Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-04-24T14:49:15.614Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive-Affective Neuroscience of Depersonalization

Published online by Cambridge University Press:  07 November 2014

Dan J. Stein  and
Daphne Simeon
Get access Rights & Permissions [Opens in a new window]

Abstract

Depersonalization disorder (DPD) is characterized by a subjective sense of detachment from one's own being and a sense of unreality. An examination of the psychobiology of depersonalization symptoms may be useful in understanding the cognitive-affective neuroscience of embodiment. DPD may be mediated by neurocircuitry and neurotransmitters involved in the integration of sensory processing and of the body schema, and in the mediation of emotional experience and the identification of feelings. For example, DPD has been found to involve autonomic blunting, deactivation of sub-cortical structures, and disturbances in molecular systems in such circuitry. An evolutionary perspective suggests that attenuation of emotional responses, mediated by deactivation of limbic structures, may sometimes be advantageous in response to inescapable stress.

Type
Pearls in Clinical Neuroscience
Information
CNS Spectrums , Volume 14 , Issue 9 , September 2009 , pp. 467 - 471
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Simeon, D, Gross, S, Guralnik, O, et al.Feeling unreal: 30 cases of DSM-III-R depersonalization disorder. Am J Psychiatry. 1997;154:1107–1113.Google Scholar
2.Simeon, D. Depersonalisation disorder: a contemporary overview. CNS Drugs. 2004;18:343–354.CrossRefGoogle ScholarPubMed
3.Sierra, M, Berrios, GE. The phenomenological stability of depersonalization: Comparing the old with the new. J Nerv Ment Dis. 2001;189:629–636.CrossRefGoogle ScholarPubMed
4.Simeon, D, Giesbrecht, T, Knutelska, M, et al.Alexithymia, absorption, and cognitive failures in depersonalization disorder a comparison to posttraumatic stress disorder and healthy volunteers. J Nerv Ment Dis. 2009;197:492–498.Google Scholar
5.Montagne, B, Sierra, M, Medford, N, et al.Emotional memory and perception of emotional faces in patients suffering from depersonalization disorder. Br J Psychology. 2007;98:517–527.CrossRefGoogle ScholarPubMed
6.Medford, N, Brierley, B, Brammer, M, et al.Emotional memory in depersonalization disorder: a functional MRI study. Psychiatry Res. 2006;148:93–102.Google Scholar
7.Guralnik, O, Schmeidler, J, Simeon, D. Feeling Unreal: Cognitive Processes in Depersonalization. Am J Psychiatry. 2000;157:103–109.Google Scholar
8.Guralnik, O, Giesbrecht, T, Knutelska, M, et al.Cognitive functioning in depersonalization disorder. J Nerv Ment Dis. 2007;195:983–988.Google Scholar
9.Aderibigbe, YA, Bloch, RR, Walker, WR. Prevalence of depersonalization and derealizatibn experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol. 2001;36:63–69.Google Scholar
10.Michal, M, Wiltink, J, Subic-Wrana, C, et al.Prevalence, correlates, and predictors of depersonalization experiences in the German general population. J Nerv Ment Dis. 2009;197:499–506.Google Scholar
11.Hunter, EC, Sierra, M, David, AS. The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol. 2004;39:9–18.Google Scholar
12.Hunter, EC, Phillips, ML, Chalder, T, et al.Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behav Res Ther. 2003;41:1451–1467.Google Scholar
13.Kenna, JC, Sedman, G. Depersonalization in temporal-lobe epilepsy and the organic psychoses. Br J Psychiatry. 1965;111:293–299.Google Scholar
14.Sierra, M, Lopera, F, Lambert, MV, et al.Separating depersonalisation and derealisation: the relevance of the “lesion method”. J Neurol Neurosurg Psychiatry. 2002;72:530–532.Google ScholarPubMed
15.Blanke, O, Arzy, S. The out-of-body experience: disturbed self-processing at the temporo-parietal junction. Neuroscientist. 2005;11:16–24.Google Scholar
16.Arzy, S, Thut, G, Mohr, C, et al.Neural basis of embodiment: distinct contributions of temporoparietal junction and extrastriate body area. J Neurosci. 2006;26:8074–8081.CrossRefGoogle ScholarPubMed
17.Devinsky, O, Putnam, F, Grafman, J, et al.Dissociative states and epilepsy. Neurology. 1989;39:835–840.Google Scholar
18.Salanova, V, Andermann, F, Rasmussen, T, et al.Parietal lobe epilepsy: clinical manifestations and outcome in 82 patients treated surgically between 1929 and 1988. Brain. 1995;118:607–627.Google Scholar
19.Simeon, D, Guralnik, O, Hazlett, EA, et al.Feeling Unreal: A PET study of depersonalization disorder. Am J Psychiatry. 2000;157:1782–1788.CrossRefGoogle ScholarPubMed
