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Depersonalisation Disorder

A Contemporary Overview

CNS Drugs volume 18, pages 343–354 (2004)Cite this article

Abstract

Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1: 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personality disorders are often comorbid with depersonalisation disorder but none predict symptom severity.

The most common immediate precipitants of the disorder are severe stress, depression and panic, and marijuana and hallucinogen ingestion. Depersonalisation disorder has also been associated with childhood interpersonal trauma, in particular emotional maltreatment.

Neurochemical findings have suggested possible involvement of serotonergic, endogenous opioid and glutamatergic NMDA pathways. Brain imaging studies in depersonalisation disorder have revealed widespread alterations in metabolic activity in the sensory association cortex, as well as prefrontal hyperactivation and limbic inhibition in response to aversive stimuli. Depersonalisation disorder has also been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation.

To date, treatment recommendations and guidelines for depersonalisation disorder have not been established. There are few studies assessing the use of pharmacotherapy in this disorder. Medication options that have been reported include clomipramine, fluoxetine, lamotrigine and opioid antagonists. However, it does not appear that any of these agents have a potent anti-dissociative effect. A variety of psychotherapeutic techniques has been used to treat depersonalisation disorder (including trauma-focused therapy and cognitive-behavioural techniques), although again none of these have established efficacy to date. Overall, novel therapeutic approaches are clearly needed to help individuals experiencing this refractory disorder.

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References

  1. Aderibigbe YA, Bloch RM, Waler WR. Prevalence of depersonalization and derealization experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 63–9

    Article  PubMed  CAS  Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washingon, DC: American Psychiatric Association, 1994

    Google Scholar 

  3. Ross CA. Epidemiology of multiple personality disorder and dissociation. Psych Clin N Amer 1991; 14: 503–17

    CAS  Google Scholar 

  4. Simeon D, Gross S, Guralnik O, et al. Feeling unreal: 30 cases of DSM-III depersonalization disorder. Am J Psychiatry 1997 Aug; 154(8): 1107–13

    PubMed  CAS  Google Scholar 

  5. Simeon D, Knutelska M, Nelson D, et al. Feeling unreal: a depersonalization disorder update of 117 cases. J Clin Psychiatry 2003; 64(9): 990–7

    Article  PubMed  Google Scholar 

  6. Baker D, Hunter E, Lawrence E, et al. Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 2003; 182: 428–33

    Article  PubMed  Google Scholar 

  7. Sierra M, Berrios GE. The phenomenological stability of depersonalization: comparing the old with the new. J Nerv Ment Dis 2001; 189: 629–36

    Article  PubMed  CAS  Google Scholar 

  8. Medford N, Baker D, Hunter E, et al. Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases. Addiction 2003; 98: 1731–6

    Article  PubMed  Google Scholar 

  9. Guralnik O, Schmeidler J, Simeon D. Feeling unreal: cognitive processes in depersonalization. Am J Psychiatry 2000; 157: 103–9

    PubMed  CAS  Google Scholar 

  10. van Ijzendoorn MH, Schuengel C. The measurement of dissociation in normal and clinical populations: meta-analytic validation of the Dissociative Experiences Scale (DES). Clin Psychol Rev 1996; 16: 365–82

    Article  Google Scholar 

  11. Simeon D, Guralnik O, Schmeidler J, et al. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry 2001 Jul; 158(7): 1027–33

    Article  PubMed  CAS  Google Scholar 

  12. Butler LD, Duran RE, Jasiukaitis P, et al. Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology. Am J Psychiatry 1996; 153(7 Suppl.): 42–63

    PubMed  CAS  Google Scholar 

  13. Waller NG, Ross CA. The prevalence and biometric structure of pathological dissociation in the general population: taxometric and behavior genetic findings. J Abnorm Psychol 1997; 106: 499–510

    Article  PubMed  CAS  Google Scholar 

  14. Jang KL, Paris J, Zweig-Frank H, et al. Twin study of dissociative experience. J Nerv Ment Dis 1998 Jun; 186(6): 345–51

