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Abstract

Symptoms of depersonalisation (DP) and derealisation (DR) are increasingly recognised in both clinical and non-clinical settings, but their importance and underlying pathophysiology is only now being addressed. This paper is a systematic review of the current state of knowledge about the prevalence of depersonalisation and derealisation using computerised databases and citation searches. All potential studies were examined and numerical data included. Three categories of study are reviewed: questionnaire and interview surveys of selected student and non-clinical samples; population-based community surveys using standardised diagnostic interviews; and clinical surveys of depersonalisation/derealisation symptoms occurring within inpatients with psychiatric disorders. In addition, we present newly analysed data of the prevalence of depersonalisation/derealisation from five large population-based studies. Epidemiological surveys demonstrate that transient symptoms of depersonalisation/derealisation in the general population are common, with a lifetime prevalence rate of between 26 and 74% and between 31 and 66% at the time of a traumatic event. Community surveys employing standardised diagnostic interviews reveal rates of between 1.2 and 1.7 % for one month prevalence in a UK sample and a 2.4% current prevalence rate in a Canadian sample. Current prevalence rates in samples of consecutive inpatient admissions are reported between 1 and 16%, although screening measures employed may have resulted in these being an underestimate. Prevalence rates in clinical samples of specific psychiatric disorders vary between 30% of war veterans with PTSD and 60% of those with unipolar depression. There is a high prevalence within panic disorder with rates varying from 7.8 to 82.6%. DP and DR symptoms are common in normal and psychiatric populations, but prevalence estimates are hampered by inconsistent definitions and the use of variable time-frames. Population-based surveys using diagnostic interviews yield prevalence rates of clinically significant DP/DR in the region of 1-2%. Surveys of clinical populations in which common screening and assessment instruments were used also yield consistently high prevalence rates. The use of reliable diagnostic assessments and rating scales is needed. The relationship between DP/DR and certain other psychiatric disorders (e. g. panic) suggests possible common pathophysiological or aetiological factors.

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... Patients with derealisation disorder have an overall experience of the external environment as not real, as well documented in psychiatry and psychopatology (Hunter et al., 2004;Parnas and Sass 2001;Sacco, 2010;Aderibigbe et al., 2001;Shorvon et al., 1946;Lambert et al., 2002;Sierra & David, 2011;Simeon, 2004;Reed and Sedman 1964). This is clear on both the phenomenological (DSM-5; Oyebode, 2008, p. 245) and the neuro-computational side (Seth et al. 2012;Dewe et al., 2018). ...
... More precisely, it seems that those patients lack the strong and common experience that the external world is something 'standing on its own', in its solid existence and externality. This world does not manifest its clear independence (DSM-5;Oyebode, 2008;Hunter et al., 2004;Parnas and Sass 2001;Sacco, 2010;Aderibigbe et al., 2001;Shorvon et al., 1946;Lambert et al., 2002;Sierra & David, 2011;Simeon, 2004). Thus, reality here seems to refer to mind-independence. ...
... This perfectly complements with the fact that derealized patients can also be healthy, perceptually speaking. This is indeed confirmed, except for those few mentions of perceptual problems (which, however, as we saw, may actually be at the level of reports, not perception per se), from the literature on derealization (DSM-5; Hunter et al., 2004;Dokic & Martin, 2015;Seth et al. 2012;Parnas and Sass 2001;Sacco, 2010;Aderibigbe et al., 2001;Shorvon et al., 1946;Lambert et al., 2002;Sierra & David, 2011;Simeon, 2004;Ratcliffe, 2008;Deroy and Rappe 2022). ...
Article
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The present paper offers an analysis of derealization disorder, a disorder in which the experience of reality is altered. In this respect, usually, real objects are experienced as mind-independent and as offering motoric interaction. These two features seem to be responsible for our experience of objects in quality of real objects. Then, a crucial question is the following: what aspect of the experience of reality is derealization, in quality of a disorder of reality, about? This paper suggests that, in the case of derealization, what is disrupted is the experience of mind-independence, but not the experience of possibility for motor interaction. By doing so, however, the paper also suggests something important on the relation between these two experiences, namely, that they can be, contra any alleged, very general intuition, disjointed, as the case of derealization shows.
... V průběhu námi sledovaného období došlo u souboru sledovaných dětí a adolescentů ke zvyšování výskytu disociativních poruch se statisticky významným trendem (p = 0,021). Za rizikový faktor pro rozvoj disociativní poruchy je považováno zejména období dětství nebo adolescence (20), což plně odpovídá našim výsledkům, neboť v námi sledovaném souboru byly děti a adolescenti ve věku 3-19 let, průměrný věk byl 9,4 let. Mezi rizikovými faktory disociativní poruchy je uváděno ženské pohlaví, anamnéza traumatu, emočního, tělesného, sexuálního zneužívání, zanedbávání či týrání (20). ...
... Za rizikový faktor pro rozvoj disociativní poruchy je považováno zejména období dětství nebo adolescence (20), což plně odpovídá našim výsledkům, neboť v námi sledovaném souboru byly děti a adolescenti ve věku 3-19 let, průměrný věk byl 9,4 let. Mezi rizikovými faktory disociativní poruchy je uváděno ženské pohlaví, anamnéza traumatu, emočního, tělesného, sexuálního zneužívání, zanedbávání či týrání (20). To potvrzují výsledky naší studie, kdy za celé sledované období byl v našem souboru zjištěn velmi vysoký průměrný podíl dětí s traumatem, a to 83,3 %. ...
... (3,4,9). Disociační poruchy u dětí mají mnoho příčin a na jejich vzniku se velmi často podílí specifická rodinná a výchovná konstelace v dětství, kdy děti byly vychovávány v ponižujícím a emočně odmítavém prostředí, což u nich vedlo k emoční frustraci a traumatizaci (20). Také byl v námi sledovaném souboru zjištěn vysoký počet dětí, které byly vychovávány pouze jedním z rodičů, výchova dítěte pouze matkou byla v našem souboru zjištěna u 65,2 % dětí, případně výchova mimo domov v našem souboru byla v průměru u 32,9 % dětí. ...
Article
44 HYGIENA § 2024 § 69(2) § 44-49 PŮVODNÍ PRÁCE SOUHRN Cíl: V současné době je problematika poruch duševního zdraví u dětí v centru pozornosti, také v souvislosti s plnými kapacita-mi psychiatrických ambulancí pro děti a dorost, ale také adiktologických ambulancí a dětských psychiatrických klinik. V souvislos-ti s předpoklady zhoršujícího se psychického stavu dětí byla provedena retrospektivní studie za účelem vyhodnocení situace v ob-dobí let 2016-2022. Cílem výzkumu bylo zhodnocení vývoje stavu duševního zdraví u dětských klientů adiktologické ambulance se zaměřením na identifikaci rizikových faktorů ovlivňujících výskyt disociačních poruch a traumat u sledovaných dětí v souvislos-ti se závislostním chováním v letech 2016-2022. Metody: V období 2016-2022 byla ve spolupráci s rodiči a dětskými psychiatry každoročně získána anamnestická data od 30 vybraných klientů adiktologické ambulance pro děti a dorost. Respondenti zařazení do studie byli vybráni metodou náhodného výběru ze všech klientů ambulance v daném roce. Za celé sledované období se tedy jednalo o 210 respondentů. Získaná data byla statisticky zpracována a vyhodnocena, k testu trendu byl použitý model lineární regrese a pro vícerozměrnou analýzu vlivu faktorů na výskyt disociované poruchy a závislostního chování na internetu (IAD) u dětí byla použita logistická regrese. Poměr šancí (OR) byl použit jako ukazatel míry asociace kategoriálních proměnných. Testováno bylo na hladině významnosti 0,05. Výsledky: Děti, u kterých bylo diagnostikováno psychiatrické onemocnění v dětství a psychiatrická zátěž v anamnéze rodičů, pro-kazují významný koeficient rizika pro výskyt disociativní poruchy. U dětí s rizikovým faktorem psychiatrické anamnézy bylo 6,3ná-sobně zvýšené riziko výskytu disociativní poruchy ve srovnání s dětmi bez psychiatrické anamnézy. Statisticky významný faktor nejvíce spojený s rizikem výskytu IAD je užívání nelegálních návykových látek. Děti, které užívaly nelegální návykové látky, včet-ně problematického užívání psychofarmak, měly 15,1násobné zvýšení rizika výskytu IAD ve srovnání s dětmi, které nelegální ná-vykové látky neužívaly. Významné zvýšení rizika nastává u chlapců, u dětí s traumatem v dětství, s poruchami chování a ADHD (attention deficit hyperactivity disorder-porucha pozornosti s hyperaktivitou). Závěr: Ke změně lze přispět v úzké spolupráci odborníků z oborů dětské psychiatrie, psychologie, adiktologie a psychoterapie, ale zejména spoluprací s rodiči v rámci rodinné terapie. 1 Univerzita Karlova, 1. lékařská fakulta a VFN, Adiktologická ambulance pro děti a dorost, Praha, Česká republika 2 Univerzita obrany, Vojenská lékařská fakulta, Hradec Králové, Česká republika 3 Státní zdravotní ústav, Oddělení biostatistiky, Praha, Česká republika 4 Univerzita Karlova, 3. lékařská fakulta, Ústav epidemiologie a biostatistiky, Praha, Česká republika 5 Vysoká škola zdravotnická, Praha, Česká republika 6 Univerzita Karlova, Fakulta humanitních studií, Praha, Česká republika SUMMARY Aim: Mental health disorders in children have recently been drawing an increasing amount of attention, also in connection with the full capacities of psychiatric outpatient clinics for children and adolescents, as well as addiction outpatient clinics and children's psychiatric clinics. In line with assumptions that the mental state of children deteriorates, a retrospective study was conducted to evaluate the situation from 2016 to 2022. The aim of the research was to evaluate the state of mental health of child clients of the addiction clinic with a focus on the identification of risk factors influencing the occurrence of dissociation disorders in monitored children in connection with addictive behaviour and development in the years 2016-2022. Methods: During the period from 2016 to 2022, in cooperation with parents and child psychiatrists, anamnestic data were obtained annually from 30 selected clients of the addiction clinic for children and adolescents. Respondents included in the study were selected by random sampling from all clinic clients in a given year. For the entire monitored period, there were 210 respondents. The collected data were statistically processed and evaluated. A linear regression model was used for trend testing, and logistic regression was employed for the multivariate analysis of factors influencing the occurrence of dissociative disorder and Internet Addiction Disorder (IAD) in children. The odds ratio (OR) was used as an indicator of the association between categorical variables. The significance level was set at 0.05.
