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Anthony S David - One of the best experts on this subject based on the ideXlab platform.
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symptom profiles in Depersonalization and anxiety disorders an analysis of the beck anxiety inventory
Psychopathology, 2015Co-Authors: Steffen Nestler, Mauricio Sierra, Emmalouise Jay, Anthony S DavidAbstract:Background: Depersonalization disorder (DPD) entails distressing alterations in self-experiencing. However, it has long been recognized that depersonalisation symptoms occur in other disorders, particularly anxiety and panic. One strand of research proposes that Depersonalization phenomenology arises through altered autonomic arousal in response to stress. Sampling and Methods: We sought to examine profiles of anxiety symptoms through a secondary data analysis of individual items and factor subscales on the Beck Anxiety Inventory (BAI), comparing two relatively large patient samples with DPD or with a variety of anxiety conditions, respectively. The DPD sample (n = 106) had a lower overall BAI score than the combined anxiety disorders group (n = 525). Results: After controlling for this as well as for potential confounders such as age and gender, the DPD group presented significantly lower scores on the panic subscale, marginally lower scores on the autonomic subscale and significantly higher scores on the neurophysiological subscale of the BAI. Conclusions: These differences imply similarities between the cognitive components of DPD and anxiety disorders while physiological experiences diverge. The findings encourage future research looking at direct physiological measures and longitudinal designs to confirm the mechanisms underlying different clinical manifestations of anxiety.
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Depersonalization disorder and anxiety a special relationship
Psychiatry Research-neuroimaging, 2012Co-Authors: Mauricio Sierra, Nick Medford, Geddes Wyatt, Anthony S DavidAbstract:A significant association between anxiety and Depersonalization has been found in healthy controls and psychiatric patients irrespective of underlying conditions. Although patients with Depersonalization disorder (DPD) often have a history of severe anxiety symptoms, clinical observations suggest that the relation between anxiety and Depersonalization is complex and poorly understood. Using relevant rating scales, levels of anxiety and Depersonalization were assessed in 291 consecutive DPD cases. 'High' and 'low' Depersonalization groups, were compared according to anxiety severity. Correlation and multivariate regression analyses were also used to assessed the contribution of anxiety to the phenomenology and natural course of Depersonalization. A low but significant association between Depersonalization and anxiety (as measured by Beck's Anxiety Inventory) was only apparent in those patients with low intensity Depersonalization, but not in those with severe Depersonalization. Levels of anxiety did not seem to make specific contributions to the clinical features of Depersonalization itself, although DPD patients with high anxiety seem characterised by additional non-specific perceptual symptoms. The presence of a 'statistical dissociation' between Depersonalization and anxiety adds further evidence in favour of Depersonalization disorder being an independent condition and suggests that its association with anxiety has been overemphasized.
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prevalence and childhood antecedents of Depersonalization syndrome in a uk birth cohort
Social Psychiatry and Psychiatric Epidemiology, 2012Co-Authors: William Lee, Charlie H T Kwok, Elaine Hunter, Marcus Richards, Anthony S DavidAbstract:Depersonalization syndrome is characterised by a sense of unreality about the self [Depersonalization (DP)] and/or the outside world [derealization (DR)]. Prevalence estimates vary widely. Little is known about childhood antecedents of the disorder although emotional abuse is thought to play a role. Longitudinal data from 3,275 participants of a UK population-based birth cohort (the MRC National Survey of Health and Development) were used to: (1) assess the prevalence of DP syndrome at age 36, measured by the Present State Examination (PSE); and (2) examine the effects of a range of socio-demographic, childhood adversity and emotional responses as potential risk factors for DP. Thirty three survey members were classified with DP, yielding a prevalence of 0.95% [95% confidence intervals (CI) 0.56–1.34]. There were no associations with socio-economic status, parental death or divorce; self-reported accidents, childhood depression, tendency to daydream or reactions to criticism. However, teacher-estimated childhood anxiety was a strong independent predictor of adult Depersonalization, and there were strong cross-sectional relationships between DP and anxiety and depression caseness. To our knowledge this is the first study assessing nationwide prevalence of the DP syndrome and uses longitudinal data to explore childhood risk factors for adult DP. The prevalence of adult DP was slightly lower than reported by other surveys. The study found that childhood anxiety was the only significant predictor of the adult DP syndrome, supporting the view that depersonalisation disorder forms part of the spectrum of responses to anxiety.