20.Irle, E, Lange, C, Weniger, G, et al.Size abnormalities of the superior parietal cortices are related to dissociation in borderline personality disorder. Psychiatry Res. 2007;156:139–149.Google Scholar
21.Phillips, ML, Medford, N, Senior, C, et al.Depersonalization disorder: thinking without feeling. Psychiatry Res. 2001;108:145–160.Google Scholar
22.Lemche, E, Surguladze, SA, Giampietro, VP, et al.Limbic and prefrontal responses to facial emotion expressions in depersonalization. Neuroreport. 2007;18:473–477.Google Scholar
23.Lemche, E, Anilkumar, A, Giampietro, VP, et al.Cerebral and autonomic responses to emotional facial expressions in depersonalisation disorder. Br J Psychiatry. 2008;193:222–228Google Scholar
24.Sierra, M, Berrios, GE. Depersonalization: neurobiological perspectives. Biological Psychiatry. 1998;44:898–908.Google Scholar
25.Phillips, ML, Sierra, M. Depersonalization disorder: a functional neuroanatomical perspective. Stress. 2003;6:157–165.CrossRefGoogle ScholarPubMed
26.Stein, DJ, Muller, J. Cognitive-affective neuroscience of somatization disorder and functional somatic syndromes: Reconceptualizing the triad of depression-anxiety-somatic symptoms. CNS Spectr. 2008;13:379–384.Google Scholar
27.Stein, DJ. Emotional regulation: Implications for the psychobiology of psychotherapy. CNS Spectr. 2008;13:195–198.Google Scholar
28.Roder, CH, Michal, M, Overbeck, G, et al.Pain response in depersonalization: A functional Imaging study using hypnosis in healthy subjects. Psychother Psychosom. 2007;76:115–121.Google Scholar
29.Simeon, D, Hollander, E, Stein, DJ, et al.Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine. Psychiatry Res. 1995;58:161–164.CrossRefGoogle ScholarPubMed
30.Sedman, G, Kenna, JC. Occurrence of depersonalization phenomena under LSD. Psychiatr Neurologia. 1964;147:129–137.Google Scholar
31.Rusconi, AC, Carlone, C, Muscillo, M, et al.SSRI discontinuation syndrome: incidence and differences on three groups of patients treated with paroxetine. Rivista di Psichiatria. 2009;44:169–175.Google Scholar
32.Simeon, D, Knutelska, M, Nelson, D, et al.Feeling unreal: a depersonalization disorder update of 117 cases. J Clin Psychiatry. 2003;64:990–997.Google Scholar
33.Medford, N, Baker, D, Hunter, E, et al.Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases. Addiction. 2003;98:1731–1736.Google Scholar
34.Mathew, RJ, Wilson, WH, Chiu, NY, et al.Regional cerebral blood flow and depersonalization after tetrahydrocannabinol administration. Acta Psychiatr Scand. 1999;100:67–75.Google Scholar
35.Abel, KM, Allin, MPG, Kucharska-Pietura, K, et al.Ketamine alters neural processing of facial emotion recognition in healthy men: an fMRI study. Neuroreport. 2003;14:387–391.CrossRefGoogle ScholarPubMed
36.Sierra, M, Senior, C, Dalton, J, et al.Autonomic response in depersonalization disorder. Arch Gen Psychiatry. 2002;59:833–838Google Scholar
37.Sierra, M, Senior, C, Phillips, ML, et al.Autonomic response in the perception of disgust and happiness in depersonalization disorder. Psychiatry Res. 2006;145:225–231.Google Scholar
38.Simeon, D, Guralnik, O, Knutelska, M, et al.Basal norepinephrine in depersonalization disorder. Psychiatry Res. 2003;121:93–97.Google Scholar
39.Stanton, BR, David, AS, Cleare, AJ, et al.Basal activity of the hypothalamic-pituitary-adrenal axis in patients with depersonalization disorder. Psychiatry Res. 2001;104:85–89.Google Scholar
40.Simeon, D, Guralnik, O, Knutelska, M, et al.Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder. Neuropsychopharmacology. 2001;25:793–795.CrossRefGoogle ScholarPubMed
41.Sierra-Siegert, M, David, AS. Depersonalization and individualism: The effect of culture on symptom profiles in panic disorder. J Nerv Ment Dis. 2007;195:989–995.Google Scholar
42.Simeon, D, Guralnik, O, Schmeidler, J, et al.The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry. 2001;158:1027–1033.Google Scholar
43.Michal, M, Beutel, ME, Jordan, J, et al.Depersonalization, mindfulness, and childhood trauma. J Nerv Ment Dis. 2007;195:693–696.Google Scholar
44.Kihlstrom, JF. Dissociative disorders. Annu Rev Clin Psychol. 2005;1:227–253.CrossRefGoogle ScholarPubMed
45.Mula, M, Pini, S, Cassano, GB. The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal. J Affect Disord. 2007;99:91–99.Google Scholar
46.Hollander, E, Liebowitz, MR, DeCaria, C, et al.Treatment of depersonalization with serotonin reuptake blockers. J Clin Psychopharmacol. 1990;10:200–203Google Scholar
