Historyof Mental Illness· Founder Psychologist: Ludovic Dugaso “A state in which there is the feeling orsensation that thoughts and acts elude the self and become strange; there is analienation of personality; in other words, a depersonalization.”§ Originalthought: dysfunction of mental faculty· SensoryTheoryo Depersonalization Disorder frompathological changes in the sensory apparatuso Due to 1700s thoughts of bodily sensationsand the “feeling of self”o Challengers: Dugas and Moutier§ Patient’scomplaints taken literally not metaphorically§ Patientsof loss of joint sense -> no complaint of sensations of unreality· FacultyPsychologyo Memory§ Associationwith Déjà vu (double consciousness) by Dugas· Failure due to each as independent identity§ G.Heymans -> Correlation between Déjà vu and DPD· DPD “more severe of the phenomenon”· “Feeling of familiarity” -> # andstrength of associations with earlier memorieso Affect§ Storring:Theory of “self-awareness”· Feelings active§ Model:· Coenesthesiao Basis of “self-experience”o Awareness of one’s body· Lack of activity-feelingso Absence of feelings -> unreality· Power of perceptiono Body Image§ Viewsthe body parts§ Shilder’sview: Emotions override -> loss of sensationSierra, Mauricio. “A History ofDepersonalization.” Depersonalization: A New Look at a Neglected Syndrome,Cambridge University Press, Cambridge, 2009, pp. 7–23.
Characteristicswith Examples (Case study)· Case study of 223 patients, DPD results tothat of the “Only-Depressed-Group”:a. Sociodemographic characteristics i. More male ii. Younger individuals iii. Often still lived with parents iv.
Holder of German citizenship v. Higher educational level vi. More often employedb. Comorbid conditions, symptom burdenand clinical course i. Higher comorbidity with anxiety disorders ii.
More clinical Axis-I disorders iii. Earlier age of onset iv. Longer disease duration v.
Symptoms of depression vi. Anxiety vii. Global severity index viii. Lower burden of somatic symptoms ix. Slightly lower severity of social anxietyc. Functional Impairment i. Disruption of home and work lifed.
Current psychosocial stressors i. No association with 1. weight or appearance worries2. Difficulties with partners3. Stress at work or school4.
Financial worries5. Having no one to turn to 6. Recent or past bad events.e. Family history and childhoodadversities i. Significant Association:1. Emotionalabuse2. Emotionalneglect3.
Physicalabuse4. Physicalneglect5. Sexualabuse ii. No association:1. Severityof childhood traumatic experiences with severity of depersonalization.f.
Treatmentand health care wishes i. DDS had a high treatment rate ii. Previous psychiatric inpatient treatmentvery likely in DDS patients. iii. Majority of the DDS patients previouslyconsulted a doctor or psychotherapist iv. Interested in DP/DR specific counseling v. Internet often for DDS to searchinformation about symptoms and specialists vi.
Interested in internet-based treatmentapproaches.Michal, Matthias, etal. “A Case Series of 223 Patients with Depersonalization-DerealizationSyndrome.” BMC Psychiatry, BioMed Central, 27 June 2016, doi.org/10.1186/s12888-016-0908-4.Causes(Detailed)· Brain electrical mapping: · Primary depersonalization disorder -> associationwith activation of the left hemispheric frontotemporal.
Hollander , E, et al.”Left Hemispheric Activation in Depersonalization Disorder: A Case Report.”Biological Psychiatry, Elsevier, 14 Mar. 2003, www.sciencedirect.com/science/article/pii/000632239290161R · Significantgroup-by-associative-region-by-Brodmann’s area interaction. · Noteworthy pattern of altered metabolicactivity in the major sensory association across brain lobes.· Subjective symptoms of the DPD in visualand somatosensory modalities, so MAIN FACTOR the parietooccipital cortex.
· · According to Dr. Simeon, “no statisticalsignificance differences found for the prefrontal cortex, precentral cortex, orcingulate cortex.” (Simeon)· Temporal lobe in the Brodmann’s area: · Lowermetabolic rates:1. Area22 (auditory association area) of the right superior temporal gyrus2. Area21 of the middle temporal gyrus· Highermetabolic rates:1.
Area7B (somatosensory association area)2. Area39 (multimodal association area)· Positive correlation of relative glucosemetabolic rates with:· TotalDissociative Experiences Scale score· DissociativeExperiences Scale depersonalization score. · Possible causes for the “two dimensionalflattened, two-dimensional perspective commonly described in depersonalization”:· Dysfunctional areas: · Depthperception associated areas:1. Visualassociation cortices of areas 18 and 19 and with the parietal associationcortex. · Visuoconstructiveabilities such as block constructions and the block design subtest of the WAIS:1. Posteriorparietal area and dysfunction a.
InferiorWAIS block design performance in depersonalization. · Difficultyevoking visual imagery:1. Dueto visual association areas 18 and 19 and by higher-order visual corticalcenters at the occipital-temporal-parietal junction.· Causes behind dysfunctionalities:· Traumatic head injury· More likely to occur after mild injury· High comorbidity for PTSD· Quantitative EEG of alcohol-inducedtransient depersonalization:· Generalizedslowing attributed to metabolic encephalopathy.
Simeon, Daphne, et al. “FeelingUnreal: A PET Study of Depersonalization Disorder.” American Journal ofPsychiatry, vol. 157, no. 11, 1 Nov. 2000, pp.
Treatments(Detailed)· Current Treatment Types:a. MultiscaleDissociation Inventory: i. 30-item self-report test of dissociativesymptomatology; normal standardized ii. 6 different type of dissociative response:1. Disengagement(alpha reliabilities in general population = .83)2.
Depersonalization(alpha reliabilities in general population = .90)3. Derealization(alpha reliabilities in general population = .
91)4. EmotionalConstriction/Numbing (alpha reliabilities in general population = .94)5. MemoryDisturbance (alpha reliabilities in general population = .
74)6. IdentityDissociation (alpha reliabilities in general population = .75)7. TotalDissociation Score (alpha reliabilities in general population = .96)b. MultidimensionalInventory of Dissociation: i. All-inclusive dissociative profile ii. Unique measure of self-report dissociationdue to validity scales.
c. Dissociative ExperiencesScale-Revised i. Revision of the Dissociative ExperiencesScale to include the Likert response scale1. Answersfrom never to at least once per week· In Diagnosis:a. Distinguishing”Hearing voices” i. Auditory hallucinations experienced inpsychosis ii. “Voices” in dissociative episodesb. DPDpatients: i.
No explanation of hallucinations ordissociative experiences with the delusional thought processes ii. The general description: 1. “inexplicableand frightening” and “crazy”· Periods of “acute stressors, frequentdissociation, and/or severe depression and anxiety:” a. Interventionsof coping· Periods of “relatively mild symptoms”a. Psychodynamicapproach: self-reflection and self-examination with help of psychiatrist· No pharmacotherapy for the treatment ofDDDa. Potentialdrugs are opioid antagonists.b. Antidepressantsand anxiolytic for comorbid anxiety and mood symptomsBriere, John.
“MultiscaleDissociation Inventory (MDI).” Multiscale Dissociation Inventory (MDI).N.p.
, n.d. Web. 30 Jan.
, et al. “STRESS AND TRAUMA:Psychotherapy and Pharmacotherapy for Depersonalization/DerealizationDisorder.” Innovations in Clinical Neuroscience, Matrix Medical Communications,2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/.