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autonomic response in the perception of disgust and happiness in Depersonalization disorder
Psychiatry Research-neuroimaging, 2006Co-Authors: Mauricio Sierra, Mary L Phillips, Anthony S DavidAbstract:Patients with Depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that Depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV Depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with Depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with Depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.
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lamotrigine as an add on treatment for Depersonalization disorder a retrospective study of 32 cases
Clinical Neuropharmacology, 2006Co-Authors: Mauricio Sierra, Nick Medford, Mary L Phillips, Dawn Baker, Emma Lawrence, Maxine X Patel, Anthony S DavidAbstract:OBJECTIVES: Depersonalization disorder (DPD) is a chronic condition characterized by the persistent subjective experience of unreality and detachment from the self. To date, there is no known treatment. Lamotrigine as sole agent was not found to be effective in a previous small double-blind, randomized crossover trial. However, evidence from open trials suggests that it may be beneficial as an add-on medication with antidepressants. METHODS: We report here an extended series of 32 patients with DPD in whom lamotrigine was prescribed as an augmenting medication. Most of the patients were receiving selective serotonin reuptake inhibitors. RESULTS: Fifty-six percent (n = 18) of patients had a more than or equal to 30% reduction on the Cambridge Depersonalization Scale score at follow-up. Both maximum dose of lamotrigine used and before treatment Cambridge Depersonalization Scale scores showed positive correlations with the percentage of response. CONCLUSIONS: The results of this trial suggest that a significant number of patients with DPD may respond to lamotrigine when combined with antidepressant medication. The results are sufficiently positive to prompt a larger controlled evaluation of lamotrigine as "add-on" treatment in DPD
Daphne Simeon - One of the best experts on this subject based on the ideXlab platform.
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cognitive affective neuroscience of Depersonalization
Cns Spectrums, 2009Co-Authors: Dan J Stein, Daphne SimeonAbstract:Depersonalization disorder (DPD) is characterized by a subjective sense of detachment from one's own being and a sense of unreality. An examination of the psychobiology of Depersonalization symptoms may be useful in understanding the cognitive-affective neuroscience of embodiment. DPD may be mediated by neurocircuitry and neurotransmitters involved in the integration of sensory processing and of the body schema, and in the mediation of emotional experience and the identification of feelings. For example, DPD has been found to involve autonomic blunting, deactivation of sub-cortical structures, and disturbances in molecular systems in such circuitry. An evolutionary perspective suggests that attenuation of emotional responses, mediated by deactivation of limbic structures, may sometimes be advantageous in response to inescapable stress.
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alexithymia absorption and cognitive failures in Depersonalization disorder a comparison to posttraumatic stress disorder and healthy volunteers
Journal of Nervous and Mental Disease, 2009Co-Authors: Daphne Simeon, Timo Giesbrecht, Margaret Knutelska, Rebecca Jo Smith, Lisa M SmithAbstract:Abstract: Alexithymia, absorption, and cognitive failures are traits that have been implicated in dissociative psychopathology. Forty-six participants with Depersonalization disorder (DPD), 21 with posttraumatic stress disorder, and 35 healthy controls completed measures of dissociation, alexithymia, absorption, cognitive failures, and childhood trauma. The DPD and posttraumatic stress disorder groups had significantly and comparably elevated absorption and cognitive failures scores. Only the DPD group had significantly elevated alexithymia scores, specifically in “difficulty identifying feelings.” Regression analyses revealed that “alexithymia—difficulty identifying feelings” was predictive of both DPD diagnosis and Depersonalization scores. In contrast, amnesia scores were predicted by childhood trauma and absorption. In conclusion, the link between Depersonalization and alexithymia appeared to be specific rather than broadly related to early trauma or to trauma-spectrum psychopathology.