    Article  PubMed  CAS  Google Scholar 

  15. Curran HV, Morgan C. Cognitive, dissociative, and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later. Addiction 2000; 95: 575–90

    Article  PubMed  CAS  Google Scholar 

  16. Anand A, Charney D, Oren D, et al. Attenuation of the neuropsychiatric effects of ketamine with lamotrigine: support for hyperglutamatergic effects of N-methyl-D-aspartate receptor antagonists. Arch Gen Psychiatry 2000 Mar; 57(3): 270–6

    Article  PubMed  CAS  Google Scholar 

  17. Feigenbaum JJ, Bergmann F, Richmond SA, et al. Nonpsychotropic cannabinoid acts as a functional N-methyl-D-aspartate receptor blocker. Proc Natl Acad Sci U S A 1989 Dec; 86(23): 9584–7

    Article  PubMed  CAS  Google Scholar 

  18. Szymanski HV. Prolonged depersonalization after marijuana use. Am J Psychiatry 1981 Feb; 138(2): 231–3

    PubMed  CAS  Google Scholar 

  19. Keshaven MS, Lishman WA. Prolonged depersonalization following cannabis abuse. Br J Addict 1986 Feb; 81(1): 140–2

    Article  PubMed  CAS  Google Scholar 

  20. Torch EM. Review of the relationship between obsession and depersonalization. Acta Psychiatr Scand 1978; 58: 191–8

    Article  PubMed  CAS  Google Scholar 

  21. Simeon D, Hollander E, Stein DJ, et al. Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine. Psychiatry Res 1995 Sep 29; 58(2): 161–4

    Article  PubMed  CAS  Google Scholar 

  22. Southwick SM, Krystal JH, Bremner JD, et al. Noradrenergic and serotonergic function in posttraumatic stress disorder. Arch Gen Psychiatry 1997 Aug; 54(8): 749–58

    Article  PubMed  CAS  Google Scholar 

  23. Madden J, Akil H, Patrick RL, et al. Stress-induced parallel changes in central opioid levels and pain responsiveness in the rat. Nature 1977 Jan; 265(5592): 358–60

    Article  PubMed  CAS  Google Scholar 

  24. Pitman RK, Van der Kolk BA, Orr SP, et al. Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder: a pilot study. Arch Gen Psychiatry 1990 Jun; 47(6): 541–4

    Article  PubMed  CAS  Google Scholar 

  25. Walsh SL, Geter-Douglas B, Strain EC, et al. Enadoline and butorphanol: evaluation of kappa-agonists on cocaine pharmacodynamics and cocaine self-administration in humans. J Pharmacol Exp Ther 2001 Oct; 299(1): 147–58

    PubMed  CAS  Google Scholar 

  26. Bohus MJ, Landwehrmeyer B, Stiglmayr CE, et al. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: a open-label trial. J Clin Psychiatry 1999 Sep; 60(9): 598–603

    Article  PubMed  CAS  Google Scholar 

  27. Nuller YL, Morozova MG, Kushnir ON, et al. Effect of naloxone therapy on depersonalization: a pilot study. J Psychopharmacol 2001; 15(2): 93–5

    Article  PubMed  CAS  Google Scholar 

  28. Glover H. A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. Isr J Psychiatry Relat Sci 1993; 30(4): 255–63

    PubMed  CAS  Google Scholar 

  29. Griffin MG, Resick PA, Mechanic MB. Objective assessment of peritraumatic dissociation: psychophysiological indicators. Am J Psychiatry 1997 Aug; 154(8): 1081–8

    PubMed  CAS  Google Scholar 

  30. Sierra M, Senior C, Dalton J, et al. Autonomie response in depersonalization disorder. Arch Gen Psychiatry 2002 Sep; 59(9): 833–8

