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Dindinger RA, Manzo LL, Manupule SE, Harp SL. Perinatal Care for Persons with Dissociative Disorders. MCN Am J Matern Child Nurs 2024:00005721-990000000-00055. [PMID: 38864882 DOI: 10.1097/nmc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented.
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Woelk SP, Garfinkel SN. Dissociative Symptoms and Interoceptive Integration. Curr Top Behav Neurosci 2024. [PMID: 38755513 DOI: 10.1007/7854_2024_480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.
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Affiliation(s)
- Sascha P Woelk
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, London, UK
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Gwyther MPD, Lenggenhager B, Windt JM, Aspell JE, Ciaunica A. Examining the association between depersonalisation traits and the bodily self in waking and dreaming. Sci Rep 2024; 14:6107. [PMID: 38480797 PMCID: PMC10937666 DOI: 10.1038/s41598-024-56119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one's body. We conducted an online study in healthy participants (n = 514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a 'spared space' where people can temporarily 'retrieve' their sense of self and sense of bodily presence. We found that higher DP traits-i.e. higher scores on the Cambridge Depersonalisation Scale (CDS)-were associated with more frequent dream experiences from an outside observer perspective (r = 0.28) and more frequent dream experiences of distinct bodily sensations (r = 0.23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = 0.24), more frequent nightmares (r = 0.33) and higher dream recall (r = 0.17). CDS scores were negatively correlated with body boundary scores (r = - 0.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r = - 0.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation -derealisation disorder).
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Affiliation(s)
- Matt P D Gwyther
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.
| | - Bigna Lenggenhager
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Jennifer M Windt
- Department of Philosophy, Monash University, Melbourne, Australia
- Monash Centre for Consciousness and Contemplative Studies, Melbourne, Australia
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Anna Ciaunica
- Centre for Philosophy of Science, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
- Institute of Cognitive Neuroscience, University College London, London, WC1N 3AR, UK
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Michal M, Wiltink J, Tibubos AN, Wild PS, Münzel T, Lackner K, Pfeiffer N, König J, Gieswinkel A, Beutel M, Kerahrodi JG. Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study. BMC Psychiatry 2024; 24:196. [PMID: 38459472 PMCID: PMC10924423 DOI: 10.1186/s12888-024-05658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. METHODS The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. RESULTS There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. CONCLUSIONS The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany.
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Karl Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Jochem König
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Gieswinkel
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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5
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Salami A, Andreu-Perez J, Gillmeister H. Finding neural correlates of depersonalisation/derealisation disorder via explainable CNN-based analysis guided by clinical assessment scores. Artif Intell Med 2024; 149:102755. [PMID: 38462269 DOI: 10.1016/j.artmed.2023.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 03/12/2024]
Abstract
Mental health disorders are typically diagnosed based on subjective reports (e.g., through questionnaires) followed by clinical interviews to evaluate the self-reported symptoms. Therefore, considering the interconnected nature of psychiatric disorders, their accurate diagnosis is a real challenge without indicators of underlying physiological dysfunction. Depersonalisation/derealisation disorder (DPD) is an example of dissociative disorder affecting 1-2 % of the population. DPD is characterised mainly by persistent disembodiment, detachment from surroundings, and feelings of emotional numbness, which can significantly impact patients' quality of life. The underlying neural correlates of DPD have been investigated for years to understand and help with a more accurate and in-time diagnosis of the disorder. However, in terms of EEG studies, which hold great importance due to their convenient and inexpensive nature, the literature has often been based on hypotheses proposed by experts in the field, which require prior knowledge of the disorder. In addition, participants' labelling in research experiments is often derived from the outcome of the Cambridge Depersonalisation Scale (CDS), a subjective assessment to quantify the level of depersonalisation/derealisation, the threshold and reliability of which might be challenged. As a result, we aimed to propose a novel end-to-end EEG processing pipeline based on deep neural networks for DPD biomarker discovery, which requires no prior handcrafted labelled data. Alternatively, it can assimilate knowledge from clinical outcomes like CDS as well as data-driven patterns that differentiate individual brain responses. In addition, the structure of the proposed model targets the uncertainty in CDS scores by using them as prior information only to guide the unsupervised learning task in a multi-task learning scenario. A comprehensive evaluation has been done to confirm the significance of the proposed deep structure, including new ways of network visualisation to investigate spectral, spatial, and temporal information derived in the learning process. We argued that the proposed EEG analytics could also be applied to investigate other psychological and mental disorders currently indicated on the basis of clinical assessment scores. The code to reproduce the results presented in this paper is openly accessible at https://github.com/AbbasSalami/DPD_Analysis.
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Affiliation(s)
- Abbas Salami
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK.
| | - Javier Andreu-Perez
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK; Centre for Computational Intelligence, Smart Health Technologies Group, Institute of Public Health and Wellbeing, University of Essex, Colchester CO4 3SQ, UK; Simbad2, Department of Computer Science, University of Jaén, 23071 Jaen, Spain; Biomedical Research Institute of Malaga (IBIMA), 29590 Málaga, Spain.
| | - Helge Gillmeister
- Centre for Computational Intelligence, Smart Health Technologies Group, Institute of Public Health and Wellbeing, University of Essex, Colchester CO4 3SQ, UK; Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.
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6
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Stanghellini G. The dynamic paradigm of illness in psychopathology. World Psychiatry 2024; 23:163-164. [PMID: 38214641 PMCID: PMC10785972 DOI: 10.1002/wps.21175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Italy
- Centro de Estudios de Fenomenologia y Psiquiatria, Universidad "Diego Portales", Santiago, Chile
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Basso JC, Satyal MK, McKee KL, Lynn S, Gyamfi D, Bickel WK. Dissociation and other trauma symptomatology are linked to imbalance in the competing neurobehavioral decision systems. Front Psychol 2024; 14:1317088. [PMID: 38356995 PMCID: PMC10864435 DOI: 10.3389/fpsyg.2023.1317088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Dissociation is a conscious state characterized by alterations in sensation and perception and is thought to arise from traumatic life experiences. Previous research has demonstrated that individuals with high levels of dissociation show impairments in cognitive-emotional processes. Therefore, using the Competing Neurobehavioral Decisions System (CNDS) theory, we used statistical modeling to examine whether dissociative experience and trauma symptoms are independently predicted by impulsivity, risk-seeking, affective state (i.e., anxiety, depression, stress, and negative affect), and trauma history. Method In this cross-sectional study design, data were collected via Amazon Mechanical Turk from a total of n = 557 English-speaking participants in the United States. Using Qualtrics, participants answered a series of self-reported questionnaires and completed several neurocognitive tasks. Three independent multiple linear regression models were conducted to assess whether impulsivity, risk seeking, affective state, and trauma history predict depersonalization, trauma symptoms, and PTSD symptoms. Results As hypothesized, we found that depersonalization and other trauma symptoms are associated with heightened impulsivity, increased risk-seeking, impaired affective states, and a history of traumatic experiences. Conclusion We demonstrate that an imbalanced CNDS (i.e., hyperimpulsive/hypoexecutive), as evidenced by decreased future valuation, increased risk seeking, and impaired affective states, predicts heightened depersonalization and other trauma and PTSD symptomatology. This is the first time that dissociation has been connected to delay discounting (i.e., the tendency to place more value on rewards received immediately compared to farther in the future). Interventions that positively impact areas of the CNDS, such as episodic future thinking or mindfulness meditation, may be a target to help decrease dissociative symptoms.
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Affiliation(s)
- Julia C. Basso
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Medha K. Satyal
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Kevin L. McKee
- Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, United States
| | - Sarah Lynn
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Daphne Gyamfi
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Warren K. Bickel
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
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Joshi SD, Ruffini G, Nuttall HE, Watson DG, Braithwaite JJ. Optimised Multi-Channel Transcranial Direct Current Stimulation (MtDCS) Reveals Differential Involvement of the Right-Ventrolateral Prefrontal Cortex (rVLPFC) and Insular Complex in those Predisposed to Aberrant Experiences. Conscious Cogn 2024; 117:103610. [PMID: 38056338 DOI: 10.1016/j.concog.2023.103610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Research has shown a prominent role for cortical hyperexcitability underlying aberrant perceptions, hallucinations, and distortions in human conscious experience - even in neurotypical groups. The rVLPFC has been identified as an important structure in mediating cognitive affective states / feeling conscious states. The current study examined the involvement of the rVLPFC in mediating cognitive affective states in those predisposed to aberrant experiences in the neurotypical population. Participants completed two trait-based measures: (i) the Cortical Hyperexcitability Index_II (CHi_II, a proxy measure of cortical hyperexcitability) and (ii) two factors from the Cambridge Depersonalisation Scale (CDS). An optimised 7-channel MtDCS montage for stimulation conditions (Anodal, Cathodal and Sham) was created targeting the rVLPFC in a single-blind study. At the end of each stimulation session, participants completed a body-threat task (BTAB) while skin conductance responses (SCRs) and psychological responses were recorded. Participants with signs of increasing cortical hyperexcitability showed significant suppression of SCRs in the Cathodal stimulation relative to the Anodal and sSham conditions. Those high on the trait-based measures of depersonalisation-like experiences failed to show reliable effects. Collectively, the findings suggest that baseline brain states can mediate the effects of neurostimulation which would be missed via sample level averaging and without appropriate measures for stratifying individual differences.