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somatoform dissociation in Depersonalization disorder
Journal of Trauma & Dissociation, 2008Co-Authors: Daphne Simeon, Margaret Knutelska, Rebecca Jo Smith, Lisa M SmithAbstract:Along with psychoform dissociation, somatoform dissociation has been put forth as a core aspect of dissociative states, possibly as reliable as psychoform dissociation in the screening for dissociative disorders. The goal of this study was to investigate the prominence and correlates of somatoform dissociation in one of the major Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) dissociative disorders, Depersonalization disorder (DPD). A total of 54 adults with DPD and 47 healthy control participants free of lifetime Axis I and II disorders were administered the 20-item Somatoform Dissociation Questionnaire (SDQ) as well as the Dissociative Experiences Scale, the Cambridge Depersonalization Scale, and the Childhood Trauma Questionnaire-Short Form. Somatoform dissociation scores were statistically significantly, but clinically only modestly, elevated in the DPD as compared to the healthy control group. SDQ items significantly elevated in the DPD group were mostly perceptual in nature. Depersonalization scores were significantly correlated with somatoform dissociation in the DPD group, whereas absorption and amnesia scores were not. With respect to childhood interpersonal trauma, although emotional abuse was significantly associated with Depersonalization severity, none of the 5 categories of trauma were significantly associated with somatoform dissociation in the DPD group. In conclusion, somatoform dissociation is modest in DPD, and the SDQ is a weak instrument for the screening of dissociation in this disorder, detecting only one third of the sample when using the traditional SDQ cutoff score of 30.
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de constructing Depersonalization further evidence for symptom clusters
Psychiatry Research-neuroimaging, 2008Co-Authors: Daphne Simeon, David Stephen Kozin, Karina Segal, Brenna Lerch, Roxanne Dujour, Timo GiesbrechtAbstract:Depersonalization disorder is defined in the DSM-IV-TR using a single symptom criterion, which does not do justice to the phenomenological complexity of the disorder. In 394 affected adults, the Cambridge Depersonalization Scale yielded five factors (numbing, unreality of self, perceptual alterations, unreality of surroundings, and temporal disintegration), put forth as symptom criteria for a better diagnosis of Depersonalization disorder.
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cognitive functioning in Depersonalization disorder
Journal of Nervous and Mental Disease, 2007Co-Authors: Orna Guralnik, Timo Giesbrecht, Margaret Knutelska, Beth Sirroff, Daphne SimeonAbstract:Depersonalization disorder (DPD) is a dissociative disorder characterized by a subjective sense of unreality and detachment, and has been associated with deficits in perception and short-term memory. In this study, 21 DPD and 17 healthy comparison participants free of psychiatric disorders were administered a comprehensive neuropsychologic battery. The groups did not differ in full-scale, verbal, and performance IQ (Wechsler Adult Intelligence Scale), in working memory (Paced Auditory Serial Addition Test), or in selective attention (Digit Span with Distracters). The DPD group performed significantly worse on immediate visual and verbal recall (Wechsler Memory Scale, Revised), but not on delayed recall. Dissociation severity was significantly correlated with processing slowness and distractibility. We conclude that DPD is associated with cognitive disruptions in early perceptual and attentional processes.
Mauricio Sierra - One of the best experts on this subject based on the ideXlab platform.
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symptom profiles in Depersonalization and anxiety disorders an analysis of the beck anxiety inventory
Psychopathology, 2015Co-Authors: Steffen Nestler, Mauricio Sierra, Emmalouise Jay, Anthony S DavidAbstract:Background: Depersonalization disorder (DPD) entails distressing alterations in self-experiencing. However, it has long been recognized that depersonalisation symptoms occur in other disorders, particularly anxiety and panic. One strand of research proposes that Depersonalization phenomenology arises through altered autonomic arousal in response to stress. Sampling and Methods: We sought to examine profiles of anxiety symptoms through a secondary data analysis of individual items and factor subscales on the Beck Anxiety Inventory (BAI), comparing two relatively large patient samples with DPD or with a variety of anxiety conditions, respectively. The DPD sample (n = 106) had a lower overall BAI score than the combined anxiety disorders group (n = 525). Results: After controlling for this as well as for potential confounders such as age and gender, the DPD group presented significantly lower scores on the panic subscale, marginally lower scores on the autonomic subscale and significantly higher scores on the neurophysiological subscale of the BAI. Conclusions: These differences imply similarities between the cognitive components of DPD and anxiety disorders while physiological experiences diverge. The findings encourage future research looking at direct physiological measures and longitudinal designs to confirm the mechanisms underlying different clinical manifestations of anxiety.
