Daphne Simeon

Icahn School of Medicine at Mount Sinai | MSSM · Department of Psychiatry

Depersonalization/derealization (dpdr) is known to occur across mood and anxiety disorders (MAD) and has been proposed as a marker of worse illness. However, despite the well-known clinical association, there are no epidemiological data on the relationship between dpdr and MAD. In this NCS-R analysis clinically significant dpdr (DPDR-C) was defined...

There exists some evidence for a link between dissociation and emotionally avoidant information processing, yet studies to date have been contradictory. Our goal was to investigate emotionally avoidant processing in Depersonalization Disorder (DDD) using a directed forgetting (DF) paradigm. Thirty-two participants with DSM-IV DDD and 40 healthy con...

The Multidimensional Inventory of Dissociation (MID) was administered to 23 participants diagnosed with DSM-IV-TR Depersonalization Disorder (DDD) by structured interview. The MID has not been previously examined in DDD and does not generate a diagnostic formula for the disorder. Mean MID score for the sample was modestly elevated at 18.54, and was...

We investigated cognition in depersonalization-spectrum dissociative disorders without comorbid posttraumatic stress disorder to explore evidence for emotionally avoidant information processing. Forty-eight participants with DSM-IV dissociative disorder (DD) (Depersonalization Disorder - 37, Dissociative Disorder NOS -11), 36 participants with Post...

Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathologic...

The disorders in this chapter share the feature of impulse dyscontrol. Individuals who experience such dyscontrol are overwhelmed by the urge to commit certain acts that are often apparently illogical or harmful. Included in the chapter are Intermittent Explosive Disorder (IED) (failure to resist aggressive impulses), Kleptomania (failure to resist...

Emotional stimuli draw attention to such an extent that they hamper the processing of subsequent signals, a phenomenon termed emotion-induced blindness (EIB). As depersonalization is associated with self-reported attenuated emotional responses, the present study explored whether individuals scoring high on the Cambridge Depersonalization Scale (CDS...

Background: 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. Methods: This paper review...

Oxytocin has known stress-reducing and attachment-enhancing effects. We thus hypothesized that oxytocin would attenuate emotional and hormonal responses to stress in borderline personality disorder (BPD). Fourteen BPD and 13 healthy control (HC) adults received 40 IU intranasal oxytocin or placebo in double-blind randomized order followed by the Tr...

Abstract Objectives. Pathological gambling (PG) is an impulse control disorder characterized by recurrent gambling thoughts and behaviours that impair social functioning. Earlier studies suggested that topiramate may be effective in treating some impulse control disorders. We conducted the first randomized, controlled trial of topiramate in PG. Met...

This is the first clinical trial of repetitive Transcranial Magnetic Stimulation (rTMS) in depersonalization disorder (DPD). After 3weeks of right temporo-parietal junction (TPJ) rTMS, 6/12 patients responded. Five responders received 3 more weeks of right TPJ rTMS showing 68% DPD symptoms improvement. Right TPJ rTMS was safe and effective.

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, phenomenolog...

Little is known about the potentially unique sources of distress in populations seeking family-oriented treatment for bipolar disorder. The present study aimed to characterize this new treatment population by measuring depression, anxiety, quality of life, knowledge of bipolar disorder, therapeutic alliance, and mental illness stigma in 43 bipolar...

We investigated the effects of intranasal oxytocin (OXT) on trust and cooperation in borderline personality disorder (BPD), a disorder marked by interpersonal instability and difficulties with cooperation. Although studies in healthy adults show that intranasal OXT increases trust, individuals with BPD may show an altered response to exogenous OXT...

Depersonalization: A New Look at a Neglected Syndrome. By SierraM.. (Pp. 182; $90.00; ISBN-13: 9780521874984 hb.) Cambridge University Press: New York. 2009. - Volume 40 Issue 10 - DAPHNE SIMEON

In our reply we query Richard Chefetz's view that what happens in the privacy of one's family and emotional system precedes the intrusion of the State and cultural discourse. From our perspective, many seemingly private fragmented states of mind are actually reflective of the ideology of the State. Using Hartman's vignette, we demonstrate how compe...

Depersonalization is the experience of profound estrangement and alienation from Self and Reality. Although highly prevalent in our postmodern world, the syndrome of depersonalization has been systematically understudied, misdiagnosed, and unsuccessfully treated. In this paper we summarize our theoretical conclusions after a decade-long empirical s...

It is often assumed that when confronted with an emotional event, patients with DPD inhibit information processing. It is also thought that this fosters memory fragmentation. This hypothesis has not been tested in chronic depersonalization. The aim of this study was to investigate the temporal pattern of autonomic responding to emotional material i...