... Transient DP experiences affect between 1% and 2% of the population (Hunter et al., 2004), often associated with everyday phenomena such as fatigue, sleep deprivation, or travelling to new places (Hunter et al., 2004;Salami et al., 2020;Tibubos et al., 2018;van Heugten-van der Kloet et al., 2015). When DP symptoms become chronic and debilitating, it may indicate the presence of a clinical Depersonalisation-Derealisation Disorder (DPD) (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., DSM-IV-TR), 1 with between 0.95% and 2.4% of the general population suffering from DPD (Hunter et al., 2004;Lee et al., 2012). ...
... Transient DP experiences affect between 1% and 2% of the population (Hunter et al., 2004), often associated with everyday phenomena such as fatigue, sleep deprivation, or travelling to new places (Hunter et al., 2004;Salami et al., 2020;Tibubos et al., 2018;van Heugten-van der Kloet et al., 2015). When DP symptoms become chronic and debilitating, it may indicate the presence of a clinical Depersonalisation-Derealisation Disorder (DPD) (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., DSM-IV-TR), 1 with between 0.95% and 2.4% of the general population suffering from DPD (Hunter et al., 2004;Lee et al., 2012). ...
... Transient DP experiences affect between 1% and 2% of the population (Hunter et al., 2004), often associated with everyday phenomena such as fatigue, sleep deprivation, or travelling to new places (Hunter et al., 2004;Salami et al., 2020;Tibubos et al., 2018;van Heugten-van der Kloet et al., 2015). When DP symptoms become chronic and debilitating, it may indicate the presence of a clinical Depersonalisation-Derealisation Disorder (DPD) (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., DSM-IV-TR), 1 with between 0.95% and 2.4% of the general population suffering from DPD (Hunter et al., 2004;Lee et al., 2012). ...
Article
Perception of one's own body in time and space is a fundamental aspect of self-consciousness. It scaffolds our subjective experience of being present, in the here and now, a vital condition for our survival and well-being. Depersonalisation (DP) is characterized by a distressing feeling of being 'spaced out', detached from one's self, as well as atypical 'flat' time perception. Using an audio-tactile paradigm, we conducted a study looking at the effect of DP experiences on peripersonal space (PPS) - the space close to the body - and time perception. Strikingly, we found no difference in PPS perception in people with higher DP experiences (High DPe) versus low occurrences of DP experiences (Low DPe). To assess time perception, we used the Mental Time Travel (MTT) task measuring the individuals' capacity to take one's present as a reference point for situating personal versus general events in the past and the future. We found an overall poorer performance in locating events in time relative to their present reference point in High DPe. By contrast, Low DPe showed significant variation in performance when answering to relative past events, while High DPe did not. Our study sheds light on the close link between altered sense of self and egocentric spatiotemporal perception in individuals with DP experiences, the third most common psychological symptom in the general population.
... On the other hand, peritraumatic dissociation relates to dissociative reactions during or immediately after traumatic experiences, including: amnesia, depersonalisation and derealisation (Breh & Seidler, 2007). Between 31% and 66% of people had DepDer at the time of a traumatic event (Hunter, Sierra & David, 2004). While peritraumatic dissociation may be a risk factor for PTSD, Van der Velden and Wittmann (2008) note that similar phenomena also accompany pleasurable or sensation-seeking activities (e.g., skydiving, bungee jumping). ...
... While peritraumatic dissociation may be a risk factor for PTSD, Van der Velden and Wittmann (2008) note that similar phenomena also accompany pleasurable or sensation-seeking activities (e.g., skydiving, bungee jumping). Hunter, Sierra and David (2004) also show that between 26% and 74% of people in the general population report transient DepDer experiences. Such states can also be induced by physiological factors (e.g., fatigue) or the use of psychoactive substances such as hallucinogens or cannabinoids (Madden & Einhorn, 2018). ...
... Being a paramedic is challenging because it frequently activates physiological reactions related to threat, such as fight/flight. Interestingly, none of our participants mentioned having freeze reactions, which are modulated partly by the parasympathetic autonomic nervous system and may entail DepDer (Hunter, Sierra & David, 2004). This kind of reaction could interfere with task completion. ...
Article
Depersonalisation and derealisation (DepDer) are alterations in consciousness occurring in both healthy people and those with mental problems, including trauma-related disorders. Depersonalisation relates to emotional detachment or numbing and distorted bodily sensations. Derealisation is associated with experiencing the environment as unreal or strange. This qualitative study explores these phenomena occurring during rescue operations by paramedics. Eight women participated in in-depth interviews which were transcribed and subjected to interpretative phenomenological analysis, leading to identifying seven salient themes: 1) Getting excited and alert before rescue operations, 2) Running on autopilot under stress, 3) Filtering out stimuli to avoid distraction, 4) Agitation affects the perception of time, 5) Abreactions when detachment fades, 6) Selective memory about the course of events, and 7) Dealing with loss. Results show that DepDer were functional during emergency actions. Further research is necessary into normal and pathological forms of DepDer, and examining them in terms of state and trait.
... 11 DPDR disorder can be precipitated by factors such as traumatic experiences, depression, severe stress, or drug use 5 and it is estimated that about 1-2 percent of the population may suffer a clinical manifestation of these symptoms. 12 However, a much larger proportion of the population (estimated between 26 and 74 percent) experience some of these symptoms momentarily and transiently at some point in their lives. 12 The present approach focuses on these momentary DPDR symptoms as potentially resulting from prolonged VR use, rather than on DPDR as a chronic dissociative mental disorder. ...
... 12 However, a much larger proportion of the population (estimated between 26 and 74 percent) experience some of these symptoms momentarily and transiently at some point in their lives. 12 The present approach focuses on these momentary DPDR symptoms as potentially resulting from prolonged VR use, rather than on DPDR as a chronic dissociative mental disorder. ...
... This effect may also be moderated by the individual characteristics of the users. 7 In particular, because younger individuals seem to be more prone to experience DPDR, 12,19 VR use might lead to experiencing DPDR symptoms more easily (i.e., after fewer hours of use) among younger individuals than among older adults. Thus, we expect: H1: The amount of time spent using VR over the last 6 months is positively correlated with the presence of DPDR symptoms in the same period. ...
Article
Previous research shows that virtual reality (VR) users may experience symptoms of depersonalization/derealization (DPDR) immediately after use. However, the impact of long-term VR use on these symptoms has not been analyzed so far. In a preregistered study, we conducted an online survey among a bigger sample of VR users (N = 754) to investigate the relationship between time of use during the past 6 months and the presence of DPDR symptoms. The results support the absence of a linear association between time of VR use and the presence of symptoms, when controlling for other factors. DPDR symptoms are more frequent among younger female users and in those who experience higher levels of embodiment during use. Secondary analyses show that symptoms are more common among newer users and among those who engage in longer sessions. These findings suggest that current common VR experiences are not a cause of long-term DPDR symptoms for the majority of users, yet also encourage further research about specific cases where VR use might trigger DPDR experiences in the long term.
... Despite its high lifetime prevalence in the general population, the phenomenon of depersonalization/derealization has received relatively little attention in psychiatric research. Epidemiological studies indicate that between 26% and 74% of individuals experience short-term symptoms of depersonalization/derealization at some point in their lives (Hunter et al. 2004). ...
... However, due to under-recognition by medical and mental health professionals, DDD often remains untreated for an extended period. On average, it takes 7-12 years to receive a correct diagnosis of DDD (Hunter et al. 2004;Medford et al. 2003). Once diagnosed, DPDR typically shows poor response to pharmacotherapy (Simeon et al. 2000(Simeon et al. , 2004. ...
... Depersonalisation Derealisation Disorder (DDD) is a distressing mental health condition where a person has a profound sense of disconnection and unreality about themselves and/or the world [1]. Systematic reviews estimate the prevalence of DDD in community surveys at around 1%, which is similar to rates of schizophrenia and obsessive-compulsive disorder [2][3][4]. The prevalence of DDD amongst mental health service users is higher at approximately 20%, usually in combination with other disorders [3,4]. ...
... Systematic reviews estimate the prevalence of DDD in community surveys at around 1%, which is similar to rates of schizophrenia and obsessive-compulsive disorder [2][3][4]. The prevalence of DDD amongst mental health service users is higher at approximately 20%, usually in combination with other disorders [3,4]. However, there is a gap between true prevalence rate and clinical diagnosis; chronic under-diagnosis of DDD, often coming after delays of several years, has contributed to the widely held, but erroneous, assumption that DDD is rare [5]. ...
Article
Full-text available
Background Depersonalisation-Derealisation Disorder (DDD) is a distressing mental health condition which causes individuals to have a sense of ‘unreality’ or detachment about themselves and/or the world around them. DDD is chronically under-researched, and as a result, under-diagnosed, with a population prevalence of about 1%. In systematic reviews, Cognitive Behavioural Therapy (CBT) has been found to be the only intervention with significant clinical impact on alleviating the symptoms of DDD. However, previous studies have suffered from small sample sizes, reliance on expert clinicians to provide therapy and narrow population demographics. This feasibility randomised controlled trial aims to provide more robust evidence for the treatment efficacy of CBT in DDD. Methods The study aims to recruit 40 participants from two NHS trusts, 20 per arm from two community Mental Health NHS services in London. The intervention group will receive 12–24 individual CBT sessions over a 6-month period from CBT therapists following specialist training for DDD. The control group will receive Treatment as Usual. We will assess the feasibility of a future RCT through measuring the acceptability of the intervention, and assessing our ability to recruit, retain and randomise participants. We will calculate the correlation of scores on the Cambridge Depersonalisation Scale, its baseline standard deviation, assess the magnitude/direction of change and characterise the uncertainty in the outcome scores and the probability that the results have been obtained by chance. Discussion The outputs of this trial will guide whether a definite RCT is feasible and acceptable, for both the clinician and participant. Trial registration The ISRCTN registration number is ISRCTN97686121(https://doi.org/10.1186/ISRCTN97686121).
... These states generally describe periods of time in which there is a change in attention such that the usual mechanisms for self-monitoring are temporarily and reversibly disrupted. In fact, lifetime symptoms of depersonalization and derealization have been reported in ranges of 26-70% in the general population [14]. This is consistent with the idea that some level of dissociation is part of normal human experience. ...