    Article  PubMed  Google Scholar 

  31. Southwick SM, Bremner JD, Rasmusson A, et al. Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry 1999 Nov; 46(9): 1192–204

    Article  PubMed  CAS  Google Scholar 

  32. Simeon D, Guralnik O, Knutelska M, et al. Basal norepinephrine in depersonalization disorder. Psych Res 2003; 121: 93–7

    Article  CAS  Google Scholar 

  33. Yehuda R. Sensitization of the hypothalamic-pituitary-adrenal axis in posttraumatic stress disorder. Ann N Y Acad Sci 1997; 821: 57–75

    Article  PubMed  CAS  Google Scholar 

  34. Simeon D, Guralnik O, Knutelska M, et al. Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder. Neuropsychopharmacology 2001 Nov; 25(5): 793–5

    Article  PubMed  CAS  Google Scholar 

  35. Stanton BR, David AS, Cleare AJ, et al. Basal activity of the hypothalamic-pituitary-adrenal axis in patients with depersonalization disorder. Psychiatry Res 2001 Oct; 104(1): 85–9

    Article  PubMed  CAS  Google Scholar 

  36. Penfield W, Rasmussen T. The cerebral cortex of man: a clinical study of localization of function. New York: MacMillan Company, 1950: 157–81

    Google Scholar 

  37. Sierra M, Berrios GE. Depersonalization: neurobiological perspectives. Biol Psychiatry 1998; 44: 898–908

    Article  PubMed  CAS  Google Scholar 

  38. Sierra M, Lopera F, Lambert MV, et al. Separating depersonalization and derealisation: the relevance of the “lesion” method. J Neurol Neurosurg Psychiatry 2002; 72: 530–2

    PubMed  CAS  Google Scholar 

  39. Lambert MV, Sierra M, Phillips ML, et al. The spectrum of organic depersonalization: a review plus four new cases. J Neuropsychiatry Clin Neurosci 2002; 14: 141–54

    Article  PubMed  Google Scholar 

  40. Krystal J, Bremner D, Southwick SM, Charney DS. The emerging neurobiology of dissociation: implications for the treatment of posttraumatic stress disorder. In: Bremner JD, Marmar CR, editors. Trauma, memory, and dissociation. Washington, DC: American Psychiatric Press Inc, 1998

    Google Scholar 

  41. Devinsky O, Putnam F, Grafman J, et al. Dissociative states and epilepsy. Neurology 1989 Jun; 39(6): 835–40

    Article  PubMed  CAS  Google Scholar 

  42. Ackner B. Depersonalization: I. Etiology and phenomenology: II. clinical syndromes. J Ment Sci 1954; 100: 838–72

    CAS  Google Scholar 

  43. Vallar G, Perani D. The anatomy of unilateral neglect after right-hemisphere stroke lesions: a clinical/CT-scan correlation study in man. Neuropsychologia 1986; 24(5): 609–22

    Article  PubMed  CAS  Google Scholar 

  44. Salanova V, Andermann F, Rasmussen T, et al. Parietal lobe epilepsy: clinical manifestations and outcome in 82 patients treated surgically between 1929 and 1988. Brain 1995 Jun; 118(3): 607–27

    Article  PubMed  Google Scholar 

  45. Adolphs R, Damasio H, Tranel D, et al. A role for somatosensory cortices in the visual recognition of emotion as revealed by three-dimensional lesion mapping. J Neurosci 2000 Apr; 20(7): 2683–90

    PubMed  CAS  Google Scholar 

  46. Gorno-Tempini ML, Price CJ, Josephs O, et al. The neural systems sustaining face and proper-name processing. Brain 1998 Nov; 121(11): 2103–18

    Article  PubMed  Google Scholar 

  47. Blanke O, Ortigue S, Landis T, et al. Stimulating illusory own-body perceptions. Nature 2002 Sep; 419(6904): 269–70

    Article  PubMed  CAS  Google Scholar 

  48. Mathew RJ, Wilson WH, Chiu NY, et al. Regional cerebral blood flow and depersonalization after tetrahydrocannibol administration. Acta Psychiatr Scand 1999; 100: 67–75