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Depersonalization disorder and anxiety a special relationship
Psychiatry Research-neuroimaging, 2012Co-Authors: Mauricio Sierra, Nick Medford, Geddes Wyatt, Anthony S DavidAbstract:A significant association between anxiety and Depersonalization has been found in healthy controls and psychiatric patients irrespective of underlying conditions. Although patients with Depersonalization disorder (DPD) often have a history of severe anxiety symptoms, clinical observations suggest that the relation between anxiety and Depersonalization is complex and poorly understood. Using relevant rating scales, levels of anxiety and Depersonalization were assessed in 291 consecutive DPD cases. 'High' and 'low' Depersonalization groups, were compared according to anxiety severity. Correlation and multivariate regression analyses were also used to assessed the contribution of anxiety to the phenomenology and natural course of Depersonalization. A low but significant association between Depersonalization and anxiety (as measured by Beck's Anxiety Inventory) was only apparent in those patients with low intensity Depersonalization, but not in those with severe Depersonalization. Levels of anxiety did not seem to make specific contributions to the clinical features of Depersonalization itself, although DPD patients with high anxiety seem characterised by additional non-specific perceptual symptoms. The presence of a 'statistical dissociation' between Depersonalization and anxiety adds further evidence in favour of Depersonalization disorder being an independent condition and suggests that its association with anxiety has been overemphasized.
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Depersonalization disorder pharmacological approaches
Expert Review of Neurotherapeutics, 2008Co-Authors: Mauricio SierraAbstract:Depersonalization disorder (DPD) is a chronic and distressing condition with a prevalence in the general population between 0.8 and 2%. Several neurobiological studies in the last decade have shown that patients have suppressed limbic activation to emotional stimuli. Such findings are in line with a model which suggests that the condition is generated by an anxiety-triggered, ’hard-wired’ inhibitory response to threat. Such a mechanism would ensure the preservation of adaptive behavior, during situations normally associated with overwhelming and potentially disorganizing anxiety. In DPD, such a response would become chronic and dysfunctional. Depersonalization remains a condition for which no definitive treatment exists, and for which conventional medications, such as antidepressants or antipsychotics, have been found to be of little value. Fortunately, a few promising lines of pharmacological treatment have emerged in recent years, although more rigorous studies are needed. For example, a number of studi...
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Limbic and prefrontal responses to facial emotion expressions in Depersonalization
NeuroReport, 2007Co-Authors: Erwin Lemche, Simon Surguladze, Vincent Giampietro, Ananthapadmanabha Anilkumar, Michael Brammer, Mauricio Sierra, Xavier Chitnis, Steven Williams, David Gasston, Peter JoraschkyAbstract:Depersonalization disorder, characterized by emotional detachment, has been associated with increased prefrontal cortical and decreased autonomic activity to emotional stimuli. Event-related fMRI with simultaneous measurements of skin conductance levels occurred in nine Depersonalization disorder patients and 12 normal controls to neutral, mild and intense happy and sad facial expressions. Patients, but not controls, showed decreases in subcortical limbic activity to increasingly intense happy and sad facial expressions, respectively. For both happy and sad expressions, negative correlations between skin conductance measures in bilateral dorsal prefrontal cortices occurred only in Depersonalization disorder patients. Abnormal decreases in limbic activity to increasingly intense emotional expressions, and increases in dorsal prefrontal cortical activity to emotionally arousing stimuli may underlie the emotional detachment of Depersonalization disorder.
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autonomic response in the perception of disgust and happiness in Depersonalization disorder
Psychiatry Research-neuroimaging, 2006Co-Authors: Mauricio Sierra, Mary L Phillips, Anthony S DavidAbstract:Patients with Depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that Depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV Depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with Depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with Depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.
Margaret Knutelska - One of the best experts on this subject based on the ideXlab platform.
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alexithymia absorption and cognitive failures in Depersonalization disorder a comparison to posttraumatic stress disorder and healthy volunteers
Journal of Nervous and Mental Disease, 2009Co-Authors: Daphne Simeon, Timo Giesbrecht, Margaret Knutelska, Rebecca Jo Smith, Lisa M SmithAbstract:Abstract: Alexithymia, absorption, and cognitive failures are traits that have been implicated in dissociative psychopathology. Forty-six participants with Depersonalization disorder (DPD), 21 with posttraumatic stress disorder, and 35 healthy controls completed measures of dissociation, alexithymia, absorption, cognitive failures, and childhood trauma. The DPD and posttraumatic stress disorder groups had significantly and comparably elevated absorption and cognitive failures scores. Only the DPD group had significantly elevated alexithymia scores, specifically in “difficulty identifying feelings.” Regression analyses revealed that “alexithymia—difficulty identifying feelings” was predictive of both DPD diagnosis and Depersonalization scores. In contrast, amnesia scores were predicted by childhood trauma and absorption. In conclusion, the link between Depersonalization and alexithymia appeared to be specific rather than broadly related to early trauma or to trauma-spectrum psychopathology.
