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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Krupnik V. I like therefore I can, and I can therefore I like: the role of self-efficacy and affect in active inference of allostasis. Front Neural Circuits 2024; 18:1283372. [PMID: 38322807 PMCID: PMC10839114 DOI: 10.3389/fncir.2024.1283372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Active inference (AIF) is a theory of the behavior of information-processing open dynamic systems. It describes them as generative models (GM) generating inferences on the causes of sensory input they receive from their environment. Based on these inferences, GMs generate predictions about sensory input. The discrepancy between a prediction and the actual input results in prediction error. GMs then execute action policies predicted to minimize the prediction error. The free-energy principle provides a rationale for AIF by stipulating that information-processing open systems must constantly minimize their free energy (through suppressing the cumulative prediction error) to avoid decay. The theory of homeostasis and allostasis has a similar logic. Homeostatic set points are expectations of living organisms. Discrepancies between set points and actual states generate stress. For optimal functioning, organisms avoid stress by preserving homeostasis. Theories of AIF and homeostasis have recently converged, with AIF providing a formal account for homeo- and allostasis. In this paper, we present bacterial chemotaxis as molecular AIF, where mutual constraints by extero- and interoception play an essential role in controlling bacterial behavior supporting homeostasis. Extending this insight to the brain, we propose a conceptual model of the brain homeostatic GM, in which we suggest partition of the brain GM into cognitive and physiological homeostatic GMs. We outline their mutual regulation as well as their integration based on the free-energy principle. From this analysis, affect and self-efficacy emerge as the main regulators of the cognitive homeostatic GM. We suggest fatigue and depression as target neurocognitive phenomena for studying the neural mechanisms of such regulation.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton, Camp Pendleton, Oceanside, CA, United States
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang S, Zheng S, Zhang X, Ma R, Feng S, Song M, Zhu H, Jia H. The Treatment of Depersonalization-Derealization Disorder: A Systematic Review. J Trauma Dissociation 2024; 25:6-29. [PMID: 37431255 DOI: 10.1080/15299732.2023.2231920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/26/2023] [Indexed: 07/12/2023]
Abstract
Depersonalization-derealization disorder (DPD) is characterized by persistent or recurrent experiences of detachment from oneself and surroundings, as well as a sense of unreality. Considering the inadequacy of current research on treatment, we performed a systematic review of the available pharmacotherapies, neuromodulations, and psychotherapies for DPD. The systematic review protocol was based on PRISMA 2020 guidelines and pre-registered. The PubMed, Web of Science, PsycINFO, Embase, the Cochrane Library, Scopus, and ScienceDirect databases were searched from inception to June 2021. All treatments for DPD and all study types, including controlled and observational studies as well as case reports, were assessed. Of the identified 17,540 studies, 41 studies (four randomized controlled trials, one non-randomized controlled trial, 10 case series, and 26 case reports) involving 300 participants met the eligibility criteria. We identified 30 methods that have been applied independently or in combination to treat DPD since 1955. The quality of these studies was considered. The relationship between individual differences, such as symptoms, comorbidities, history, and duration since onset, and treatment effects was explored. The results suggest that a series of treatments, such as pharmacotherapies, neuromodulation, and psychotherapies, could be considered in combination. However, the quality and quantity of studies were generally low considering the high prevalence of DPD. The review concludes with suggestions for future research and an urgent call for more high-quality research.
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Affiliation(s)
- Sici Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sisi Zheng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiatian Zhang
- Department of Computer Science, Durham University, Durham, UK
| | - Rui Ma
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sitong Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Mingkang Song
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hong Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hongxiao Jia
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Seligman R. Metaphor and the politics and poetics of youth distress in an evidence-based psychotherapy. Transcult Psychiatry 2023; 60:819-834. [PMID: 34994270 DOI: 10.1177/13634615211066692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article explores the relationship between metaphors and emotion in the context of adolescent distress and psychotherapeutic treatment. Drawing on data from an ethnographic study of Mexican American adolescents receiving outpatient treatment for a variety of emotional and behavioral problems, the article examines what I call "prescribed" metaphors deployed in mainstream, manualized child and adolescent Cognitive Behavioral Therapies commonly used in mainstream clinical contexts. I explore the models of emotion communicated to youth by one such metaphor, youth responses to this metaphor, and the potential implications for young people as they take up the underlying models and affective practices embedded in the metaphor. Specifically, I examine how youth respond to messages about emotion metacognition and emotion regulation embedded in a metaphor that equates feelings with temperatures that can be monitored and objectively measured. I find that youth are at once convinced that abstract knowledge about internal states is inherently valuable because it is linked to desired forms of personhood, but also concerned about the limits of technical metaphors to capture aspects of lived experience and the flattening and homogenization of affect that might accompany the practices such metaphors help to enact. I analyze alternative interpretations of prescribed metaphors as well as the spontaneous metaphors used by youth to talk about their emotions and experiences of distress, in an effort to think through the politics and poetics of emotion metaphors in the context of an evidence-based psychotherapy for young people.
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Jicol C, Cheng HY, Petrini K, O’Neill E. A predictive model for understanding the role of emotion for the formation of presence in virtual reality. PLoS One 2023; 18:e0280390. [PMID: 36928040 PMCID: PMC10019638 DOI: 10.1371/journal.pone.0280390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023] Open
Abstract
Users' emotions may influence the formation of presence in virtual reality (VR). Users' expectations, state of arousal and personality may also moderate the relationship between emotions and presence. An interoceptive predictive coding model of conscious presence (IPCM) considers presence as a product of the match between predictions of interoceptive emotional states and the actual states evoked by an experience (Seth et al. 2012). The present paper aims to test this model's applicability to VR for both high-arousal and low-arousal emotions. The moderating effect of personality traits on the creation of presence is also investigated. Results show that user expectations about emotional states in VR have an impact on presence, however, expression of this relationship is moderated by the intensity of an emotion, with only high-arousal emotions showing an effect. Additionally, users' personality traits moderated the relationship between emotions and presence. A refined model is proposed that predicts presence in VR by weighting emotions according to their level of arousal and by considering the impact of personality traits.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Cavedon-Taylor D. Aphantasia and psychological disorder: Current connections, defining the imagery deficit and future directions. Front Psychol 2022; 13:822989. [PMID: 36312098 PMCID: PMC9614338 DOI: 10.3389/fpsyg.2022.822989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Aphantasia is a condition characterized by a deficit of mental imagery. Since several psychopathologies are partially maintained by mental imagery, it may be illuminating to consider the condition against the background of psychological disorder. After outlining current findings and hypotheses regarding aphantasia and psychopathology, this paper suggests that some support for defining aphantasia as a lack of voluntary imagery may be found here. The paper then outlines potentially fruitful directions for future research into aphantasia in general and its relation to psychopathology in particular, including rethinking use of the SUIS to measure involuntary imagery, whether aphantasia offers protection against addiction, and whether hyperphantasia is a potential risk factor for maladaptive daydreaming, among others.
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9
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Millman LSM, Hunter ECM, David AS, Orgs G, Terhune DB. Assessing responsiveness to direct verbal suggestions in depersonalization-derealization disorder. Psychiatry Res 2022; 315:114730. [PMID: 35870293 DOI: 10.1016/j.psychres.2022.114730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/03/2022] [Accepted: 07/16/2022] [Indexed: 10/17/2022]
Abstract
The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r = -.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r = .25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.