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Hunter ECM, Wong CLM, Gafoor R, Lewis G, David AS. Cognitive Behaviour Therapy (CBT) for Depersonalization Derealization Disorder (DDD): a self-controlled cross-over study of waiting list vs. active treatment. Cogn Behav Ther 2023; 52:672-685. [PMID: 37711065 DOI: 10.1080/16506073.2023.2255744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Depersonalisation-Derealisation Disorder (DDD) has a prevalence of around 1% but is under-recognised and often does not respond to medical intervention. We report on a clinical audit of 36 participants with a diagnosis of chronic DDD who were sequentially recruited from a specialist DDD National Health Service clinic in London, United Kingdom, and who completed Cognitive Behavioural Therapy specifically adapted for DDD. The sample population had a mean age of 38.7 years (s.d. = 13.4), 61% were male and 69% were of White ethnicity. Three outcomes were assessed (Cambridge Depersonalisation Scale [CDS], Beck Depression Inventory [BDI], and the Beck Anxiety Inventory [BAI]) at three time points in a naturalistic, self-controlled, cross-over design. Hierarchical longitudinal analyses for outcome response clustered by patient were performed using scores from baseline, beginning, and end of therapy. All scores showed improvement during the treatment period, with medium effect sizes. CBT may be an effective treatment for DDD. However, treatment was not randomly assigned, and the sample was small. More research is needed, including the use of randomisation to assess the efficacy of CBT for DDD.
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Affiliation(s)
- Elaine C M Hunter
- Department of Academic Psychiatry, University College London, London, UK
| | | | - Rafael Gafoor
- Department of Academic Psychiatry, University College London, London, UK
| | - Glyn Lewis
- Department of Academic Psychiatry, University College London, London, UK
| | - Anthony S David
- Department of Academic Psychiatry, University College London, London, UK
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Cassady M, Baslet G. Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature. Seizure 2023; 110:220-230. [PMID: 37433243 DOI: 10.1016/j.seizure.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023] Open
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Affiliation(s)
- Maureen Cassady
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Korte M, Cerci D, Wehry R, Timmers R, Williamson VJ. The same but different. Multidimensional assessment of depression in students of natural science and music. Health Psychol Res 2023; 11:74879. [PMID: 37405314 PMCID: PMC10317516 DOI: 10.52965/001c.74879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Depression is one of the most common and debilitating health problems, however, its heterogeneity makes a diagnosis challenging. Thus far the restriction of depression variables explored within groups, the lack of comparability between groups, and the heterogeneity of depression as a concept limit a meaningful interpretation, especially in terms of predictability. Research established students in late adolescence to be particularly vulnerable, especially those with a natural science or musical study main subject. This study used a predictive design, observing the change in variables between groups as well as predicting which combinations of variables would likely determine depression prevalence. 102 under- and postgraduate students from various higher education institutions participated in an online survey. Students were allocated into three groups according to their main study subject and type of institution: natural science students, music college students and a mix of music and natural science students at university with comparable levels of musical training and professional musical identity. Natural science students showed significantly higher levels of anxiety prevalence and pain catastrophizing prevalence, while music college students showed significantly higher depression prevalence compared to the other groups. A hierarchical regression and a tree analysis found that depression for all groups was best predicted with a combination of variables: high anxiety prevalence and low burnout of students with academic staff. The use of a larger pool of depression variables and the comparison of at-risk groups provide insight into how these groups experience depression and thus allow initial steps towards personalized support structures.
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Affiliation(s)
| | - Deniz Cerci
- Klinik für Forensische Psychiatrie Universitätsmedizin Rostock, Germany
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12
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Soffer-Dudek N. Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice. Front Psychol 2023; 14:1132800. [PMID: 37051604 PMCID: PMC10084853 DOI: 10.3389/fpsyg.2023.1132800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.
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Affiliation(s)
- Nirit Soffer-Dudek
- The Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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13
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Millman LM, Hunter EC, Terhune DB, Orgs G. Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder. Complement Ther Clin Pract 2023; 51:101749. [PMID: 37018935 DOI: 10.1016/j.ctcp.2023.101749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Depersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach. MATERIALS AND METHODS We developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n = 31) and healthy controls (n = 29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness - II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks. RESULTS At baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness. CONCLUSION Individual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body.
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Lassri D, Bregman-Hai N, Soffer-Dudek N, Shahar G. The Interplay Between Childhood Sexual Abuse, Self-Concept Clarity, and Dissociation: A Resilience-Based Perspective. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2313-2336. [PMID: 35593092 PMCID: PMC9850382 DOI: 10.1177/08862605221101182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite a robust consensus regarding the potentially negative implications of childhood sexual abuse (CSA), research investigating risk and protective factors-particularly among well-functioning young adults-is scant. Dissociation is one of the major maladaptive outcomes of CSA. Nevertheless, CSA explains only about 10% of the variance of dissociation. Possibly, this modest effect size is due to protective factors moderating the relation between CSA and dissociative symptoms. One such factor may be the extent to which one has succeeded in developing a clear and coherent sense of who they are. OBJECTIVE We aimed to explore whether self-concept clarity (SCC) moderates the relationship between CSA and dissociation (Model 1), and an alternative hypothesis, whereby CSA may moderate the relationship between SCC and dissociation (Model 2). PARTICIPANTS AND SETTING This was tested among 65 well-functioning young women drawn from an earlier study that intentionally oversampled CSA survivors. METHODS We included data from survivors of CSA by a known perpetrator (n = 35) and women with no sexual trauma (n = 30). RESULTS Findings were consistent with both Model 1 and Model 2, but only when depersonalization-derealization, namely detachment, was considered. Simple effects analyses revealed that CSA was related to depersonalization-derealization only under low SCC levels (Model 1), and SCC was negatively related to depersonalization-derealization only in the CSA group (Model 2). CONCLUSIONS Findings suggest that SCC is a protective factor, buffering the association between CSA and detachment (depersonalization-derealization) symptoms. Clinical implications are discussed.
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Affiliation(s)
- Dana Lassri
- The Paul Baerwald School of Social
Work and Social Welfare, The Hebrew University of
Jerusalem, Jerusalem, Israel
- Research Department of Clinical,
Educational and Health Psychology, UCL (University College
London), London, UK
| | - Noa Bregman-Hai
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
| | - Nirit Soffer-Dudek
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
| | - Golan Shahar
- Department of Psychology,
Ben-Gurion
University of the Negev, Beer-Sheva,
Israel
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15
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How vestibular dysfunction transforms into symptoms of depersonalization and derealization? J Neurol Sci 2023; 444:120530. [PMID: 36586207 DOI: 10.1016/j.jns.2022.120530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Psychiatric Depersonalization/Derealization (DPDR) symptoms were demonstrated in patients with peripheral vestibular disorders. However, only semicircular canals (SCCs) dysfunction was evaluated, therefore, otoliths' contribution to DPDR is unknown. Also, DPDR symptoms in patients with central vestibular dysfunction are presently unknown. DPDR was also studied in the context of spatial disorientation and anxiety, but the relation of these cognitive and emotional functions to vestibular dysfunction requires clarification. METHODS We tested patients with peripheral Bilateral Vestibular Hypofunction (pBVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. Participants completed the video Head Impulse Test (vHIT) for SCCs function, cervical Vestibular Evoked Myogenic Potentials test (cVEMPt) for sacculi function, Body Sensation Questionnaire (BSQ) for panic anxiety, Object Perspective-Taking test (OPTt) for spatial orientation and Cox & Swinson DPDR inventory for DPDR symptoms. RESULTS pBVH patients showed significant SCCs and sacculi dysfunction, spatial disorientation, elevated panic anxiety, and DPDR symptoms. MJD patients showed significant SCCs hypofunction but preserved sacculi function, spatial disorientation but normal levels of panic anxiety and DPDR symptoms. Only pBVH patients demonstrated a positive correlation between the severity of the DPDR and spatial disorientation and panic anxiety. CONCLUSIONS DPDR develops in association with sacculi dysfunction, either with or without SSCs dysfunction. Spatial disorientation and anxiety seem to mediate the transformation of vestibular dysfunction into DPDR symptoms. DPDR does not develop in MJD with central vestibular hypofunction but a normal saccular response. We propose a three-step model that describes the development of DPDR symptoms in vestibular patients.
