Striking Discrepancy of Anomalous Body Experiences with Normal Interoceptive Accuracy in Depersonalization-Derealization Disorder

Abstract

BackgroundDisembodiment is a core feature of depersonalization disorder (DPD). Given the narratives of DPD patients about their disembodiment and emotional numbing and neurobiological findings of an inhibition of insular activity, DPD may be considered as a mental disorder with specific impairments of interoceptive awareness and body perception.MethodsWe investigated cardioceptive accuracy (CA) of DPD patients (n = 24) as compared to healthy controls (n = 26) with two different heartbeat detection tasks (“Schandry heartbeat counting task” and “Whitehead heartbeat discrimination task”). Self-rated clearness of body perception was measured by questionnaire.ResultsContrary to our hypothesis, DPD patients performed similarly to healthy controls on the two different heartbeat detection tasks, and they had equal scores regarding their self-rated clearness of body perception. There was no correlation of the severity of “anomalous body experiences” and depersonalization with measures of interoceptive accuracy. Only among healthy controls CA in the Schandry task was positively correlated with self-rated clearness of body perception. Depersonalization was unrelated to severity of depression or anxiety, while depression and anxiety were highly correlated. Anxiety and depression did not modify the associations of depersonalization with interoceptive accuracy.ConclusionsOur main findings highlight a striking discrepancy of normal interoception with overwhelming experiences of disembodiment in DPD. This may reflect difficulties of DPD patients to integrate their visceral and bodily perceptions into a sense of their selves. This problem may be considered an important target for psychotherapeutic treatment approaches.

Altered Patterns of Heartbeat-Evoked Potentials in Depersonalization/Derealization Disorder

“…HEP amplitudes have been shown to be associated with attention focus on heartbeats (25)(26)(27), heartbeat perception accuracy (21)(22)(23), and the motivation (24) in performing heartbeat perception tasks. Thus, the current difference in In line with that, we have previously found that patients with DPD differ from HCs in heartbeat perception accuracy curves: although healthy individuals have lower initial values and show an increase over time, patients with DPD begin with higher initial values and show a decrease over time, resulting in an overall zero effect in heartbeat perception (16). This might indicate that patients with DPD have difficulties with focusing on their actual bodily perceptions (16).…”

“…Disembodiment could be reflected in a reduction of the overall amplitude of HEPs, as previously shown for major depression (28). A decrease of interoceptive accuracy over time (16) may imply deficits in focusing attention on bodily sensations. Given that HEPs assessed during a heartbeat perception task reflect attentional focus (25)(26)(27), it is plausible to assume that HEP amplitudes may be impaired to reflect attention focused on heartbeats in DPD.…”

“…However, there remains uncertainty about any differences in interoceptive accuracy and associated psychophysiological processes between patients with DPD and healthy individuals. In contrast to their feelings of disembodiment, patients with DPD perform similarly well in heartbeat perception tasks compared with healthy individuals (16). Nevertheless, there is evidence that patients with DPD may have difficulties with sustained attention to interoceptive signals, as patterns of performance in heartbeat perception accuracy over time differ between patients with DPD and healthy controls, with a decrease in performance observed in DPD and an increase in healthy controls.…”

“…Patients with DPD reported significantly more childhood trauma experiences (all p values < .05), as indicated by the CTQ total score and all subscales, except for "sexual abuse" (p = .25), as well as higher alexithymia as indexed by the TAS total score and its subscales "difficulty identifying feelings" and "difficulty describing feelings" (all p values < .001; see Table S1, Supplemental Digital Content 3, http://links.lww.com/PSYMED/A217). Accuracy scores of heartbeat perception tasks are reported elsewhere (16). Table 2), whereas the difference between both trials at electrode Fz was only marginally significant (p = .053).…”

“…The study was approved by the Ethics Committee of the State Board of Physicians of Rhineland-Palatinate (Germany) and was part of an extended protocol, which is in parts reported elsewhere (16). All participants provided written informed consent.…”