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Affiliation(s)
- L S Merritt Millman
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom.
| | - Elaine C M Hunter
- Institute of Mental Health, University College London, Maple House, 149 Tottenham Court Rd, Fitzrovia, London W1T 7BN, United Kingdom
| | - Anthony S David
- Institute of Mental Health, University College London, Maple House, 149 Tottenham Court Rd, Fitzrovia, London W1T 7BN, United Kingdom
| | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
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Correa R, Rodriguez N, Bortolaso M. What is the nature of the alteration of temporality in Trauma-Related Altered States of Consciousness? A neuro-phenomenological analysis✰,✰✰,★,★★. European Journal of Trauma & Dissociation 2022. [DOI: 10.1016/j.ejtd.2021.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Gerrans P. Alienation and identification in addiction. Philosophical Psychology 2022. [DOI: 10.1080/09515089.2022.2067034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Philip Gerrans
- Department of Philosophy, University of Adelaide, Adelaide, Australia
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12
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Gatus A, Jamieson G, Stevenson B. Past and Future Explanations for Depersonalization and Derealization Disorder: A Role for Predictive Coding. Front Hum Neurosci 2022; 16:744487. [PMID: 35321264 PMCID: PMC8934883 DOI: 10.3389/fnhum.2022.744487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Depersonalization (DP) and derealization (DR) refer to states of dissociation in which one feels a sense of alienation in relation to one's self and environment, respectively. Whilst transient episodes often diminish without treatment, chronic experiences of DP and DR may last for years, with common treatments lacking a strong evidence base for their efficacy. We propose a theoretical explanation of DP and DR based on interoceptive predictive coding, and discuss how transient experiences of DP and DR may be induced in the non-clinical population using virtual reality. Further, we review the use of heartbeat evoked potentials in detecting the neural correlates of DP and DR allowing for an objective measure of these experiences in the non-clinical population. Finally, we discuss how the induction and detection of transient experiences of DP and DR in the non-clinical population could shed light on how the brain constructs one's sense of self and reality.
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Affiliation(s)
- Andrew Gatus
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
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Britton WB, Desbordes G, Acabchuk R, Peters S, Lindahl JR, Canby NK, Vago DR, Dumais T, Lipsky J, Kimmel H, Sager L, Rahrig H, Cheaito A, Acero P, Scharf J, Lazar SW, Schuman-Olivier Z, Ferrer R, Moitra E. From Self-Esteem to Selflessness: An Evidence (Gap) Map of Self-Related Processes as Mechanisms of Mindfulness-Based Interventions. Front Psychol 2021; 12:730972. [PMID: 34880805 PMCID: PMC8645694 DOI: 10.3389/fpsyg.2021.730972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Self-related processes (SRPs) have been theorized as key mechanisms of mindfulness-based interventions (MBIs), but the evidence supporting these theories is currently unclear. This evidence map introduces a comprehensive framework for different types of SRPs, and how they are theorized to function as mechanisms of MBIs (target identification). The evidence map then assesses SRP target engagement by mindfulness training and the relationship between target engagement and outcomes (target validation). Discussion of the measurement of SRPs is also included. The most common SRPs measured and engaged by standard MBIs represented valenced evaluations of self-concept, including rumination, self-compassion, self-efficacy, and self-esteem. Rumination showed the strongest evidence as a mechanism for depression, with other physical and mental health outcomes also supported. Self-compassion showed consistent target engagement but was inconsistently related to improved outcomes. Decentering and interoception are emerging potential mechanisms, but their construct validity and different subcomponents are still in development. While some embodied self-specifying processes are being measured in cross-sectional and meditation induction studies, very few have been assessed in MBIs. The SRPs with the strongest mechanistic support represent positive and negative evaluations of self-concept. In sum, few SRPs have been measured in MBIs, and additional research using well-validated measures is needed to clarify their role as mechanisms.
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Affiliation(s)
- Willoughby B. Britton
- School of Public Health, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Gaëlle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rebecca Acabchuk
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Sarah Peters
- School of Public Health, Brown University, Providence, RI, United States
| | - Jared R. Lindahl
- Department of Religious Studies and Clinical and Affective Neuroscience Lab, Brown University, Providence, RI, United States
| | - Nicholas K. Canby
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Department of Psychology, Clark University, Worcester, MA, United States
| | - David R. Vago
- Osher Center for Integrative Medicine, Vanderbilt University, Nashville, TN, United States
| | - Travis Dumais
- School of Public Health, Brown University, Providence, RI, United States
| | - Jonah Lipsky
- School of Public Health, Brown University, Providence, RI, United States
| | - Hannah Kimmel
- School of Public Health, Brown University, Providence, RI, United States
| | - Lauren Sager
- School of Public Health, Brown University, Providence, RI, United States
| | - Hadley Rahrig
- School of Public Health, Brown University, Providence, RI, United States
| | - Aya Cheaito
- School of Public Health, Brown University, Providence, RI, United States
| | - Pamela Acero
- School of Public Health, Brown University, Providence, RI, United States
| | - Jodi Scharf
- School of Public Health, Brown University, Providence, RI, United States
| | - Sara W. Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Zev Schuman-Olivier
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Rebecca Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute, Bethesda, MD, United States
| | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Orrù G, Bertelloni D, Cesari V, Conversano C, Gemignani A. Targeting temporal parietal junction for assessing and treating disembodiment phenomena: a systematic review of TMS effect on depersonalization and derealization disorders (DPD) and body illusions. AIMS Neurosci 2021; 8:181-194. [PMID: 33709023 PMCID: PMC7940112 DOI: 10.3934/neuroscience.2021009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a fundamental aspect of the self. On the contrary, the sense of disembodiment, an alteration of one's sense of self or the sense of being localized out of one's physical body, is a prominent feature in specific dissociative disorders, namely depersonalization/derealization disorders (DPD). The aims of the study were to provide: 1) a qualitative synthesis of the effect of Transcranial Magnetic Stimulation (TMS), taking into account its use for therapeutic and experimental purposes; 2) a better understanding on whether the use of TMS could support the treatment of DPD and other clinical conditions in which depersonalization and derealization are displayed. To identify suitable publications, an online search of the PubMed, Cochrane Library, Web of science and Scopus databases was performed using relevant search terms. In addition, an in-depth search was performed by screening review articles and the references section of each included articles. Our search yielded a total of 108 records through multiple databases searching and one additional record was identified through other sources. After duplicates removal, title and abstract reading, we retained 16 records for the assessment of eligibility. According to our inclusion criteria, we retained 8 studies. The selected studies showed that TMS targeting the TPJ is a promising technique for treating disembodiment phenomena DPD and for inducing reversible disembodiment states in healthy subjects. These data represent the first step towards a greater understanding of possible treatments to be used in disembodiment disorders. The use of TMS over the TPJ appears to be promising for treating disembodiment phenomena.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Davide Bertelloni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
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D'Amour S, Harris LR, Berti S, Keshavarz B. The role of cognitive factors and personality traits in the perception of illusory self-motion (vection). Atten Percept Psychophys 2021; 83:1804-17. [PMID: 33409903 DOI: 10.3758/s13414-020-02228-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Vection is a perceptual phenomenon that describes the visually induced subjective sensation of self-motion in the absence of physical motion. Previous research has discussed the potential involvement of top-down cognitive mechanisms on vection. Here, we quantified how cognitive manipulations such as contextual information (i.e., expectation) and plausibility (i.e., chair configuration) alter vection. We also explored how individual traits such as field dependence, depersonalization, anxiety, and social desirability might be related to vection. Fifty-one healthy adults were exposed to an optic flow stimulus that consisted of horizontally moving black-and-white bars presented on three adjacent monitors to generate circular vection. Participants were divided into three groups and given experimental instructions designed to induce either strong, weak, or no expectation with regard to the intensity of vection. In addition, the configuration of the chair (rotatable or fixed) was modified during the experiment. Vection onset time, duration, and intensity were recorded. Results showed that expectation altered vection intensity, but only when the chair was in the rotatable configuration. Positive correlations for vection measures with field dependence and depersonalization, but no sex-related effects were found. Our results show that vection can be altered by cognitive factors and that individual traits can affect the perception of vection, suggesting that vection is not a purely perceptual phenomenon, but can also be affected by top-down mechanisms.