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16
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Bafei SEC, Chen J, Qian Y, Yuan L, Zhou Y, Sambou ML, Walker AN, Li W, Liu S. The Association between Burnout, Social Support, and Psychological Capital among Primary Care Providers in Togo: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010175. [PMID: 36676799 PMCID: PMC9864046 DOI: 10.3390/medicina59010175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
Background and Objectives: Job burnout is prevalent among primary care providers (PCPs) in different countries, and the factors that can alleviate burnout in these countries have been explored. However, no study has addressed the prevalence and the correlates of job burnout among Togolese PCPs. Therefore, we aimed to examine the prevalence of burnout and its association with social support and psychological capital among PCPs in Togo. Material and Methods: We conducted a cross-sectional study in Togo from 5 to 17 November 2020 among 279 PCPs of 28 peripheral care units (PCUs). Participants completed the Maslach Burnout Inventory, Job Content Questionnaire, and Psychological Capital Questionnaire. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test, Pearson correlation analysis, and multiple linear regression. Results: We received 279 responses, out of which 37.28% experienced a high level of emotional exhaustion (EE), 13.62% had a high level of depersonalization (DP), and 19.71% experienced low levels of personal accomplishment (PA). EE had a significant negative correlation with the supervisor's support. In contrast, self-efficacy, hope, optimism, and resilience had a significant negative correlation with DP and a significant positive correlation with PA. Furthermore, supervisors' support significantly predicted lower levels of EE. Optimism significantly predicted lower levels of DP and higher levels of PA. Conclusions: Burnout is common among Togolese PCPs, and self-efficacy, optimism, and supervisors' support significantly contribute to low levels of job burnout among Togolese PCPs. This study provided insight into intervention programs to prevent burnout among PCPs in Togo.
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Affiliation(s)
- Solim Essomandan Clémence Bafei
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jiaping Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yinan Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Lei Yuan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yimin Zhou
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Muhammed Lamin Sambou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Anita Nyarkoa Walker
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Wei Li
- Department of Anesthesiology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
- Correspondence: (W.L.); (S.L.)
| | - Sijun Liu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence: (W.L.); (S.L.)
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17
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Barreda-Ángeles M, Hartmann T. Experiences of Depersonalization/Derealization Among Users of Virtual Reality Applications: A Cross-Sectional Survey. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:22-27. [PMID: 36595349 DOI: 10.1089/cyber.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous research shows that virtual reality (VR) users may experience symptoms of depersonalization/derealization (DPDR) immediately after use. However, the impact of long-term VR use on these symptoms has not been analyzed so far. In a preregistered study, we conducted an online survey among a bigger sample of VR users (N = 754) to investigate the relationship between time of use during the past 6 months and the presence of DPDR symptoms. The results support the absence of a linear association between time of VR use and the presence of symptoms, when controlling for other factors. DPDR symptoms are more frequent among younger female users and in those who experience higher levels of embodiment during use. Secondary analyses show that symptoms are more common among newer users and among those who engage in longer sessions. These findings suggest that current common VR experiences are not a cause of long-term DPDR symptoms for the majority of users, yet also encourage further research about specific cases where VR use might trigger DPDR experiences in the long term.
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Affiliation(s)
- Miguel Barreda-Ángeles
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tilo Hartmann
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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18
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Oleichik IV, Moreva AS, Baranov PA. [Depersonalization depression in young female patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:68-73. [PMID: 38127703 DOI: 10.17116/jnevro202312311268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To study psychopathological structure characteristics of depersonalization depression in young women and nonsuicidal autoaggressive and suicidal behavior characteristics in these states. MATERIAL AND METHODS We studied 36 adolescent female patients (16-25 years) with endogenous depression (F31.3-4; F34.0; F21.3-4+F31.3-4; F60.X+F31.3-4), whose clinical picture was dominated by depersonalization disorders represented by their auto-, allo-, and somatopsychic forms or combinations. RESULTS Depersonalization depressions in young female patients are characterized by the following features: the dominance of the manifestations of the sensory («hysterical») form of depersonalization (83.3%; n=30); the proximity of the phenomenon of somatopsychic depersonalization (77.8%, n=28) to the manifestations of dysmorphic disorders; the specificity of the manifestations of derealization in the form of a feeling of «pretended, staged» environment; infrequent manifestations of psychic anesthesia; marked polymorphism of the clinical picture with comorbid obsessive-compulsive, hysteria-conversion, senestopathic, dysmorphic, and attenuated psychotic disorders; high risk of suicide (83.3%; n=30) with the predominance of planned suicide attempts over impulsive ones; significant frequency and variety of nonsuicidal self-harm with the predominance of «depersonalizing» motives for its commission. CONCLUSIONS Depersonalization depression in young female patients is characterized by the clinical specificity manifested both in depersonalization symptomatology and spectrum of comorbid disorders and in the specificity of motives and methods of suicide attempts and nonsuicidal self-harm.
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Affiliation(s)
| | - A S Moreva
- Mental Health Research Center, Moscow, Russia
| | - P A Baranov
- Mental Health Research Center, Moscow, Russia
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19
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Saini F, Ponzo S, Silvestrin F, Fotopoulou A, David AS. Depersonalization disorder as a systematic downregulation of interoceptive signals. Sci Rep 2022; 12:22123. [PMID: 36543824 PMCID: PMC9772393 DOI: 10.1038/s41598-022-22277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022] Open
Abstract
Depersonalisation disorder (DPD) is a psychopathological condition characterised by a feeling of detachment from one's own body and surrounding, and it is understood as emerging from the downregulation of interoceptive afferents. However, the precise mechanisms that drive this 'interoceptive silencing' are yet to be clarified. Here we present a computational and neurobiologically plausible model of DPD within the active inference framework. Specifically, we describe DPD as arising from disrupted interoceptive processing at higher levels of the cortical hierarchy where the interoceptive and exteroceptive streams are integrated. We simulated the behaviour of an agent subjected to a situation of high interoceptive activation despite the absence of a perceivable threat in the external environment. The simulation showed how a similar condition, if perceived as inescapable, would result in a downregulation of interoceptive signals, whilst leaving the exteroceptive ones unaffected. Such interoceptive silencing would force the agent to over-rely on exteroceptive information and would ultimately lead to the DPD phenomenology. Finally, our simulation shows that repeated exposure to similar situations over time will lead the agent to increasingly disengage from bodily responses even in the face of a less triggering situation, explaining how a single episode of depersonalization can lead to chronic DPD.
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Affiliation(s)
- Fedal Saini
- grid.499389.60000 0004 0375 2443Institute of Psychiatry, Psychology and Neuroscience, King’s London College, London, SE5 8AF UK
| | - Sonia Ponzo
- Flo Health, London, UK ,grid.83440.3b0000000121901201Institute of Health Informatics, University College London, London, UK
| | - Francesco Silvestrin
- Thrive Therapeutic Software Ltd., London, UK ,grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ UK
| | - Aikaterini Fotopoulou
- grid.83440.3b0000000121901201Division of Psychology & Language Sciences, Clinical, Educational & Health Psychology Research Department, University College London, London, UK
| | - Anthony S. David
- grid.83440.3b0000000121901201Institute of Mental Health, Faculty of Brain Sciences, University College London, London, UK
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20
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Simeon D, Putnam F. Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment. J Trauma Dissociation 2022; 23:490-503. [PMID: 35422203 DOI: 10.1080/15299732.2022.2064580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.
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Affiliation(s)
- Daphne Simeon
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Frank Putnam
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
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21
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La Marra M, Messina A, Ilardi CR, Staiano M, Di Maio G, Messina G, Polito R, Valenzano A, Cibelli G, Monda V, Chieffi S, Iavarone A, Villano I. Factorial Model of Obese Adolescents: The Role of Body Image Concerns and Selective Depersonalization-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11501. [PMID: 36141782 PMCID: PMC9517425 DOI: 10.3390/ijerph191811501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The relationship binding body weight to psychological well-being is unclear. The present study aims at identifying the contribution, and specificity, of some dimensions (i.e., eating-related symptoms, body image disorders, eating habits, personality traits, and emotional difficulties) characterizing the psychological profile of obese adolescents (749 participants, 325 females; 58.3% normal-weight, 29.9% overweight, and 11.7% obese; mean age = 16.05, SD = 0.82). METHODS By introducing the scores obtained by standardized self-report tools into a generalized linear model, a factorial reduction design was used to detect the best fitting discriminant functions and the principal components explaining the higher proportion of the variance. RESULTS We found two discriminant functions correctly classifying 87.1% of normal-weight, 57.2% of overweight, and 68.2% of obese adolescents. Furthermore, two independent factors, explaining 69.68% of the total variance, emerged. CONCLUSIONS The first factor, "Body Image Concerns", included the drive for thinness, body dissatisfaction, and interpersonal distrust. The second factor, "Selective Depersonalization", included a trend toward depersonalization and dissatisfaction with the torso. The neurophysiological implications of our findings will be discussed.