The research planning agenda for DSM-V examined possible similarities in phenomenology, comorbidity, familial and genetic features, brain circuitry, and treatment response between obsessive-compulsive disorder (OCD) and several related disorders that are characterized by repetitive thoughts or behaviors. Such data support a re-examination of the DS...

Depersonalization disorder (DPD) is characterized by a subjective sense of detachment from one's own being and a sense of unreality. An examination of the psychobiology of depersonalization symptoms may be useful in understanding the cognitive-affective neuroscience of embodiment. DPD may be mediated by neurocircuitry and neurotransmitters involved...

Alexithymia, absorption, and cognitive failures are traits that have been implicated in dissociative psychopathology. Forty-six participants with depersonalization disorder (DPD), 21 with posttraumatic stress disorder, and 35 healthy controls completed measures of dissociation, alexithymia, absorption, cognitive failures, and childhood trauma. The...

The thrust of biological research in psychiatry has generally followed the classic approach which aims at identifying biochemical differences between individuals who make up one diagnostic group and either normal controls or patients from another diagnostic group (e.g. schizophrenia vs. normal controls or schizophrenia vs. depression). The focus of...

Phenomenology of depersonalization and schizotypyNeurocognitive profiles of depersonalization and schizotypyNeurobiology of depersonalization and schizotypyClinical vignettesConclusion References

Previous studies have documented that in a substantial minority of individuals with depersonalization disorder, onset is first triggered by illicit drug ingestion. The goal of this study was to systematically compare a large sample of individuals with drug-initiated (D) versus non-drug-initiated (ND) chronic depersonalization. We conducted an inter...

The presence of obsessive-compulsive symptoms (OCS) or obsessive-compulsive disorder (OCD) is common in patients with schizophrenia. The impact of OCS and OCD on severity of psychotic symptoms has been assessed in several past studies yielding inconclusive results. In this report, we aim to integrate the findings of prior studies by means of a syst...

Objective: The presence of obsessive-compulsive symptoms (OCS) or obsessive-compulsive disorder (OCD) is common in patients with schizophrenia. The impact of OCS and OCD on severity of psychotic symptoms has been assessed in several past studies yielding inconclusive results. In this report, we aim to integrate the findings of prior studies by mean...

Nine months on average after the World Trade Center (WTC) attack, 21 highly exposed adults and 10 healthy controls without major exposure did not differ in cortisol and physiologic measures. Dissociation and posttraumatic stress symptoms were quantified in the exposed group. Dissociation was associated with greater peritraumatic dissociation and, m...

The impulse-control disorders (intermittent explosive disorder, kleptomania, pyromania, pathological gambling, and trichotillomania) share the feature of the irresistible urge to act in a given way. Effort to resist may be associated with rising tension, giving rise to further need to act on the given impulse. This chapter reviews clinical features...

Recently in 2006, a group of experts in obsessive compulsive disorder (OCD) and obsessive compulsive-related disorders (OCRDs) convened in Washington, DC, to review existing data on the relationships between these various disorders, and to suggest approaches to address the gaps in our knowledge, in preparation for the upcoming Diagnostic and Statis...

The present study examined how acute dissociation, trait-like dissociative symptoms, and physiological reactivity relate to each other. Sixty-nine undergraduate students were exposed to 14 aversive auditory probes, while their skin conductance responses were measured. A combination of self-reported anxiety and trait-like dissociation was found to p...

Body dysmorphic disorder (BDD), a preoccupation with imagined ugliness, is a disabling condition that seems to respond preferentially to selective serotonin reuptake inhibitors. This open-label trial examines venlafaxine's efficacy in BDD and is the first known study of this serotonin-norepinephrine reuptake inhibitor in BDD. A total of 17 BDD pati...

Along with psychoform dissociation, somatoform dissociation has been put forth as a core aspect of dissociative states, possibly as reliable as psychoform dissociation in the screening for dissociative disorders. The goal of this study was to investigate the prominence and correlates of somatoform dissociation in one of the major Diagnostic and Sta...

Depersonalization disorder is defined in the DSM-IV-TR using a single symptom criterion, which does not do justice to the phenomenological complexity of the disorder. In 394 affected adults, the Cambridge Depersonalization Scale yielded five factors (numbing, unreality of self, perceptual alterations, unreality of surroundings, and temporal disinte...

Depersonalization disorder (DPD) is a dissociative disorder characterized by a subjective sense of unreality and detachment, and has been associated with deficits in perception and short-term memory. In this study, 21 DPD and 17 healthy comparison participants free of psychiatric disorders were administered a comprehensive neuropsychologic battery....

Mature defenses comprise one well-validated indicator of resilience. We investigated the relationships of resilience to trauma, attachment, temperament, cortisol, and cognitive performance in adult healthy volunteers. Participants were administered the Defense Style Questionnaire; the Relationship Questionnaire; the Childhood Trauma Questionnaire,...