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Abstract
Visual imagery allows us to revisit the appearance of things in their absence and to test out virtual combinations of sensory experience. Visual imagery has been linked to many cognitive processes, such as autobiographical and visual working memory. Imagery also plays symptomatic and mechanistic roles in neurologic and mental disorders and is utilized in treatment. A large network of brain activity spanning frontal, parietal, temporal, and visual cortex is involved in generating and maintain images in mind. The ability to visualize has extreme variations, ranging from completely absent (aphantasia) to photo-like (hyperphantasia). The anatomy and functionality of visual cortex, including primary visual cortex, have been associated with individual differences in visual imagery ability, pointing to a potential correlate for both aphantasia and hyperphantasia. Preliminary evidence suggests that lifelong aphantasia is associated with prosopagnosia and reduction in autobiographical memory; hyperphantasia is associated with synesthesia. Aphantasic individuals can also be highly imaginative and are able to complete many tasks that were previously thought to rely on visual imagery, demonstrating that visualization is only one of many ways of representing things in their absence. The study of extreme imagination reminds us how easily invisible differences can escape detection.
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Affiliation(s)
- Rebecca Keogh
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Joel Pearson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Adam Zeman
- Cognitive Neurology Research Group, University of Exeter College of Medicine and Health, University of Exeter, Exeter, United Kingdom.
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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19
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Horn M, Fovet T, Vaiva G, Thomas P, Amad A, D'Hondt F. Emotional response in depersonalization: A systematic review of electrodermal activity studies. J Affect Disord 2020; 276:877-882. [PMID: 32739705 DOI: 10.1016/j.jad.2020.07.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 07/05/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depersonalization is a complex phenomenological experience initially described as a psychological disturbance of self-awareness. Among the different dimensions underlying depersonalization, emotional numbing appears to be a key symptom but remains a poorly understood phenomenon. METHOD We conducted a systematic review, following PRISMA guidelines, of studies investigating electrodermal activity, a well-documented marker of bodily arousal expression of emotion. Studies were selected from the PubMed, Scopus, Web of Science and PsychINFO databases. RESULTS Among the 64 studies initially identified, 11 were finally included, involving 148 patients with depersonalization disorder and 173 healthy subjects for whom depersonalization symptoms were assessed. The main results of these studies suggest that depersonalization is marked by a high skin conductance level and attenuated skin conductance responses to negative stimuli. LIMITATIONS Due to discrepancies in methodology, we were not able to conduct quantitative analyses. Moreover, the studies included had limited sample sizes, restricting the generalizability of the results. CONCLUSION Though further evidence is required, it appears from electrodermal studies that depersonalization is associated with hypervigilance and emotional detachment during threatening situations. However, because emotional numbing might not be restricted to negative events, we proposed perspectives for future research, stressing the need to explore emotional responses of patients with depersonalization to positive situations.
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Affiliation(s)
- Mathilde Horn
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000 Lille France; CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France.
| | - Thomas Fovet
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000 Lille France; CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France
| | - Guillaume Vaiva
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000 Lille France; CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France; Centre National de Ressources et Résilience pour les Psychotraumatisme Lille Paris (CN2R), F-59000 LILLE, France
| | - Pierre Thomas
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000 Lille France; CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France
| | - Ali Amad
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000 Lille France; CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France
| | - Fabien D'Hondt
- CHU Lille, Pôle de Psychiatrie, F-59000 Lille, France; Centre National de Ressources et Résilience pour les Psychotraumatisme Lille Paris (CN2R), F-59000 LILLE, France
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20
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Gerrans P. Pain Asymbolia as Depersonalization for Pain Experience. An Interoceptive Active Inference Account. Front Psychol 2020; 11:523710. [PMID: 33192765 PMCID: PMC7658103 DOI: 10.3389/fpsyg.2020.523710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
"Mineness," also called "subjective presence" or "personalization," is the feeling that experiences belong to a continuing self. This article argues that mineness is produced by processes of interoceptive active inference that model the self as the underlying cause of continuity and coherence in affective experience. A key component of this hierarchical processing system and hub of affective self-modeling is activity in the anterior insula cortex. I defend the account by applying it to the phenomenon of pain asymbolia, a condition in which nociceptive signals (of bodily damage) are not attributed to the self. Thus, pain asymbolia is a form of "depersonalization for pain" as Klein puts it. The pain is experienced as happening to my body but is not experienced as mine. Thus, we can describe it as loss of subjective presence or "mineness" for the experience of pain.
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Affiliation(s)
- Philip Gerrans
- Department of Philosophy, University of Adelaide, Adelaide, SA, Australia
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dooley LM, Alizadeh A, Qiu S, Wu H. Does Servant Leadership Moderate the Relationship between Job Stress and Physical Health? Sustainability 2020; 12:6591. [DOI: 10.3390/su12166591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High school teachers experience high levels of job stress, which could lead to serious health problems. This study focused on Chinese high school teachers, as they have to manage negative stress and health issues. The research aimed to: (1) investigate the relationship between hindrance job stress, depersonalization, and physical health; (2) investigate if servant leadership, in fact moderates the relationship between hindrance job stress and depersonalization, as well as physical health. The study desisgn was cross-sectional and data analyses were conducted by using SPSS 21 and Mplus 7. The sample consisted of 857 high school teachers across Southern China. The results showed that hindrance stress is related to depersonalization among high school teachers (β = 0.63, p < 0.01). Both hindrance job stress (β = 0.32, p < 0.01) and depersonalization (β = 0.16, p < 0.01) are positively related to physical health. In addition, servant leadership moderates the relationship between hindrance job stress and physical health among the Chinese high school teachers (β = −0.09, p < 0.01). However, the results did not find that the effect of hindrance job stress on depersonalization is moderated by servant leadership (β = 0.02, p = 0.53). It is suggested that Chinese high schools recruit and train leaders in servant leadership, relieve teachers’ stress, and promote their health to ensure the sustainable development of schools.
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Scalabrini A, Mucci C, Esposito R, Damiani S, Northoff G. Dissociation as a disorder of integration - On the footsteps of Pierre Janet. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109928. [PMID: 32194203 DOI: 10.1016/j.pnpbp.2020.109928] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 12/19/2022]
Abstract
At the end of the 19th century Pierre Janet described dissociation as an altered state of consciousness manifested in disrupted integration of psychological functions. Clinically, such disruption comprises compartmentalization symptoms like amnesia, detachment symptoms like depersonalization/derealization, and structural dissociation of personality with changes in the sense of self. The exact neuronal mechanisms leading to these different symptoms remain unclear. We here suggest to put Janet's original account of dissociation as disrupted integration of psychological functions into a novel context, that is, a neuronal context as related to current brain imaging. This requires a combined theoretical and empirical approach on data supporting such neuronal reframing of Janet. For that, we here review (i) past and (ii) recent psychological and neuronal views on dissociation together with neuroscientific theories of integration, which (iii) are supported and complemented by preliminary fMRI data. We propose three neuronal mechanisms of dynamic integration operating at different levels of the brain's spontaneous activity - temporo-spatial binding on the regional level, temporo-spatial synchronization on the network level, and temporo-spatial globalization on the global level. These neuronal mechanisms, in turn, may be related to different symptomatic manifestation of dissociation operating at different levels, e.g., compartmentalization, detachment, and structural, which, as we suggest, can all be traced to disrupted integration of neuronal and psychological functions as originally envisioned by Janet.
