum MS
Feeling unreal: a PET
study of depersonalization disorder.
Am J Psychiatry.
OBJECTIVE: The goal of this study was to assess brain
glucose metabolism and its relationship to dissociation measures and clinical
symptoms in DSM-IV depersonalization disorder. METHOD: Positron emission tomography
scans coregistered with magnetic resonance images of eight subjects with depersonalization
disorder were compared to those of 24 healthy comparison subjects. The two groups
did not differ in age, sex, education, performance on a baseline neuropsychological
battery, or performance on a verbal learning task administered during [(18)F]fluorodeoxyglucose
uptake. A cortical analysis by individual Brodmann's areas was performed. RESULTS:
Compared to the healthy subjects, subjects with depersonalization disorder showed
significantly lower metabolic activity in right Brodmann's areas 22 and 21 of
the superior and middle temporal gyri and had significantly higher metabolism
in parietal Brodmann's areas 7B and 39 and left occipital Brodmann's area 19.
Dissociation and depersonalization scores among the subjects with depersonalization
disorder were significantly positively correlated with metabolic activity in area
7B. CONCLUSIONS: Depersonalization appears to be associated with functional abnormalities
along sequential hierarchical areas, secondary and cross-modal, of the sensory
cortex (visual, auditory, and somatosensory), as well as areas responsible for
an integrated body schema. These findings are in good agreement with the phenomenological
conceptualization of depersonalization as a dissociation of perceptions as well
as with the subjective symptoms of depersonalization disorder. [Abstract]
MV, Sierra M, Phillips ML, David AS
The spectrum of
organic depersonalization: a review plus four new cases.
Neuropsychiatry Clin Neurosci. 2002 Spring;14(2):141-54.
and derealization are commonly reported in the general population as a response
to stress. The symptoms have also been described in patients with a primary psychiatric
or organic diagnosis, where their secondary status precludes a DSM-IV diagnosis
of depersonalization disorder. The authors present 4 new cases of depersonalization
in patients with an underlying organic condition, along with 47 cases from the
literature in which the available information permits diagnosis of organic depersonalization.
Information from case series documenting depersonalization in the context of medical
illnesses is also presented and the underlying etiology discussed. Epilepsy and
migraine appear to be the disorders most commonly associated with depersonalization.
Left-sided temporal lobe dysfunction and anxiety are suggested as factors in the
development of depersonalization; however, further studies are needed to determine
the relationship. The introduction to the DSM-IV of an organic subtype of depersonalization
disorder would facilitate research in this area. [Abstract]
E, Carrasco JL, Mullen LS, Trungold S, DeCaria CM, Towey J
hemispheric activation in depersonalization disorder: a case report.
Psychiatry. 1992 Jun 1;31(11):1157-62.
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. [Abstract]
ML, Medford N, Senior C, Bullmore ET, Suckling J, Brammer MJ, Andrew C, Sierra
M, Williams SC, David AS
thinking without feeling.
Psychiatry Res. 2001 Dec
Patients with depersonalization disorder (DP) experience
a detachment from their own senses and surrounding events, as if they were outside
observers. A particularly common symptom is emotional detachment from the surroundings.
Using functional magnetic resonance imaging (fMRI), we compared neural responses
to emotionally salient stimuli in DP patients, and in psychiatric and healthy
control subjects. Six patients with DP, 10 with obsessive-compulsive disorder
(OCD), and six volunteers were scanned whilst viewing standardized pictures of
aversive and neutral scenes, matched for visual complexity. Pictures were then
rated for emotional content. Both control groups rated aversive pictures as much
more emotive, and demonstrated in response to these scenes significantly greater
activation in regions important for disgust perception, the insula and occipito-temporal
cortex, than DP patients (covarying for age, years of education and total extent
of brain activation). In DP patients, aversive scenes activated the right ventral
prefrontal cortex. The insula was activated only by neutral scenes in this group.
Our findings indicate that a core phenomenon of depersonalization--absent subjective
experience of emotion--is associated with reduced neural responses in emotion-sensitive
regions, and increased responses in regions associated with emotion regulation.