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Affiliation(s)
- Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Rosario Ilardi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Maria Staiano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, 80133 Naples, Italy
| | - Sergio Chieffi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandro Iavarone
- Neurological Unit, CTO Hospital, AORN “Ospedali dei Colli”, 80131 Naples, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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22
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White matter abnormalities in first-episode patients with depersonalization/derealization disorder: A tract-based spatial statistics study. J Affect Disord 2022; 309:19-26. [PMID: 35469908 DOI: 10.1016/j.jad.2022.04.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neuroimaging studies on depersonalization / derealization disorder (DPD) have revealed that there are structural and functional alterations across numerous brain regions. However, to date, the exact white matter abnormalities that are associated with different clinical symptoms and cognitive impairments in first-episode, drug-naïve patients with DPD remain unclear. METHODS Overall, 25 first-episode, drug-naïve patients with DPD and 23 healthy controls were recruited and underwent DTI scans. The tract-based spatial statistics analysis was conducted in order to determine white matter microstructural changes between the two groups. Correlation analysis was conducted between the fractional anisotropy (FA) of abnormal WM fibers and the total score of the 30-item Cambridge Depersonalization Scale (CDS-30), cognitive assessments. RESULTS Patients with DPD demonstrated higher FA in the right corpus callosum (CC), and posterior corona radiate (CR), compared to healthy controls. The FA in the right CC demonstrated a positive correlation with total score of CDS-30, numbing, unreality of self, perceptual alterations, and temporal disintegration, respectively. FA in the right CR region indicated a positive correlation with the total score of CDS-30, unreality of self, perceptual alterations, and temporal disintegration, respectively. Furthermore, FA in the right CR region was found to be negatively correlated with the Continuous Performance Test and the Stroop color-word test. CONCLUSION The altered white matter microstructure and cognitive impairments of medication naïve DPD patients were observed. Abnormalities in the integrity of CC and CR were associated with severity of symptoms and cognitive impairments, which may provide a potential biomarker for clinical studies on DPD.
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23
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French NJ, Eberle JW, Teachman BA. Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization. ANXIETY, STRESS, AND COPING 2022; 35:395-408. [PMID: 34524043 PMCID: PMC8920942 DOI: 10.1080/10615806.2021.1977797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND OBJECTIVES Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization. DESIGN We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention. METHODS Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires. RESULTS As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship. CONCLUSIONS These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.
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Affiliation(s)
- Noah J French
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy W Eberle
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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24
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Taveira MC, Sá JD, Rosa MGD. Virtual Reality-Induced Dissociative Symptoms: A Retrospective Study. Games Health J 2022; 11:262-267. [PMID: 35648035 DOI: 10.1089/g4h.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The use of virtual reality (VR) has been increasing worldwide, as devices are becoming more sophisticated and provide an escape from reality during the COVID-19 lockdown. This recent rise in the use of VR leads to new side effects being reported, such as dissociative symptoms that may or may not constitute a mental health concern. This retrospective study investigated the prevalence and intensity of dissociative symptoms in VR users, as well as some potential predisposing conditions that may trigger them, and their impact on the subjects' wellbeing. Materials and Methods: We conducted a survey (n = 358) that was posted on VR Facebook groups. This survey was approved by the University of Lisbon Medical Faculty's IRB, and comprised a modified version of the Clinician-Administered Dissociative State Scale (CADSS) and questions regarding potential risk factors known to induce dissociative disorders or experiences. Results: Data analysis revealed that 83.9% participants reported dissociative symptoms, with varying intensity according to CADSS (X̄=7.62;s=7.89). Significant correlations were found between CADSS score and the time spent playing, the use of software applications (apps) that involve virtual hands or hand tracking, history of previous dissociative experiences, traumatic childhood events, avoidant coping strategies, and psychiatric disorders. Nonetheless, most participants categorized the symptoms as nonanxiogenic (85.8%) and minute lasting (77.4%). Conclusion: In conclusion, this study revealed that although VR can induce dissociative experiences, they seem to be short lasting and nonthreatening to the individual's wellbeing and might be predicted or attenuated by managing other known risk factors for dissociative phenomena.
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Affiliation(s)
| | - João de Sá
- Department of Neurology, Hospital de Santa Maria, Lisboa, Portugal
| | - Michele Gomes da Rosa
- Department of Physiology, Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal
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25
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Gago-Valiente FJ, Moreno-Sánchez E, Vélez-Moreno E, Merino-Godoy MDLÁ, Sáez-Padilla J, de Paula Rodríguez-Miranda F, da Costa EIMT, Saenz-de-la-Torre LC, Segura-Camacho A, Mendoza-Sierra MI. The Upshot of the SARS-CoV-2 Pandemic on Nursing Assistants: Evaluating Mental Health Indicators in Huelva. J Clin Med 2022; 11:2586. [PMID: 35566711 PMCID: PMC9105936 DOI: 10.3390/jcm11092586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Healthcare professionals who work in front-line situations are among those under the highest risk of presenting negative mental health indicators. We sought to assess the prevalence of low personal realization, emotional exhaustion, and depersonalization as well as probable non-psychotic psychiatric pathologies during the pandemic in nursing assistants in the city of Huelva (Spain), and to study the association between these mental health indicators and sociodemographic and professional variables. A cross-sectional descriptive investigation with a quantitative approach was used. A representative sample of these professionals, consisting of 29 men and 284 women, completed the GHQ-12 questionnaire, including sociodemographic data and the MBI-HSS questionnaire, collecting information on situations of contact with SARS-CoV-2. Data analysis was conducted, and correlations were established. We found that emotional exhaustion, depersonalization and probable non-psychotic, psychiatric pathologies were related to contact with SARS-CoV-2. Moreover, personal realization, depersonalization and emotional exhaustion were related to just gender. We conclude that nursing assistants from public hospitals in the city of Huelva who had contact with patients with SARS-CoV-2 in the workplace, showed poor mental health indicators than those who did not come into contact with infected individuals.
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Affiliation(s)
| | - Emilia Moreno-Sánchez
- Department of Pedagogy, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
| | - Emilia Vélez-Moreno
- Medicine Department, Faculty of Medicine, University of Malaga, 29071 Malaga, Spain
| | | | - Jesús Sáez-Padilla
- Integrated Didactics Department, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain
| | | | - Emília Isabel Martins Teixeira da Costa
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal
- Health Sciences Research Unit, Nursing, Nursing School of Coimbra, 3000 Coimbra, Portugal
| | - Luis-Carlos Saenz-de-la-Torre
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
| | - Adrián Segura-Camacho
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
| | - María-Isabel Mendoza-Sierra
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
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Ciaunica A, Seth A, Limanowski J, Hesp C, Friston KJ. I overthink—Therefore I am not: An active inference account of altered sense of self and agency in depersonalisation disorder. Conscious Cogn 2022; 101:103320. [PMID: 35490544 PMCID: PMC9130736 DOI: 10.1016/j.concog.2022.103320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
This paper examines potential mechanisms behind atypical sense of self and agency in Depersonalisation Disorder (DPD). Using Active Inference, we argue that aberrant somatosensory attenuation and precision weighting underlies DPD. Failures of somatosensory attenuation may disrupt the sense of agency and control over one’s perceptions and actions. In DPD, individuals may believe ‘another agent’ is controlling their thoughts, perceptions or actions. Unlike psychosis however, in DPD the individual maintains the full insight that the ‘other agent’ is ‘me’ (the self).
This paper considers the phenomenology of depersonalisation disorder, in relation to predictive processing and its associated pathophysiology. To do this, we first establish a few mechanistic tenets of predictive processing that are necessary to talk about phenomenal transparency, mental action, and self as subject. We briefly review the important role of ‘predicting precision’ and how this affords mental action and the loss of phenomenal transparency. We then turn to sensory attenuation and the phenomenal consequences of (pathophysiological) failures to attenuate or modulate sensory precision. We then consider this failure in the context of depersonalisation disorder. The key idea here is that depersonalisation disorder reflects the remarkable capacity to explain perceptual engagement with the world via the hypothesis that “I am an embodied perceiver, but I am not in control of my perception”. We suggest that individuals with depersonalisation may believe that ‘another agent’ is controlling their thoughts, perceptions or actions, while maintaining full insight that the ‘other agent’ is ‘me’ (the self). Finally, we rehearse the predictions of this formal analysis, with a special focus on the psychophysical and physiological abnormalities that may underwrite the phenomenology of depersonalisation.