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somatoform dissociation in Depersonalization disorder
Journal of Trauma & Dissociation, 2008Co-Authors: Daphne Simeon, Margaret Knutelska, Rebecca Jo Smith, Lisa M SmithAbstract:Along with psychoform dissociation, somatoform dissociation has been put forth as a core aspect of dissociative states, possibly as reliable as psychoform dissociation in the screening for dissociative disorders. The goal of this study was to investigate the prominence and correlates of somatoform dissociation in one of the major Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) dissociative disorders, Depersonalization disorder (DPD). A total of 54 adults with DPD and 47 healthy control participants free of lifetime Axis I and II disorders were administered the 20-item Somatoform Dissociation Questionnaire (SDQ) as well as the Dissociative Experiences Scale, the Cambridge Depersonalization Scale, and the Childhood Trauma Questionnaire-Short Form. Somatoform dissociation scores were statistically significantly, but clinically only modestly, elevated in the DPD as compared to the healthy control group. SDQ items significantly elevated in the DPD group were mostly perceptual in nature. Depersonalization scores were significantly correlated with somatoform dissociation in the DPD group, whereas absorption and amnesia scores were not. With respect to childhood interpersonal trauma, although emotional abuse was significantly associated with Depersonalization severity, none of the 5 categories of trauma were significantly associated with somatoform dissociation in the DPD group. In conclusion, somatoform dissociation is modest in DPD, and the SDQ is a weak instrument for the screening of dissociation in this disorder, detecting only one third of the sample when using the traditional SDQ cutoff score of 30.
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cognitive functioning in Depersonalization disorder
Journal of Nervous and Mental Disease, 2007Co-Authors: Orna Guralnik, Timo Giesbrecht, Margaret Knutelska, Beth Sirroff, Daphne SimeonAbstract:Depersonalization disorder (DPD) is a dissociative disorder characterized by a subjective sense of unreality and detachment, and has been associated with deficits in perception and short-term memory. In this study, 21 DPD and 17 healthy comparison participants free of psychiatric disorders were administered a comprehensive neuropsychologic battery. The groups did not differ in full-scale, verbal, and performance IQ (Wechsler Adult Intelligence Scale), in working memory (Paced Auditory Serial Addition Test), or in selective attention (Digit Span with Distracters). The DPD group performed significantly worse on immediate visual and verbal recall (Wechsler Memory Scale, Revised), but not on delayed recall. Dissociation severity was significantly correlated with processing slowness and distractibility. We conclude that DPD is associated with cognitive disruptions in early perceptual and attentional processes.
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an open trial of naltrexone in the treatment of Depersonalization disorder
Journal of Clinical Psychopharmacology, 2005Co-Authors: Daphne Simeon, Margaret KnutelskaAbstract:Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a pervasive subjective sense of unreality and detachment with intact reality testing. Two recent controlled medication trials, one with lamotrigine and one with fluoxetine, failed to show efficacy. There is some evidence for dysregulation of endogenous opioid systems in Depersonalization, and a few studies have suggested that opioid antagonists may have efficacy in the treatment of dissociation and Depersonalization symptoms. In this prospective open treatment trial, 14 subjects were recruited and treated with naltrexone for 6 weeks to a maximum dose of 100 mg/d (first 7 subjects) or 10 weeks to a maximum dose of 250 mg/d (next 7 subjects). Mean naltrexone dose was 120 mg/d. There was an average 30% reduction of symptoms with treatment, as measured by 3 validated dissociation scales. Three patients were very much improved, and 1 patient was much improved with naltrexone treatment. These findings are potentially promising in a highly treatment-refractory disorder for which no treatment guidelines exist and warrant a randomized controlled trial.
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basal norepinephrine in Depersonalization disorder
Psychiatry Research-neuroimaging, 2003Co-Authors: Daphne Simeon, Orna Guralnik, Margaret Knutelska, Rachel Yehuda, James SchmeidlerAbstract:In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in Depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy comparison (HC) subjects. Norepinephrine was measured via 24-h urine collection and three serial plasma determinations. Groups did not differ significantly in plasma norepinephrine levels. Compared to the HC group, the DPD group demonstrated significantly higher urinary norepinephrine, only prior to covarying for anxiety. The DPD group also demonstrated a highly significant inverse correlation between urinary norepinephrine and Depersonalization severity (r=-0.88). Norepinephrine and cortisol levels (reported in a prior study) were not intercorrelated. We concluded that although dissociation accompanied by anxiety was associated with heightened noradrenergic tone, there was a marked basal norepinephrine decline with increasing severity of dissociation. The findings are in concordance with the few reports on autonomic blunting in dissociation and merit further investigation.
