Feeling Unreal: A PET Study of Depersonalization Disorder

Simeon, Daphne; Guralnik, Orna; Hazlett, Erin A.; Spiegel-Cohen, Jacqueline; Hollander, Eric; Buchsbaum, Monte S.

doi:10.1176/appi.ajp.157.11.1782

Cited by 263 publications

(132 citation statements)

References 33 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…31,32 Röeder and colleagues 33 found reduced amygdala activity during induced depersonalization in healthy control participants. Taken together, these findings suggest that reduced temporal activity is a potential correlate of dissociation and reduced pain sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

109

113

View full text Add to dashboard Cite

Background: Stress-induced dissociative states involving analgesia are a common feature of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Our aim was to investigate the psychologic, somatosensory (pain sensitivity) and neural correlates of dissociative states in patients with these disorders. Methods: We included 15 women with BPD who were not taking medication; 10 of these women had comorbid PTSD. While undergoing functional magnetic resonance imaging at 1.5 Tesla, participants were exposed to a script describing a personalized dissociation-inducing situation and a personalized script describing a neutral situation. We assessed dissociative psychopathology and pain sensitivity. Results: Dissociative psychopathology scores were significantly higher and pain sensitivity was lower after the dissociation-inducing script was read compared with the neutral script. The blood oxygen level-dependent (BOLD) signal was significantly increased in the left inferior frontal gyrus (Brodmann area [BA] 9) during the presentation of the dissociationinducing script. Regression analyses revealed positive correlations between BOLD signal and dissociative psychopathology in the left superior frontal gyrus (BA 6) and negative correlations in the right middle (BA 21) and inferior temporal gyrus (BA 20). In the subgroup of participants with comorbid PTSD, we also found increased activity in the left cingulate gyrus (BA 32) during script-driven imagery-induced dissociation, a positive correlation between dissociation scores and activity in the right and left insula (BA 13) and a negative correlation in the right parahippocampal gyrus (BA 35). Limitations: The main limitation of this pilot study is the absence of a control group. Therefore, the results may also reflect the neural correlates of non-BPD/PTSD specific dissociative states or the neural correlates of emotionally stressful or "loaded" memories. Another limitation is the uncorrected statistical level of the functional magnetic resonance imaging results. Conclusion: Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD. These states were characterized by reduced pain sensitivity and a fronto limbic activation pattern, which resembles the findings in participants with PTSD while in dissociative states.

show abstract

Section: Discussionmentioning

confidence: 99%

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

109

113

View full text Add to dashboard Cite

show abstract

“…Yen Pik Sang et al [120] reported that caloric vestibular stimulations in healthy subjects may induce transient symptoms of depersonalization and derealisation (''body feels strange/different in some ways'', ''feeling of detachment or separation from surroundings'') by a disintegration in personal space and/or disintegration between personal and extrapersonal space. In a PET study on depersonalization, Simeon et al [106] found brain activation changes related to embodiment in regions that have also been shown to be activated by caloric vestibular stimulation, such as the superior temporal gyrus, posterior insula and inferior parietal lobule [19,20,39,47,50,112]. Collectively, these findings suggest that caloric vestibular stimulation interferes with self-processing and embodiment, also inducing symptoms of depersonalization, which share several aspects with out-ofbody experiences [105].…”

Section: Effects Of Natural and Artificial Vestibular Stimulations Onmentioning

confidence: 99%

Body ownership and embodiment: Vestibular and multisensory mechanisms

Lopez

Halje

Blanke

2008

Neurophysiologie Clinique/Clinical Neurophysiology

236

163

View full text Add to dashboard Cite

Summary Body ownership and embodiment are two fundamental mechanisms of selfconsciousness. The present article reviews neurological data about paroxysmal illusions during which body ownership and embodiment are affected differentially: autoscopic phenomena (out-of-body experience, heautoscopy, autoscopic hallucination, feeling-of-a-presence) and the room tilt illusion. We suggest that autoscopic phenomena and room tilt illusion are related to different types of failures to integrate body-related information (vestibular, proprioceptive and tactile cues) in addition to a mismatch between vestibular and visual references. In these patients, altered body ownership and embodiment has been shown to occur due to pathological activity at the temporoparietal junction and other vestibular-related areas arguing for a key importance of vestibular processing. We also review the possibilities of manipulating body ownership and embodiment in healthy subjects through exposition to weightlessness as well as caloric and galvanic stimulation of the peripheral vestibular apparatus. In healthy subjects, disturbed self-processing might be related to interference of vestibular stimulation with vestibular cortex leading to disintegration of bodily information and altered body ownership and embodiment. We finally propose a differential contribution of the vestibular cortical areas to the different forms of altered body ownership and embodiment. Résumé L'attribution du corps propre et de ses éléments constitutifs (body ownership), ainsi que le sentiment d'incarnation (embodiment) -le fait d'habiter ce corps, d'être localisé dans les limites physiques de ce corps -, sont deux éléments fondamentaux de la conscience de soi. Nous faisons ici la synthèse de données issues de la neurologie montrant que des manifestations paroxystiques telles que les phénomènes autoscopiques (expérience de sortie du corps, héautoscopie, hallucination autoscopique, sensation de présence) et l'illusion de bascule de l'environnement (room tilt illusion) se caractérisent par une atteinte différentielle des mécanismes d'attribution du corps propre et du sentiment d'incarnation. Nous faisons l'hypothèse que les différents phénomènes autoscopiques et l'illusion de bascule de l'environnement se caractérisent par différents patrons de déficits d'intégration des informations sensorielles corporelles (informations visuelles, musculaires proprioceptives et tactiles) combinés à une perte de cohérence entre les références visuelles et vestibulaires. Chez les patients souffrant de phénomènes autoscopiques, les déficits d'attribution du corps propre et du sentiment d'incarnation ont été liés à un dysfonctionnement au niveau de la jonction temporopariétale et d'autres régions corticales recevant des informations vestibulaires, suggérant une contribution importante des afférences vestibulaires dans les mécanismes de la conscience de soi. Nous rapportons également des données de la littérature recueillies chez des sujets sains suggérant la possibilité de manipuler l'attribution ...

show abstract

“…DPD is characterised by a persistent or recurrent disruption in self-awareness typically revolving around feelings of disembodiment and a subjective emotional numbing (see Table 1: Sierra, 2009;Sierra & David, 2011;Simeon et al, 2000). Patients often describe feeling detached or estranged from themselves, from their bodies and from their emotions.…”

Section: Introductionmentioning

confidence: 99%