Depersonalization Disorder: Disconnection of Cognitive Evaluation from Autonomic Responses to Emotional Stimuli

Matthias Michal,Manfred E. Beutel,Julia Adler,Marco Canterino,Gerhard Vossel,Ansgar Koechel,Matthias Gamer,Iris Reiner,Allan Siegel

doi:10.1371/journal.pone.0074331

Abstract

BackgroundPatients with depersonalization disorder (DPD) typically complain about emotional detachment. Previous studies found reduced autonomic responsiveness to emotional stimuli for DPD patients as compared to patients with anxiety disorders. We aimed to investigate autonomic responsiveness to emotional auditory stimuli of DPD patients as compared to patient controls. Furthermore, we examined the modulatory effect of mindful breathing on these responses as well as on depersonalization intensity.Methods22 DPD patients and 15 patient controls balanced for severity of depression and anxiety, age, sex and education, were compared regarding 1) electrodermal and heart rate data during a resting period, and 2) autonomic responses and cognitive appraisal of standardized acoustic affective stimuli in two conditions (normal listening and mindful breathing).ResultsDPD patients rated the emotional sounds as significantly more neutral as compared to patient controls and standardized norm ratings. At the same time, however, they responded more strongly to acoustic emotional stimuli and their electrodermal response pattern was more modulated by valence and arousal as compared to patient controls. Mindful breathing reduced severity of depersonalization in DPD patients and increased the arousal modulation of electrodermal responses in the whole sample. Finally, DPD patients showed an increased electrodermal lability in the rest period as compared to patient controls.ConclusionsThese findings demonstrated that the cognitive evaluation of emotional sounds in DPD patients is disconnected from their autonomic responses to those emotional stimuli. The increased electrodermal lability in DPD may reflect increased introversion and cognitive control of emotional impulses. The findings have important psychotherapeutic implications.

Highlights

Depersonalization disorder (DPD) is characterized by persistent or recurrent depersonalization, i.e. experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, sensations, actions or feelings and is often accompanied by derealization, i.e. experiences of unreality or detachment with respect to surroundings
The prevalence of DPD is around 1% in the general population, DPD has a high comorbidity with depression and anxiety disorders, and its course is typically chronic [2,3,4,5,6,7]
Participants fulfilled the criteria of DPD according to DSMIV (300.6) as well as the criteria of the depersonalizationderealization-syndrome according to ICD-10 (F48.1)

Summary

Introduction

Depersonalization disorder (DPD) is characterized by persistent or recurrent depersonalization, i.e. experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, sensations, actions or feelings and is often accompanied by derealization, i.e. experiences of unreality or detachment with respect to surroundings. One neuroimaging and two psychophysiological studies found reduced autonomic responsiveness to unpleasant emotional stimuli and reduced limbic activation as compared to patients with anxiety disorders [17,18,19] These findings support the cortico-limbic disconnection model of DPD, postulating that prefrontal inhibition of limbic areas, presumably mediated via attentional mechanisms, impairs “emotional coloring” of perceptions and cognitions [9]. Methods: 22 DPD patients and 15 patient controls balanced for severity of depression and anxiety, age, sex and education, were compared regarding 1) electrodermal and heart rate data during a resting period, and 2) autonomic responses and cognitive appraisal of standardized acoustic affective stimuli in two conditions (normal listening and mindful breathing).

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