Depersonalization-derealization Disorder Research Articles

Clinical characteristics of 217 Chinese cases with depersonalization/derealization disorder

Depersonalization/derealization disorder (DPD) is a prevalent yet inadequately understood clinical condition characterized by a recurrent or persistent sense of unreality. This study aims to provide insight into DPD through descriptive and comparative analyses involving a large group of Chinese participants. The socio-demographic details (age, gender proportion, education, occupational status, marital status), depersonalized and dissociative symptom characteristics (symptomatic factors or subscales of the Cambridge Depersonalization Scale and the Dissociative Experiences Scale), development trajectory (age of onset, potential precipitating factors, course characteristics), treatment history (duration of delayed healthcare attendance, duration of delayed diagnosis, previous diagnoses), and adverse childhood experiences of the DPD patients are presented. Comparisons of anxiety and depressive symptoms, alongside psychosocial functioning, between DPD participants and those diagnosed with generalized anxiety disorder, bipolar disorders, and major depressive disorder were conducted. The analysis highlights a higher male preponderance and early onset of DPD, symptomatology marked by derealization, notable impairment in psychosocial functioning, and prolonged periods of delayed healthcare attendance and diagnosis associated with symptom severity. Furthermore, noteworthy relationships between adverse childhood experiences and symptom levels were identified. The findings substantiate the view that DPD is a serious but neglected mental disorder, urging initiatives to improve the current condition of DPD patients.

Confrontation with others' emotions changes bodily resonance differently in those with low and high levels of depersonalization.

We present novel research on the cortical dynamics of atypical perceptual and emotional processing in people with symptoms of depersonalization-derealization disorder (DP-DR). We used electroencephalography (EEG)/event-related potentials (ERPs) to delineate the early perceptual mechanisms underlying emotional face recognition and mirror touch in adults with low and high levels of DP-DR symptoms (low-DP and high-DP groups). Face-sensitive visual N170 showed markedly less differentiation for emotional versus neutral face-voice stimuli in the high- than in the low-DP group. This effect was related to self-reported bodily symptoms like disembodiment. Emotional face-voice primes altered mirror touch at somatosensory cortical components P45 and P100 differently in the two groups. In the high-DP group, mirror touch occurred only when seeing touch after being confronted with angry face-voice primes. Mirror touch in the low-DP group, however, was unaffected by preceding emotions. Modulation of mirror touch following angry others was related to symptoms of self-other confusion. Results suggest that others' negative emotions affect somatosensory processes in those with an altered sense of bodily self. Our findings are in line with the idea that disconnecting from one's body and self (core symptom of DP-DR) may be a defence mechanism to protect from the threat of negative feelings, which may be exacerbated through self-other confusion. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Perinatal Care for Persons with Dissociative Disorders.

Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented.

The level of depersonalization/derealization disorder (D.D.D) among refugees: A descriptive study of Syrian refugees in Mecca city in 2023 through some of demographic variables