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Abstract
Objectives Methods Results Conclusions Supplementary Information
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Ciaunica A, Pienkos E, Nakul E, Madeira L, Farmer H. Exploration of self- and world experiences in depersonalization traits. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2056009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Ciaunica
- Institute of Philosophy, University of Porto, via Panoramica s/n 4150-564 Porto, Portugal
- Institute of Cognitive Neuroscience, University College London, WC1N 3AR London, UK
- Centre for Philosophy of Science, University of Lisbon, Campo Gra, 1749-016 Lisbon, Portugal
| | | | - Estelle Nakul
- Aix Marseille Univ, CNRS, LNC, FR3C, Marseille, France
| | - Luis Madeira
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Harry Farmer
- School of Human Sciences, University of Greenwich, UK
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Gago-Valiente FJ, Moreno-Sánchez E, Santiago-Sánchez A, Gómez-Asencio D, Merino-Godoy MDLÁ, Castillo-Viera E, Costa EI, Segura-Camacho A, Saenz-de-la-Torre LC, Mendoza-Sierra MI. Work-Family Interaction, Self-Perceived Mental Health and Burnout in Specialized Physicians of Huelva (Spain): A Study Conducted during the SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3717. [PMID: 35329411 PMCID: PMC8955258 DOI: 10.3390/ijerph19063717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The medical staff who work in specialized healthcare are among the professionals with a greater risk of presenting negative indicators of mental health. These professionals are exposed to numerous sources of stress that can have a negative influence on their personal life. Currently, SARS-CoV-2 poses an additional and relevant source of stress. The aim of this study was to identify the interactions between the work and family environments, as well as to analyze self-perceived mental health and burnout in physicians who, during the COVID-19 pandemic, carried out their jobs in public health in Huelva (Spain), also considering a series of sociodemographic variables. METHODS This is a descriptive, cross-sectional study. Information from 128 participants was collected using the SWING, MBI-HSS and GHQ-12 questionnaires, along with sociodemographic data and possible situations of contact with SARS-CoV-2. The data were analyzed, and correlations were established. RESULTS Most of the sample obtained a positive interaction result of work over family. Those who had been in contact with SARS-CoV-2 represented higher percentages of a positive result in GHQ-12, negative work-family interaction, burnout, emotional exhaustion and depersonalization. In general, the men showed a worse mental health state than women. CONCLUSIONS The medical staff of Huelva who had been in contact with situations of SARS-CoV-2 in their work environment presented worse indicators of mental health and greater negative interaction of work over family than those who had not been in contact with these situations.
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Affiliation(s)
| | - Emilia Moreno-Sánchez
- Department of Pedagogy, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain; (E.M.-S.); (D.G.-A.)
| | | | - David Gómez-Asencio
- Department of Pedagogy, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain; (E.M.-S.); (D.G.-A.)
| | | | - Estefanía Castillo-Viera
- Integrated Didactics Department, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21071 Huelva, Spain;
| | - Emília Isabel Costa
- Health Sciences Research Unit: Nursing, 3000 Coimbra, Portugal;
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal
| | - Adrián Segura-Camacho
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain; (A.S.-C.); (L.-C.S.-d.-l.-T.); (M.-I.M.-S.)
| | - Luis-Carlos Saenz-de-la-Torre
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain; (A.S.-C.); (L.-C.S.-d.-l.-T.); (M.-I.M.-S.)
| | - María-Isabel Mendoza-Sierra
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain; (A.S.-C.); (L.-C.S.-d.-l.-T.); (M.-I.M.-S.)
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Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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Ciaunica A, McEllin L, Kiverstein J, Gallese V, Hohwy J, Woźniak M. Zoomed out: digital media use and depersonalization experiences during the COVID-19 lockdown. Sci Rep 2022; 12:3888. [PMID: 35273200 PMCID: PMC8913838 DOI: 10.1038/s41598-022-07657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Depersonalisation is a common dissociative experience characterised by distressing feelings of being detached or 'estranged' from one's self and body and/or the world. The COVID-19 pandemic forcing millions of people to socially distance themselves from others and to change their lifestyle habits. We have conducted an online study of 622 participants worldwide to investigate the relationship between digital media-based activities, distal social interactions and peoples' sense of self during the lockdown as contrasted with before the pandemic. We found that increased use of digital media-based activities and online social e-meetings correlated with higher feelings of depersonalisation. We also found that the participants reporting higher experiences of depersonalisation, also reported enhanced vividness of negative emotions (as opposed to positive emotions). Finally, participants who reported that lockdown influenced their life to a greater extent had higher occurrences of depersonalisation experiences. Our findings may help to address key questions regarding well-being during a lockdown, in the general population. Our study points to potential risks related to overly sedentary, and hyper-digitalised lifestyle habits that may induce feelings of living in one's 'head' (mind), disconnected from one's body, self and the world.
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Affiliation(s)
- Anna Ciaunica
- Centre for Philosophy of Science, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal.
- Institute of Philosophy, University of Porto, via Panoramica s/n, 4150-564, Porto, Portugal.
- Institute of Cognitive Neuroscience, University College London, London, WC1N 3AR, UK.
| | - Luke McEllin
- University of Warwick, Coventry, UK
- Department of Cognitive Science, Social Mind Center, Central European University, Vienna, Austria
| | - Julian Kiverstein
- Department of Psychiatry, Amsterdam University Medical Centre, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Via Volturno 39, 43121, Parma, Italy
| | - Jakob Hohwy
- Cognition and Philosophy Lab, Department of Philosophy, Monash University, Melbourne, Australia
- Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, Australia
| | - Mateusz Woźniak
- Department of Cognitive Science, Social Mind Center, Central European University, Vienna, Austria.
- Cognition and Philosophy Lab, Department of Philosophy, Monash University, Melbourne, Australia.
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Virtual reality induces symptoms of depersonalization and derealization: A longitudinal randomised control trial. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Flückiger R, Schmidt SJ, Michel C, Kindler J, Kaess M. Introducing a Group Therapy Program (PLAN D) for Young Outpatients with Derealization and Depersonalization: A Pilot Study. Psychopathology 2022; 55:62-68. [PMID: 34818653 DOI: 10.1159/000520008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
Depersonalization and derealization (DD) cause significant distress and are associated with poor role and social functional outcomes. Despite the relatively high prevalence of DD symptoms and the chronic course in those suffering from a DD disorder, there still exists a need for effective interventions. Preliminary evidence indicates that cognitive behavioral therapy (CBT) delivered in an individual setting demonstrates some positive intervention effects for patients with DD regarding their symptom levels. By considering DD-specific treatment needs, a group therapy program was developed as an add-on therapy based on CBT techniques called PLAN D comprising the following elements: psychoeducation, lifestyle interventions, acceptance and mindfulness training, and new patterns of DD-related cognitions. In a pilot study, we present an 8-week group intervention for adolescents and young adults with DD disorder. To our knowledge, no standardized group intervention program for DD exists so far. Thus, this novel intervention represents a promising opportunity to positively influence long-term outcomes and course of DD.
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Affiliation(s)
- Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Theunissen EL, Kuypers KPC, Mason NL, Ramaekers JG. A Comparison of Acute Neurocognitive and Psychotomimetic Effects of a Synthetic Cannabinoid and Natural Cannabis at Psychotropic Dose Equivalence. Front Psychiatry 2022; 13:891811. [PMID: 35664482 PMCID: PMC9160432 DOI: 10.3389/fpsyt.2022.891811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 01/12/2023] Open
Abstract
Due to differences in potency, efficacy, and affinity for CB1 receptors, similarities and differences in psychoactive effect profiles of natural cannabis and synthetic cannabinoids (SCs) cannot reliably be derived from equipotent dose comparisons. Instead, the current study proposes to compare the intrinsic psychoactive effects of natural cannabis (THC) and an SC, JWH-018, at psychotropic dose equivalence. Participants from two placebo-controlled studies were matched for their levels of subjective high to compare neurocognitive and psychotomimetic effects of THC and JWH-018. At equal subjective intoxication levels, both drugs impaired psychomotor, divided attention, and impulse control, with no significant difference between the two drugs. Both drugs also caused significant psychotomimetic effects, but dissociative effects were considerably more pronounced for JWH-018 than THC. We conclude that psychotropic dose equivalence provides a uniform approach for comparing the neurocognitive and psychotomimetic profiles of CB1 agonists, which can also be applied to other drug classes.