... This is consistent with the idea that some level of dissociation is part of normal human experience. More commonly, dissociative experiences are seen in the peri-traumatic period and are thought to represent a normal response to trauma [14]. Nijenhuis et al. proposed two categories of dissociation: "psychoform dissociation" and "somatoform dissociation" [15]. ...
Article
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
... DDD is primarily characterized by symptoms of depersonalization and derealization (DD), which may manifest as disruptions in self-awareness, feelings of detachment and disembodiment, and a sense of unreality from both the self and the outside world [13]. Transient, short-lived experiences of DD are relatively common in the general population, with an estimated prevalence of 23% [13], and can occur as a result of fatigue, substance abuse, or trauma [14]. Chronic DDD affects approximately 1% of the population [14,15] but remains widely unknown and underdiagnosed. ...
... Transient, short-lived experiences of DD are relatively common in the general population, with an estimated prevalence of 23% [13], and can occur as a result of fatigue, substance abuse, or trauma [14]. Chronic DDD affects approximately 1% of the population [14,15] but remains widely unknown and underdiagnosed. A core feature of DDD is the experience of physiological numbing and feelings of disembodiment [16]. ...
Article
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Background: Depersonalization-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 methods: We 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. Results: At 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. Conclusion: Individual 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.
... Depersonalization symptoms are common to different diagnoses, such as panic disorder (Hunter et al., 2004), depression (Soffer-Dudek, 2014), bipolar affective disorder (Mula et al., 2009) andPTSD (van Huijstee &Vermetten, 2018). ...
Article
Full-text available
This study aimed to a) discuss the neurobiological mechanisms of depersonalization as arising from activation at the brainstem level and b) assess the effectiveness of deep brain reorienting psychotherapy (DBR) with a patient presenting with depersonalization-derealization disorder (DDD). In the first part of the paper, we discuss verbal abuse as a severe form of relational trauma and how it can be connected to depersonalization. It is argued that suddenly aversive experiences engage the brainstem locus coeruleus in widespread noradrenergic activation of the thalamus and cortex such that the balance of functioning within the cortex becomes disturbed and a subjective experience of chronic depersonalization results. In the second part, the single-case study aims to provide initial evidence of how the patient experienced and responded to DBR therapy. Pre- and post-treatment measures consisted of instruments to measure depersonalization, social anxiety symptoms and quality of life. After 43 DBR sessions, the participant's depersonalization and comorbid symptoms decreased significantly. Patients with DDD may benefit from DBR. Future research is required to address generalizability to a larger population.
... It has been reported that, in people who present unipolar depression, the symptom of associated depersonalization is more strong compared to healthy controls, and there is also a favorable correlation between depersonalization and depression (Gago-Valiente et al., 2021, 2022Maslach & Jackson, 1998). These damages may not be discrete categories, and they could have common biological bases and be at least segment of a continuous spectrum or a spectrum of affective illnesses (Hunter et al., 2004). These findings were observed in the present study, where the contributors with positive GHQ-12 also represented higher proportions of affectation in emotional exhaustion and depersonalization. ...
Article
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As medical staff, orderlies are at danger of showing negative signs of psychological health. They are exposed to many stresses that may have a negative impact on their personal lives, and they have also been subjected to the difficult condition of COVID-19 in their workplace. However, since they are not considered to be medical professionals, very few studies and interventions are focused on them. The aim of the present research was to detect the interactions among the work and family environments, as well as to analyze self-perceived mental health and burnout in people who worked as orderlies during the pandemic in public healthcare centers in Huelva (Spain), considering a set of sociodemographic variables. The field work was conducted between April and June 2020. Systematic random sampling was carried out. Information from 84 contributors was gathered through the SWING, MBI-HSS, and GHQ-12 forms. Univariate and bivariate analyzes and correlation tests were carried out. The data were analyzed and correlations were established. The majority of the participants obtained a negative interaction result of work over family. Those who had had contact with SARS-CoV-2 situations presented greater proportions of positive outcome in GHQ-12, bad work-family interaction, burnout, emotional exhaustion, and depersonalization. The men presented a worse general mental health state than the women. Orderlies of Huelva who have had contact with COVID-19 in their workplace present worse indicators of psychological health and greater negative interaction of work over family than those who have not had any contact with these circumstances.
... This phenomenon can be described on a continuum, ranging from chronic, clinical form (depersonalization/derealization disorder), to transient episodes. Short-term experiences of depersonalization are mostly triggered by fatigue, anxiety, substance abuse, stress (18), or artificial induction (19) and are considered universal in the general population (20). Depersonalization appears in order to preserve adaptive behaviors (21) and allows to put off emotions and feelings that are too difficult to cope with and, therefore, tolerate the circumstances one is in (22). ...
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Background The clinical form of depersonalization affects approximately 1%–2% of the adult population. This study aimed to describe the symptoms of depersonalization in a non-clinical sample and to operationalize depersonalization as a regulatory mechanism. This article introduces the Depersonalization Mechanism Scale, 41-item measure developed to assess one’s tendency for depersonalization in response to overstimulation. The aim of the study is to explore how depersonalization mechanism is associated with cognitive and behavioral emotion regulation strategies, depression, and anxiety. Method The study included a sample of 300 Polish adults (149 men) from the general population, ranging in age from 18 to 60. Participants were administered the following questionnaires: Depersonalization Mechanism Scale (DMS), Behavioral Emotion Regulation Questionnaire (BERQ), Cognitive Emotion Regulation Questionnaire (CERQ), Occupational Depression Inventory (ODI), Patient Health Questionnaire (PHQ), and Trait Anxiety Scale (SL-C). Results An exploratory factor analysis revealed a two-factor structure of Depersonalization Mechanism Scale, with very high reliability coefficients for both subscales and full scale. A regression analysis revealed that depersonalization mechanism is a significant predictor of depressive symptoms. Depersonalization mechanism is strongly correlated with maladaptive regulation strategies such as withdrawal, ignoring, rumination, catastrophizing, self-blame, and blaming others. Weaker but significant connections were identified with certain adaptive strategies: acceptance, positive refocusing, putting into perspective, and seeking social support. Women were more prone to depersonalization than men. Conclusions Further research on depersonalization in non-clinical samples may improve understanding of this mechanism in the general population. This knowledge, combined with greater education about non-clinical forms of depersonalization, may support preventive programs against depression and professional assistance for people facing acute or chronic stressful life events.
... The total score (between 0 and 290) points is calculated by summing over all items. CDS-29 has good statistical properties [12][13][14][15][16][17] with internal reliability for different language versions reported between 0.89 and 0.94 (Cronbach alpha). Moreover, previous research extracted four subscales from CDS-29 11 : (i) Anomalous Body Experience, (ii) Emotional Numbing, (iii) Anomalous Subjective Recall, and (iv) Alienation from Surroundings. ...
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The sense of agency, the feeling of controlling one’s bodily actions and the world is altered in Depersonalisation (DP), a condition that makes people feel detached from one’s self and body. To investigate the link between depersonalisation and both implicit and explicit sense of agency, an online study was conducted using the influential Intentional Binding paradigm in a sample of non-clinical DP participants. The results did not reveal significant differences between individuals with low and high occurrences of DP experiences on the implicit and explicit sense of agency. However, participants with high occurrences of DP experiences showed a more time-sensitive explicit sense of agency and greater temporal distortions for short intervals in the absence of self-initiated motion. These results suggest that there is a discrepancy between implicit and explicit sense of agency in people with high levels of depersonalisation. Altogether, these findings call for further investigations of the key role of time perception on altered sense of self and agency in both non-clinical and clinical populations, to disentangle the mechanisms associated with the explicit and implicit sense of agency.
... The total score (between 0 and 290) points is calculated by summing over all items. CDS-29 has good statistical properties [12][13][14][15][16][17] with internal reliability for different language versions reported between 0.89 and 0.94 (Cronbach alpha). Moreover, previous research extracted four subscales from CDS-29 11 : (i) Anomalous Body Experience, (ii) Emotional Numbing, (iii) Anomalous Subjective Recall, and (iv) Alienation from Surroundings. ...
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The sense of agency, i.e. the subjective feeling of voluntarily controlling one’s bodily actions is profoundly altered in Depersonalisation (DP henceforth), a condition that makes people feel detached from one’s self and body. The intentional binding (IB henceforth) effect has been proposed as an influential implicit measure of the sense of agency. IB refers to the phenomenon of perceived temporal compression between a voluntary action and its subsequent consequence. To examine the link between DP and the sense of agency in non-clinical population, an online study was conducted, combining the IB task as an implicit measure of the sense of agency with self-reports measuring the explicit sense of agency. Our study found no significant differences between individuals with low and high occurrences of DP experiences with regards to implicit sense of agency. However, a trend for participants with higher occurences of DP experiences to display a steeper slope, i.e. a more time-sensitive explicit sense of agency was observed. Specifically, whilst temporal estimations were significantly different for short intervals in the Baseline condition for the High and Low DP groups, this difference was not significant in the Operant condition, suggesting that action might “help” DP participants with high scores to experience the same temporality with participants scoring lower on the depersonalization scale.
... The phenomena are characterized by feeling detached or disconnected from the self or environment and can occur from mild to severe pathological states. DP/DR symptoms have a high prevalence of 30-80% in various mental disorders [1][2][3][4]. Populationbased surveys reported prevalence rates for clinically significant symptoms of DP/DR varying between 11.9% in a large student sample with a mean age of around 16 years [5] and 0.8% in a large population-based community sample with a mean age of 55 ± 10 years [6]. ...
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Background Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. Methods The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. Results There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. Conclusions The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.
... Participants with higher DP traits (as measured by CDS-total score) will report that they trust internal bodily signals less while awake Yes r = − 0.52 1b Participants with higher DP traits will report that they notice internal bodily signals less while awake No r = − 0.08 2a Participants with higher DP traits will report that they have more dream experiences from an outside observer perspective Yes r = 0.28 2b Participants with higher DP traits will report that they are less aware of the presence (or absence) of their body in dreams No r = 0.02 2c Participants with higher DP traits will report that they have more dream experiences of distinct bodily sensations Yes r = 0.23 2d Participants with higher DP traits will report that they have more dream experiences of alterations in bodily perception Yes r = 0.24 3 Participants with higher DP traits will report that the boundaries of their body are more permeable while awake Yes r = − 0.31 4 Participants with higher DP traits will report that their sense of self is more separate from others while awake No r = − 0.01 5 Participants with higher DP traits will report more frequent nightmares Yes r = 0.33 6 Participants with higher DP traits will report more frequent dream recall Yes r = 0.17 www.nature.com/scientificreports/ show a significant negative association between CDS scores and the interoception measure MAIA-2 subscale 'Trusting' (r = − 0.52) (Fig. 7). ...