James Schmeidler - One of the best experts on this subject based on the ideXlab platform.
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basal norepinephrine in Depersonalization disorder
Psychiatry Research-neuroimaging, 2003Co-Authors: Daphne Simeon, Orna Guralnik, Margaret Knutelska, Rachel Yehuda, James SchmeidlerAbstract:In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in Depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy comparison (HC) subjects. Norepinephrine was measured via 24-h urine collection and three serial plasma determinations. Groups did not differ significantly in plasma norepinephrine levels. Compared to the HC group, the DPD group demonstrated significantly higher urinary norepinephrine, only prior to covarying for anxiety. The DPD group also demonstrated a highly significant inverse correlation between urinary norepinephrine and Depersonalization severity (r=-0.88). Norepinephrine and cortisol levels (reported in a prior study) were not intercorrelated. We concluded that although dissociation accompanied by anxiety was associated with heightened noradrenergic tone, there was a marked basal norepinephrine decline with increasing severity of dissociation. The findings are in concordance with the few reports on autonomic blunting in dissociation and merit further investigation.
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hypothalamic pituitary adrenal axis dysregulation in Depersonalization disorder
Neuropsychopharmacology, 2001Co-Authors: Daphne Simeon, Orna Guralnik, Eric Hollander, Margaret Knutelska, James SchmeidlerAbstract:Background: The purpose of this preliminary study was to investigate HPA axis function in dissociation. Methods: Nine subjects with DSM-IV Depersonalization disorder (DPD), without lifetime Posttraumatic Stress Disorder (PTSD) or current major depression, were compared to nine healthy comparison (HC) subjects of comparable age and gender. Results: DPD subjects demonstrated significant hyposuppression to low-dose dexamethasone administration and significantly elevated morning plasma cortisol levels when covaried for depression scores, but no difference in 24-hour urinary cortisol excretion. Dissociation scores powerfully predicted suppression whereas depression scores did not contribute to the prediction. Conclusions: Primary dissociative conditions, such as Depersonalization disorder, may be associated with a pattern of HPA axis dysregulation that differs from PTSD and merits further study.
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the role of childhood interpersonal trauma in Depersonalization disorder
American Journal of Psychiatry, 2001Co-Authors: Daphne Simeon, Orna Guralnik, James Schmeidler, Beth Sirof, Margaret KnutelskaAbstract:OBJECTIVE: In contrast to trauma’s relationship with the other dissociative disorders, the relationship of trauma to Depersonalization disorder is unknown. The purpose of this study was to systematically investigate the role of childhood interpersonal trauma in Depersonalization disorder. METHOD: Forty-nine subjects with DSM-IV Depersonalization disorder and 26 healthy comparison subjects who were free of lifetime axis I and II disorders and of comparable age and gender were administered the Dissociative Experiences Scale and the Childhood Trauma Interview, which measures separation or loss, physical neglect, emotional abuse, physical abuse, witnessing of violence, and sexual abuse. RESULTS: Childhood interpersonal trauma as a whole was highly predictive of both a diagnosis of Depersonalization disorder and of scores denoting dissociation, pathological dissociation, and Depersonalization. Emotional abuse, both in total score and in maximum severity, emerged as the most significant predictor both of a diag...
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feeling unreal cognitive processes in Depersonalization
American Journal of Psychiatry, 2000Co-Authors: Orna Guralnik, James Schmeidler, Daphne SimeonAbstract:OBJECTIVE: Depersonalization disorder is characterized by a detachment from one’s sense of self and one’s surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. METHOD: Fifteen patients with Depersonalization disorder were compared to 15 matched normal comparison subjects on a comprehensive neuropsychological test battery that assessed cognitive function. RESULTS: The subjects with Depersonalization disorder showed a distinct cognitive profile. They performed significantly worse than the comparison subjects on certain measures of attention, short-term visual and verbal memory, and spatial reasoning within the context of comparable intellectual abilities. CONCLUSIONS: The authors propose that Depersonalization involves alterations in the attentional and perceptual systems, specifically in the ability to effortfully c...
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the detection and measurement of Depersonalization disorder
Journal of Nervous and Mental Disease, 1998Co-Authors: Daphne Simeon, Orna Guralnik, Shira Gross, Dan J Stein, James Schmeidler, Eric HollanderAbstract: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.