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Affiliation(s)
- Eef Lien Theunissen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim Paula Colette Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha Leigh Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes Gerardus Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Psychotomimetic symptoms after a moderate dose of a synthetic cannabinoid (JWH-018): implications for psychosis. Psychopharmacology (Berl) 2022; 239:1251-1261. [PMID: 33501595 PMCID: PMC9110546 DOI: 10.1007/s00213-021-05768-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Synthetic cannabinoids (SCs) are the largest class of novel psychoactive substances (NPS) and are associated with an increased risk of overdosing and adverse events such as psychosis. JWH-018 is one of the earliest SCs and still widely available in large parts of the world. Controlled studies to assess the safety and behavioural profiles of SCs are extremely scarce. AIM The current study was designed to assess the psychotomimetic effects of a moderate dose of JWH-018. METHODS Twenty-four healthy participants (10 males, 14 females) entered a placebo-controlled, double blind, within-subjects trial and inhaled vapour of placebo or 75μg/kg bodyweight JWH-018. To ascertain a minimum level of intoxication, a booster dose of JWH-018 was administered on an as-needed basis. The average dose of JWH-018 administered was 5.52 mg. Subjective high, dissociative states (CADSS), psychedelic symptoms (Bowdle), mood (POMS) and cannabis reinforcement (SCRQ) were assessed within a 4.5-h time window after drug administration. RESULTS JWH-018 caused psychedelic effects, such as altered internal and external perception, and dissociative effects, such as amnesia, derealisation and depersonalisation and induced feelings of confusion. CONCLUSION Overall, these findings suggest that a moderate dose of JWH-018 induces pronounced psychotomimetic symptoms in healthy participants with no history of mental illness, which confirms that SCs pose a serious risk for public health.
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Psychological inflexibility as a mediator of the relationship between adverse childhood experiences and dissociation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ricci V, Ceci F, Di Carlo F, Lalli A, Ciavoni L, Mosca A, Sepede G, Salone A, Quattrone D, Fraticelli S, Maina G, Martinotti G. Cannabis use disorder and dissociation: A report from a prospective first-episode psychosis study. Drug Alcohol Depend 2021; 229:109118. [PMID: 34688166 DOI: 10.1016/j.drugalcdep.2021.109118] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated. AIMS To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis. METHODS Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected. RESULTS FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it. DISCUSSION Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.
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Affiliation(s)
- V Ricci
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy
| | - F Ceci
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy.
| | - F Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Lalli
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - L Ciavoni
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Mosca
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - G Sepede
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Salone
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - D Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Ln, London SE5 8AF, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159 Mannheim, Germany
| | - S Fraticelli
- DSM PIPSM ASL ROMA 1, Via Plinio, 31, 00193 Roma
| | - G Maina
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy; Rita Levi Montalcini Department of Neurosciences, University of Turin, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy; Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
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Bertule M, Sebre SB, Kolesovs A. Childhood abuse experiences, depression and dissociation symptoms in relation to suicide attempts and suicidal ideation. J Trauma Dissociation 2021; 22:598-614. [PMID: 33427600 DOI: 10.1080/15299732.2020.1869652] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to examine associations between suicide attempts (SA), suicidal ideation (SI), depression, dissociative symptoms, emotional abuse, physical abuse and sexual abuse, and to explore predictors of SA and SI, as well as possible mediating factors. We also aimed to examine support for a dissociative depression subgroup. Participating in this study were 342 adults, of these were 138 respondents with a diagnosis of depression (DG), and 204 respondents comprising a community sample (CS). Respondents completed the Center for Epidemiologic Studies Depression Scale - Revised (CESD-R), Childhood Trauma Questionnaire - Short Form (CTQ-SF), and Dissociative Experience Scale (DES). All but two (DES-Absorption and DES - Depersonalization/Derealization) of the study variable mean scores were higher in the DG than in the CS group. Regression analysis showed that SA was predicted by sexual abuse and DES-Amnesia in the CS group. Structural equation modeling revealed that in both groups the types of abuse were reciprocally correlated, emotional abuse was linked to dissociation, which in turn was related to depression, which is turn was predictive of suicide ideation. Depression had a full mediating effect between dissociation and suicide ideation in the CS, and a partial mediating effect in the DG. Sexual abuse had a direct effect upon depression and suicide ideation in the DG. Cluster analysis provided support for a dissociative depression subtype.
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Affiliation(s)
- Marika Bertule
- Department of Psychology, University of Latvia, Riga, Latvia
| | - Sandra B Sebre
- Department of Psychology, University of Latvia, Riga, Latvia
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Millman LSM, Hunter ECM, Orgs G, David AS, Terhune DB. Symptom variability in depersonalization-derealization disorder: A latent profile analysis. J Clin Psychol 2021; 78:637-655. [PMID: 34487354 DOI: 10.1002/jclp.23241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups. METHOD We applied latent profile analysis to psychometric measures of anxiety, depersonalization-derealization, and dissociation in 303 DDD patients. RESULTS The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety. CONCLUSION These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD.
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Affiliation(s)
| | | | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK
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Abstract
ZusammenfassungGewalterfahrungen in der Kindheit und Jugend werden möglicherweise psychisch so verarbeitet, dass das Gegenüber später in einer spezifischen Weise auf die Betroffenen reagiert. Wir untersuchten dies anhand der Frage, ob sich Reaktionen (Assoziationen) auf Berichte an den Gutachter dahingehend unterscheiden, ob der Patient Gewalterfahrungen in der Kindheit oder Jugend in der Herkunftsfamilie gemacht hat oder nicht. Es wurden 22 pseudonymisierte Berichte an den Gutachter im Rahmen des Antragsverfahrens auf Kostenübernahme von Psychotherapie von zwei Untersucherinnen qualitativ analysiert. Die Analyse erfolgte über die Qualitative Inhaltsanalyse nach Mühlfeld.Beim Vergleich der deduktiv entwickelten Kategoriensysteme konnten im Hinblick auf die Reaktionsmuster Parallelen, aber auch mehrere Differenzen zwischen den beiden Patientengruppen festgestellt werden. Als Reaktionsmuster auf Patienten mit Gewalterfahrung zeigten sich Sprachlosigkeit, Tod oder Sich-verstecken-Wollen, was sich so bei der anderen Gruppe nicht fand. Parallelen ergaben sich unter anderem bei Reaktionsmustern von Zartheit, Ekel oder Relativierung von Leid. Bei Berichten über Patienten ohne Gewalterfahrung kam es zu einer größeren emotionalen Varianz in den Reaktionsmustern.Die gefundenen Reaktionsmuster stimmen nur teilweise mit Angaben der Literatur zu „typischen“ Gegenübertragungsreaktionen auf traumatisierte Patienten überein. Die geringere emotionale Varianz gegenüber Berichten von Patienten mit Gewalterfahrungen könnte ein empirischer Beleg für deren geringere Symbolisierungsfähigkeiten sein.
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Gago-Valiente FJ, Mendoza-Sierra MI, Moreno-Sánchez E, Arbinaga F, Segura-Camacho A. Emotional Exhaustion, Depersonalization, and Mental Health in Nurses from Huelva: A Cross-Cutting Study during the SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7860. [PMID: 34360153 PMCID: PMC8345483 DOI: 10.3390/ijerph18157860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/28/2023]
Abstract
Currently, healthcare professionals are particularly vulnerable to the impact of the SARS-CoV-2pandemic since they directly deal with patients suffering from this disease and are in the first line of fire, which increases their risk of contagion. This research examines the prevalence of emotional exhaustion, depersonalization, and possible non-psychotic psychiatric disorders in 48 male and 270 female nursing professionals of Huelva during the COVID-19 pandemic. To this end, we analyzed the relationship between these dependent variables and considered various sociodemographic variables. The nursing staff of public hospitals in Huelva who have had contact with cases of SARS-CoV-2 in their work environment showed a poorer state of mental health than that of others of this same professional category who have not had contact with this type of situation.
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Affiliation(s)
| | - María-Isabel Mendoza-Sierra
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain; (M.-I.M.-S.); (A.S.-C.)
| | - Emilia Moreno-Sánchez
- Department of Pedagogy, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain;
| | - Félix Arbinaga
- Department of Clinical and Experimental Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain;
| | - Adrián Segura-Camacho
- Department of Social, Development and Educational Psychology, Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain; (M.-I.M.-S.); (A.S.-C.)