ML, Sierra M
Depersonalization disorder: a functional
Stress. 2003 Sep;6(3):157-65.
reports of depersonalization suggest that attenuated emotional experience is a
central feature of the condition. Patients typically complain of emotional numbness
and some patients ascribe their feelings of unreality to a lack of affective "colouring"
in things perceived. Recent neuroimaging and psychophysiological studies support
these assumptions as they show both attenuated autonomic responses in depersonalization,
and decreased activity within neural regions important for the generation of affective
responses to emotive stimuli. Furthermore, findings from neuroimaging studies
indicate increased prefrontal cortical activity in depersonalised patients, particularly
within regions associated with contextualization and appraisal of emotionally-salient
information rather than mood induction per se. Taken together, these finding suggest
that symptoms of depersonalization, and in particular emotional numbing, may be
related to a reversal of normal patterns of autonomic and neural response to emotive
M, Senior C, Dalton J, McDonough M, Bond A, Phillips ML, O'Dwyer AM, David AS
response in depersonalization disorder.
Psychiatry. 2002 Sep;59(9):833-8.
BACKGROUND: Emotional-processing inhibition
has been suggested as a mechanism underlying some of the clinical features of
depersonalization and/or derealization. In this study, we tested the prediction
that autonomic response to emotional stimuli would be reduced in patients with
depersonalization disorder. METHODS: The skin conductance responses of 15 patients
with chronic depersonalization disorder according to DSM-IV, 15 controls, and
11 individuals with anxiety disorders according to DSM-IV, were recorded in response
to nonspecific elicitors (an unexpected clap and taking a sigh) and in response
to 15 randomized pictures with different emotional valences: 5 unpleasant, 5 pleasant,
and 5 neutral. RESULTS: The skin conductance response to unpleasant pictures was
significantly reduced in patients with depersonalization disorder (magnitude of
0.017 micro siemens in controls and 0.103 micro siemens in patients with anxiety
disorders; P =.01). Also, the latency of response to these stimuli was significantly
prolonged in the group with depersonalization disorder (3.01 seconds compared
with 2.5 and 2.1 seconds in the control and anxiety groups, respectively; P =.02).
In contrast, latency to nonspecific stimuli (clap and sigh) was significantly
shorter in the depersonalization and anxiety groups (1.6 seconds) than in controls
(2.3 seconds) (P =.03). CONCLUSIONS: In depersonalization disorder, autonomic
response to unpleasant stimuli is reduced. The fact that patients with depersonalization
disorder respond earlier to a startling noise suggests that they are in a heightened
state of alertness and that the reduced response to unpleasant stimuli is caused
by a selective inhibitory mechanism on emotional processing. [Abstract]
D, Guralnik O, Knutelska M, Hollander E, Schmeidler J
axis dysregulation in depersonalization disorder.
BACKGROUND: The purpose of this preliminary study was
to investigate HPA axis function in dissociation. METHODS: Nine subjects with
DSM-IV depersonalization disorder (DPD), without lifetime Posttraumatic Stress
Disorder (PTSD) or current major depression, were compared to nine healthy comparison
(HC) subjects of comparable age and gender. RESULTS: DPD subjects demonstrated
significant hyposuppression to low-dose dexamethasone administration and significantly
elevated morning plasma cortisol levels when covaried for depression scores, but
no difference in 24-hour urinary cortisol excretion. Dissociation scores powerfully
predicted suppression whereas depression scores did not contribute to the prediction.
CONCLUSIONS: Primary dissociative conditions, such as depersonalization disorder,
may be associated with a pattern of HPA axis dysregulation that differs from PTSD
and merits further study. [Abstract]
BR, David AS, Cleare AJ, Sierra M, Lambert MV, Phillips ML, Porter RJ, Gallagher
P, Young AH
Basal activity of the hypothalamic-pituitary-adrenal
axis in patients with depersonalization disorder.
Res. 2001 Oct 10;104(1):85-9.
Depersonalisation disorder may occur during severe
anxiety or following a traumatic event, suggesting a possible role of stress hormones.
This study investigated basal activity of the hypothalamic-pituitary-adrenal (HPA)
axis in patients with depersonalisation disorder. Salivary cortisol levels were
measured at four time points over 12 h in patients with depersonalisation disorder
(N=13), major depressive disorder (MDD, N=14) and healthy controls (N=13). Beck
Depression Inventory scores were significantly higher in depersonalised subjects
than controls, while MDD subjects demonstrated higher scores than both groups.
Basal cortisol levels of depersonalised subjects were significantly lower than
those of MDD subjects but not healthy controls. These results point to reduced
basal activity of the HPA axis in depersonalisation disorder. This pilot study
supports the distinction between depersonalisation disorder and major depressive
disorder which should be examined in a larger sample. [Abstract]
D, Guralnik O, Knutelska M, Yehuda R, Schmeidler J
norepinephrine in depersonalization disorder.