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Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one’s body. We conducted an online study in healthy participants (n=514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a ‘spared space’ where people can temporarily ‘retrieve’ their sense of self and sense of bodily presence. We found that higher DP traits - i.e. higher scores on the Cambridge Depersonalisation Scale (CDS) - were associated with more frequent dream experiences from an outside observer perspective (r = .28) and more frequent dream experiences of distinct bodily sensations (r = .23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = .24), more frequent nightmares (r = .33) and higher dream recall (r = .17). CDS scores were negatively correlated with body boundary scores (r = -.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r = -.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation -derealisation disorder).
... These findings underscore the significance of recognizing and addressing dissociative symptoms in patients with PD, particularly those with a history of trauma. It is important to note that while dissociative disorders have a distinct diagnostic category, dissociative symptoms are common across various psychiatric conditions [25,52]. This study underlines that dissociative symptoms are not confined to a single diagnostic group but can influence the clinical course of various psychiatric disorders. ...
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Background: Patients with panic disorder (PD) may experience increased vulnerability to dissociative and anxious phenomena in the presence of repeated traumatic events, and these may be risk factors for the development of complex post-traumatic stress disorder (cPTSD). The present study aims to find out whether the presence of cPTSD exacerbates anxiety symptoms in patients suffering from panic disorder and whether this is specifically associated with the occurrence of dissociative symptoms. Methods: One-hundred-and-seventy-three patients diagnosed with PD were recruited and divided into two groups based on the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ) scale. Dissociative and anxious symptoms were assessed using the Cambridge Depersonalization Scale (CDS) and Hamilton Anxiety Scale (HAM-A), respectively. Results: Significant differences in re-experienced PTSD (p < 0.001), PTSD avoidance (p < 0.001), PTSD hyperarousal (p < 0.001), and DSO dysregulation (p < 0.001) were found between the cPTSD-positive and cPTSD-negative groups. A statistically significant association between the presence of cPTSD and total scores on the HAM-A (p < 0.001) and CDS (p < 0.001) scales was found using regression analysis. Conclusions: This study highlights the potential link between dissociative symptoms and a more severe clinical course of anxiety-related conditions in patients with PD. Early intervention programs and prevention strategies are needed.
... In a psychopharmacological context, depersonalization is an "alteration in the perception or experience of the self" (Dell and O'Neil, 2009) and is accompanied by symptoms of bodily detachment, emotional numbing, feelings of estrangement and detachment from personal memories, and the feeling that the external world looks unreal (Sierra et al., 2005). Transient instances of depersonalization are common, even in a general population, with stress as a primary trigger (Hunter et al., 2004). Though depersonalization is treated as a deleterious symptom in a clinical context, depersonalization is common and in fact pursued as part of psychedelic (Griffiths et al., 2006;Carhart-Harris et al., 2021) and meditative practice (Dahl et al., 2015). ...
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Common mental health pathologies such as depression, anxiety, addiction, and PTSD have recently seen treatment inroads. These issues share a phenomenological core—a dissociative quality that involves the disintegration of self and other. Interestingly, some of the most effective treatments of these pathologies are themselvesacutely dissociative. For example, psychedelic therapy has been effective at treating these pathologies and involves highly dissociative altered states. This pattern holds across other dissociative methods such as hypnosis, CBT, and meditation, leading some to hypothesize that there is a common pathway from acutely altered states to long-term treatment of conditions that involve pathological dissociation. Among the proposed mechanisms are pivotal mental states, the entropic brain, REBUS, and pattern breaking. In this paper, I highlight the methods and mechanisms behind the observed clinical efficacy in treating pathologically dissociative mental health issues. I also propose a simplified underlying structure and an experimental approach that could result in effective treatment without complicated pharmacological interventions.
... While the prevalence of clinical dissociative disorders is relatively low, between 1.2 and 2.4%, these experiences commonly occur in individuals with other psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) (Şar, 2014). Additionally, up to 74% of the general population experiences transient symptoms of depersonalization or derealization in their lifetime (Hunter et al., 2004). Both clinical and scientific work indicates that dissociative experiences, especially in clinical disorders, emerge from traumatic experiences (Nijenhuis et al., 1998;Şar, 2014). ...
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Objective Dissociation is a conscious state characterized by alterations in sensation and perception and is thought to arise from traumatic life experiences. Previous research has demonstrated that individuals with high levels of dissociation show impairments in cognitive-emotional processes. Therefore, using the Competing Neurobehavioral Decisions System (CNDS) theory, we used statistical modeling to examine whether dissociative experience and trauma symptoms are independently predicted by impulsivity, risk-seeking, affective state (i.e., anxiety, depression, stress, and negative affect), and trauma history. Method In this cross-sectional study design, data were collected via Amazon Mechanical Turk from a total of n = 557 English-speaking participants in the United States. Using Qualtrics, participants answered a series of self-reported questionnaires and completed several neurocognitive tasks. Three independent multiple linear regression models were conducted to assess whether impulsivity, risk seeking, affective state, and trauma history predict depersonalization, trauma symptoms, and PTSD symptoms. Results As hypothesized, we found that depersonalization and other trauma symptoms are associated with heightened impulsivity, increased risk-seeking, impaired affective states, and a history of traumatic experiences. Conclusion We demonstrate that an imbalanced CNDS (i.e., hyperimpulsive/hypoexecutive), as evidenced by decreased future valuation, increased risk seeking, and impaired affective states, predicts heightened depersonalization and other trauma and PTSD symptomatology. This is the first time that dissociation has been connected to delay discounting (i.e., the tendency to place more value on rewards received immediately compared to farther in the future). Interventions that positively impact areas of the CNDS, such as episodic future thinking or mindfulness meditation, may be a target to help decrease dissociative symptoms.
... Like I was experiencing life in the third person" (Lofthouse, 2014quoted in Deane et al. 2020). Its symptoms are often protracted, deeply troubling for the person in question and associated with concomitant anxiety and depression (Hunter et al., 2004;Medford et al., 2005;Millman et al., 2022). ...
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Flow has been described as a state of optimal performance, experienced universally across a broad range of domains: from art to athletics, gaming to writing. However, its phenomenal characteristics can, at first glance, be puzzling. Firstly, individuals in flow supposedly report a loss of self-awareness, even though they perform in a manner which seems to evince their agency and skill. Secondly, flow states are felt to be effortless, despite the prerequisite complexity of the tasks that engender them. In this paper, we unpick these features of flow, as well as others, through the active inference framework, which posits that action and perception are forms of active Bayesian inference directed at sustained self-organisation; i.e., the minimisation of variational free energy. We propose that the phenomenology of flow is rooted in the deployment of high precision weight over i) the expected sensory consequences of action and ii) beliefs about how action will sequentially unfold. This computational mechanism thus draws the embodied cognitive system to minimise the ensuing (i.e., expected) free energy through the exploitation of the pragmatic affordances at hand. Furthermore, given the challenging dynamics the flow-inducing situation presents, attention must be wholly focussed on the unfolding task whilst counterfactual planning is restricted, leading to the attested loss of the sense of self-as-object. This involves the inhibition of both the sense of self as a temporally extended object and higher–order, meta-cognitive forms of self-conceptualisation. Nevertheless, we stress that self-awareness is not entirely lost in flow. Rather, it is pre-reflective and bodily. Our approach to bodily-action-centred phenomenology can be applied to similar facets of seemingly agentive experience beyond canonical flow states, providing insights into the mechanisms of so-called selfless experiences, embodied expertise and wellbeing.
... It is quite rare to find characters that have the experiences of a cozy, familiar belongingness either to their family or to any community in many of Murakami's books. The extreme manifestation of this defamiliarization is derealization, a dream-like state in which the world appears unfamiliar (Hunter et al., 2004). Those who experience derealization report that individuals or objects are experienced as unreal, foggy, lifeless, or visually distorted (American Psychiatric Association, 2013). ...
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Existential analyses of Murakami's fiction have dealt mostly with identity issues during adolescence and adulthood. This article presents a different existential conceptualization by examining how Yalom's four ultimate life concerns—isolation, meaninglessness, freedom, and death ─ are embodied in the life of some of Haruki Murakami's fictional protagonists. In this work, I will also bring standard diagnostic nomenclature and psychoanalytic conceptualizations into dialog with the existential tradition, by demonstrating how certain mental conditions, which are considered by clinicians as forms of psychopathology, can also be interpreted as modes of existence in an alienated reality, and as non‐conformity.
... For example, experiences of depersonalization and/or derealization (DEP/DER), are characterized by feeling detached or estranged from oneself, either one's own mental processes, body, or actions (e.g., individuals may feel as if they were located outside of their body), or from the world (e.g., objects, actions, or events may be perceived as "dreamlike" or as moving in slow-motion). The prevalence of DEP/DER disorder is estimated at 1-2%, but transient DEP/DER sensations are very common, with lifetime estimations ranging between 26 and 74% (Hunter et al., 2004). A recent, integrative theoretical account of dissociative experiences maintains that whereas early, severe, or complex traumatic stress (e.g., childhood physical or sexual abuse) may result in extreme dissociative disorders (DID, dissociative amnesia), mild-to-moderate stress may result in mild-to-moderate dissociative experiences, such as DEP/DER (Buchnik-Daniely et al., 2021;Soffer-Dudek and Somer, 2022). ...
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A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.
... In industrialized countries the prevalence of dissociative disorders varies between estimates of 2.4% [13] in the general population and 11.4% in college students samples [14]. The disorders need to be differentiated from dissociative symptoms that can occur in up to 75% of healthy adults [15]. Dissociative disorders often develop in the context of traumatic life events with a special focus on adverse childhood experiences (ACE) [16]. ...
... DP is a response to negative and stressful situations in daily life [35,36]. In this study, DP prevalence was lower than in the findings of a study among PCPs from Brazil [9]. ...