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Maghbouli N, Fatehi F, Mafinejad MK, Pourhassan S, Sohrabpour AA, Ali JH. Burnout and clinical learning environment among residents in Tehran: A cross-sectional study. Heliyon 2021; 7:e07238. [PMID: 34189297 PMCID: PMC8215171 DOI: 10.1016/j.heliyon.2021.e07238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the quality of the educational environment in Tehran University of Medical Sciences across different medical specialties and its correlation with residents’ burnout. Materials and methods This cross-sectional study was conducted at Tehran University of Medical Sciences among residents drawn from three largest teaching hospitals affiliated. The Maslach Burnout Inventory and Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire were used to collect data through web-based, as well as paper-and pencil questionnaires. The data was analyzed using SPSS. Results A total of 221 residents completed the survey, with a response rate of 82%. Burnout was reported by 67.4% of medical residents. The total PHEEM score had a negative correlation with emotional exhaustion (r = - 0.57, P < 0.001), depersonalization (r = - 0.40, P < 0.001), and a positive one with personal accomplishment (r = 0.42, P < 0.001). Perception of social support significantly predicted burnout subscales (P < 0.05). PHEEM subscales also explained a small proportion of variance in emotional exhaustion (R = 0.55, R2 = 0.308, P < .001). Clinical learning environment independent of personal characteristics was associated with residents' burnout according to multivariate regression analysis [OR = 0.567 (0.170–0.883), P = 0.012]. Conclusion Clinical learning environment independent of personal characteristics was associated with residents' burnout in Iran. We suggest some initiatives to be introduced ranging from improving the clinical environments, reduce workloads and provide social support to all residents as well as encouraging them to involve in other extracurricular activities like music and physical exercise.
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Affiliation(s)
- Nastaran Maghbouli
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Mentoring Office, Faculty Education Deputy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Department of Neurology, Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Khabaz Mafinejad
- Department of Medical Education, Education Development Center (EDC), Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Pourhassan
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Amir Ali Sohrabpour
- Department of Internal Medicine, Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jemal Haidar Ali
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
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Ciaunica A, Roepstorff A, Fotopoulou AK, Petreca B. Whatever Next and Close to My Self-The Transparent Senses and the "Second Skin": Implications for the Case of Depersonalization. Front Psychol 2021; 12:613587. [PMID: 34135800 PMCID: PMC8200628 DOI: 10.3389/fpsyg.2021.613587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/19/2021] [Indexed: 12/22/2022] Open
Abstract
In his paper “Whatever next? Predictive brains, situated agents, and the future of cognitive science,” Andy Clark seminally proposed that the brain's job is to predict whatever information is coming “next” on the basis of prior inputs and experiences. Perception fundamentally subserves survival and self-preservation in biological agents, such as humans. Survival however crucially depends on rapid and accurate information processing of what is happening in the here and now. Hence, the term “next” in Clark's seminal formulation must include not only the temporal dimension (i.e., what is perceived now) but also the spatial dimension (i.e., what is perceived here or next-to-my-body). In this paper, we propose to focus on perceptual experiences that happen “next,” i.e., close-to-my-body. This is because perceptual processing of proximal sensory inputs has a key impact on the organism's survival. Specifically, we focus on tactile experiences mediated by the skin and what we will call the “extended skin” or “second skin,” that is, immediate objects/materials that envelop closely to our skin, namely, clothes. We propose that the skin and tactile experiences are not a mere border separating the self and world. Rather, they simultaneously and inherently distinguish and connect the bodily self to its environment. Hence, these proximal and pervasive tactile experiences can be viewed as a “transparent bridge” intrinsically relating and facilitating exchanges between the self and the physical and social world. We conclude with potential implications of this observation for the case of Depersonalization Disorder, a condition that makes people feel estranged and detached from their self, body, and the world.
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Affiliation(s)
- Anna Ciaunica
- Institute of Philosophy, University of Porto, Porto, Portugal.,Faculty of Brain Sciences, Institute of Cognitive Neuroscience, University College London, London, United Kingdom
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Lovegrove CJ, Bannigan K. What is the lived experience of anxiety for people with Parkinson's? A phenomenological study. PLoS One 2021; 16:e0249390. [PMID: 33831029 PMCID: PMC8031398 DOI: 10.1371/journal.pone.0249390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Anxiety is a common non-motor symptom of Parkinson's and there is no specific pharmacological intervention for people with Parkinson's who experience anxiety. Yet there is little specific research documenting how individuals with this condition experience anxiety. It is important to explore the experiences of people with Parkinson's to identify potential issues in developing future non-pharmacological interventions. This study explored the lived experience of anxiety for people with Parkinson's. MATERIALS AND METHODS Six participants were recruited into a descriptive phenomenological study, through the charity Parkinson's UK, using a maximum variation sampling strategy. Face to face interviews were conducted. Data analysis employed thematic analysis. RESULTS Three key themes encapsulated the data: Finding ways to cope to "Try not to let it rule your life", Amplifies symptoms "It's emotionally draining it it's also physically draining" and "Anxiety is a funny thing" experienced in myriad ways. A model of the experience of PWP experience of anxiety is proposed. CONCLUSIONS Anxiety is a complex experience constructed of interlinked parts affecting people with Parkinson's in myriad ways. Researchers and healthcare professionals should take these findings into account when designing future studies and interventions.
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Affiliation(s)
- Christopher J. Lovegrove
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, United Kingdom
| | - Katrina Bannigan
- Department of Occupational Therapy and Human Nutrition and Dietetics, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
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Vannikov-Lugassi M, Shalev H, Soffer-Dudek N. From brooding to detachment: Rumination longitudinally predicts an increase in depersonalization and derealisation. Psychol Psychother 2021; 94 Suppl 2:321-338. [PMID: 32333727 DOI: 10.1111/papt.12279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/31/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Depersonalization-derealization (DEP-DER) is a dissociative experience which is related to psychopathology and distress. Yet, the aetiological factors leading to DEP-DER are not sufficiently clear. In this study, we suggest rumination as one possible antecedent. Thus, the goal of the study was to explore the longitudinal relationship between rumination and DEP-DER. DESIGN Longitudinal self-report study; mixed clinical and community sample. METHODS The study was conducted on 98 participants, 49 of them were diagnosed with depression, anxiety disorders, or obsessive-compulsive disorder, and the other 49 were healthy, matched community controls. The participants underwent a structured clinical interview and completed a battery of questionnaires. Then, the participants completed the same battery again once a month, for five additional assessment points (6 months in total). The data were analysed using multilevel linear modelling with time-lag analysis. RESULTS We found that levels of rumination and DEP-DER increased and decreased simultaneously, meaning that on assessments in which people reported that they tended to ruminate, they also reported higher levels of DEP-DER symptoms. In addition, we found support for a unidirectional association, consistent with our theoretical hypothesis. Specifically, rumination levels on a certain month longitudinally predicted a higher likeliness for reporting DEP-DER on the following month, even when controlling for the contemporaneous relationship. Conversely, DEP-DER symptoms did not longitudinally predict increased rumination. CONCLUSIONS These findings suggest that rumination may be an antecedent of DEP-DER, but not vice versa. Possible mechanisms to explain this link are discussed. PRACTITIONER POINTS Rumination and DEP-DER oscillate together over time; additionally, rumination predicts a longitudinal increase in DEP-DER. Clinicians noticing ruminative thought followed by decreased emotionality should distinguish between an authentic decrease of distress versus detachment. The findings provide one possible explanation for the frequency of DEP-DER symptoms in anxiety and depressive disorders. Poor sleep quality and emotion regulation difficulties should be explored as potential mediators explaining this link.
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Affiliation(s)
| | - Hadar Shalev
- Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Soroka Medical Center, Be'er Sheva, Israel
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Mondellini M, Mottura S, Guida M, Antonietti A. Influences of a Virtual Reality Experience on Dissociation, Mindfulness, and Self-Efficacy. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:767-771. [PMID: 33739862 DOI: 10.1089/cyber.2020.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
An experiment on a nonclinical sample to investigate influences of virtual reality (VR) on dissociation, mindfulness, and self-efficacy is reported. The participants were immersed for 20 minutes with a VR system in a large virtual apartment and have been charged to look around and find a set of objects previously observed on pictures. Questionnaires pre- and postimmersion were administered to measure the levels of such psychological constructs; cybersickness was assessed as well. Results showed an upward trend in dissociation and a significant increase of mindfulness after immersion in the VR environment. No influences on self-efficacy were found. Findings are discussed with reference to past studies, where a different picture emerged, by considering possible differences due to changes in technology and context.