Res. 2003 Nov 1;121(1):93-7.
In contrast to the noradrenergic dysregulation
described in PTSD, little is known regarding noradrenergic function in dissociative
disorders. The purpose of this preliminary study was to investigate basal norepinephrine
in depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime
PTSD, were compared to nine healthy comparison (HC) subjects. Norepinephrine was
measured via 24-h urine collection and three serial plasma determinations. Groups
did not differ significantly in plasma norepinephrine levels. Compared to the
HC group, the DPD group demonstrated significantly higher urinary norepinephrine,
only prior to covarying for anxiety. The DPD group also demonstrated a highly
significant inverse correlation between urinary norepinephrine and depersonalization
severity (r=-0.88). Norepinephrine and cortisol levels (reported in a prior study)
were not intercorrelated. We concluded that although dissociation accompanied
by anxiety was associated with heightened noradrenergic tone, there was a marked
basal norepinephrine decline with increasing severity of dissociation. The findings
are in concordance with the few reports on autonomic blunting in dissociation
and merit further investigation. [Abstract]
M, Bellodi L, Perna G, Scarone S
EEG power modifications
in panic disorder during a temporolimbic activation task: relationships with temporal
lobe clinical symptomatology.
J Neuropsychiatry Clin
Neurosci. 1993 Fall;5(4):409-14.
Computerized EEG activity derived from the
temporal lobes was investigated in normal subjects and panic disorder patients
with and without depersonalization and/or derealization, in a resting condition
and during an odor stimulation task. Panic patients without depersonalization
or derealization showed an increase of fast and a decrease of slow activities
independent of odor stimulation. Panic patients with depersonalization and/or
derealization showed an increase of slow activity and bilateral lack of responsiveness
in the fast alpha frequency band during odor stimulation. Findings suggest there
are different EEG patterns in the temporal regions of the two different groups
of panic patients during rest and activating conditions. [Abstract]
EC, Phillips ML, Chalder T, Sierra M, David AS
disorder: a cognitive-behavioural conceptualisation.
Res Ther. 2003 Dec;41(12):1451-67.
Depersonalisation (DP) and derealisation
(DR) are subjective experiences of unreality in, respectively, one's sense of
self and the outside world. These experiences occur on a continuum from transient
episodes that are frequently reported in healthy individuals under certain situational
conditions to a chronic psychiatric disorder that causes considerable distress
(depersonalisation disorder, DPD). Despite the relatively high rates of reporting
these symptoms, little research has been conducted into psychological treatments
for this disorder. We suggest that there is compelling evidence to link DPD with
the anxiety disorders, particularly panic. This paper proposes that it is the
catastrophic appraisal of the normally transient symptoms of DP/DR that results
in the development of a chronic disorder. We suggest that if DP/DR symptoms are
misinterpreted as indicative of severe mental illness or brain dysfunction, a
vicious cycle of increasing anxiety and consequently increased DP/DR symptoms
will result. Moreover, cognitive and behavioural responses to symptoms such as
specific avoidances, 'safety behaviours' and cognitive biases serve to maintain
the disorder by increasing awareness of the symptoms, heightening the perceived
threat and preventing disconfirmation of the catastrophic misinterpretations.
A coherent model facilitates the development of potentially effective cognitive
and behavioural interventions. [Abstract]
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. [Abstract]
J, Kaye K
Incidence and correlates of depersonalization
following head trauma.
Brain Inj. 1993 Nov-Dec;7(6):507-13.
the criteria of the Structured Clinical Interview for DSM-III-R Dissociative Disorders
(SCID-D), we assessed the incidence of feelings of unreality among a sample of
70 persons who had sustained head injuries. Among those whose head trauma could
be classified as mild, more than 60% complained of a depersonalization syndrome.
Among those with a significant period of unconsciousness, only 11% had similar
complaints. There was a high comorbidity with post-traumatic stress disorder and
vertigo. Feelings of unreality were not associated with cognitive impairment or
elevated personality test scores, nor were there significant relationships with
gender or involvement in litigation. A conservative estimate of incidence of depersonalization
among persons with minor head trauma is 13%, while, at the upper end, as many
as 67% of persons who sustain mild head injury may experience feelings of unreality.
R, Hoenk PR, Kuperman S, Slymen DJ
in accident victims and psychiatric patients.
Ment Dis. 1977 Jun;164(6):401-7.