هدفت الدراسة إلى معرفة مستوى اختلال الآنيَّة وعلاقته ببعض المتغيرات لدى عينة من اللاجئين السوريين بمدينة مكة المكرمة. وتكونت عينة الدراسة من (377) لاجئًا ولاجئة من الجنسية السورية؛ على اختلاف مستواهم التعليمي، والخبرة الصادمة لديهم؛ تم اختيارهم بطريقة قصدية. ولتحقيق أغراض الدراسة تم اتباع المنهج الوصفي، واستخدام مقياس اختلال الآنيَّة من إعداد عمر (2018)؛ الذي قامت بتطويره الدراسة الحالية ليُلائم عينة اللاجئين؛ وقد تم التحقق من الخصائص السيكومترية للمقياس، ومناسبته لعينة الدراسة. ولتحقيق أغراض الدراسة تم استخدام المتوسطات الحسابية، والانحرافات المعيارية، واختبار (ت). وكشفت نتائج الدراسة عن: وجود مستوى متوسط من اختلال الآنيَّة لدى عينة الدراسة، ووجود فروق ذات دلالة إحصائية في مستوى اختلال الآنيَّة (بُعد تبدد الشخصية فقط) لدى اللاجئين السوريين؛ تُعزى إلى متغير النوع؛ لصالح الإناث، ووجود فروق ذات دلالة إحصائية في مستوى اختلال الآنيَّة لدى اللاجئين السوريين؛ تُعزى إلى متغير المستوى التعليمي؛ لصالح ثانوي فأقل، ووجود فروق ذات دلالة إحصائية في مستوى اختلال الآنيَّة لدى اللاجئين السوريين؛ تُعزى إلى متغير الخبرة الصادمة؛ لصالح فئة من (تعرضوا لصدمات ما قبل اللجوء)، مقارنة بمن (لا يوجد لديهم تعرض لصدمات)؛ ولصالح فئة من (تعرضوا لصدمات في رحلة اللجوء)، مقارنة بمن (تعرضوا لصدمات في البلد المُضيف)، ومن (لا يوجد لديهم تعرض لصدمات). وأوصت الدراسة بضرورة إنشاء برامج علاجية من قِبل الجهات الصحية؛ للتخفيف من أعراض اختلال الآنيَّة، وزيادة الاهتمام بالرعاية النفسية للاجئين؛ من خلال توفير خط ساخن لتقديم الدعم النفسي لهم.

Cognitive Behaviour Therapy (CBT) for Depersonalization Derealization Disorder (DDD): a self-controlled cross-over study of waiting list vs. active treatment

ABSTRACT Depersonalisation-Derealisation Disorder (DDD) has a prevalence of around 1% but is under-recognised and often does not respond to medical intervention. We report on a clinical audit of 36 participants with a diagnosis of chronic DDD who were sequentially recruited from a specialist DDD National Health Service clinic in London, United Kingdom, and who completed Cognitive Behavioural Therapy specifically adapted for DDD. The sample population had a mean age of 38.7 years (s.d. = 13.4), 61% were male and 69% were of White ethnicity. Three outcomes were assessed (Cambridge Depersonalisation Scale [CDS], Beck Depression Inventory [BDI], and the Beck Anxiety Inventory [BAI]) at three time points in a naturalistic, self-controlled, cross-over design. Hierarchical longitudinal analyses for outcome response clustered by patient were performed using scores from baseline, beginning, and end of therapy. All scores showed improvement during the treatment period, with medium effect sizes. CBT may be an effective treatment for DDD. However, treatment was not randomly assigned, and the sample was small. More research is needed, including the use of randomisation to assess the efficacy of CBT for DDD.

Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder

BackgroundDepersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach. Materials and methodsWe developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n = 31) and healthy controls (n = 29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness – II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks. ResultsAt baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness. ConclusionIndividual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body.

Chasing Bodily-Self Ghost: Interoception-Aided Hypnosis in the Treatment for Depersonalization-A Case Study

This paper aims to introduce a relatively novel approach for Hypnosis to treat Depersonalization-derealization Disorder (DPRD). Depersonalization is conceptualized as a disrupted interoceptive process disorder. Based on this conceptualization, Hypnotic intervention is tailored to counter the flawed process. It is exemplified by a case of a young man suffering from depersonalization disorder who couldn't bear looking at himself in the mirror. The hypnotic intervention used in this case is then explained by predictive coding theory.

Burnout Syndrome Present in the Process of Rehabilitation in Teachers at the Primary Level

The purpose of this research work is to determine the Burnout Syndrome present in the rehabilitation process in teachers at the primary level after the Covid-19 pandemic in Mexico, being a quantitative, cross-sectional, analytical study and its universe. It was made up of basic level teachers, a sociodemographic questionnaire was applied, teachers were evaluated with a self-application instrument on organizational climate, mental health and finally fatigue. Where it was found that 85% that teachers notice alterations and refers to the fact that they are usually noticed in a different, strange or uncomfortable way in difference with other colleagues, it is important to point out the manifestations of apathy that exist among co-workers given the labor characteristics, these sensations continue to appear continuously or never completely disappear. Teachers are affected by their ability to function, in any of their personal and social roles, and they may be considered to suffer from depersonalization-derealization disorder. It is important to point out that they manifest a feeling of not being able to control their movements or that they simply feel like a robot, having little coordination when doing exercises with the students and also that it manifests itself in communication with other teachers. They manifest having emotional and physical numbness in response to living with the world around them. Fear of the social environment under normal characteristics causes emotional exhaustion, a high level of stress and poor mental health, which is why 80% of teachers at the time of the study are considered to have Bournout syndrome.

An Experimental Study of Subliminal Self-Face Processing in Depersonalization-Derealization Disorder.

The self-perception or self-experience of patients with depersonalization/derealization disorder (DPD) is altered, leading to a profound disruption in self-awareness. The main aim of the study is to explore the characteristics of subliminal self-face processing in DPD patients. To our knowledge, this is the first experimental study that has measured and evaluated subliminal self-processing in DPD. To better understand this, we examined the ability of patients with DPD and healthy controls (HC) to identify pictures of faces using an experimental paradigm of breaking continuous flash suppression. There were 23 DPD outpatients from Beijing Anding Hospital, Capital Medical University and 23 matched HC who participated in this experiment. The time needed for a face to break into awareness was taken as the measure of participants' subliminal processing of that face. The results indicated that there were significant differences between the DPD patients and HC in subliminal reaction times to different faces. Under experimental conditions, the average reaction response of self-face recognition in the HC group was significantly faster than for a famous face. However, this difference was not observed in DPD patients, which means that DPD patients did not show the processing advantage of their own faces as did the HC. The results suggest a deficit in subliminal self-face processing in DPD.

An exploration of the antecedents and mechanisms causing athletes’ stress and twisties symptom

Research backgroundTwisties symptoms have attracted the world's attention in the sports field since the 2020 Tokyo Olympics. AimHowever, studies on the symptoms and causes, inducing mechanisms, and relationships between DP/DR (Depersonalization/Derealization Disorder) and anxiety and depression for athletes have been sparse for both the general population and athletes. The literature on the twisties issue of athletes is quite scarce in the past. Research methodAdopting the criteria appealing to PRISMA Items to review the subject twisties in a broader mode and combing with the IPO (Input-Process-Output) model for triangulation testing purpose, this study categorized the literature to explore input variables causing athletes’ twisties and identified process variables in psychological mechanisms bridging suppression and finally discussed the existing possible ways in helping athletes to solve problems caused by twisties. ResultsThe authors formed 6 propositions in summarizing twisties' influential factors and mechanisms and tried to propose solutions to reduce the stress and the relevant twisties symptom of athletes. (1) Promotion of Athletes' Mental Toughness to Resist Stressors. (2) Interventions that correct for cognitive misinterpretations and appropriate relaxation and mindfulness practice in correcting a range of attention might reduce DP/DR. (3) Monitoring the athlete's HRV test results to ensure the Athlete's ability to resist pressure. (4) Avoid organizational stressors. (5) Written Emotional Disclosure method. (6) Improve various support systems for athletes: dual career paths. (7) Athletes' Stressful Awareness about the impact of gender, seniority, and environment. ConclusionThrough the theoretical dialogue on the symptom of twisties, this study helps promote the development of the research of “twisties” and depersonalization-derealization symptoms (DDS); both have been under-researched.

Embodying the (Dis)embodiment: Narrating Depersonalization-Derealization Disorder.

Depersonalization-Derealization Disorder is an under-researched condition that is often left out of the larger discourse surrounding mental health and mental illness. This autoethnography examines the material and discursive tensions that are a product of my experience with Depersonalization-Derealization Disorder. In this critical self-exploration, I use communication privacy management theory, communication theory of resilience, and stigma management communication theory to unpack the communicative negotiations that accompany my disembodied experience, with the overarching goal of spreading awareness about Depersonalization-Derealization Disorder to help others make sense of their own diagnosis.

Potential Targets for Noninvasive Brain Stimulation on Depersonalization-Derealization Disorder.

Introduction: Non-invasive brain stimulation seems to be beneficial for DPD patients. However, the sites used in previous studies were empirical. Exploring new stimulation locations via functional magnetic resonance imaging may improve the efficacy. Objectives: The objective was to find potential locations for non-invasive brain stimulation on the depersonalization-derealization disorder. Methods: We explored the potential brain surface regions from three pipelines: pipeline 1: activation likelihood estimation meta-analysis (five studies with 36 foci included); pipeline 2: functional connectivity analysis based on DPD-network (76 subjects included); and pipeline 3: functional connectivity analysis based on DPD regions of interest from the meta-analysis. Potential targets were the 10–20 system coordinates for brain surface regions. Results: We identified several potential brain surface regions, including the bilateral medial prefrontal cortex, dorsal lateral prefrontal cortex, superior parietal gyrus, superior temporal gyrus, and right ventrolateral prefrontal cortex as potential sites. Conclusion: Our findings of the potential stimulation targets might help clinicians optimize the application of non-invasive brain stimulation therapy in individuals with DPD.

Assessing responsiveness to direct verbal suggestions in depersonalization-derealization disorder

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.

White matter abnormalities in first-episode patients with depersonalization/derealization disorder: A tract-based spatial statistics study

BackgroundNeuroimaging studies on depersonalization / derealization disorder (DPD) have revealed that there are structural and functional alterations across numerous brain regions. However, to date, the exact white matter abnormalities that are associated with different clinical symptoms and cognitive impairments in first-episode, drug-naïve patients with DPD remain unclear. MethodsOverall, 25 first-episode, drug-naïve patients with DPD and 23 healthy controls were recruited and underwent DTI scans. The tract-based spatial statistics analysis was conducted in order to determine white matter microstructural changes between the two groups. Correlation analysis was conducted between the fractional anisotropy (FA) of abnormal WM fibers and the total score of the 30-item Cambridge Depersonalization Scale (CDS-30), cognitive assessments. ResultsPatients with DPD demonstrated higher FA in the right corpus callosum (CC), and posterior corona radiate (CR), compared to healthy controls. The FA in the right CC demonstrated a positive correlation with total score of CDS-30, numbing, unreality of self, perceptual alterations, and temporal disintegration, respectively. FA in the right CR region indicated a positive correlation with the total score of CDS-30, unreality of self, perceptual alterations, and temporal disintegration, respectively. Furthermore, FA in the right CR region was found to be negatively correlated with the Continuous Performance Test and the Stroop color-word test. ConclusionThe altered white matter microstructure and cognitive impairments of medication naïve DPD patients were observed. Abnormalities in the integrity of CC and CR were associated with severity of symptoms and cognitive impairments, which may provide a potential biomarker for clinical studies on DPD.

ON THE DIFFICULTIES IN THE DIFFERENTIAL DIAGNOSIS BETWEEN PRIMARY DEPERSONALIZATION-DEREALIZATION DISORDER AND SCHIZOTYPAL DISORDER

Purpose. In this article, we want to show to the reader (both with the thorough literature review, and with presentation of two clinical cases from our own practice), what might be the objective difficulties in differential diagnosis between primary depersonalization-derealization disorder (DPD, code 6B66 according to ICD-11, F48.1 according to ICD-10) and schizotypal disorder (STD, code 6A22 according to ICD-11, F21 according to ICD-10), what may be the cause of these difficulties, and how can a psychiatrist still distinguish between these disorders in his everyday clinical practice.
 Methodology. First, we turned to well-known and scientifically respectable DPD monographs, in particular to the Daphne Simeon’s book «Feeling Unreal: Depersonalization Disorder and the Loss of the Self» and to the Maurizio Sierra’s book «Depersonalization: A New Look at a Neglected Syndrome», and to similarly respected monographs on STD, in particular «Schizotypy: New dimensions» by Oliver Mason and Gordon Claridge, and «Schizotypal Personality» by Adrian Reine, as well as to the relevant sources which were cited by these authors in respective chapters of their books.
 Then we searched for other relevant articles on the topic of interest, with the use of keywords such as «depersonalization disorder», «schizotypal disorder», «differential diagnosis», in the international scientific databases PubMed, Google Scholar, Web of Science, Elsevier ScienceDirect, Elsevier ClinicalKey.
 The literature data we have found were then analyzed, summarized and presented in this article, together with a thorough description and clinical and psychopathological analysis of two clinical cases from our own practice.
 Results. The data we have obtained while writing this literature review, as well as our own clinical experience, presented there in the form of a thorough description of two cases from our own practice, in our opinion, convincingly indicate that the differential diagnosis between primary DPD and STD is sometimes difficult. Nevertheless, such differential diagnosis is not only possible, but also necessary. In the field of psychiatry, making the correct diagnosis is also of great practical importance for choosing the correct strategy and tactics of treatment, both psychopharmacological and psychotherapeutic.
 Our data also convincingly indicate that, unfortunately, in Russia and post-Soviet countries, overdiagnosis of STE is extremely common in cases where the patient actually has primary DPD, or depersonalization-derealization syndrome (DP/DR syndrome) within the clinical picture of some other mental disorder (usually from an anxiety disorders spectrum or from affective disorders spectrum), as well as a misunderstanding of what the DP/DR syndrome is, what are the typical symptoms and phenomenology of it, together with underestimation of its importance in the overall clinical picture of any given mental disease, underestimation of the importance of specific measures to eliminate the DP/DR syndrome in a given patient, and insufficient ability of specialists to diagnose and treat this devastating syndrome. In light of this, we believe that the material presented in this article is of particular relevance and importance for Russian and other post-Soviet countries’ psychiatrists.
 Practical implications. In our opinion, the results we have presented in this review deserve the widest possible application in psychiatry.

Differentiated Learning in the Context of Immersive Technologies

This article includes a literature review about the impact of fully immersive virtual reality experiences on a students’ well-being, focusing on side effects such as cybersickness and depersonalization-derealization disorder. The purpose of this article is to emphasize the importance of some aspects of pedagogical work, in case of using virtual reality technology, such as the importance of educators being informed about the reasons why a student may not want to use virtual reality technology, significance of ability to understand student’s reactions during virtual reality experience, the possibility to offer alternatives and find the best solutions, so student can have the most positive and safe virtual reality learning experience. Therefore, this article raises the question of the need for a differentiated learning in the context of extended reality technologies in school education, identifying several possible alternatives such as desktop virtual reality and augmented reality to fully immersive virtual reality.

I Am Not All the Way Here

I Am Not All the Way Here

Repetitive transcranial magnetic stimulation in depersonalization-derealization disorder – a review

Repetitive transcranial magnetic stimulation in depersonalization-derealization disorder – a review

Mindfulness-Based Cognitive Therapy in Depersonalization-Derealization disorder: A Case Report

Mindfulness-Based Cognitive Therapy in Depersonalization-Derealization disorder: A Case Report

Effectiveness of a Constructive Model of Variables related to Depersonalization- Derealization Disorder of University Students

The aims of this study were to identify the correlation between Depersonalization - Derealization Disorder (DPDR), anxiety, depression, and obsessive-compulsive disorders and to propose a constructive model of anxiety, depression and obsessive- compulsive disorders related to Depersonalization Derealization Disorder of university students. The sample consisted of 344 students (325 female and 19 male), with a mean age of (24.4) years. The study applied the following scales: structured clinical interview for depersonalization-derealization spectrum, Cambridge Depersonalization Scale, Generalised anxiety scale (GAD-7), Hamilton Depression Rating Scale and Maudsley Obsessional–Compulsive Inventory. Results indicated that obsessive-compulsive disorder and depression played a major role in developing DPDR due to a significant positive effect of these disorders, while anxiety had a weak correlation. The study developed a constructive model of variables related to DPDR based on AMOS software. The results illustrated that the contribution of obsessive-compulsive and depression as independent variables in predicting PDRD was 61.8 and 44.9, respectively, while no effect of anxiety was recorded. The findings also developed a model for the causal relationships between anxiety, depression, and obsessive-compulsive influence on DPDR disorder. The results of the causal model test indicated that the obsessive-compulsive variable is hypothesized to be a mediator in influencing the DPDR disorder as it is affected by both anxiety and depression.