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Affiliation(s)
- Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy.
| | - Clara Mucci
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy
| | - Rosy Esposito
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia 27100, Italy
| | - Georg Northoff
- The Royal's Institute of Mental Health Research, University of Ottawa, Canada; Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Tianmu Road 305, Zhejiang Province, Hangzhou 310013, China; Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Zhejiang Province, Hangzhou 310013, China; TMU Research Centre for Brain and Consciousness, Shuang Hospital, Taipei MedicalUniversity, No. 250 Wu-Xing Street, 11031 Taipei, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei 11031, Taiwan.
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de Haan EHF, Corballis PM, Hillyard SA, Marzi CA, Seth A, Lamme VAF, Volz L, Fabri M, Schechter E, Bayne T, Corballis M, Pinto Y. Split-Brain: What We Know Now and Why This is Important for Understanding Consciousness. Neuropsychol Rev 2020; 30:224-233. [PMID: 32399946 PMCID: PMC7305066 DOI: 10.1007/s11065-020-09439-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
Recently, the discussion regarding the consequences of cutting the corpus callosum (“split-brain”) has regained momentum (Corballis, Corballis, Berlucchi, & Marzi, Brain, 141(6), e46, 2018; Pinto et al., Brain, 140(5), 1231–1237, 2017a; Pinto, Lamme, & de Haan, Brain, 140(11), e68, 2017; Volz & Gazzaniga, Brain, 140(7), 2051–2060, 2017; Volz, Hillyard, Miller, & Gazzaniga, Brain, 141(3), e15, 2018). This collective review paper aims to summarize the empirical common ground, to delineate the different interpretations, and to identify the remaining questions. In short, callosotomy leads to a broad breakdown of functional integration ranging from perception to attention. However, the breakdown is not absolute as several processes, such as action control, seem to remain unified. Disagreement exists about the responsible mechanisms for this remaining unity. The main issue concerns the first-person perspective of a split-brain patient. Does a split-brain harbor a split consciousness or is consciousness unified? The current consensus is that the body of evidence is insufficient to answer this question, and different suggestions are made with respect to how future studies might address this paucity. In addition, it is suggested that the answers might not be a simple yes or no but that intermediate conceptualizations need to be considered.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Paul M Corballis
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Steven A Hillyard
- School of Health Sciences, University of California Dan Diego, La Jolla, CA, USA
| | - Carlo A Marzi
- School of Medicine and Surgery, University of Verona, Verona, Italy
| | - Anil Seth
- Sackler Centre for Consciousness Science, Sussex University, Brighton, UK
| | - Victor A F Lamme
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Lukas Volz
- Klinik für Neurologie, Universitätsklinikum Köln, Kerpener Str, 62, Köln, Germany
| | - Mara Fabri
- Dipartimento di Medicina Sperimentale e Clinica, Via Tronto 10/A, 60020, Ancona, Italy
| | | | - Tim Bayne
- Department of Philosophy, Monash University, Melbourne, Australia
| | | | - Yair Pinto
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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25
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Braithwaite JJ, Watson DG, Dewe H. The Body-Threat Assessment Battery (BTAB): A new instrument for the quantification of threat-related autonomic affective responses induced via dynamic movie clips. Int J Psychophysiol 2020; 155:16-31. [PMID: 32387395 DOI: 10.1016/j.ijpsycho.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
We present a new instrument for the assessment of responses to threat-related imagery directed towards a human body - the Body-Threat Assessment Battery (BTAB). The BTAB consists of a series of high-definition dynamic clips depicting body-threats and matched non-threat baseline behaviours. For body-threat stimuli a perspective manipulation was included to assess the effects of viewing threats from the point-of-view of the observer (POV) or from an external/exocentric perspective (EXO). Green-screen technology was used so that extraneous background information could be removed and standardised in post-production. Categorical normative data for psychological ratings (valence, arousal and pain), psychophysiological, phasic skin conductance responses (SCRs) and tonic skin conductance levels (SCLs) were obtained for all stimuli. Body-threat stimuli evoked significantly higher psychological ratings of arousal and pain, with more negative ratings of valence, relative to baseline stimuli. In addition, threat stimuli also had an increased efficacy at evoking SCRs, and these were significantly stronger relative to baseline stimuli. There were no effects of perspective on psychophysiological or psychological responses to threat imagery. The findings are discussed in the context of the utility and scope of the BTAB for supporting neurocognitive investigations of aversive imagery and body-threats specifically in the study of embodiment, body-processing and self-consciousness.
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Affiliation(s)
| | | | - Hayley Dewe
- Department of Psychology, Durham University, DH1 3LE, UK
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26
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Shin GI, Goldstein LH, Pick S. Evidence for subjective emotional numbing following induced acute dissociation. Behav Res Ther 2019; 119:103407. [PMID: 31176137 DOI: 10.1016/j.brat.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/26/2019] [Accepted: 05/17/2019] [Indexed: 01/19/2023]
Abstract
The aim of the study was to examine the effects of acute dissociation on emotional responsivity in healthy individuals. We used a previously validated technique (mirror-gazing, Caputo, 2010) to experimentally induce acute dissociation in non-clinical participants and assessed post-induction subjective responsivity (ratings of valence and arousal) to standardized emotional images. Fifty non-clinical participants were randomised to either the dissociation induction (n = 25) or control conditions (n = 25). The dissociation manipulation effect was corroborated by a significant post-induction elevation in state dissociation in the dissociation-induction group relative to controls (p = .004). The dissociation-induction group rated negative (p = .028) and neutral (p = .025) stimuli as significantly less unpleasant than controls. There was also a non-significant trend for positive stimuli to be rated as less pleasant by the dissociation-induction group compared to controls (p = .060). These findings provide experimental evidence for the short-term alleviation (i.e., emotional numbing) of negative affect during dissociative states, which may serve as a coping mechanism for some individuals. However, this tendency of emotional numbing also reduced positive affective responses to pleasant stimuli to some extent. Further investigation of dissociative phenomena and their impact on emotional processing appears warranted.
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Affiliation(s)
- Ga In Shin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK; Neuropsychiatry Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, UK
| | - Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK.
