Depersonalisation- emotional dissociation?

4 Dec

“I want to feel things like everyone else again, but I’m deadened and numb. I can laugh or cry but it’s intellectual, my muscles move but I feel nothing.”- Greg (Simeon & Abugel, 2006)

Depersonalization (DP) is a dissociative disorder, and can be explained as feelings of unreality (Sierra & Berrios, 2000). The American Psychiatric Association (1994) defined depersonalization in the DSM-IV as the ’alteration in the perception or experience of the self so that one feels detached from and as if one is an outside observer of ones mental processes or body (e.g. feeling as if one is in a dream)’. Depersonalization is thought to be prevalent in up to 20% of the population (Simeon et al., 1997). It can be a disorder of its own but can also be an effect of depression, anxiety, and other psychological disorders such as schizophrenia (Baker et al., 2003; Nuller, 2007; Roth, 1959). It may also have resulted from prolonged trauma and substance abuse (Simeon et al., 1997; Cohen & Cocores, 1997; Mathew, Wilson, Humphreys, Lowe & Weithe, 1993; Wenzel et al, 1996). This blog is going to discuss the effects of DP on emotions, and briefly evaluate treatment available.

Sierra and Berrios (2000) have suggested that depersonalization has two distinctive effects on the sufferer; these are a lack of emotional processing and a higher level of alertness. Individuals with DP commonly report a lack of emotional response and feeling (Sierra & Berrios, 1998). This is termed by Davidson (1966) as de-affectualization and involves a loss of affection and pleasure, emotional numbing, lack of emotional colouring, changes to the individual’s perceptions and cognitions and a lack of aversion to fearful or disgustful situations (Ackner, 1954; Mayer-Gross, 1935; Roth, 1959; Sapperstein 1949; Sierra & Berrios, 2000). This lack of emotion has been put down to the fact individuals affected with DP do not feel as though they are in reality (Lewis, 1934), but fMRI studies suggest that it could be due to neural differences in the brain.

On an fMRI task, individuals with DP showed a loss in brain activity when the intensity of happy and sad emotional expressions increased, which is opposite to those who do not have DP (Lemche et al., 2008). The same has been found when DP patients viewed aversive stimuli, as they were found to show lower brain activity in areas that are known to be sensitive to emotions, for example the insula and the posterior occipital temporal cortex (Phillips et al., 2001). It has been suggested that individuals with DP actually process aversive stimuli a different way than typical people (Medford et al., 2006). Alongside this, when presented with an aversive stimuli, they showed an increase in brain activity in the inferior and lateral frontal cortex; an area which is associated with the regulation of emotion (Phillips et al., 2001). This higher level of emotional regulation explains the self-reported loss in emotions.

This increase in emotional regulation in individuals with DP can be linked to the suggestion that depersonalization is used as a coping defense when daily stresses become too much to handle (Golembiewski, Munzenrider & Stevenson, 1986). To support this suggestion, it has been found that a higher number of stressors led to a more serious depersonalization (Zapf, Seifert, Schmutte, Mertini & Holz, 2001). This implies that the increased emotional regulation, which leads to a lack of response to aversive situations, is an innate system, designed to help people with stress, anxiety and depression cope with life.

Currently, there is no treatment for DP that has been found to be effective (Pini & Cassano, 2007). Medical treatments including the use of Serotonin Reuptake Inhibitors and Opioid Antagonists have been researched, and found to be helpful is some patients, but not a significant percentage (Pini & Cassano, 2007). Psychotherapeutic techniques, including cognitive-behavioral therapy (CBT) have been implemented (Simeon, 2004). Whilst the results of these studies have produced mixed results, they appear to be more effective than the use of medication, with one study claiming that CBT use over six months cleared the DP symptoms in 29% of the patients (Hunter, Baker, Phillips, Sierra & David, 2005). The higher effectiveness of therapy than medication could be explained regarding the idea of depersonalization being a coping mechanism, referring to the idea that therapy would target the underlying stress, rather than the after effects. It could be debated that the use of medication could be harmful to the individual as it could leave the underlying cause of the depersonalization untreated.

References:

Ackner, B. (1954) Depersonalization I. Aetiology and phenomenology. Journal of Mental Science, 100(421), 838. doi:10.1192/bjp.100.421.838

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Press.

Baker, D., Hunter, E., Lawrence, E., Medford, N., Patel, M., Senior, C., Sierra, M., Lambert, M. V., Phillips, M. L., & David, A. S. (2003). Depersonalisation disorder: clinical features of 204 cases. The British Journal of Psychiatry, 182(1), 428-433. doi: 10.1192/bjp.02.399

Cohen, R. S., & Cocores, J. (1997). Neuropsychiatric manifestations following the use of 3,4-methylenedioxymethamphetamine (MDMA: “ecstasy”). Progress in Neuropsychopharmacology and Biological Psychiatry, 21(4), 727– 734.

