Depersonalization disorder: thinking without feeling

Phillips, Mary L.; Medford, Nicholas; Senior, Carl; Bullmore, Edward T.; Suckling, John; Brammer, Michael; Andrew, Chris; Sierra, Mauricio; Williams, Steven; David, Anthony S.

doi:10.1016/s0925-4927(01)00119-6

Cited by 174 publications

(149 citation statements)

References 44 publications

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“…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

108

113

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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.

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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

108

113

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“…Injury to the ILF may interrupt this transmission, depriving visual experiences of emotional qualities and producing the visual hypoemotionality (or de-affectualization) that commonly underlies experiences of derealization. Dysfunction of this visual-emotional integrative mechanism may occur in non-lesional forms of dissociation as well, potentially explaining why individuals with dissociative experiences exhibit a diminished autonomic response and diminished temporo-occipital activity while viewing emotional images (Phillips et al, 2001;, and why hypoperfusion of the right medial temporal lobe has been observed in visual hypoemotionality caused by drug toxicity Fig. 2.…”

Section: Discussionmentioning

confidence: 99%

Right inferior longitudinal fasciculus lesions disrupt visual-emotional integration

Fischer

Perez

Prasad³

et al. 2016

Social Cognitive and Affective Neuroscience

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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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“…One prominent theoretical account proposed to explain the aberrant experiences reported by patients with DPD, argue for a fronto-limbic suppressive network where structures like the anterior insula and the amygdala become inappropriately inhibited by over-active inhibitory connections emanating from frontal regions (Phillips & Sierra, 2003;Sierra & Berrios, 1998; for imaging evidence see Phillips et al, 2001;Lemche et al, 2007;. As a net consequence of these interactions, emotion is divorced and prevented from colouring the typical integration between perception and cognition resulting in an altered, diluted, sense of presence and the subjective feelings of 'unreality'.…”

Section: Theoretical Accountsmentioning

confidence: 99%

“…This was achieved by screening participants on questionnaire measures of trait-based dissociative experience and a novel body-threat illusion task. Previous research has established that patients diagnosed with DPD show a suppressed emotional response to aversive stimuli and that such biases are likely related to a reduced sense of presence and the distorted sense of self and surroundings often reported (Phillips et al, 2001;Sierra et al, 2002;Sierra, Senior, Phillips & David, 2006).…”

Section: The Present Studymentioning

confidence: 99%

Uncomfortably numb: new evidence for suppressed emotional reactivity in response to body-threats in those predisposed to sub-clinical dissociative experiences

Dewe

Watson

Braithwaite

2016

Cognitive Neuropsychiatry

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Depersonalization disorder: thinking without feeling

Cited by 174 publications

References 44 publications

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

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

Right inferior longitudinal fasciculus lesions disrupt visual-emotional integration

Uncomfortably numb: new evidence for suppressed emotional reactivity in response to body-threats in those predisposed to sub-clinical dissociative experiences

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