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27
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Paul ER, Farmer M, Kämpe R, Cremers HR, Hamilton JP. Functional Connectivity Between Extrastriate Body Area and Default Mode Network Predicts Depersonalization Symptoms in Major Depression: Findings From an A Priori Specified Multinetwork Comparison. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 4:627-635. [PMID: 31103548 DOI: 10.1016/j.bpsc.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depersonalization/derealization disorder is a dissociative disorder characterized by feelings of unreality and detachment from the self and surroundings. Depersonalization/derealization disorder is classified as a primary disorder, but depersonalization symptoms are frequently observed in mood and anxiety disorders. In the context of major depressive disorder (MDD), depersonalization symptoms are associated with greater depressive severity as indexed by treatment resistance, inpatient visits, and duration of depressive episodes. In the current investigation, we tested four network-based, neural-functional hypotheses of depersonalization in MDD. These hypotheses were framed in terms of functional relationships between 1) extrastriate body area and default mode network (DMN); 2) hippocampus and DMN; 3) medial prefrontal cortex and ventral striatum; and 4) posterior and anterior insular cortex. METHODS We conducted functional magnetic resonance imaging during resting state on 28 female patients with MDD and 27 control subjects with no history of a psychiatric disorder. Functional connectivity between seed and target regions as specified by our network-level hypotheses was computed and correlated with scores on the Cambridge Depersonalization Scale. We used a conservative, unbiased bootstrapping procedure to test the significance of neural-behavioral correlations observed under each of the four models tested. RESULTS Of the four neural-functional models of depersonalization symptoms tested, only the model proposing that reduced connectivity between the extrastriate body area and DMN predicts higher levels of depersonalization symptoms in MDD was confirmed. CONCLUSIONS Our results indicate that depersonalization/derealization disorder symptoms in patients with depression are related to reduced functional connectivity between brain regions that are proposed to support processing of body-related (extrastriate body area) and autobiographical (DMN) information.
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Affiliation(s)
- Elisabeth R Paul
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Madison Farmer
- Department of Industrial and Organizational Psychology, Roosevelt University, Chicago, Illinois
| | - Robin Kämpe
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henk R Cremers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - J Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Chefetz RA. Psycho-Neurobiology and Its Potential Influence on Psychotherapy: Being, Doing, and the Risk of Scientism. Psychodyn Psychiatry 2019; 47:53-80. [PMID: 30840558 DOI: 10.1521/pdps.2019.47.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neuroscientific information may transform the modern practice of psychotherapy. Still we must pay heed to the most salient of the common factors generating therapeutic change: the relationship between patient and therapist. Likewise, brain and body are both part of mind and we ignore this at our clinical peril. Research on affective, cognitive, mnemic, somatic, psychophysiologic, developmental, and integrative mental processes, amongst others, must hold to a high standard of translation from basic scientific findings or we risk practicing a psychotherapy enslaved to an authoritarian scientism as a substitute for the creation of unfettered intimacy and engagement. A balanced approach is required if in trauma treatment, for example, we are to be both potential beneficiaries of understanding what is in our human heads while not losing track of our very human hearts. Each clinician need develop a basic knowledge of neuroscience in order to critically assess the meanings of new findings and their proper place in the practice of all the psychotherapies.
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Affiliation(s)
- Richard A Chefetz
- Psychiatrist in private practice in Washington, D.C. He was President of the International Society for the Study of Trauma and Dissociation (2002-2003), and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington-Baltimore Center for Psychoanalysis
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29
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Voss U, D'Agostino A, Kolibius L, Klimke A, Scarone S, Hobson JA. Insight and Dissociation in Lucid Dreaming and Psychosis. Front Psychol 2018; 9:2164. [PMID: 30483185 PMCID: PMC6241172 DOI: 10.3389/fpsyg.2018.02164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
Dreams and psychosis share several important features regarding symptoms and underlying neurobiology, which is helpful in constructing a testable model of, for example, schizophrenia and delirium. The purpose of the present communication is to discuss two major concepts in dreaming and psychosis that have received much attention in the recent literature: insight and dissociation. Both phenomena are considered functions of higher order consciousness because they involve metacognition in the form of reflective thought and attempted control of negative emotional impact. Insight in dreams is a core criterion for lucid dreams. Lucid dreams are usually accompanied by attempts to control the dream plot and dissociative elements akin to depersonalization and derealization. These concepts are also relevant in psychotic illness. Whereas insightfulness can be considered innocuous in lucid dreaming and even advantageous in psychosis, the concept of dissociation is still unresolved. The present review compares correlates and functions of insight and dissociation in lucid dreaming and psychosis. This is helpful in understanding the two concepts with regard to psychological function as well as neurophysiology.
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Affiliation(s)
- Ursula Voss
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,VITOS Hochtaunus Klinik, Psychiatrisches Krankenhaus, Friedrichsdorf, Germany
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Luca Kolibius
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,VITOS Hochtaunus Klinik, Psychiatrisches Krankenhaus, Friedrichsdorf, Germany
| | - Ansgar Klimke
- Psychology, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany.,Department of Psychiatry, Psychiatry Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Silvio Scarone
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - J Allan Hobson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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30
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Gentsch A, Sel A, Marshall AC, Schütz-Bosbach S. Affective interoceptive inference: Evidence from heart-beat evoked brain potentials. Hum Brain Mapp 2018; 40:20-33. [PMID: 30159945 DOI: 10.1002/hbm.24352] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/14/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
The perception of internal bodily signals (interoception) is central to many theories of emotion and embodied cognition. According to recent theoretical views, the sensory processing of visceral signals such as one's own heartbeat is determined by top-down predictions about the expected interoceptive state of the body (interoceptive inference). In this EEG study we examined neural responses to heartbeats following expected and unexpected emotional stimuli. We used a modified stimulus repetition task in which pairs of facial expressions were presented with repeating or alternating emotional content, and we manipulated the emotional valence and the likelihood of stimulus repetition. We found that affective predictions of external socially relevant information modulated the heartbeat-evoked potential, a marker of cardiac interoception. Crucially, the HEP changes highly relied on the expected emotional content of the facial expression. Thus, expected negative faces led to a decreased HEP amplitude, whereas such an effect was not observed after an expected neutral face. These results suggest that valence-specific affective predictions, and their uniquely associated predicted bodily sensory state, can reduce or amplify cardiac interoceptive responses. In addition, the affective repetition effects were dependent on repetition probability, highlighting the influence of top-down exteroceptive predictions on interoception. Our results are in line with recent models of interoception supporting the idea that predicted bodily states influence sensory processing of salient external information.
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Affiliation(s)
- Antje Gentsch
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, Munich, Germany
| | - Alejandra Sel
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Amanda C Marshall
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, Munich, Germany
| | - Simone Schütz-Bosbach
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, Munich, Germany
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31
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Ismaylova E, Lévesque ML, Pomares FB, Szyf M, Nemoda Z, Fahim C, Vitaro F, Brendgen M, Dionne G, Boivin M, Tremblay RE, Booij L. Serotonin transporter promoter methylation in peripheral cells and neural responses to negative stimuli: A study of adolescent monozygotic twins. Transl Psychiatry 2018; 8:147. [PMID: 30089832 PMCID: PMC6082838 DOI: 10.1038/s41398-018-0195-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/30/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022] Open
Abstract
Several studies have examined associations between peripheral DNA methylation patterns of the serotonin transporter gene (SLC6A4) promoter and symptoms of depression and anxiety. The SLC6A4 promoter methylation has also been associated with frontal-limbic brain responses to negative stimuli. However, it is unclear how much of this association is confounded by DNA sequence variations. We utilized a monozygotic-twin within-pair discordance design, to test whether DNA methylation at specific CpG sites in the SLC6A4 promoter of peripheral cells is associated with greater frontal-limbic brain responses to negative stimuli (sadness and fear), independently of DNA sequence effects. In total 48 pairs of healthy 15-year-old monozygotic twins from the Quebec Newborn Twin Study, followed regularly since birth, underwent functional magnetic resonance imaging while conducting an emotion-processing task. The SLC6A4 promoter methylation level was assessed in saliva samples using pyrosequencing. Relative to the co-twins with lower SLC6A4 promoter methylation levels, twins with higher peripheral SLC6A4 methylation levels showed greater orbitofrontal cortical (OFC) activity and left amygdala-anterior cingulate cortex (ACC) and left amygdala-right OFC connectivity in response to sadness as well as greater ACC-left amygdala and ACC-left insula connectivity in response to fearful stimuli. By utilising a monozygotic-twin design, we provided evidence that associations between peripheral SLC6A4 promoter methylation and frontal-limbic brain responses to negative stimuli are, in part, independent of DNA sequence variations. Although causality cannot be determined here, SLC6A4 promoter methylation may be one of the mechanisms underlying how environmental factors influence the serotonin system, potentially affecting emotional processing through frontal-limbic areas.