Borderline personality disorder (BPD) is associated with several symptoms, including impulsivity, aggression, and intense unstable affect, which can be targeted with anticonvulsant agents. Divalproex extended-release (ER) is used widely in clinical practice, which leads to the question of its efficacy and tolerability in treating BPD. This study as...

This study investigated basal and stress-induced hypothalamic-pituitary-adrenal (HPA)-axis alterations in dissociative disorders (DDs). Forty-six subjects with DD without lifetime post-traumatic stress disorder (PTSD), 35 subjects with PTSD, and 58 healthy comparison (HC) subjects, free of current major depression, were studied as inpatients. After...

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Distortions of the experience of time are central to some types of dissociative experiences. In this study, we investigated the relationship between a self-report measure of temporal disintegration and symptoms of dissociation in depersonalization disorder (DPD). Fifty-two DPD and thirty non-clinical control participants were administered the Disso...

The goal of the current study was to investigate subjective and neurohormonal reactivity to acute psychosocial stress in borderline personality disorder (BPD) as a function of dissociative symptoms. Five BPD subjects with high dissociation, 8 BPD subjects with low dissociation, and 11 healthy control subjects were compared in basal urinary cortisol...

Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a...

We conducted a 1-year follow-up of an original mail survey of early reactions to the World Trade Center disaster. Of the 75 subjects originally surveyed, 58 (77%) responded. The survey included measures of dissociation (Dissociative Experiences Scale, Cambridge Depersonalization Scale, Clinician-Administered Dissociative States Scale), post-traumat...

The relationship between dissociation and psychosis-proneness remains controversial to this day. We investigated this relationship in Depersonalization Disorder, a primary dissociative disorder, hypothesizing that the constructs of schizotypy and dissociation would be distinguishable. Forty-eight depersonalization disorder (DPD) and 22 healthy comp...

Despite anecdotal reports that serotonin reuptake inhibitors may improve depersonalisation, there is no proven efficacious treatment for depersonalisation disorder. To investigate the efficacy of fluoxetine in the treatment of depersonalisation disorder. Fifty-four people who met DSM-IV criteria for depersonalisation disorder were recruited through...

Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1: 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personalit...

Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1 : 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personali...

In recent years, the pathologic dissociation taxon developed by Waller, Putnam, and Carlson (Psychological Methods 1:300-321, 1996) from a Dissociative Identity Disorder (DID) sample has been increasingly used in studies of dissociation in general. However, the taxon's convergence with dissociative diagnoses other than DID, as well as the taxon's c...

In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy compariso...

Dissociation is a prominent feature in some individuals with borderline personality disorder (BPD), yet our understanding of the meanings and implications of prominent dissociation in BPD remains limited. The purpose of this study was to investigate the relationship between dissociation and childhood trauma in BPD and to explore the relationships o...

The World Trade Center disaster was of unprecedented magnitude and impact in U.S. history. The authors conducted a pilot survey investigating these effects. A questionnaire regarding the disaster was sent to responders to an advertisement. It included demographic and disaster-exposure questions and three scales applied to "during and shortly after"...

Despite a surge of interest and literature on depersonalization disorder in recent years, a large series of individuals with the disorder has not been described to date. In this report, we systematically elucidate the phenomenology, precipitants, antecedents, comorbidity, and treatment history in such a series. 117 adult subjects with depersonaliza...

In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy compariso...

The purpose of this study was to investigate temperamental, psychodynamic, and cognitive factors associated with dissociation. Fifty-three subjects with DSM-IV-defined depersonalization disorder and 22 healthy comparison subjects were administered the Dissociative Experiences Scale, the Tridimensional Personality Questionnaire, the Defense Style Qu...

Although trichotillomania and pathological skin-picking are both characterized by repetitive self-injurious stereotypic behaviors, the former is classified as an impulse control disorder, while the latter is not given a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) [APA, 1994]. There are, ho...

Background: The purpose of this preliminary study was to investigate HPA axis function in dissociation. Methods: Nine subjects with DSM-IV depersonalization disorder (DPD), without lifetime Posttraumatic Stress Disorder (PTSD) or current major depression, were compared to nine healthy comparison (HC) subjects of comparable age and gender. Resul...

In contrast to trauma's relationship with the other dissociative disorders, the relationship of trauma to depersonalization disorder is unknown. The purpose of this study was to systematically investigate the role of childhood interpersonal trauma in depersonalization disorder. Forty-nine subjects with DSM-IV depersonalization disorder and 26 healt...

Our aim was to develop a clinician-rated scale assessing depersonalization severity for use in clinical trials of Depersonalization Disorder and trauma-related disorders in general. The 6-item Depersonalization Severity Scale (DSS) was administered to 63 participants with DSM-IV Depersonalization Disorder as diagnosed by the SCID-D, and its psychom...