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Affiliation(s)
- Marta Mondellini
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing; National Research Council of Italy, STIIMA - CNR, Lecco, Italy
| | - Stefano Mottura
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing; National Research Council of Italy, STIIMA - CNR, Milano, Italy
| | - Marco Guida
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
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Salami A, Andreu-Perez J, Gillmeister H. Symptoms of depersonalisation/derealisation disorder as measured by brain electrical activity: A systematic review. Neurosci Biobehav Rev 2020; 118:524-537. [PMID: 32846163 DOI: 10.1016/j.neubiorev.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
Depersonalisation/derealisation disorder (DPD) refers to frequent and persistent detachment from bodily self and disengagement from the outside world. As a dissociative disorder, DPD affects 1-2 % of the population, but takes 7-12 years on average to be accurately diagnosed. In this systematic review, we comprehensively describe research targeting the neural correlates of core DPD symptoms, covering publications between 1992 and 2020 that have used electrophysiological techniques. The aim was to investigate the diagnostic potential of these relatively inexpensive and convenient neuroimaging tools. We review the EEG power spectrum, components of the event-related potential (ERP), as well as vestibular and heartbeat evoked potentials as likely electrophysiological biomarkers to study DPD symptoms. We argue that acute anxiety- or trauma-related impairments in the integration of interoceptive and exteroceptive signals play a key role in the formation of DPD symptoms, and that future research needs analysis methods that can take this integration into account. We suggest tools for prospective studies of electrophysiological DPD biomarkers, which are urgently needed to fully develop their diagnostic potential.
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Affiliation(s)
- Abbas Salami
- School of Computer Science and Electronic Engineering, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK; Smart Health Technologies Group, Centre for Computational Intelligence, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - Javier Andreu-Perez
- School of Computer Science and Electronic Engineering, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK; Smart Health Technologies Group, Centre for Computational Intelligence, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - Helge Gillmeister
- Department of Psychology and Centre for Brain Science, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK; Smart Health Technologies Group, Centre for Computational Intelligence, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
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Schlax J, Wiltink J, Beutel ME, Münzel T, Pfeiffer N, Wild P, Blettner M, Ghaemi Kerahrodi J, Michal M. Symptoms of depersonalization/derealization are independent risk factors for the development or persistence of psychological distress in the general population: Results from the Gutenberg health study. J Affect Disord 2020; 273:41-47. [PMID: 32421621 DOI: 10.1016/j.jad.2020.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) have a high prevalence in patient and community samples. Previous studies suggested that DP/DR symptoms might represent a marker of disease severity and poor prognosis. However, population-based studies investigating the impact of DP/DR symptoms on the course of depression and anxiety are sparse. Therefore, we aimed to analyze whether symptoms of DP/DR are longitudinally associated with the persistence or incidence of elevated symptoms of depression/anxiety. METHODS We analyzed observational data from a sample of 13.182 participants of the Gutenberg Health Study. The outcomes were elevated symptoms of depression/anxiety at the 2.5 years follow-up as determined by the 2-item depression scale (PHQ-2), the 2-item anxiety scale (GAD-2), and the compound measure PHQ-4 respectively. The predictor was the 2-item Cambridge Depersonalization Scale (CDS-2). RESULTS 8.7% of the sample were bothered by symptoms of DP/DR at baseline. They had an increased risk for elevated symptoms of depression/anxiety at the 2.5-year follow-up beyond baseline depression/anxiety and other factors. Each point increment in the CDS-2 scale, ranging from 0-6, was associated with a 21% increase of risk for PHQ-4 ≥ 3 at the follow-up (odds ratio 1.21, 95% confidence interval 1.11-1.32). LIMITATIONS The study was mostly questionnaire-based. CONCLUSION Symptoms of DP/DR are independent risk factors for the persistence or incidence of elevated symptoms of depression/anxiety. Symptoms of DP/DR represent an easily assessable risk factor for the course of mental disorders. Treatment and prevention of mental disorders might benefit from the broader recognition of these phenomena.
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Affiliation(s)
- Jasmin Schlax
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Philipp Wild
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology & Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
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Dissociative Symptoms in a Nationally Representative Sample of Trauma-Exposed U.S. Military Veterans: Prevalence, Comorbidities, and Suicidality. J Affect Disord 2020; 272:138-145. [PMID: 32379605 DOI: 10.1016/j.jad.2020.03.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dissociative symptoms have been documented in diverse clinical and non-clinical populations, and are associated with poor mental health outcomes. Yet, research on dissociative symptoms is frequently limited to PTSD samples, and therefore little is known about the prevalence, clinical correlates, and risk factors related to dissociative symptoms in broader, representative trauma-exposed populations. METHODS The current study assessed dissociative symptoms in a contemporary, nationally representative sample of trauma-exposed U.S. veterans irrespective of PTSD diagnostic status. We then compared sociodemographic, military, and psychiatric characteristics, trauma histories, level of functioning, and quality of life in veterans with dissociative symptoms to those without dissociative symptoms; and determined the incremental association between dissociative symptoms, and suicidality, functioning, and quality of life, independent of comorbidities. RESULTS A total 20.8% of U.S. veterans reported experiencing mild-to-severe dissociative symptoms. Compared to veterans without dissociative symptoms, veterans with dissociative symptoms were younger, and more likely to be non-white, unmarried/partnered and unemployed, had lower education and income, and were more likely to have been combat-exposed and use the VA are their primary source of healthcare. They also had elevated rates of psychiatric comorbidities, lower functioning and quality of life, and a 5-fold greater likelihood of current suicidal ideation and 4-fold greater likelihood of lifetime suicide attempt history. LIMITATIONS Cross-sectional data limit inference of the directionality of findings, and results may not generalize to non-veteran populations. CONCLUSIONS Dissociative symptoms are prevalent in U.S. veterans and may be an important transdiagnostic marker of heightened risk for suicidality and psychiatric comorbidities. These results underscore the importance of assessing, monitoring, and treating dissociative symptoms in this population.
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Büetiger JR, Hubl D, Kupferschmid S, Schultze-Lutter F, Schimmelmann BG, Federspiel A, Hauf M, Walther S, Kaess M, Michel C, Kindler J. Trapped in a Glass Bell Jar: Neural Correlates of Depersonalization and Derealization in Subjects at Clinical High-Risk of Psychosis and Depersonalization-Derealization Disorder. Front Psychiatry 2020; 11:535652. [PMID: 33024435 PMCID: PMC7516266 DOI: 10.3389/fpsyt.2020.535652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as feelings of unreality and detachment from the self (DP) or the surroundings (DR). Both DP and DR often occur in concert with other symptoms, for example in subjects at clinical high-risk (CHR) for psychosis, but also appear isolated in the form of DP/DR disorder. Despite evidence that DP/DR causes immense distress, little is known about their neurobiological underpinnings. Therefore, we investigated the neural correlates of DP/DR using pseudo-continuous arterial spin labeling MRI. METHODS We evaluated the frequency of DP/DR symptoms in a clinical sample (N = 217) of help-seeking individuals from the Early Detection and Intervention Centre for Mental Crisis (CHR, n = 97; clinical controls (CC), n = 91; and first-episode psychosis (FEP), n = 29). Further, in a subsample of those CHR subjects who underwent MRI, we investigated the resting-state regional cerebral blood flow (rCBF). Here, individuals with (n = 21) and without (n = 23) DP/DR were contrasted. Finally, rCBF was measured in a small independent second sample of patients with DP/DR disorder (n = 6) and healthy controls (HC, n = 6). RESULTS In the complete clinical sample, significantly higher frequency of DP/DR was found in CHR compared to CC (50.5 vs. 16.5%; χ2 (2) = 24.218, p ≤ 0.001, Cramer's V = 0.359) as well as in FEP compared to CC (37.9 vs. 16.5%; χ2 (2) = 5.960, p = 0.015, Cramer's V = 0.223). In MRI, significantly lower rCBF was detected in the left orbitofrontal cortex in CHR with vs. without DP/DR (x/y/z = -16/42/-22, p < 0.05, FWE corrected). In patients with DP/DR disorder, significantly higher rCBF was detected in the left caudate nucleus (x/y/z = -18/-32/18, p < 0.05) compared to HC. CONCLUSIONS This study shows that DP/DR symptoms are frequently found in CHR subjects. Investigating two separate DP/DR populations with an identical neuroimaging technique, our study also indicates that there may be divergent pathophysiological mechanisms-decreased neuronal activity in the orbitofrontal cortex, but increased activity within the caudate nucleus-leading to a final common pathway with similar psychopathological symptoms. This suggests that both top-down (orbitofrontal cortex) and bottom-up (caudate nucleus) mechanisms could contribute to the emergence of DP/DR.
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Affiliation(s)
- Jessica R Büetiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephan Kupferschmid
- Integrated Psychiatric Services of Winterthur and Zurich Unterland (ipw), Winterthur , Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Federspiel
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martinus Hauf
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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