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Affiliation(s)
- Elmira Ismaylova
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0001 2292 3357grid.14848.31Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Melissa L. Lévesque
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0001 2292 3357grid.14848.31Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Florence B. Pomares
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0004 1936 8630grid.410319.eDepartment of Psychology, Concordia University, Montreal, Canada
| | - Moshe Szyf
- 0000 0004 1936 8649grid.14709.3bDepartment of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Zsofia Nemoda
- 0000 0004 1936 8649grid.14709.3bDepartment of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Cherine Fahim
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada
| | - Frank Vitaro
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0001 2292 3357grid.14848.31School of Psychoeducation, University of Montreal, Montreal, Canada
| | - Mara Brendgen
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0001 2181 0211grid.38678.32Department of Psychology, University of Quebec à Montreal, Montreal, Canada
| | - Ginette Dionne
- 0000 0004 1936 8390grid.23856.3aSchool of Psychology, University of Laval, Quebec, Canada
| | - Michel Boivin
- 0000 0004 1936 8390grid.23856.3aSchool of Psychology, University of Laval, Quebec, Canada ,0000 0001 1088 3909grid.77602.34Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - Richard E. Tremblay
- 0000 0001 2173 6322grid.411418.9CHU Sainte-Justine Research Centre, Montreal, Canada ,0000 0001 2292 3357grid.14848.31Department of Psychology, University of Montreal, Montreal, Canada ,0000 0001 0768 2743grid.7886.1School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Linda Booij
- CHU Sainte-Justine Research Centre, Montreal, Canada. .,Department of Psychiatry, University of Montreal, Montreal, Canada. .,Department of Psychology, Concordia University, Montreal, Canada.
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32
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Dewe H, Watson DG, Kessler K, Braithwaite JJ. The depersonalized brain: New evidence supporting a distinction between depersonalization and derealization from discrete patterns of autonomic suppression observed in a non-clinical sample. Conscious Cogn 2018; 63:29-46. [PMID: 29929064 DOI: 10.1016/j.concog.2018.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 12/11/2022]
Abstract
Depersonalization and Derealization are characterised by feelings of detachment from one's bodily self/surroundings and a general emotional numbness. We explored predisposition to trait-based experiences of depersonalization/derealization-type experiences and autonomic arousal toward simulated body-threats, which were delivered to the participant's own body (i.e. Self) and when observed being delivered to another individual (i.e. Other). Ninety participants took part in an "Implied Body-Threat Illusion" task (Dewe, Watson, & Braithwaite, 2016) and autonomic arousal was recorded via standardised skin conductance responses and finger temperature. Autonomic suppression in response to threats delivered to the Self correlated with increases in trait-based depersonalization-type experiences. In contrast, autonomic suppression for threats delivered to Others correlated with trait-based derealization-like experiences. Body-temperature and anticipatory arousal did not correlate reliably with predisposition to depersonalization- or derealization-type experiences. The theoretical implications of these findings are discussed in terms of a fronto-limbic autonomic suppression mechanism.
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Affiliation(s)
- Hayley Dewe
- Behavioural Brain Sciences Centre, School of Psychology, University of Birmingham, UK.
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33
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Sierk A, Daniels JK, Manthey A, Kok JG, Leemans A, Gaebler M, Lamke JP, Kruschwitz J, Walter H. White matter network alterations in patients with depersonalization/derealization disorder. J Psychiatry Neurosci 2018; 43:170110. [PMID: 29877178 PMCID: PMC6158023 DOI: 10.1503/jpn.170110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/01/2017] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. METHODS We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. RESULTS Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. LIMITATIONS To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. CONCLUSION In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.
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Affiliation(s)
- Anika Sierk
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Judith K Daniels
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Antje Manthey
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jelmer G Kok
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Alexander Leemans
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Michael Gaebler
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jan-Peter Lamke
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Johann Kruschwitz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Henrik Walter
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
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Abstract
Purpose of Review In this article, we aim to give an overview over recent neuroimaging research on dissociation in borderline personality disorder (BPD). Stress-related dissociation is highly prevalent in BPD, while so far only little is known about its neural underpinnings. Recent Findings Based on research in depersonalization and the dissociative subtype of posttraumatic stress disorder, it has been proposed that dissociation involves alterations in a cortico-limbic network. In BPD, neuroimaging research explicitly focusing on dissociation is still scarce. Summary Functional neuroimaging studies have provided preliminary evidence for an altered recruitment and interplay of fronto-limbic regions (amygdala, anterior cingulate, inferior frontal gyrus, medial and dorsolateral prefrontal cortices) and temporoparietal areas (superior temporal gyrus, inferior parietal lobule, fusiform gyrus), which may underlie disrupted affective-cognitive processing during dissociation in BPD. More neuroimaging research with larger samples, clinical control groups, and repeated measurements is needed to deepen the understanding of dissociation in BPD.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Bernet Elzinga
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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Tibubos AN, Grammes J, Beutel ME, Michal M, Schmutzer G, Brähler E. Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms. J Affect Disord 2018; 227:571-579. [PMID: 29172049 DOI: 10.1016/j.jad.2017.11.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/14/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences. METHODS In a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions. RESULTS In line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences. LIMITATIONS Our study is limited to these two habitual emotion regulation strategies employing a cross sectional design. CONCLUSION Our findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.
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Affiliation(s)
- Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany.
| | - Jennifer Grammes
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Gabriele Schmutzer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
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36
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Abstract
Depersonalisation disorder involves an unpleasant, chronic and disabling alteration in the experience of self and environment. In addition to these classic features of depersonalisation and derealisation, symptoms may also encompass alterations in bodily sensation and a loss of emotional reactivity. Primary depersonalisation disorder is probably more common than previously thought, and here we discuss the diagnosis, assessment and treatment of the condition, with particular reference to our experiences in a specialist depersonalisation clinic. We also consider psychological and biological aspects of the condition. Although there is as yet no recognised treatment for this disorder, various pharmacological interventions, particularly a combination of lamotrigine and a selective serotonin reuptake inhibitor, have shown promise. We discuss these drug treatments, together with psychological approaches, in particular a recent cognitive–behavioural conceptualisation and treatment approach.
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Baker D, Hunter E, Lawrence E, Medford N, Patel M, Senior C, Sierra M, Lambert MV, Phillips ML, David AS. Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 2003; 182:428-33. [PMID: 12724246 DOI: 10.1192/bjp.182.5.428] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BackgroundDepersonalisation disorder is a poorly understood and underresearched syndrome.AimsTo carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic.MethodA total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM–IV criteria.ResultsThe mean age of onset was 22.8 years; early onset was associated with greater severity There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM–IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. ‘Dissociative amnesia’ was not prominent.ConclusionsDepersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.