    Article  PubMed  CAS  Google Scholar 

  49. Vollenweider FX, Vontobek P, Hell D, et al. 5-HT modulation of dopamine release in basal ganglia in psilocybin-induced psychosis in man: a PET study with [11C]raclopride. Neuropsychopharmacology 1999; 20: 424–33

    Article  PubMed  CAS  Google Scholar 

  50. Vollenweider FX, Maguire RP, Leenders KL, et al. Effects of high amphetamine dose on mood and cerebral glucose metabolism in normal volunteers using positron emission tomography (PET). Psychiatry Res 1998; 83: 149–62

    Article  PubMed  CAS  Google Scholar 

  51. Lanius RA, Williamson PC, Boksman K, et al. Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation. Biol Psychiatry 2002 Aug; 52(4): 305–11

    Article  PubMed  Google Scholar 

  52. Phillips ML, Medford N, Senior C, et al. Depersonalization disorder: thinking without feeling. Psychiatry Res 2001 Dec; 108(3): 145–60

    Article  PubMed  CAS  Google Scholar 

  53. Simeon D, Guralnik O, Hazlett EA, et al. Feeling unreal: a PET study of depersonalization disorder. Am J Psychiatry 2000; 157: 1782–8

    Article  PubMed  CAS  Google Scholar 

  54. Hollander E, Liebowitz MR, DeCaria CM, et al. Treatment of depersonalization with serotonin reuptake blockers. J Clin Psychopharmacol 1990 Jun; 10(3): 200–3

    Article  PubMed  CAS  Google Scholar 

  55. Simeon D, Stein DJ, Hollander E. Treatment of depersonalization disorder with clomipramine. Biol Psychiatry 1998 Aug; 44(4): 302–3

    Article  PubMed  CAS  Google Scholar 

  56. Fichtner CG, Horevitz RP, Braun BG. Fluoxetine in depersonalization disorder. Am J Psychiatry 1992 Dec; 149(12): 1750–1

    PubMed  CAS  Google Scholar 

  57. Ratliff NB, Kerski D. Depersonalization treated with fluoxetine. Am J Psychiatry 1995 Nov; 152(11): 1689–90

    PubMed  CAS  Google Scholar 

  58. Simeon D, Gurainik O, Schmeidler J, et al. Fluoxetine is not efficacious in depersonalisation disorders: a randomized controlled trial. Br J Psychiatry. In press

  59. Sierra M, Phillips ML, Lambert MV, et al. Lamotrigine in the treatment of depersonalization disorder. J Clin Psychiatry 2001 Oct; 62(10): 826–7

    Article  PubMed  CAS  Google Scholar 

  60. Sierra M, Phillips ML, Krystal J, et al. A placebo-controlled, crossover trial of lamotrigine in depersonalization disorder. J Psychopharmacol 2003 Mar; 17(1): 103–5

    Article  PubMed  CAS  Google Scholar 

  61. Frances A, Sacks M, Aronoff S. Depersonalization: a self-relational perspective. Int J Psychoanal 1977; 58: 325–31

    PubMed  CAS  Google Scholar 

  62. Hunter ECM, Phillips ML, Chalder T, et al. Depersonalisation disorder: a cognitive-behavioural conceptualisation. Behav Res Ther 2003; 41(12): 1451–67

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This manuscript was supported in part by the NIMH, grant number: MH62414 awarded to Dr Simeon. The author has no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, New York, 10029-6574, USA

    Daphne Simeon

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Simeon, D. Depersonalisation Disorder. CNS Drugs 18, 343–354 (2004). https://doi.org/10.2165/00023210-200418060-00002

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Keywords

  • Lamotrigine
  • Naltrexone
  • Temporal Lobe Epilepsy
  • Opioid Antagonist
  • Borderline Personality Disorder