The phenomenon of people physically hurting themselves is heterogeneous in nature, disturbing in its impact on the self and others, frightening in its blatant maladaptiveness, and often indicative of serious developmental disturbances, breaks with reality, or deficits in the regulation of affects, aggressive impulses, or self states. Further compli...

Reviews several central, psychodynamically informed approaches to impulsive self-injury in nonpsychotic or developmentally disabled people. Although behavior is multidimensional, for the sake of clarity these approaches are discussed separately. The stated goal of the authors is to inform clinicians of the main conceptualizations of self-injury in...

The goal of this study was to assess brain glucose metabolism and its relationship to dissociation measures and clinical symptoms in DSM-IV depersonalization disorder. Positron emission tomography scans coregistered with magnetic resonance images of eight subjects with depersonalization disorder were compared to those of 24 healthy comparison subje...

Subtle neurologic impairment has been reported in several mental disorders. The goals of the present study were to evaluate neurologic status in patients of both sexes with chronic posttraumatic stress disorder (PTSD) from different traumatic experiences. Twenty-one adult women who were sexually abused as children (12 with PTSD, 9 without) and 38 m...

Depersonalization disorder is characterized by a detachment from one's sense of self and one's surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. Fifteen...

Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled treatment stu...

Background Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled t...

Although there is a dire paucity of data on the pharmacologic treatment of depersonalization disorder, there have been a few reports in the literature suggesting that selective serotonin reuptake inhibitors may be of therapeutic benefit. In this study, we undertook to evaluate the efficacy of the potent serotonin reuptake inhibitor clomipramine in...

Depersonalization disorder comprises one of the four major dissociative disorders and yet remains poorly studied. There are no reports describing the application of dissociation scales to this population. Our goal was to investigate the applicability of four such scales to depersonalization disorder and to establish screening criteria for the disor...

Eighteen patients with social phobia, 21 normal control subjects, and 42 obsessive-compulsive disorder (OCD) control subjects were challenged with single doses of the partial serotonin agonist oral m-chlorophenylpiperazine (m-CPP) and placebo. Social phobics did not significantly differ from normal or OCD control subjects in prolactin response to m...

In contrast to the recent surge of interest in other dissociative disorders, DSM-III-R depersonalization disorder has not been thoroughly investigated and characterized. The authors systematically elucidated its phenomenology, comorbidity, traumatic antecedents, and treatment history. Thirty adult subjects (19 women and 11 men) were consecutively r...

Our objective was to determine the efficacy of fluoxetine in the treatment of pathologic skin picking in a double-blind, placebo-controlled, parallel trial. Twenty-one adults with chronic pathologic skin picking agreed to participate and received 10 weeks of placebo or fluoxetine with a flexible dosing schedule up to 80 mg/day. Three skin-picking m...

Administration of m-chlorophenyl-piperazine (m-CPP), a partial serotonin agonist, may lead to acute exacerbation of symptoms of obsessive-compulsive disorder (OCD), whereas administration of the alpha-2 adrenergic agonist, clonidine, may be followed by an acute decrease in symptoms. We studied behavioural response of 11 patients with trichotilloman...

We have previously found that a subgroup of patients with impulsive personality disorders respond to m-chlorophenylpiperazine (m-CPP) administration with a distinctive spacy/high behavioral reaction and with increased cortisol responses. In this report we analyzed the relationship between behavioral and neuroendocrine responses to m-CPP in an enlar...

Specificity of neuropsychological dysfunction in obsessive-compulsive disorder (OCD) was assessed by comparing neuropsychological performance in 65 OCD patients, 17 social phobic patients, and 32 normal control subjects. Although both patient groups showed visual constructional impairment relative to normal subjects, only patients with social phobi...

Target symptoms in pharmacotherapy of borderline personality disorder include mood instability, anxiety, and impulsivity. Valproate appears useful for the treatment of these target symptoms in several disorders, and carbamazepine has been found effective for such symptoms in borderline personality disorder. We therefore conducted a preliminary open...

Sixty-seven subjects, including normal volunteers and patients with obsessive-compulsive disorder, social phobia, and borderline personality disorder, received ratings of depersonalization after double-blind, placebo-controlled challenges with the partial serotonin agonist meta-chlorophenylpiperazine (m-CPP). Challenge with m-CPP induced depersonal...

This study investigated the prevalence and phenomenology of body dysmorphic disorder in patients with obsessive-compulsive disorder. The authors studied 442 patients who participated in the DSM-IV field trial for obsessive-compulsive disorder. Twelve percent (N = 51) of the patients had a lifetime comorbid diagnosis of body dysmorphic disorder. Pat...

Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population. Surveys addressing clinical profile, comor...