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Perez DL, Matin N, Williams B, Tanev K, Makris N, LaFrance WC, Dickerson BC. Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders. Hum Brain Mapp 2017; 39:428-439. [PMID: 29080235 DOI: 10.1002/hbm.23853] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/21/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Links between dissociation and functional neurological disorder (FND)/conversion disorder are well-established, yet the pathophysiology of dissociation remains poorly understood. This MRI study investigated structural alterations associated with somatoform and psychological dissociation in FND. We hypothesized that multimodal, paralimbic cingulo-insular regions would relate to the severity of somatoform dissociation in patients with FND. METHODS FreeSurfer cortical thickness and subcortical volumetric analyses were performed in 26 patients with motor FND and 27 matched healthy controls. Patients with high dissociation as measured by the Somatoform Dissociation Questionnaire-20 (SDQ) or Dissociative Experiences Scale (DES) were compared to controls in stratified analyses. Within-group analyses were also performed with SDQ and DES scores in patients with FND. All cortical thickness analyses were whole-brain corrected at the cluster-wise level. RESULTS Patients with FND and high somatoform dissociation (SDQ > 35) showed reduced left caudal anterior cingulate cortex (ACC) cortical thickness compared to controls. In within-group analyses, SDQ scores inversely correlated with left caudal ACC cortical thickness in patients with FND. Depersonalization/derealization scores positively correlated with right lateral occipital cortical thickness. Both within-group findings remained statistically significant controlling for trait anxiety/depression, borderline personality disorder and post-traumatic stress disorder, adverse life events, and motor FND subtypes in post-hoc analyses. CONCLUSION Using complementary between-group and within-group analyses, an inverse association between somatoform dissociation and left caudal ACC cortical thickness was observed in patients with FND. A positive relationship was also appreciated between depersonalization/derealization severity and cortical thickness in visual association areas. These findings advance our neuropathobiological understanding of dissociation in FND. Hum Brain Mapp 39:428-439, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Nassim Matin
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Williams
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kaloyan Tanev
- Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Nikos Makris
- Center for Morphometric Analysis, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - W Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island
| | - Bradford C Dickerson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.,Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Iamsakul K, Pavlovcik AV, Calderon JI, Sanderson LM. PROJECT HEAVEN: Preoperative Training in Virtual Reality. Surg Neurol Int 2017; 8:59. [PMID: 28540125 PMCID: PMC5421260 DOI: 10.4103/sni.sni_371_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/10/2017] [Indexed: 01/05/2023] Open
Abstract
A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure.
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Affiliation(s)
- Kiratipath Iamsakul
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Alexander V Pavlovcik
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Jesus I Calderon
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Lance M Sanderson
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
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Affiliation(s)
- Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China
| | - Jen-Ho Chang
- Institute of Ethnology, Academia Sinica, Taipei, Taiwan
| | - Chin Ming Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China
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Abstract
Mindfulness denotes a state of consciousness characterized by receptive attention to and awareness of present events and experiences. As a personality trait, it constitutes the ability to become aware of mental activities such as sensations, images, feelings, and thoughts, and to disengage from judgment, conditioned emotions, and their cognitive processing or automatic inhibition. Default brain activity reflects the stream of consciousness and sense of self at rest. Analysis of brain activity at rest in persons with mindfulness propensity may help to elucidate the neurophysiological basis of this important mental trait. The sample consisted of 32 persons-23 with mental disorders and 9 healthy controls. Dispositional mindfulness (DM) was operationalized by Mindful Attention Awareness Scale (MAAS). Brain activity at rest with eyes closed was assessed by fluorodeoxyglucose positron emission tomography (F-18-FDG PET). After adjustment for depression, anxiety, age and years of education, resting glucose metabolism in superior parietal lobule and left precuneus/Brodmann area (BA) 7 was positively associated with DM. Activity of the left inferior frontal orbital gyrus (BA 47) and bilateral anterior thalamus were inversely associated with DM. DM appears to be associated with increased metabolic activity in some core area of the default mode network (DMN) and areas connected to the DMN, such as BA 7, hosting sense of self functions. Hypometabolism on the other hand was found in some nodes connected to the DMN, such as left inferior frontal orbital gyrus and bilateral thalamus, commonly related to functions of memory retrieval, decision making, or outward attention.
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Affiliation(s)
- Martin Gartenschläger
- Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, D-55131 Germany
| | - Mathias Schreckenberger
- Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, D-55131 Germany
| | - Hans-Georg Buchholz
- Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, D-55131 Germany
| | - Iris Reiner
- 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
| | - Julia Adler
- 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
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Abstract
Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia). While the precise neurobiological underpinnings of dissociation remain elusive, neuroimaging studies in disorders, characterized by high dissociation (e.g., depersonalization/derealization disorder (DDD), dissociative identity disorder (DID), dissociative subtype of posttraumatic stress disorder (D-PTSD)), have provided valuable insight into brain alterations possibly underlying dissociation. Neuroimaging studies in borderline personality disorder (BPD), investigating links between altered brain function/structure and dissociation, are still relatively rare. In this article, we provide an overview of neurobiological models of dissociation, primarily based on research in DDD, DID, and D-PTSD. Based on this background, we review recent neuroimaging studies on associations between dissociation and altered brain function and structure in BPD. These studies are discussed in the context of earlier findings regarding methodological differences and limitations and concerning possible implications for future research and the clinical setting.
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Mosquera D, Steele K. Complex trauma, dissociation and Borderline Personality Disorder: Working with integration failures. European Journal of Trauma & Dissociation 2017; 1:63-71. [DOI: 10.1016/j.ejtd.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dewe H, Watson DG, Braithwaite JJ. Uncomfortably numb: new evidence for suppressed emotional reactivity in response to body-threats in those predisposed to sub-clinical dissociative experiences. Cogn Neuropsychiatry 2016; 21:377-401. [PMID: 27466978 DOI: 10.1080/13546805.2016.1212703] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Depersonalisation and derealisation disorders refer to feelings of detachment and dissociation from one's "self" or surroundings. A reduced sense of self (or "presence") and emotional "numbness" is thought to be mediated by aberrant emotional processing due to biases in self-referent multi-sensory integration. This emotional "numbing" is often accompanied by suppressed autonomic arousal to emotionally salient stimuli. METHODS 118 participants completed the Cambridge Depersonalisation scale [Sierra, & Berrios, 2000. The Cambridge Depersonalisation Scale: A new instrument for the measurement of depersonalisation. Psychiatry Research, 93, 153-164)] as an index of dissociative anomalous experience. Participants took part in a novel "Implied Body-Threat Illusion" task; a pantomimed injection procedure conducted directly onto their real body (hand). Objective psychophysiological data were recorded via standardised threat-related skin conductance responses and finger temperature measures. RESULTS Individuals predisposed to depersonalisation/derealisation revealed suppressed skin conductance responses towards the pantomimed body-threat. Although the task revealed a reliable reduction in finger temperature as a fear response, this reduction was not reliably associated with measures of dissociative experience. CONCLUSIONS The present findings significantly extend previous research by revealing emotional suppression via a more direct body-threat task, even for sub-clinical groups. The findings are discussed within probabilistic and predictive coding frameworks of multi-sensory integration underlying a coherent sense of self.