47.Segui, J, Marquez, M, Garcia, L, et al.Depersonalization in panic disorder: a clinical study. Compr Psychiatry. 2000;41:172–178.Google Scholar
48.Mula, M, Pini, S, Preve, M, et al.Clinical correlates of depersonalization symptoms in patients with bipolar disorder. J Affect Disord. 2009;115:252–256.Google Scholar
49.Michal, M, Kaufhold, J, Grabhorn, R, et al.Depersonalization and social anxiety. J Nerv Ment Dis. 2005;193:629–632.Google Scholar
50.Sedman, G, Kenna, JC. Depersonalization and mood changes in schizophrenia. Br J Psychiatry. 1963;109:669–673.Google Scholar
51.Torch, EM. Review of relationship between obsession and depersonalization. Acta Psychiatr Scand. 1978;58:191–198.CrossRefGoogle ScholarPubMed
52.Lambert, MV, Senior, C, Fewtrell, WD, et al.Primary and secondary depersonalisation disorder: a psychometric study. J Affect Disord. 2001;63:249–256.Google Scholar
53.Lambert, MV, Sierra, M, Phillips, ML, et al.The spectrum of organic depersonalization: a review plus four new cases. J Neuropsychiatry Clin Neurosci. 2002;14:141–154.Google Scholar
54.Baker, D, Hunter, E, Lawrence, E, et al.Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry. 2003;182:428–433.Google Scholar
55.Simeon, D, kozin, Ds, Segal, K, Lerch, B. Is depersonalization disorder initiated by illicit durg use any different? A survey of 394 adults. J Clin Psych. In press.Google Scholar
56.Sierra, M, Berrios, GE. The Cambridge Depersonalisation Scale: a new instrument for the measurement of depersonalisation. Psychiatry Res. 2000;93:153–164.Google Scholar
57.Simeon, D, Guralnik, O, Gross, S, et al.The detection and measurement of depersonalization disorder. J Nerv Ment Dis. 1998;186:536–542.CrossRefGoogle ScholarPubMed
58.Simeon, D, Guralnik, O, Schmeidler, J. Development of a depersonalization severity scale. J Trauma Stress. 2001;14:341–349.Google Scholar
59.Mula, M, Pini, S, Calugi, S, et al.Validity and reliability of the Structured Clinical Interview for Depersonalization-Derealization Spectrum (SCI-DER). Neuropsychiatr Dis Treat. 2008;4:977–986.Google Scholar
60.Simeon, D, Kozin, DS, Segal, K, et al.De-constructing depersonalization: further evidence for symptom clusters. Psychiatry Res. 2008;157:303–306.Google Scholar
61.Sierra, M, Baker, D, Medford, N, et al.Unpacking the depersonalization syndrome: an exploratory factor analysis on the Cambridge Depersonalization Scale. Psychol Med. 2005;35:1523–1532.Google Scholar
62.Simeon, D, Guralnik, O, Schmeidler, J, et al.Fluoxetine therapy in depersonalisation disorder: randomised controlled trial. Br J Psychiatry. 2004;185:31–36.Google Scholar
63.Sierra, M, Phillips, ML, Ivin, G, et al.A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder. J Psychopharmacol. 2003;17:103–105.Google Scholar
64.Nuller, YL, Morozova, MG, Kushnir, ON, et al.Effect of naloxone therapy on depersonalization: a pilot study. J Psychopharmacol. 2001;15:93–95.Google Scholar
65.Simeon, D, Knutelska, M. An open trial of naltrexone in the treatment of depersonalization disorder. J Clin Psychopharmacol. 2005;25:267–270.Google Scholar
66.Sierra, M, Baker, D, Medford, N, et al.Lamotrigine as an add-on treatment for depersonalization disorder: A retrospective study of 32 cases. Clin Neuropharmacol. 2006;29:253–258.Google Scholar
67.Simeon, D, Stein, DJ, Hollander, E. Treatment of depersonalization disorder with clomipramine. Biol Psychiatry. 1998;44:302–303.Google Scholar
68.Jimenez-Genchi, AM. Repetitive transcranial magnetic stimulation improves depersonalization: a case report. CNS Spectr. 2004;9:375–376.Google Scholar
69.Sierra, M. Depersonalization disorder: pharmacological approaches. Expert Rev Neurother. 2008;8:19–26.CrossRefGoogle ScholarPubMed
70.Mancini-Marie, A, Fahim, C, Potvin, S, et al.Quetiapine: focus on emotional numbing in depersonalization disorder: an fMRI case report. Eur Psychiatry. 2006;21:574–577.CrossRefGoogle ScholarPubMed
71.Medford, N, Stringaris, A, Sierra, M; et al.Response to aversive stimuli in depersonalization disorder: neural activation patterns in two patients before and after treatment with lamotrigine. Biol Psychiatry. 2004;55:812.Google Scholar
72.Hunter, ECM, Baker, D, Phillips, ML, et al.Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behav Res Ther. 2005;43:1121–1130.Google Scholar
73.Frances, A, Sacks, M, Aronoff, MS. Depersonalization: a self-relations perspective. Int J Psychoanal. 1977;58:325–331.Google Scholar