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Background and Objectives: Job burnout is prevalent among primary care providers (PCPs) in different countries, and the factors that can alleviate burnout in these countries have been explored. However, no study has addressed the prevalence and the correlates of job burnout among Togolese PCPs. Therefore, we aimed to examine the prevalence of burnout and its association with social support and psychological capital among PCPs in Togo. Material and Methods: We conducted a cross-sectional study in Togo from 5 to 17 November 2020 among 279 PCPs of 28 peripheral care units (PCUs). Participants completed the Maslach Burnout Inventory, Job Content Questionnaire, and Psychological Capital Questionnaire. Data were analyzed using the Mann–Whitney U test, Kruskal–Wallis H test, Pearson correlation analysis, and multiple linear regression. Results: We received 279 responses, out of which 37.28% experienced a high level of emotional exhaustion (EE), 13.62% had a high level of depersonalization (DP), and 19.71% experienced low levels of personal accomplishment (PA). EE had a significant negative correlation with the supervisor’s support. In contrast, self-efficacy, hope, optimism, and resilience had a significant negative correlation with DP and a significant positive correlation with PA. Furthermore, supervisors’ support significantly predicted lower levels of EE. Optimism significantly predicted lower levels of DP and higher levels of PA. Conclusions: Burnout is common among Togolese PCPs, and self-efficacy, optimism, and supervisors’ support significantly contribute to low levels of job burnout among Togolese PCPs. This study provided insight into intervention programs to prevent burnout among PCPs in Togo.
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Dissociative identity disorder is the most complex, severe, and chronic condition within the category of dissociative disorders. The core issue in dissociative identity disorder involves significant divisions and discontinuities in an individual's memory, behavior, emotions, consciousness, and identity, which typically function as a cohesive whole. These dissociative experiences lead to impairments in various psychological functions and are often accompanied by other psychological disorders. Compared to other mental health conditions, environmental factors play a more prominent role in the development of dissociative identity disorder. This is primarily because the etiology of dissociative disorders is closely linked to repeated, systematic, and traumatic experiences, particularly during childhood. Historically, dissociative identity disorder has been diagnosed late, and its association with trauma has often been overlooked. The presence of alter identities and the challenges in recognizing dissociative identity disorder have contributed to this oversight, resulting in a delay in exploring the connections between dissociative identity disorder and other diagnoses. This study aims to investigate the history, diagnostic criteria, treatment approaches, and dissociative aspects of dissociative identity disorder, as well as its relationships with other mental health disorders. Notably, dissociative identity disorder has strong associations with conditions such as post-traumatic stress disorder, schizophrenia, borderline personality disorder, somatization, eating disorders, and attention deficit hyperactivity disorder. The interplay between these diagnoses and dissociative identity disorder is examined through the lens of shared symptoms, comorbidity, etiology, and epidemiology. The delayed recognition of the diagnostic and therapeutic protocols for dissociative identity disorder and the consequent neglect of its relationship with other disorders in the literature underscore the significance of this study. By highlighting these connections, we can enhance our understanding and improve the treatment of individuals affected by dissociative identity disorder and its comorbid conditions.
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This study explores the relationship between depersonalization symptoms, social touch seeking and acceptance, self-concept clarity, and psychological factors in a large sample of Argentinian participants (N = 273). In this online study, we assessed participants' acceptance of (or willingness to receive) touch from strangers, friends/family, and intimate partners. Replicating previous studies, we found a higher acceptance of touch from closer social bonds. Touch acceptance from intimate partners showed weak links with self-concept clarity and lower depersonalization symptoms. However, no definitive link between depersonalization symptoms and touch seeking or acceptance was found. Higher depersonalization symptoms were associated with increased social touch avoidance and decreased self-concept clarity. Mediation analyses indicated that social touch avoidance partially mediates the relationship between depersonalization and self-concept clarity. Additionally, depersonalization was associated with higher levels of anxiety, depression, and negative affect, and lower levels of positive affect and life satisfaction. Our results underscore the importance of considering touch in creating therapeutic interventions for depersonalization.
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A recent wave of research in psychiatry and neuroscience has re-examined the properties of ‘classic’ psychedelic substances—also known as serotonergic hallucinogens—such as psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT). Evidence to date suggests that psychedelics can be given safely in controlled conditions, at moderate to high doses, and may have potential as therapeutic agents in the treatment of various addictive and mood disorders. The main mechanism of action appears to be the induction of a dramatically altered state of consciousness, but the details of how psychedelic-assisted psychotherapy works are hotly debated, as are the relations between psychedelic experiences themselves and the neural changes induced by the drugs. The chapters collected in this volume address the fascinating philosophical questions raised by the renewed psychiatric use of psychedelics. The topics of these chapters cluster around three main themes, in terms of which the volume is organized. Chapters in Section One, ‘Self and Mind’, ask: what can we learn about the self and the mind from psychedelic science? Chapters in Section Two, ‘Science and Psychiatry’, address methodological, theoretical, and clinical questions concerning how psychedelics can best be studied scientifically and used therapeutically, and how they might work to relieve psychiatric suffering. Finally, chapters in Section Three, ‘Ethics and Spirituality’, address broader questions about the interpretation of psychedelic experience, its ethical implications, and its possible role(s) in the broader culture.
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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’.
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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.
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The sense of agency, the feeling of controlling one’s bodily actions and the world is altered in Depersonalisation (DP), a condition that makes people feel detached from one’s self and body. To investigate the link between depersonalization and both implicit and explicit sense of agency, an online study was conducted using the influential Intentional Binding paradigm in a sample of non-clinical DP participants. The results did nor reveal significant differences between individuals with low and high occurrences of DP experiences on implicit and explicit sense of agency. However, participants with high occurences of DP experiences showed a more time-sensitive explicit sense of agency and greater temporal distortions for short intervals in the absence of self-initiated motion. This suggests that there is a discrepancy between implicit and explicit sense of agency in people with high levels of depersonalization. Altogether, these findings call for further investigations of the key role of time perception on altered sense of self and agency in both non-clinical and clinical population, in order to disentangle the mechanisms associated with explicit and implicit sense of agency.
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La dissociazione in psicopatologia viene definita come «la frammentazione e/o discontinuità della normale integrazione della coscienza, con particolare riferimento a memorie, identità, emozioni, percezioni, rappresentazioni soma-tiche, controllo motorio e comportamento» (DSM-5, 2013). Storicamente il concetto di dissociazione è stato introdotto per la prima volta alla fine dell'800 da Pierre Janet (désagrégation), che lo definì come il «fallimento nell'integrazione di esperienze (percezioni, memorie, pensieri, emozioni) che sono normalmente associate tra loro nel flusso di coscienza». I suoi meccani-smi neurali sono interpretabili, alla luce delle Neuroscienze, come espressione di una deconnessione cortico-limbica.
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Objective: To study psychopathological structure characteristics of depersonalization depression in young women and nonsuicidal autoaggressive and suicidal behavior characteristics in these states. Material and methods: We studied 36 adolescent female patients (16-25 years) with endogenous depression (F31.3-4; F34.0; F21.3-4+F31.3-4; F60.X+F31.3-4), whose clinical picture was dominated by depersonalization disorders represented by their auto-, allo-, and somatopsychic forms or combinations. Results: Depersonalization depressions in young female patients are characterized by the following features: the dominance of the manifestations of the sensory («hysterical») form of depersonalization (83.3%; n=30); the proximity of the phenomenon of somatopsychic depersonalization (77.8%, n=28) to the manifestations of dysmorphic disorders; the specificity of the manifestations of derealization in the form of a feeling of «pretended, staged» environment; infrequent manifestations of psychic anesthesia; marked polymorphism of the clinical picture with comorbid obsessive-compulsive, hysteria-conversion, senestopathic, dysmorphic, and attenuated psychotic disorders; high risk of suicide (83.3%; n=30) with the predominance of planned suicide attempts over impulsive ones; significant frequency and variety of nonsuicidal self-harm with the predominance of «depersonalizing» motives for its commission. Conclusions: Depersonalization depression in young female patients is characterized by the clinical specificity manifested both in depersonalization symptomatology and spectrum of comorbid disorders and in the specificity of motives and methods of suicide attempts and nonsuicidal self-harm.
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Depersonalization is a common and distressing experience characterized by a feeling of estrangement from one’s self, body, and the world. In order to examine the relationship between depersonalization and selfhood we conducted an experimental study comparing processing of three types of self-related information between nonclinical groups of people experiencing high and low levels of depersonalization. Using a sequential matching task, we compared three types of biases for processing of self-related information: prioritization of one’s name, of self-associated abstract stimuli (geometrical shapes), and of self-associated bodily stimuli (avatar faces). We found that both groups demonstrated the standard pattern of results for self-prioritization of one’s name and geometrical shapes, but they differed with regard to avatar faces. While people with low depersonalization showed the standard prioritization of avatar faces, people with high depersonalization showed overall better response accuracy with avatar faces, and faster response times for stranger-associated avatar faces. These results were complemented by the additional finding that people with high depersonalization reported being more likely to use avatars of a different gender to their own outside of the experimental context. Finally, in this large sample (N = 180) we investigated the relationships between different measures of self-related processing and self-identification, finding no correlation between explicit reports of self-identification with self-associated avatar faces and geometrical shapes, self-prioritization of these stimuli, and prioritization of one’s name.
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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.
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Depression is one of the most common and debilitating health problems, however, its heterogeneity makes a diagnosis challenging. Thus far the restriction of depression variables explored within groups, the lack of comparability between groups, and the heterogeneity of depression as a concept limit a meaningful interpretation, especially in terms of predictability. Research established students in late adolescence to be particularly vulnerable, especially those with a natural science or musical study main subject. This study used a predictive design, observing the change in variables between groups as well as predicting which combinations of variables would likely determine depression prevalence. 102 under- and postgraduate students from various higher education institutions participated in an online survey. Students were allocated into three groups according to their main study subject and type of institution: natural science students, music college students and a mix of music and natural science students at university with comparable levels of musical training and professional musical identity. Natural science students showed significantly higher levels of anxiety prevalence and pain catastrophizing prevalence, while music college students showed significantly higher depression prevalence compared to the other groups. A hierarchical regression and a tree analysis found that depression for all groups was best predicted with a combination of variables: high anxiety prevalence and low burnout of students with academic staff. The use of a larger pool of depression variables and the comparison of at-risk groups provide insight into how these groups experience depression and thus allow initial steps towards personalized support structures.