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Affiliation(s)
- Hayley Dewe
- a Behavioural Brain Sciences Centre , School of Psychology, University of Birmingham , Edgbaston , Birmingham , UK
| | - Derrick G Watson
- b Department of Psychology , University of Warwick , Coventry , UK
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Jay EL, Nestler S, Sierra M, McClelland J, Kekic M, David AS. Ventrolateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of depersonalization disorder: A consecutive case series. Psychiatry Res 2016; 240:118-122. [PMID: 27104926 PMCID: PMC4906152 DOI: 10.1016/j.psychres.2016.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 12/18/2022]
Abstract
Case reports and an open trial have reported promising responses to repetitive transcranial magnetic stimulation (rTMS) to prefrontal and temporo-parietal sites in patients with depersonalization disorder (DPD). We recently showed that a single session of rTMS to the ventrolateral prefrontal cortex (VLPFC) was associated with a reduction in symptoms and increase in physiological arousal. Seven patients with medication-resistant DSM-IV DPD received up to 20 sessions of right-sided rTMS to the VLPFC for 10 weeks. Stimulation was guided using neuronavigation software based on participants' individual structural MRIs, and delivered at 110% of resting motor threshold. A session consisted of 1Hz repetitive TMS for 15min. The primary outcome measure was reduction in depersonalization symptoms on the Cambridge Depersonalization Scale (CDS). Secondary outcomes included scores on the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). 20 sessions of rTMS treatment to right VLPFC significantly reduced scores on the CDS by on average 44% (range 2-83.5%). Two patients could be classified as "full responders", four as "partial" and one a non-responder. Response usually occurred within the first 6 sessions. There were no significant adverse events. A randomized controlled clinical trial of VLPFC rTMS for DPD is warranted.
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Affiliation(s)
- Emma-Louise Jay
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK
| | - Steffen Nestler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK
| | - Mauricio Sierra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK
| | - Jessica McClelland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK
| | - Maria Kekic
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK
| | - Anthony S David
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
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Medford N, Sierra M, Stringaris A, Giampietro V, Brammer MJ, David AS. Emotional Experience and Awareness of Self: Functional MRI Studies of Depersonalization Disorder. Front Psychol 2016; 7:432. [PMID: 27313548 PMCID: PMC4890597 DOI: 10.3389/fpsyg.2016.00432] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/10/2016] [Indexed: 11/21/2022] Open
Abstract
This paper presents functional MRI work on emotional processing in depersonalization disorder (DPD). This relatively neglected disorder is hallmarked by a disturbing change in the quality of first-person experience, almost invariably encompassing a diminished sense of self and an alteration in emotional experience such that the sufferer feels less emotionally reactive, with emotions experienced as decreased or “damped down,” so that emotional life seems to lack spontaneity and subjective validity. Here we explored responses to emotive visual stimuli to examine the functional neuroanatomy of emotional processing in DPD before and after pharmacological treatment. We also employed concurrent skin conductance measurement as an index of autonomic arousal. In common with previous studies we demonstrated that in DPD, there is attenuated psychophysiological response to emotional material, reflected in altered patterns of (i) regional brain response, (ii) autonomic responses. By scanning participants before and after treatment we were able to build on previous findings by examining the changes in functional MRI response in patients whose symptoms had improved at time 2. The attenuation of emotional experience was associated with reduced activity of the insula, whereas clinical improvement in DPD symptoms was associated with increased insula activity. The insula is known to be implicated in interoceptive awareness and the generation of feeling states. In addition an area of right ventrolateral prefrontal cortex emerged as particularly implicated in what may be “top-down” inhibition of emotional responses. The relevance of these findings to the wider study of emotion, self-related processes, and interoception is discussed.
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Affiliation(s)
- Nick Medford
- Department of Psychiatry, Brighton and Sussex Medical SchoolBrighton, UK; Sackler Centre for Consciousness Science, University of SussexBrighton, UK
| | - Mauricio Sierra
- Institute of Psychiatry, Psychology, and Neuroscience London, UK
| | | | | | | | - Anthony S David
- Institute of Psychiatry, Psychology, and Neuroscience London, UK
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Fischer DB, Perez DL, Prasad S, Rigolo L, O'Donnell L, Acar D, Meadows ME, Baslet G, Boes AD, Golby AJ, Dworetzky BA. Right inferior longitudinal fasciculus lesions disrupt visual-emotional integration. Soc Cogn Affect Neurosci 2016; 11:945-51. [PMID: 26940563 DOI: 10.1093/scan/nsw011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 01/28/2016] [Indexed: 11/14/2022] Open
Abstract
The mechanism by which the brain integrates visual and emotional information remains incompletely understood, and can be studied through focal lesions that selectively disrupt this process. To date, three reported cases of visual hypoemotionality, a vision-specific form of derealization, have resulted from lesions of the temporo-occipital junction. We present a fourth case of this rare phenomenon, and investigate the role of the inferior longitudinal fasciculus (ILF) in the underlying pathophysiology. A 50-year-old right-handed male was found to have a right medial temporal lobe tumor following new-onset seizures. Interstitial laser ablation of the lesion was complicated by a right temporo-parieto-occipital intraparenchymal hemorrhage. The patient subsequently experienced emotional estrangement from visual stimuli. A lesion overlap analysis was conducted to assess involvement of the ILF by this patient's lesion and those of the three previously described cases, and diffusion tensor imaging was acquired in our case to further investigate ILF disruption. All four lesions specifically overlapped with the expected trajectory of the right ILF, and diminished structural integrity of the right ILF was observed in our case. These findings implicate the ILF in visual hypoemotionality, suggesting that the ILF is critical for integrating visual information with its emotional content.
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Affiliation(s)
- David B Fischer
- Harvard Medical School, Boston, MA 02115, USA, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,
| | - David L Perez
- Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA and Department of Psychiatry
| | | | - Laura Rigolo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Lauren O'Donnell
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | - Aaron D Boes
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA, Department of Neurology and
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Schulz A, Köster S, Beutel ME, Schächinger H, Vögele C, Rost S, Rauh M, Michal M. Altered patterns of heartbeat-evoked potentials in depersonalization/derealization disorder: neurophysiological evidence for impaired cortical representation of bodily signals. Psychosom Med 2015; 77:506-16. [PMID: 25984819 DOI: 10.1097/PSY.0000000000000195] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Core features of depersonalization/derealization disorder (DPD) are emotional numbing and feelings of disembodiment. Although there are several neurophysiological findings supporting subjective emotional numbing, the psychobiology of disembodiment remains unclear. METHODS Heartbeat-evoked potentials (HEPs), which are considered psychophysiological indicators for the cortical representation of afferent signals originating from the cardiovascular system, were assessed in 23 patients with DPD and 24 healthy control individuals during rest and while performing a heartbeat perception task. RESULTS Absolute HEP amplitudes did not differ between groups. Nevertheless, healthy individuals showed higher HEPs during the heartbeat perception task than during rest, whereas no such effect was found in patients with DPD (p = .031). Patients with DPD had higher total levels of salivary α-amylase than did healthy individuals (9626.6 [8200.0] versus 5344.3 [3745.8] kU min/l; p = .029), but there were no group differences in cardiovascular measures (heart rate = 76.2 [10.1] versus 74.3 [7.5] beats/min, p = .60; normalized low-frequency heart rate variability = 0.63 [0.15] versus 0.56 [0.15] normalized units, p = .099; low frequency/high frequency ratio = 249.3 [242.7] versus 164.8 [108.8], p = .10), salivary cortisol (57.5 [46.7] versus 55.1 [43.6] nmol min/l, p = .86), or cortisone levels (593.2 [260.3] versus 543.8 [257.1] nmol min/l, p = .52). CONCLUSIONS These results suggest altered cortical representation of afferent signals originating from the cardiovascular system in patients with DPD, which may be associated with higher sympathetic tone. These findings may reflect difficulties of patients with DPD to attend to their actual bodily experiences.
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Maxwell R, Lynn SJ, Condon L. Hypnosis, hypnotic suggestibility, memory, and involvement in films. Conscious Cogn 2015; 33:170-84. [DOI: 10.1016/j.concog.2014.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 11/30/2022]
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