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. [Abstract]
NG, Lundin T
Early traumatic stress reactions among
Swedish survivors of the m/s Estonia disaster.
J Psychiatry. 1996 Dec;169(6):713-6.
BACKGROUND: This study is a three-month
follow-up study in order to assess the short-term impact of traumatic stress among
53 Swedish survivors of the Estonia disaster. METHOD: A questionnaire consisting
of general questions about conditions during and after the disaster and self-assessment
by Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), Sense
of Coherence-short version (SoC-12), and the DSM-IV list of dissociative symptoms
of Acute Stress Disorder formulated as questions regarding individual reactions
was distributed. RESULTS: The response rate was 79.2% (n = 42). The participants
scored an average of 3.9 on PTSS-10, 28.5 on IES ('intrusion' and 'avoidance'
subscales) and 62.8 on SoC-12, which shows elevated levels of post-traumatic stress
reactions but a normal level of sense of coherence. The reported occurrence of
dissociative symptoms during the disaster was as follows: emotional numbing in
43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation
in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly
higher in both PTSS-10 and IES than those with high scores in SoC. All dissociative
symptoms were predictive of post-traumatic reactions. CONCLUSIONS: This study
substantiates the importance of assessing dissociative symptoms during a life-threatening
event as a possible for later post-traumatic reactions and possible PTSD. The
Sense of Coherence Scale may be useful as an instrument to sort out survivors
at risk. [Abstract]
JP, Johnston CL
Depersonalization, vertigo and Ménière's
Psychol Rep. 1989 Apr;64(2):527-34.
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. [Abstract]
Depersonalisation--symptoms, meaning, therapy.
Psychiatr Scand. 1982 Dec;66(6):451-8.
The manifestation of depersonalisation,
its relationship with anxiety and depression, as well as its influence on the
course of endogenous psychoses were investigated. Forty patients with severe depersonalisation
were treated with the benzodiazepine, phenazepam, and 14 with clozapine. The data
indicate that depersonalisation results from anxiety; it follows an anxiety attack
and is successfully treated with anxiolytic drugs. In the case of endogenous depression,
depersonalisation leads to lingering depressive phase, increasing the patients'
resistance to antidepressive therapy. The protective and the harmful role of depersonalisation
is discussed. [Abstract]
Repetitive transcranial magnetic stimulation improves
depersonalization: a case report.
CNS Spectr. 2004
Depersonalization disorder is a poorly understood and treatment-resistant
condition. This report describes a patient with depersonalization disorder who
underwent six sessions of repetitive transcranial magnetic stimulation on the
left dorsolateral prefrontal cortex. Repetitive transcranial magnetic stimulation
produced a 28% reduction on depersonalization scores. [Abstract]
D, Guralnik O, Schmeidler J, Knutelska M
therapy in depersonalisation disorder: randomised controlled trial.
J Psychiatry. 2004 Jul;18531-6.
BACKGROUND: Despite anecdotal reports that
serotonin reuptake inhibitors may improve depersonalisation, there is no proven
efficacious treatment for depersonalisation disorder. AIMS: To investigate the
efficacy of fluoxetine in the treatment of depersonalisation disorder. METHOD:
Fifty-four people who met DSM-IV criteria for depersonalisation disorder were
recruited through newspaper advertisements, and 50 were randomised to a 10-week,
double-blind trial of fluoxetine 10-60 mg/day or placebo. Primary outcome measures
were the Dissociative Experiences Scale-Depersonalisation Factor, the Depersonalization
Severity Scale and the Clinical Global Impression-Improvement (CGI-I) scale. RESULTS:
Intention-to-treat analysis revealed that fluoxetine (mean dosage 48 mg/day) was
not superior to placebo except for a clinically minimal but statistically significantly
greater improvement in CGI-I score in the fluoxetine group prior to covarying
for anxiety and depression (2.9 v. 3.6). Depersonalisation was significantly more
likely to improve if comorbid anxiety disorder improved. CONCLUSIONS: Fluoxetine
was not efficacious in treating depersonalisation disorder, despite the commonly
reported clinical use of serotonin reuptake inhibitors for this condition. [Abstract]
M, Phillips ML, Ivin G, Krystal J, David AS
cross-over trial of lamotrigine in depersonalization disorder.
Psychopharmacol. 2003 Mar;17(1):103-5.
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. [Abstract]
D, Stein DJ, Hollander E
Treatment of depersonalization
disorder with clomipramine.
Biol Psychiatry. 1998
BACKGROUND: Although there is a dire paucity of data on
the pharmacologic treatment of depersonalization disorder, there have been a few
reports in the literature suggesting that selective serotonin reuptake inhibitors
may be of therapeutic benefit. In this study, we undertook to evaluate the efficacy
of the potent serotonin reuptake inhibitor clomipramine in treating depersonalization.
METHODS: Eight subjects with DSM-III-R depersonalization disorder were entered
into a double-blind crossover trial consisting of 8 weeks desipramine and 8 weeks
clomipramine. Due to the very small size of the trial findings are presented descriptively.
RESULTS: Of 7 subjects who entered the clomipramine trial, two showed significant
improvement in depersonalization. Three subjects dropped out early, unable to
tolerate adverse effects. Of 6 subjects who entered the desipramine trial, I showed
significant improvement in depersonalization. One clomipramine responder was subsequently
followed in open maintenance treatment with clomipramine for 4 years, and her
depersonalization symptoms remained in almost complete remission, with relapses
upon each attempt to taper off or switch medication. CONCLUSIONS: Clomipramine
may be a promising pharmacologic treatment for primary depersonalization disorder
and warrants further investigation. [Abstract]
KM, Allin MP, Kucharska-Pietura K, David A, Andrew C, Williams S, Brammer MJ,
Ketamine alters neural processing of facial
emotion recognition in healthy men: an fMRI study.
2003 Mar 3;14(3):387-91.
Disruption of facial emotion perception occurs in
neuropsychiatric disorders where the expression of emotion is dulled or blunted,
for example depersonalization disorder and schizophrenia. It has been suggested
that, in the clinical context of emotional blunting, there is a shift in the relative
contribution of brain regions subserving cognitive and emotional processing. The
non-competitive glutamate receptor antagonist ketamine produces such emotional
blunting in healthy subjects. Therefore, we hypothesised that in healthy subjects
ketamine would elicit neural responses to emotional stimuli which mimicked those
reported in depersonalization disorder and schizophrenia. Thus, we predicted that
ketamine would produce reduced activity in limbic and visual brain regions involved
in emotion processing, and increased activity in dorsal regions of the prefrontal
cortex and cingulate gyrus, both associated with cognitive processing and, putatively,
with emotion regulation. Measuring BOLD signal change in fMRI, we examined the
neural correlates of ketamine-induced emotional blunting in eight young right-handed
healthy men receiving an infusion of ketamine or saline placebo while viewing
alternating 30 s blocks of faces displaying fear versus neutral expressions. The
normal pattern of neural response occurred in limbic and visual cortex to fearful
faces during the placebo infusion. Ketamine abolished this: significant BOLD signal
change was demonstrated only in left visual cortex. However, with ketamine, neural
responses were demonstrated to neutral expressions in visual cortex, cerebellum
and left posterior cingulate gyrus. Emotional blunting may be associated with
reduced limbic responses to emotional stimuli and a relative increase in the visual
cortical response to neutral stimuli. [Abstract]
D, Hollander E, Stein DJ, DeCaria C, Cohen LJ, Saoud JB, Islam N, Hwang M
of depersonalization by the serotonin agonist meta-chlorophenylpiperazine.
Res. 1995 Sep 29;58(2):161-4.
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.
Y, Zullino DF
induced by reboxetine.
Swiss Med Wkly. 2003 Jul 12;133(27-28):398-9.
high variety of factors have been implicated in the emergence of depersonalisation
and derealisation episodes, including different drugs. A case abruptly induced
by two applications of reboxetine, a selective and specific norepinephrine reuptake
inhibitor, is reported occurring in a 50-year-old woman treated for a major depressive
episode. The episode rapidly remitted after discontinuation of reboxetine. [Abstract]
Medication-associated depersonalization symptoms:
report of transient depersonalization symptoms induced by minocycline.
Med J. 2004 Jan;97(1):70-3.
Patients with depersonalization disorder experience
episodes in which they have a feeling of detachment from themselves. Symptoms
of depersonalization may occur in individuals who have other mental disorders,
or who have various medical conditions, or who have taken certain medications.
A woman developed depersonalization symptoms after initiation of minocycline therapy.
Her symptoms ceased after treatment was stopped and recurred when she restarted
the drug. Medications that have been associated with causing symptoms of depersonalization
are presented and the postulated pathogenesis by which some of these drugs induced
depersonalization symptoms is discussed. Medication-associated depersonalization
symptoms typically resolve once the inducing drug has been withdrawn. [Abstract]
LA, Gurpegui M
Cannabis-induced psychosis: a cross-sectional
comparison with acute schizophrenia.