Davidson, P. W. (1966). Depersonalization phenomena in 214 adult psychiatric in-patients. Psychiatric Quarterly, 40(1-4), 702–722. doi:10.1007/BF01562791

Golembiewski R.T, Munzenrider R.F., & Stevenson J.G. (1986) Stress in Organizations: Toward a Phase Model of Burnout. Praeger: New York.

Hunter, E. C. M., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: an open study. Behaviour Research and Therapy, 43(9), 1121- 1130. Retrieved from http://www.sciencedirect.com/science/article/pii/S0005796704002153

Lemche, E., Anilkumar, A., Giampietro, V. P., Brammer, M. J., Surguladze, S. A., Lawrence, N. S., Gasston, D., Chitnis, X., Williams, S. C. R., Sierra, M., Joraschky, P., & Phillips, M. L. (2008). Cerebral and autonomic responses to emotional facial expressions in depersonalisation disorder. The British Journal of Psychiatry, 193(3), 222-228. doi: 10.1192/bjp.bp.107.044

Lewis, A. J. (1934). Melancholia: Clinical Survey of Depressive States. Journal of Mental Science, 80, 277- 378. doi: 10.1192/bjp.80.329.277

Mayer-Gross, W. (1935) On depersonalization. British Journal of Medical Psychology, 15(2), 103- 122. doi:10.1111/j.2044-8341.1935.tb01140.x

Matthew, R. J., Wilson, W. H., Humphreys, D., Lowe, J. V., & Weithe, K. E. (1993). Depersonalisation after Marijuana Smoking. Biological Psychiatry, 33(6), 431- 441.

Medford, N., Brierley, B., Brammer, M., Bullmore, E. T., David, A. S., & Phillips, M. L. (2006). Emotional memory in depersonalization disorder: A functional MRI study. Psychiatry Research: Neuroimaging, 148(2-3), 93- 102. Retrieved from http://www.sciencedirect.com/science/article/pii/S0925492706000941

Nuller, Y. L. (1982). Depersonalisation – symptoms, meaning, therapy. Acta Psychiatrica Scandinavica, 66(6), 451- 458. doi: 10.1111/j.1600-0447.1982.tb04502.x

Phillips, M. L., Medford, N., Senior, C., Bullmore, E. T., Suckling, J., Brammer, M. J., Andrew, C., Sierra, M., Williams, S. C. R., & David, A. S. (2001). Depersonalization disorder: thinking without feeling. Psychiatry Research. Neuroimaging, 108(3), 145–160. doi: 10.1016/S0925-4927(01)00119-6

Pini, M. M. S., & Cassano, G. B. (2007). The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: A critical reappraisal. Journal of Affective Dissorders, 99(1-3), 91-99. doi:http://dx.doi.org/10.1016/j.jad.2006.08.025

Roth, M. (1959). The Phobic Anxiety-depersonalization Syndrome. Proc R Soc Med., 52(8): 587–595. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1870046/?page=1

Saperstein, J. L. (1949). On the phenomena of depersonalization. Journal of Nervous and Mental Disorders, 110(3), 236–251.

Sierra, M., & Berrios, G. E. (1998). Depersonalization: neurobiological perspectives. Biological Psychiatry, 44(9), 898- 908. Retrieved from http://www.sciencedirect.com/science/article/pii/S0006322398000158

Sierra, M., & Berrios, G. E. (2000). The Cambridge Depersonalisation Scale: a new instrument for the measurement of depersonalization. Psychiatry Research, 93(2), 153- 164.

Simeon, D. (2004). Depersonalisation Disorder. CNS Drugs, 18(6), 343- 354. doi:10.2165/00023210-200418060-00002

Simeon, D., & Abugel, J. (2006). Feeling Unreal; Depersonalisation Disorder and the Loss of the Self. New York: Oxford University Press.

Simeon, D., Gross, S., Guralnik, O., Stein, D. J., Schmeidler, J., & Hollander, E. (1997). Feeling unreal: 30 cases of DSM-III-R depersonalization disorder. American Journal of Psychiatry, 154, 1107–1113. Retrieved from http://www.pn.psychiatryonline.org/data/Journals/AJP/3679/1107.pdf

Wenzel, K., Bernstein, D. P., Handelsman, L., Rinaldi, P., Ruggiero, J., & Higgins, B. (1996). Levels of dissociation in detoxified substance abusers and their relationship to chronicity of alcohol and drug use. Journal of Nervous and Mental Disease, 184(4), 220–227. doi: 10.1097/00005053-199604000-00004

Zapf, D., Siefert, C., Schutte, B., Mertini, H., & Holz, M. (2001). Emotion work and job stressors and their effects on burnout. Psychology & Health, 16(5), 527- 545. doi:10.1080/08870440108405525

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: