Symptoms Of Derealization Research Articles

Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms

BackgroundThe aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences. MethodsIn a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions. ResultsIn line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences. LimitationsOur study is limited to these two habitual emotion regulation strategies employing a cross sectional design. ConclusionOur findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.

Assessing the structure and meaningfulness of the dissociative subtype of PTSD

PurposeStudies conducted in the USA, Canada and Denmark have supported the existence of the dissociative PTSD subtype, characterized primarily by symptoms of depersonalization and derealization. The current study aimed to examine the dissociative PTSD subtype in an Eastern European, predominantly female (83.16%) sample, using an extended set of dissociative symptoms.MethodsA latent profile analysis was applied to the PTSD and dissociation data from 689 trauma-exposed university students from Slovakia.ResultsFour latent profiles of varying PTSD and dissociation symptomatology were uncovered. They were named non-symptomatic, moderate PTSD, high PTSD and dissociative PTSD. The dissociative PTSD profile showed elevations on depersonalization and derealization, but also the alternative dissociative indicators of gaps in awareness and memory, sensory misperceptions and cognitive and behavioural re-experiencing. The core PTSD symptoms of ‘memory impairment’ and ‘reckless or self-destructive behaviour’ were also significantly elevated in the dissociative PTSD profile. Moreover, anxiety and anger predicted membership in the dissociative PTSD profile.ConclusionThe results provide support for the proposal that the dissociative PTSD subtype can be characterized by a variety of dissociative symptoms.

Derealization during utricular stimulation.

Feelings of unreality have been provoked in healthy subjects undergoing stimulation of the semicircular canals, but no studies have assessed the influence of otoliths stimulation on depersonalization/derealization (DD) symptoms. To assess DD symptoms during unilateral centrifugation in healthy adults. 100 subjects participated in the study. They completed a standardized questionnaire of symptoms related to balance (Jáuregui-Renaud 2003), the 17-item Hamilton Depression Rating Scale, the Zung Instrument for Anxiety Disorders and the Cox & Swinson 28-item DD inventory. After unilateral centrifugation (300°/s at 3.5 cm), subjects completed the DD inventory again. Centrifugation provoked symptoms which subjects denied ever experiencing before. The items most frequently reported were "Body feels strange or different in some way" (56%) and "Time seems to pass very slowly" (55%). The DD total score was related to the score of symptoms related to balance and to the depression inventory with no influence from the general characteristics of the subjects or the responses to vestibular tests. The individual scores of symptoms of vestibular function and derealization were related to the report of the other DD symptoms. In healthy subjects, unilateral centrifugation provokes DD symptoms. The results support that distorted vestibular signals may create a misleading frame of reference which mismatch with the other senses, giving rise to 'unreal' perceptions.

FMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype.

BackgroundPosttraumatic stress disorder (PTSD) is associated with hyperarousal and active fight or flight defensive responses. By contrast, the dissociative subtype of PTSD, characterized by depersonalization and derealization symptoms, is frequently accompanied by additional passive or submissive defensive responses associated with autonomic blunting. Here, the periaqueductal gray (PAG) plays a central role in defensive responses, where the dorsolateral (DL‐PAG) and ventrolateral PAG (VL‐PAG) are thought to mediate active and passive defensive responses, respectively.MethodsWe examined PAG subregion (dorsolateral and ventrolateral) resting‐state functional connectivity in three groups: PTSD patients without the dissociative subtype (n = 60); PTSD patients with the dissociative subtype (n = 37); and healthy controls (n = 40) using a seed‐based approach via PickAtlas and SPM12.ResultsAll PTSD patients showed extensive DL‐ and VL‐PAG functional connectivity at rest with areas associated with emotional reactivity and defensive action as compared to controls (n = 40). Although all PTSD patients demonstrated DL‐PAG functional connectivity with areas associated with initiation of active coping strategies and hyperarousal (e.g., dorsal anterior cingulate; anterior insula), only dissociative PTSD patients exhibited greater VL‐PAG functional connectivity with brain regions linked to passive coping strategies and increased levels of depersonalization (e.g., temporoparietal junction; rolandic operculum).ConclusionsThese findings suggest greater defensive posturing in PTSD patients even at rest and demonstrate that those with the dissociative subtype show unique patterns of PAG functional connectivity when compared to those without the subtype. Taken together, these findings represent an important first step toward identifying neural and behavioral targets for therapeutic interventions that address defensive strategies in trauma‐related disorders.

Dissociative features in posttraumatic stress disorder: A latent profile analysis.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes the dissociative subtype of posttraumatic stress disorder (PTSD) in terms of the individual meeting the criteria for PTSD and additionally reporting symptoms of depersonalization and/or derealization. The current study aimed to examine whether a dissociative PTSD profile may include alternative features of dissociation and whether it could be differentiated from a nondissociative PTSD profile on certain psychopathologies and demographics. Data from 309 trauma-exposed participants, collected through Amazon Mechanical Turk, were subjected to latent profile analysis. Regression analyses were used to examine the predictors of latent classes. Three discrete profiles named Baseline, PTSD, and Dissociative profile were uncovered. All examined features of dissociation were significantly elevated in the Dissociative profile. Anxiety, male sex, being employed, and having a minority racial background significantly predicted the Dissociative profile relative to the PTSD profile. The study points to the importance of alternative symptoms of dissociation in the dissociative PTSD subtype beyond the symptoms of depersonalization and derealization. (PsycINFO Database Record

Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood.

The symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders - especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews. Assessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization. The coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO "0" Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders. In the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mother's anger in the situation of the patient's disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt. The symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events - difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.

The Development of Novel Interoceptive Exposure Methods for Inducing Derealization and Depersonalization Symptoms.

Derealization and depersonalization and are commonly experienced by individuals with panic disorder. Although interoceptive exposure (IE) is a key therapeutic component in the treatment of panic disorder, there currently are few recognized ways to elicit reactions that successfully mimic dissociative symptoms commonly experienced during panic. We examined the ability of several novel methods that elicit anomalous and confusing perceptual experiences to induce at least moderately intense dissociative reactions in a college student sample (N = 34). Two of the novel procedures (i.e., stripes and hand) and a task previously identified as effectively eliciting dissociative symptoms, strobe light plus three-dimensional (3D) glasses reliably induced derealization/depersonalization reactions. The implications of these findings for further research and the clinical practice of IE in treatment of panic attacks are discussed.

The Dissociative Subtype of PTSD Scale: Initial Evaluation in a National Sample of Trauma-Exposed Veterans.

The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.

Structural brain aberrations associated with the dissociative subtype of post-traumatic stress disorder.

One factor potentially contributing to the heterogeneity of previous results on structural grey matter alterations in adult participants suffering from post-traumatic stress disorder (PTSD) is the varying levels of dissociative symptomatology. The aim of this study was therefore to test whether the recently defined dissociative subtype of PTSD characterized by symptoms of depersonalization and derealization is characterized by specific differences in volumetric brain morphology. Whole-brain MRI data were acquired for 59 patients with PTSD. Voxel-based morphometry was carried out to test for group differences between patients classified as belonging (n = 15) vs. not belonging (n = 44) to the dissociative subtype of PTSD. The correlation between dissociation (depersonalization/derealization) severity and grey matter volume was computed. Patients with PTSD classified as belonging to the dissociative subtype exhibited greater grey matter volume in the right precentral and fusiform gyri as well as less volume in the right inferior temporal gyrus. Greater dissociation severity was associated with greater volume in the right middle frontal gyrus. The results of this first whole-brain investigation of specific grey matter volume in dissociative subtype PTSD indentified structural aberrations in regions subserving the processing and regulation of emotional arousal. These might constitute characteristic biomarkers for the dissociative subtype PTSD.

Dissociation and posttraumatic stress disorder: a latent profile analysis.

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, ) contains a dissociative subtype for posttraumatic stress disorder (PTSD) characterized by significant depersonalization and derealization. In this study the PTSD dissociative subtype was examined using latent profile analysis in a sample of 541 trauma-exposed college students. Items from the PTSD Checklist and Multiscale Dissociation Inventory were used as latent class indicators. Results supported a 3-class solution including a well-adjusted class, a PTSD class, and a PTSD/dissociative class characterized by elevated symptoms of PTSD, depersonalization, and derealization. Significant class differences were found on a number of measures of related psychopathology with Cohen's d effect size estimates ranging from 0.04 to 1.86. Diagnostic and treatment implications regarding the dissociative subtype are discussed.

Anxiety changes depersonalization and derealization symptoms in vestibular patients.

Background. Depersonalization and derealization are common symptoms reported in the general population. Objective. The aim of the present study was to establish the relationship between anxiety and depersonalization and derealization symptoms in patients with peripheral vestibular disorders. Methods. Twenty-four vestibular patients with anxiety and 18 vestibular patients without anxiety were examined for depersonalization and derealization symptoms. They were also compared to healthy controls. Results. The results revealed that anxiety consistently changes depersonalization and derealization symptoms in vestibular patients. They are more frequent, more severe, and qualitatively different in vestibular patients with anxiety than in those without anxiety. Conclusion. Anxiety has an effect on depersonalization and derealization symptoms in vestibular patients. The various hypotheses about the underlying mechanism of this effect were discussed.

In‐situation safety behaviors among patients with panic disorder: Descriptive and correlational study

In-situation safety behaviors play an important role in the maintenance of anxiety because they prevent patients from experiencing unambiguous disconfirmation of their unrealistic beliefs about feared catastrophes. Strategies for identifying particular safety behaviors, however, have not been sufficiently investigated. The aims of the present study were to (i) develop a comprehensive list of safety behaviors seen in panic disorder and to examine their frequency; and (ii) correlate the safety behaviors with panic attack symptoms, agoraphobic situations and treatment response. The subjects consisted of 46 consecutive patients who participated in group cognitive behavioral treatment (CBT) for panic disorder. All the patients completed a Safety Behavior List that was developed based on experiences with panic disorder patients. Carrying medications, distracting attention, carrying a plastic bottle, and drinking water were reported by more than half of the patients. The strongest correlations between panic symptoms and safety behaviors were found between symptoms of derealization and listening to music with headphones, paresthesia and pushing a cart while shopping, and nausea and squatting down. The strongest association between agoraphobic situations and safety behaviors was found between the fear of taking a bus or a train alone and moving around. Staying still predicted response to the CBT program, while concentrating on something predicted lack of response. An approximate guideline has been developed for identifying safety behaviors among patients with panic disorder and should help clinicians use CBT more effectively for these patients.

2321 – Derealization due to dextroamphetamine: a rare side effect which could cause premature discontinuation of treatment

Dextroamphetamine is one of the main medications for treating ADHD. It may cause several psychiatric side effects including hallucinations. As far as we know there is no previous report of clear derealization. In this report we present a 6 years old female patient with proved impression of ADHD. Her symptoms subsided with 10 mg/day Dextroamphetamine. A few months later she refused taking medication. She complained of feeling objects and persons are different and horrible way. Symptoms disappeared when the drug shifted to Ritalin. We present her history, describing symptoms of derealization and reflections of drug side effect in her drawings. We also discusses the role of side effects of Dextroamphetamine in poor compliance.

Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys

Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries.

THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS

Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype. The relevant literature pertaining to the dissociative subtype of PTSD was reviewed. Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD. We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.

P-198 - The relationship between affective temperament and recognition of facial emotions expression with depersonalization and derealization symptoms in a sample of bipolar eutimic patients

The aim of our study is to evaluate, in a sample of bipolar (BD) eutimic patients, the association between depersonalization symptoms, facial emotions expression recognition and affective temperament. 95 bipolar eutimic patients (YMRS< 6 and HDRS< 8), are assessed with: SCID-P, TEMPS, SCI-DER 1 e POFA (test of recognitionof facial emotions expression by Ekman e Friesen). Throught a regression analysis we underline that, independently to panic disorder, the ipertimic temperament is associated with: major recognition of happiness (p < 0.001; β = -4,483) and minor recognition of anger (p = 0.005; β = 3,202) in BD patients with high scores in autopsychic depersonalization domain; major recognition of sadness (p = 0.001; β = -3,944) and minor recognition of anger (p = 0.005; β = 3,181) in BD patients with high scores in affective depersonalization domain. Moreover, the cyclotimic temperament is associated with: major recognition of surprise (p = 0.004; β = -3,233) and happiness (p = 0.044; β = -2,124) in BD patients with high scores in Derealization (DER-TOT); major recognition of surprise (p = 0.001; β = -3,792) and happiness (p = 0.018; β = -2,532) in BD patients with high scores in somatopsychic depersonalization domain. The presence of depersonalization and derealization symptoms is associated with a selective deficit in the recognition of several emotions. In bipolar patients this selective deficit is dependent of type of affective temperament. Further research is warranted to replicate our clinical observation.

P-145 - Association between depersonalization and panic disorder in a sample of patients with anxiety disorders and mood

Introduction There is a strong association between depersonalization (DP) and panic disorder (PD), as documented by Roth (1960) and later by Cassano (1989) 1 . In the PD is shown a prevalence of 7.8% to 82.6% from the DP. The aim of our study was to evaluate the association between depersonalization symptoms and PD in a sample of patients with anxiety disorders and mood. Method a sample of 310 patiens was assessed with: SCID-P for axis I diagnosis and SCI-DER (structured clinical interview for depersonalization and derealization symptoms, lifetime version) 2 . Results Through a linear regression analysis we underline that, the presence of depersonalization symptoms, irrespective of age, gender and mood disorder, is significantly associated with the PD diagnosis (total score SCI-DER Tot p=0.001; derealization p=0.001; somatopsychic depersonalization p=0.001; autopsychic depersonalization p=0.003; affective depersonalization p=0.047). Conclusion the presence of depersonalization symptoms must carefully assess in clinical setting and suggest the presence of panic disorder.

Dissociative disorders in DSM-5

We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

Dissociative disorders in DSM-5

We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.

Epileptic seizures and spirit possession in Haitian culture: Report of four cases and review of the literature

Epileptic seizures have historically been associated with religious beliefs in spirit possession. These attitudes and misconceptions about epilepsy still flourish in developing countries as byproducts of specific sociocultural environments. This article presents a case series of four Haitian patients with epilepsy whose seizures were initially attributed to Voodoo spirit possession. All patients reported ictal experiential phenomena (epigastric aura, ictal fear, depersonalization, and derealization symptoms) followed by complete loss of consciousness. Electroclinical investigations revealed a temporal lobe focus. We review the existing literature on attitudes toward seizures within the Haitian culture and discuss the link between religion and epilepsy, highlighting the possible detrimental influence of specific traditional belief systems on the appropriate diagnosis and treatment of patients with epilepsy.