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Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one's body. We conducted an online study in healthy participants (n=514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a 'spared space' where people can temporarily 'retrieve' their sense of self and sense of bodily presence. We found that higher DP traits-i.e. higher scores on the Cambridge Depersonalisation Scale (CDS)-were associated with more frequent dream experiences from an outside observer perspective (r = .28) and more frequent dream experiences of distinct bodily sensations (r = .23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = .24), more frequent nightmares (r = .33) and higher dream recall (r = .17). CDS scores were negatively correlated with body boundary scores (r =-.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r =-.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation-derealisation disorder).
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Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.
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The Javanese mantra is a communicative act, and a spiritual dialogue. During the mantra ritual, the shaman Orang Pinter and supplicant receiving the intervention select become equal agents, as they intervene for change in the cultural and spiritual disposition of the supplicant. But in this paper. The presentation discusses ethnographic work over 10 years during which over 1500 mantras were documented throughout central to east Java, Indonesia, To effect the documentation process, I engaged with a range of communities and individuals throughout Java, that is, Yogyakarta, Solo, Surabaya, Alas Purwo, Salatiga, Bali, and other localities, Spiritual interventions were witnessed, and we suggest religious affiliation tells only part of the story. Drawing on frameworks of symbolic interactionism, and phenomenological nominalism, the synopsis discusses how a poetic discourse analysis of mantras can describe a system employed by these shamans and the supplicants to discursively facilitate the spiritual process, by altering the dissociative state of the supplicant. The talk concludes by presenting a model for the mantra in Java, and possibly in other global regions. Within this model, several overlapping processes mediate the drawing on cultural symbolisms, and overlap in strategic designs, to to effect change in the supplicant. The paper draws on work by Rebecca Seligman, who has conducted similar ethnographic and theoretical work in the South American context.
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Depersonalisation (DP) is characterized by distressing feelings of being detached from one’s self and body, often described as being “out of touch” with oneself. We conducted two online experiments looking at the relationship between non-clinical experiences of DP and vicarious affective touch and self touch. In Experiment 1 we found that people with lower occurrences of DP rate the perceived pleasantness of the imagined social touch as received by the self higher than if received by the other. By contrast, we found no difference in the perceived pleasantness of affective touch imagined as being received by the self vs the other in people with higher occurrences of DP experiences. In Experiment 2, we designed a new affective self-touch intervention in order to explore the effect of affective self-touch stroking on one’s dorsal forearm on the perceived pleasantness and vividness of tactile experiences as being received by the self and others . We found that both low and high DP participants, following the affective self-touch intervention, report significantly higher ratings of vividness of tactile perception. These findings may have key implications for potential sensory tactile-based interventions for people experiencing distressing feelings of DP.
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Depersonalisation was described clinically over 100 years ago, yet there has been little research into this interesting but distressing psychiatric disorder. The symptom of depersonalisation can occur alone or in the context of other psychiatric and neurological illnesses and is characterised by the experience of detachment from one's senses and the outside environment, and may be present for several years without remission. Two years after the establishment of the depersonalisation research unit at the Maudsley Hospital, London, we report on current neurobiological and clinical research findings, including functional magnetic resonance imaging, psychophysiology and neuroendocrinology and progress regarding the development of effective treatments.
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Reviews studies that relate to the norms, reliability, and validity of the Dissociative Experiences Scale (DES). Appropriate clinical and research use of the scale are discussed together with factor analytic studies and fruitful statistical analysis methods. Research reported for 1989–1992 with the DES is described, and promising new research questions are highlighted. Suggestions are made for translating and using the DES in other cultures. A 2nd version of the DES, which is easier to score, is included as an appendix. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Little consensus or systematic research exists regarding the symptoms that constitute depersonalization and its association with affective and perceptual dysfunctions. A scale was constructed to measure depersonalization experiences reported in the literature and four items representing psychotic symptoms. Five factors representing different types of depersonalization emerged: Inauthenticity, Self-Negation, Self-Objectification, Derealization, and Body Detachment. Based on the factors, scales were constructed; these scales have internal consistency ranging from .78 to .84. Each of these factor scales was factorially distinguishable from psychosis and correlated between .48 and .58 with the Jackson and Messick (1972) Feelings of Unreality Scale, suggesting divergent and convergent validity. Inauthenticity, the most frequent and pervasive form of depersonalization experience, was best predicted by a cognitive style featuring intense, critical examination of self and others. In contrast, Self-Objectification was best predicted by thought disorganization and perceptual distortion and was experienced somewhat infrequently by relatively few subjects. All forms of depersonalization were associated with depression, except Inauthenticity.
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After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.
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Forty-four veterans with posttraumatic stress disorder (PTSD) from World War II and Vietnam were compared. The groups were comparable on many socioeconomic and combat measures and age at onset of PTSD. Vietnam veterans exhibited more severe PTSD symptoms, higher Hamilton depression scores, and higher scores on the hostility, psychoticism, and "additional symptom" Symptom Checklist-90 (SCL-90) scales. They also had more survivor guilt, impairment of work and interests, avoidance of reminders of trauma, detachment/estrangement from others, startle response, derealization, and suicidal tendencies. Differences were noted between the groups as to the nature of upsetting experiences. Vietnam veterans had a greater lifetime frequency of panic disorder and an earlier age of onset for alcoholism. In other respects, the two groups were diagnostically similar, with PTSD being related to the sequential emergence of psychiatric diagnoses in similar manner for World War II and Vietnam patients.
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Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)
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We hope that the ECA Program can make a significant, and perhaps unique, contribution to the field of psychiatric epidemiology and to mental health services research. If the Program provides total true prevalence data on mental disorders according to the latest diagnostic criteria, that in itself will be a significant contribution. Such data should be of enormous benefit to those interested in etiology as well as those interested in health services research. For researchers interested in etiology, the data can be used to identify, by comparison, high-risk groups; for those interested in health services research, the results can serve as a health planning guide that does not depend on the presence or absence of treatment facilities in a given area. Incidence data will be the second major contribution of the ECA Program. Its two-wave design enhances the study of incidence, etiology, and the natural history of disorders and also allows study of the social behavior of persons entering treatment for mental disorders--a subject important to health planners. Finally, a significant result of the ECA Program may be the establishment of a viable standardized methodology for the epidemiologic study of mental disorders by means of which demonstrably replicable results can be produced. Once we demonstrate the equivalence of method and results, then the stage is set for comparative studies of all sorts.
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This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients. A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent Questionnaire, and the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients. Fifteen percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100% of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized. A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course.
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Depersonalization remains a fascinating and obscure clinical phenomenon. In addition to earlier Jacksonian neurobiological adumbrations, and conventional psychodynamic accounts, views started to be expressed in the 1930s that depersonalization might be a vestigial form of behavior, and since the 1960s that it might be a phenomenon related to the temporal lobe. Recent advances in the neurobiology of the limbic system, and the application of Geschwind's concept of disconnection in the corticolimbic system, have opened the possibility of developing testable models. This paper includes a review of these ideas and of the clinical features of depersonalization, particularly of its emotional changes, suggesting that they are important for the neurobiological understanding of depersonalization. It also draws attention to clinical similarities between the experiential narratives produced by patients suffering from depersonalization and those with corticolimbic disconnections. On the basis of this, a new model is proposed according to which the state of increased alertness observed in depersonalization results from an activation of prefrontal attentional systems (right dorsolateral prefrontal cortex) and reciprocal inhibition of the anterior cingulate, leading to experiences of "mind emptiness" and "indifference to pain" often seen in depersonalization. On the other hand, a left-sided prefrontal mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality, and lack of emotional coloring that would in turn, be reported as feelings of "unreality or detachment."
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Some patterns of deranged function—epilepsy, schizophrenia—have been enshrined as diseases; others, such as depersonalization, have, by and large, escaped this fetter. This is perhaps why there has been no difficulty in accepting that depersonalization, being a pattern of disordered function, can occur in conditions of very different aetiology. It is seen in temporal lobe epilepsy (12), temporal lobe migrane (22), depression (8), LSD intoxication (20), schizophrenia (1), phobic anxiety states (15), sleep deprivation (2) and the hypnagogic state. Shorvon (21) reported cases of depersonalization occurring in the apparent absence of other psychiatric disorder, and Davison (4) investigated in detail seven such cases. Finally the occurrence of depersonalization in people not attending psychiatric or neurological clinics is now well attested (13, 5, 18, 6).
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This manual is a guide to a particular method of standardising the elements of this diagnostic process with a view to achieving comparability between clinicians. The most important part of the book is therefore the glossary of definitions of symptoms. Everything else depends upon it. It is useless to try to determine whether a symptom is present unless it is quite clear what its specific characteristics are and how it can be distinguished from other symptoms. If the clinician knows these differential definitions, the rest is a matter of technique. If he does not, no amount of technical skill will give his judgments value.
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Presents findings from an extensive investigation of reasons for the discrepancy in admission rates for mental disorders, especially schizophrenia and affective disorders, between London and New York in the adult age range of 20-59 yr. Problems of diagnosis are stressed, and the causes of differences in classification, treatment, and correlation of treatment with psychopathology are speculated upon. (100 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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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 disorder. Two general dissociation scales and two depersonalization scales were administered to 50 subjects with DSM-III-R depersonalization disorder and 20 healthy control subjects. The depersonalization disorder group scored significantly higher than the normal control group in all scales and subscales. Factor analysis of the Dissociative Experiences Scale (DES) yielded three factors as proposed previously, absorption, amnesia, and depersonalization/derealization. A DES cutoff score of 12, markedly lower than those previously proposed for the screening of other dissociative disorders, is required for the sensitive detection of depersonalization disorder. Alternatively, the DES pathological dissociation taxon (DES-taxon) score recently generated in the literature appears more sensitive to the detection of depersonalization disorder and is better recommended for screening purposes. The other three scales were fairly strongly correlated to the DES, suggesting that they may measure similar but not identical concepts, and cutoff scores are proposed for these scales also. General implications for the screening and quantification of depersonalization pathology are discussed.
Article
The conditions necessary for the formulation of a complaint of change in depersonalizaton terms have been examined and it has been concluded that depersonalization types of complaint arise as a result of the relative failure of integration of experience into the total organization of psychic functioning, whilst the latter remains relatively intact. Such failure of integration may affect different experiences and originate from a number of different causes. Depersonalization complaints thus merge with the complaints of many other conditions which involve a change in the relation of the individual to his self, his body or the outer world. They are related often only by a loose similarity of the terms used to describe the feelings of change. Many factors contribute to the terms actually used, not the least amongst which is the fundamental limitation of our language as a means of communicating changes in experience. It is suggested that depersonalization should be used as a generic term for a number of different syndromes which, although sometimes overlapping, are yet quite distinct. Case histories illustrating different depersonalization syndromes are presented.