Scand. 2002 Mar;105(3):173-8.
OBJECTIVE: The existence of cannabis-induced
psychosis (CP) remains controversial, partly because of methodological problems.
We hypothesize that acute schizophrenia (AS) and CP can have distinct demographic,
premorbid and clinical features. METHOD: We compared 26 patients with CP to 35
with AS, after their cannabis-consumption status was confirmed by repeated urine
screens. Patients with CP were assessed after at least 1 week but not more than
1 month of abstinence. Symptoms were evaluated with the Present State Examination
(PSE). RESULTS: In group CP, male gender, expansive mood and ideation, derealization/depersonalization,
visual hallucinations, and disturbances of sensorium were more frequent than in
group AS. Premorbid schizoid personality traits were more frequently associated
to AS and antisocial personality traits to CP. CONCLUSION: The continuous heavy
use of cannabis can induce a psychotic disorder distinct from AS. These two clinical
entities share some features but they differ in others. [Abstract]
EB, Roemer RA, Moster M, Shan Y
Psychiatry. 1999 Jun 1;45(11):1523-6.
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
W, Krieg JC
[Hoigne syndrome. Case report and current
Nervenarzt. 2001 Jul;72(7):546-8.
syndrome is currently considered a pseudoanaphylactic or pseudoallergic reaction
following intramuscular and aqueous procaine penicillin administration. This disorder
is characterized predominantly by neuropsychiatric alterations including severe
psychomotor agitation with confusion, sensations of disintegration, depersonalization,
and derealization, perceived changes of body shape, visual and auditory hallucinations,
panic-like anxiety including fear of death as well as alterations of consciousness
and seizures. Beside the "classic" immediate manifestation of Hoigne's
syndrome, subacute forms as well as reactions of the so-called latent type are
also known. Including a typical case report, we present a review of the currently
available literature concerning clinical picture, hypotheses on origin, and possible
therapy regimens of this underdiagnosed complication of antibiotic penicillin
KN, Denson TF
Exacerbation of mania secondary to right
temporal lobe astrocytoma in a bipolar patient previously stabilized on valproate.
Behav Neurol. 2003 Dec;16(4):234-8.
OBJECTIVES: To investigate breakthrough
mania secondary to a right temporal lobe neoplasm in a bipolar patient previously
stabilized on sodium divalproex. BACKGROUND: Right hemispheric brain tumors involving
the orbitofrontal or basotemporal cortex are a rare cause of secondary mania.
In such cases, early neurologic signs may be difficult to distinguish from bipolar
symptoms. Breakthrough mania secondary to brain neoplasm in a bipolar patient
stabilized on medication is an extremely rare phenomena which has not been previously
reported. METHOD: The clinical course of a bipolar subject stabilized on valproate
who developed mania secondary to a right temporal lobe astrocytoma is described.
Serial brain magnetic resonance imaging (MRI), baseline electroencephalogram (EEG),
and neuropsychiatric evaluations were used to examine the relationship between
the patient's brain mass and behavioral disturbances. RESULTS: Symptoms were those
that accompanied prior episodes of mania. In addition, signs of temporal lobe
dysfunction were evident including periods of detachment, déjà vu experiences,
and olfactory hallucinations. In the context of mania, depersonalization was initially
attributed to bipolar symptoms. Only several months later, when olfactory hallucinations
and alterations in consciousness became evident, was a temporal lobe lesion suspected.
Neuropsychiatric abnormalities responded to a combination of surgical intervention,
radiation therapy, and topiramate, however the tumor was advanced and invasive
at diagnosis resulting in a poor prognosis. CONCLUSIONS: This case suggests that
clinicians examining unexplained cases of breakthrough mania should be vigilant
for early signs of temporal lobe dysfunction, which could aid in detecting treatable
AM, Gauthier S, Bertrand S
Anxiety attacks in a patient
with a right temporal lobe meningioma.
J Clin Psychiatry.
The role of neurologic factors leading to the appearance
of anxiety attacks is incompletely understood. The case of a 69-year-old woman
with no previous psychiatric illness who began to experience frequent anxiety
attacks is described. These attacks were later associated with depersonalization
and visual perceptual disturbances. The symptoms disappeared following the discovery
and removal of a right temporal lobe meningioma. [Abstract]