Article
Depersonalization remains a subject whose fascination for psychiatric investigators shows no sign of waning. That this is so may partly be due to the striking nature of the symptomatology, though for many the philosophical problems it poses cannot fail to exercise much thought (Lewis, 1949). Numerous aetiologies have been advanced, but there exists no common agreement, even amongst those of similar psychiatric discipline, as to the origin of the condition.
Article
The study examines the relationship between experiencing depresonalization during traumatic events and subsequent psychiatric symptomatology. Participants were 75 Boston University undergraduate students who reported 186 traumatic events. Information about their experiences of depersonalization during these events was obtained by the Depersonalization Questionnaire (DQ) a scale based primarily on the Dissociation Experience Scale (Bernstein and Putnam, 1986). Symptomatology was measured by the Symptom Checklist-90-Revised (Derogatis, 1977). As predicted the participants who experienced depersonalization during traumatic events were found to be significantly lower than those who did not on 7 out of the 9 SCL-90-R subscales and the General Severity Index (GSI) scale. When the severity of trauma was statistically controlled for, the significant differences between the two groups held up on five of the nine subscales and the GSI scale. These differences remained as significant when statistically controlling for the time that passed since the traumatic events. These findings suggest that, for this sample, depersonalization during traumatic events played a significant role in defending them from the full impact of these events.
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The frequency of symptoms during panic attacks and anticipation of the panic consequences were compared in patients with the subtypes of panic disorder (PD). Patients with moderate and severe agoraphobic avoidance reported that they had experienced more symptoms than patients with an uncomplicated PD (without agoraphobia [AG]); they also experienced almost all of the symptoms more frequently, with the difference being significant for a quarter of the examined panic symptoms. Panic patients with moderate and severe AG were also significantly more concerned about the loss of control and social and physical consequences of panic attacks. Taken together, these findings suggest that the severity of panic attacks, defined as the number of panic symptoms, along with a variety of anticipatory fears about the consequences of the attacks may contribute to the development of AG in panic patients.
Article
Sixty-two subjects with panic disorder recorded a total of 285 panic attacks over a two-week period using continuous self-monitoring forms. Compared to retrospective self-report during an initial interview, subjects recorded significantly fewer panic attacks and fewer total symptoms using self-monitoring. Self-monitored panic attacks occurred with an average frequency of 2.3 attacks per week, involved an average of 4.6 DSM-III-R synptoms per attack, and involved an average anxiety level of 5.4 on a 0–8 scale. The degree of anxiety experienced during panic attacks, both within and between individuals, was highly correlated with the number of symptoms. Interestingly, less than one symptom was experienced consistently, during every panic attack, by the average subject. In other words, it appeared that a given subject could experience different symptoms during separate attacks. Implications for the nature and assessment of panic attacks are discussed.
Article
The present study was designed to assess whether individuals reporting experiences of depersonalization or derealization experience higher levels of anxiety than those subjects not reporting these experiences. 221 undergraduates volunteered to complete questionnaires on depersonalization and derealization and the IPAT Anxiety Scale. Analysis indicated that subjects experiencing depersonalization or derealization scored higher on the anxiety scale than those not reporting these experiences, while subjects who reported both depersonalization and derealization scored the highest. Significant positive correlations between number of depersonalization episodes, and frequency and number of derealization episodes, and significant negative correlations between level of diminution of depersonalization or derealization and reported over-all anxiety score were obtained. The results were explained using the model proposing that individuals experiencing continued depersonalization or derealization episodes suffer from a more generic anxiety or phobic-anxiety based disorder labeled “phobic-anxiety depersonalization syndrome.”
Article
The complaints, ‘I am a stranger to myself; I am unreal’, are manifestations of depersonalization which have been noted frequently by clinicians. Depersonalization has been reported in epilepsy, after drug ingestion, encephalitis, hysteria, manic depression, and schizophrenia, as well as in various neurotic patients. It has also been noted in normals, but usually after emotional shock or physical exhaustion. Most recently, persistent feelings of depersonalization have been elevated to the status of a diagnostic entity in itself.
Article
A transient depersonalization syndrome was identified in nearly one third of persons exposed to life-threatening danger (accident victims) and close to 40% of a group of hospitalized psychiatric patients. Although the syndrome was similar in these populations, mental clouding developed more commonly among patients and alertness was more prominent among accident victims. Anxiety was significantly associated with the development of depersonalization among psychiatric patients and was almost certainly a factor in its appearance among accident victims. The findings suggest that this syndrome is a specific response to extreme danger or its associated anxiety.
Article
Basic features of depersonalization, including alterations in the experience of time, emotion, sensation, volition, reality, memory, attachment, and space, were elicited from 101 persons who had encountered life-threatening danger. Sixty-six per cent reported five or more of these features pointing to the extremely frequent appearance of this adaptive mechanism under dangerous circumstances. Contrasting effects were reported by depersonalized individuals that appeared to reflect heightened arousal on the one hand and attenuation of potentially disorganizing emotion on the other. A dissociation between an observing and a participating self was hypothesized to account for these fundamental alterations in the experience of the self and its immediate environment.
Article
For phenomenological elucidation of panic attacks, 26 patients with panic attacks were requested to name the panic symptoms in order of their occurrence and specify the patterns of their abatement. Panic symptoms were found to be classifiable into three categories: early symptoms consisting of dizziness or faintness, palpitations, and sweating; intermediate symptoms dyspnea, nausea or abdominal distress, flush or chills, chest pain or discomfort, shaking, and choking; late symptoms paresthesias, fear of dying, and fear of going crazy. Panic symptoms disappeared in 61.6% irrespective of the sequence of their occurrence. Twenty-one patients were interviewed about the experience of nocturnal panic attacks, and 23.8% experienced them. These findings suggest that fear is caused by sudden physical abnormality triggered by some biological factors.
Article
A recent survey of a large sample of the general population in the city of Winnipeg, Manitoba, showed that multiple personality disorder related to childhood abuse affects about 1% of the adult population. About 10% of the adult population has had a DSM-III-R dissociative disorder of some kind. Pathologic dissociation appears to be a major form of emotional disturbance in North America, and it appears to be about as common as anxiety, mood, and substance abuse disorders. The dissociative disorders can no longer be considered rare.
Article
Patients with multiple personality disorder (N = 102) at four different centers were interviewed with the Dissociative Disorders Interview Schedule. The presenting characteristics of the patients at all four centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. The subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on the Dissociative Experiences Scale was 41.4. The results indicate that multiple personality disorder has a stable, consistent set of features.
Article
The authors describe the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), which investigates five groups of dissociative symptoms (amnesia, depersonalization, derealization, identity confusion, and identity alteration) and systematically rates both the severity of individual symptoms and the evaluation of overall diagnosis of dissociative disorder. Preliminary findings from a study of 48 subjects with and without psychiatric diagnoses indicate good to excellent reliability and discriminant validity for the SCID-D as a diagnostic instrument for the five dissociative disorders and as a tool for the evaluation of dissociative symptoms encountered within nondissociative syndromes.
Article
Incidence data are presented for the 7 most frequent specific categories of mental disorder available in the NIMH Epidemiologic Catchment Area (ECA) program (major depressive disorder; panic disorder; phobic disorder; obsessive-compulsive disorder; drug abuse/dependence; alcohol abuse/dependence; cognitive impairment). The DSM-III case definitions in the ECA Program are according to the implementation of the Diagnostic Interview Schedule (DIS). Rates of incidence are presented specific for age, sex, and site, and pooled smoothed curves for the relationship of age to incidence, specific for sex are shown. The 7 disorders have distinctly different relationships to sex and age of onset.
Article
One hundred fifty patients with Panic Disorder (PD) with or without Phobic Avoidance were subdivided into two groups on the basis of presence/absence of derealization and/or depersonalization (D-D) during panic attacks. D-D was found in 34.7% of the sample. By comparing the two groups, the patients with D-D were found to be younger and had an earlier onset of the disorder; they had a higher prevalence of avoidance behavior and a higher severity of the agoraphobic spectrum phobias. They were also more frequently subject to concomitant disorders such as Generalized Anxiety, Obsessive-Compulsive, and depressive symptomatology. The authors have hypothesized a correlation between the presence of D-D during panic attacks and a more frequent clinical evolution toward agoraphobia. This view is supported by finding that D-D in panic attacks corresponds to severer forms of PD, both in terms of the earlier onset of PD, and because PD shows higher levels of anxiety, depression, and disability.
Article
The phenomenology of panic disorder and panic attacks was systematically assessed in 46 consecutive patients. The results suggest that DSM-III criteria include several symptoms that are not frequently present during a panic attack and that DSM-III's characterization of a panic attack is imprecise and misleading. Panic attacks were found to vary in intensity, frequency, spontaneity, and associated symptoms. A panic attack typically presents as a unified symptom complex of psychic anxiety and multiple somatic symptoms in multiple body systems. It occurs in a crescendolike pattern, is self-limited, and often leaves the subject weak or shaken. The temporal course as much as the symptomatic presentation defines a panic attack.
Article
The clinical fate of 73 schizophrenic patients collected from a rural general practice in England was followed for 38 years. The incidence of schizophrenia appears to have fallen since the introduction of phenothiazine drugs, and a more liberal attitude has developed toward these patients. Of these patients, 35% were permanently scarred and disabled by the disease; 28% of those who were traced had made a complete recovery. The outlook for victims of schizophrenia is better than it was in 1946. Some of the reasons for this improvement are explained.
Article
Introduction There have been many theories put forward to explain the not uncommon symptoms of depersonalization. They were aptly summarized by Ackner (1954) in the following way. There are theories which regard depersonalization as a symptom with an organic basis; there are theories which consider it a disturbance of a particular psychological function; there are analytic theories; and finally there is a theory which would suggest that depersonalization is a form of schizophrenia. This paper is concerned with a re-appraisal of all these theories in the light of recent and current research on the subject.
Article
1. Some aspects of depersonalization occurring in a student population have been studied. 2. The descriptions students gave of depersonalization were strikingly similar to those encountered clinically. 3. The form of depersonalization occurring in the hypnagogic state was found to differ slightly from that occurring while fully awake. 4. Depersonalization in students was found to resemble that seen in psychiatric practice in being more common in women than in men, and in being associated with (symbol in brackets indicates sex in which association attained p< 0.05): deja vu (♂), agoraphobia (♀), neuroticism (♂) and recent disturbances in emotional health (♀). 5. Of the students interviewed, 11.4 per cent had mild agoraphobia. In students with depersonalization, agoraphobia was more common in women than in men (p<0.05). 6. Some aspect of the relationship between agoraphobia, deja vu and depersonalization are discussed.
Article
This study was concerned with the incidence of depersonalization experiences in a group of 50 normal subjects, and its relation to sex, age, personality and the conditions under which the depersonalization occurred. In all, 35 subjects reported having experienced depersonalization at some time; in the majority of cases this occurred under conditions likely to be associated with an alteration of consciousness. There was no difference in respect of sex ratio, age incidence and personality assessments between the depersonalized and the non-depersonalized groups. The group of subjects who had reported the most frequent depersonalization experiences more commonly reported it during a state of clear consciousness, they were significantly younger than the group with the least number of depersonalization experiences and the non-depersonalized group and they were more predominantly females. The findings are discussed in relation to previous work on the incidence of depersonalization in normal subjects and contrasted briefly to the data available in respect of depersonalization occurring in psychiatric patients.
Article
The manifestation of depersonalisation, its relationship with anxiety and depression, as well as its influence on the course of endogenous psychoses were investigated. Forty patients with severe depersonalisation were treated with the benzodiazepine, phenazepam, and 14 with clozapine. The data indicate that depersonalisation results from anxiety; it follows an anxiety attack and is successfully treated with anxiolytic drugs. In the case of endogenous depression, depersonalisation leads to lingering depressive phase, increasing the patients' resistance to antidepressive therapy. The protective and the harmful role of depersonalisation is discussed.
Article
The present study assessed the prevalence and characteristics of depersonalization phenomena in a nonclinical population. Undergraduate students (N = 388) responded to a questionnaire soliciting information regarding the experience of depersonalization, age at onset, number, frequency, duration, and intensity of depersonalization experiences, level of pleasantness/unpleasantness, diminution of experiences with and without professional assistance, and relation of depersonalization to other factors. Of the Ss, 34% reported depersonalization. No significant sex differences were noted but relationships between years of experience of depersonalization and intensity, frequency, and number of experiences were significant.
Article
SYNOPSIS A two-stage psychiatric survey of a random sample of adults aged 18–64 from Camberwell is described. Agency interviewers carried out the first stage ( N = 800), using the shorter form of the Present State Examination (PSE). MRC interviewers, using the full PSE, saw a stratified sample of these ( N = 310) in the second stage. A second interview was sought with all those of Index of Definition (ID) level 5 and above at the first interview (‘cases’) and with a random sample of those below that level. 20·9% refused or were never available for the first interview. Of the 800 subjects successfully interviewed, 10% refused a further interview and 12·4% of those finally selected for this interview were either unavailable or changed their minds. The MRC data, weighted to represent the whole sample, are used in our analyses. The prevalence of psychiatric disorder as defined in our study was calculated at 6·1% for men and 14·9% for women. Women shared a higher prevalence of disorder in the age-groups 25–34 and 45–54, but in men there was no significant association with age. In contrast to the findings of Brown & Harris (1978), social class did not have a strong association with disorder. Single men had much higher rates than married men, while the reverse was true in women. In both sexes employment was associated with lower rates of disorder. An attempt to explain the high prevalence in women in terms of their role in marriage and child-care was only partly successful.
Article
This study attempted to estimate the prevalence of dissociative symptoms and disorders in a Canadian adult psychiatric inpatient population and also attempted to determine the extent to which dissociative disorders were recognized by the attending clinical staff. All appropriate and consenting adult psychiatric inpatients at the Kingston Psychiatric Hospital in Kingston, Ontario, were given the Dissociative Experiences Scale. Patients scoring 25 or greater were interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Admission or discharge diagnoses data were used to determine whether or not dissociative disorders were being recognized. A total of 48 patients completed the Dissociative Experiences Scale and 14 (29%) scored 25 or greater. The prevalence of dissociative disorders in this hospital population was estimated to be 17%. Dissociative identity disorder was found in six percent, dissociative amnesia in eight percent and dissociative disorder not otherwise specified in two percent of the population. These disorders tended to be under-recognized. Research on more extensive populations is required to establish the true prevalence of dissociative symptoms and disorders in psychiatric inpatients.
Article
Professional skepticism and concerns regarding diagnostic reliability hinder research in dissociative disorders and multiple personality disorder. The reported frequency of multiple personality disorder in different psychiatric settings ranges from 2.4% to 35%. The authors conducted a replication study of multiple personality disorder ascertainment in women admitted to a state hospital over a 5.5-month period. Responses to the Dissociative Experiences Scale and to the Dissociative Disorders Interview Schedule were obtained, along with data on length of stay, county of admission referral, admission commitment status, and discharge diagnoses, for 176 female inpatients in a state hospital. Of 421 women representing 483 consecutive admissions, 121 were discharged before they could be assessed for study, 64 were excluded, 60 declined to participate, 176 enrolled in the study, and 175 completed the research procedures. Twenty-one women (12%) met criteria for multiple personality disorder based on the Dissociative Disorders Interview Schedule; these women were significantly younger than the women without multiple personality disorder. Scores on the Dissociative Experiences Scale of the women with multiple personality disorder (mean = 59.5, SD = 19.6) were significantly higher than the scores of women without multiple personality disorder (mean = 22.5, SD = 20.1), but considerable overlap occurred. There was no significant difference between groups in length of stay or admission status. The authors conclude that 1) the wide variability in multiple personality disorder detection is partially due to site-specific ascertainment biases and 2) despite its apparent usefulness for screening purposes, the Dissociative Experiences Scale requires more comprehensive evaluation before it can be applied broadly.
Article
Data on naturally occurring panic attacks were gathered through continuous self-monitoring for 94 patients suffering from panic disorder with agoraphobia. A total of 1276 panic attacks were collected. In this article various aspects of panic attacks, including severity, duration and time of onset and situations in which panic occurs are addressed. In addition, the symptoms of panic were investigated, examining the (in)variability of attacks within each patient and the patterning of symptoms in the entire group of patients. The most important findings were as follows: attacks occurred predominantly in nonphobic situations; nocturnal panic attacks were generally more severe than attacks during the day; symptom patterns across various attacks, stemming from the same patient, were rather variable; and finally, a substantial number of the attacks (40%) did not meet the DSM-III-R criteria for number of symptoms.
Article
Panic attack symptomatology was investigated in 212 panic disorder patients (60 men, 152 women) using the Panic Attack Questionnaire, Feelings of helplessness and thoughts of escape had the highest mean severity ratings, but are not currently listed in the DSM-III-R. The DSM-III-R symptoms labeled choking or smothering sensations, paresthesias, nausea, and chest pain had low severity ratings. Evidence was obtained for a three-factor model of panic symptomatology consisting of dizziness-related symptoms, cardiorespiratory distress, and cognitive factors. These results provide only limited support for the current DSM-III-R symptom structure, and support the notion that panic disorder is a heterogeneous condition.
Article
During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.
Article
The goal of this study was to determine the prevalence of DSM-III-R panic disorder and to describe its correlates. The study was part of the National Comorbidity Survey, the first psychiatric epidemiologic survey of the entire U.S. population and the first to use DSM-III-R criteria for diagnosis. The 8,098 survey respondents, aged 15-54 years, were given the Composite International Diagnostic Interview. For this report, the data on panic were analyzed, and from them the prevalence of panic disorder and related experiences in the U.S. population was estimated. About 15% of the survey respondents reported the occurrence of a panic attack over their lifetimes, and 3% reported a panic attack in the preceding month. About 1% met the DSM-III-R criteria for panic disorder in the month preceding the interview. Panic attacks and panic disorder had a bimodal age distribution and were associated with female sex and lower educational achievement. Fifty percent of the survey respondents with panic disorder reported no symptoms of agoraphobia. The pattern of prevalence of correlated sociodemographic factors was similar for persons with panic attacks, panic disorder, and panic disorder with agoraphobia. There appears to be no obvious threshold for the diagnosis of panic disorder. Panic disorder and agoraphobia, although highly comorbid, also occur separately.
Article
Since Cullen coined the term "neurosis" in the 18th century, medical investigators have searched the neural substrates of conditions we now classify as anxiety disorders. Harper and Roth in 1962 hypothesized that the temporal lobes might represent one such substrate for phobic-anxious patients with depersonalization-derealization (DD); the association between the presumed temporal lobe feature and phobic anxiety was so compelling that Roth (in 1959) described the condition as "phobic-anxiety-depersonalization" syndrome. Introduced into our current nosology as panic disorder-agoraphobia (PDA), this seemingly neuropsychiatric condition is nonetheless distinct from complex partial epilepsy (CPE), from which it is conventionally differentiated through clinical and anamnestic evaluation. Yet increasingly there are clinical-and laboratory-hints of certain overlap between manifestations of the two disorders, hitherto based largely on evaluation of psychosensorial phenomena in PDA or affective phenomena in CPE. We located only one systematic study that monitored 24-hour electroencephalogram (EEG) abnormalities in PDA. Finally, recent epidemiologic data suggest a significantly greater than chance association between PDA and a history of seizures. To further explore these intriguing links, the present study directly compared a group of 91 PDA outpatients with a group of 41 CPE outpatients with respect to DD and other psychosensorial symptoms. The broad similarities discovered between psychosensorial and related phenomena provide further support for the hypothesis that there may be a common neurophysiological substrate linking CPE phenomena with PDA.
Article
Using cluster analysis of 207 patients with panic disorder (PD), we investigated the relationships between several panic symptoms at the time of panic attacks, which included anticipatory anxiety, agoraphobia, and 13 clinical symptoms based on the Diagnostic and Statistics Manual-III-Revised. Cluster analysis revealed three panic symptom clusters: cluster A (dyspnea, choking, sweating, nausea, flushes/chills); cluster B (dizziness, palpitations, trembling or shaking, depersonalization, agoraphobia, and anticipatory anxiety); and cluster C (fear of dying, fear of going crazy, paresthesias, and chest pain or discomfort). Generally, cluster A was comprised exclusively of physiological symptoms, among which respiratory symptoms were prominent, cluster B included both panic and non-panic symptoms such as agoraphobia and anticipatory anxiety, and cluster C was comprised chiefly of fear symptoms.