DP/DR Subgroup of PTSD - Breakthrough

Here is an encouraging update in understanding depersonalization -- in this case as a subtype of PTSD; PTSD is an anxiety disorder and as I have always suspected, DP/DR belong under the category of Anxiety Disorders, not Dissociative Disorders.

This article may also someone explain the use of the unofficial diagnosis of “complex PTSD” which is attributed to childhood abuse.
- Sandy -

Altered Circuits May Cause ‘Out-Of-Body’ Symptoms in Some People with PTSD <--- Click Here for full article.

Margaret McKinnon, Ph.D.
May 5, 1015
For some people with post-traumatic stress disorder (PTSD), symptoms go beyond the flashbacks, nightmares, sleeplessness, and tense feelings that trouble many. Up to 30 percent of people with PTSD also suffer from symptoms known as depersonalization and de-realization––that is, they experience “out-of-body” episodes or feelings that the world is not real. These disturbances to awareness and consciousness are known as dissociation.

New research now reveals that brain circuits involved in fear processing are wired differently in these people than in others diagnosed with PTSD. The findings, reported in Neuropsychopharmacology, suggest that such patients need different treatment options.

PTSD with dissociation is recognized as a distinct subtype of the disorder. It is most common among people whose PTSD developed after repeated traumas or childhood adversity. Genetic factors can also increase the risk of developing PTSD with dissociation.

Studies have found that reminders of traumatic events trigger different patterns of neural activity in patients with dissociative PTSD than they do in people who have PTSD without dissociation. In both groups, emotion-regulating brain circuits are thought to be disrupted. Emotional responses are undermodulated (under-regulated, or controlled) by the brain in most people with PTSD, causing them to relive traumatic events and experience hyperarousal symptoms such as being easily startled. In people with the dissociative subtype of PTSD,
in contrast, emotional responses are overmodulated (over-regulated) by the brain, leading to emotional detachment and the subtype's characteristic feelings of depersonalization and derealization.

Senior author Ruth Lanius, M.D., Ph.D., of the University of Western Ontario led a team of scientists that included two-time (2007 and 2009) NARSAD Young Investigator grantee Margaret McKinnon, Ph.D., of McMaster University in Ontario. The scientists used functional magnetic resonance imaging to compare activity in the brains of 49 people with PTSD, 13 of whom had been diagnosed with the dissociative subtype of the disorder. Their study also included 40 people without PTSD.

The researchers focused their analysis on parts of the brain that connect to the amygdala, a small structure deep in the brain that is involved in emotion and fear processing. They examined connections to two parts of the amygdala: the basolateral amygdala, which evaluates sensory information and helps integrate emotions, and the centromedial amygdala, which helps execute fear responses.

They found that in the brains of patients with the dissociative subtype of PTSD, the amygdala was more strongly connected to brain regions involved in consciousness, awareness, emotional regulation, and proprioception (the sense of body position) than it was in PTSD patients without the dissociative subtype. The researchers say that patients' dissociative symptoms may be directly related to these alterations in the brain's functional circuitry.

Feeling of Presence

An incredible advance in the understanding perceptual distortions! Though this is being applied to a greater understanding of the sense of a “phantom presence” in individuals with schizophrenia, this can be applied to understanding other perceptual distortions of the Self such as DP and DR. I have tremendous faith in this line of research.

View the video below.

Also see the full article from Andrew Sullivan’s “The Daily Dish” HERE.

A sample:
“Feeling of Presence, or FoP, is the disconcerting notion that someone else is hovering nearby, walking alongside you or even touching you. It’s the stuff of ghost stories, but also a real symptom of several neurologic conditions, including schizophrenia and Alzheimer’s disease. Scientists know so little about the underlying causes of FoP that long-term treatments and cures remain illusive.

Now, researchers are chipping away at the neurobiology behind that uncanny feeling. In a paper published November 6 in Current Biology, a team of scientists described how they used a custom-built robot to induce an eerie Feeling of Presence in healthy participants. Their findings confirm that sensorimotor conflict, a neurologic imbalance between what the mind perceives and what the body feels, lies at the root of some FoP illusions.”

Consciousness Research - U. of Arizona

I discovered another amazing center for research into consciousness. I have high hopes for this organization in terms of understanding the biological underpinnings of Depersonalization/Derealization Disorder. I will adding this to my links section as another valuable resource.

Center For Consciousness Studies -- The University of Arizona
Promoting open, rigorous discussion of all phenomena related to conscious experience

The study of human consciousness is one of science's last great frontiers. After being neglected for many years (i.e. during a period of dominance by behaviorism in psychology), interest in the science of consciousness exploded in the last decades, with much progress in neuroscience, psychology, philosophy, and other areas.

The University of Arizona has been at the center of these developments. The 1994 Tucson conference on "Toward a Science of Consciousness" is widely regarded as a landmark event, and the subsequent series of biennial conferences in Tucson have attracted extraordinary interest.

The Center for Consciousness Studies at the University of Arizona was formed in 1998 with a seed grant from the Fetzer Institute. The Center is a unique institution whose aim is to bring together the perspectives of philosophy, the cognitive sciences, neuroscience, the social sciences, medicine, and the physical sciences, the arts and humanities, to move toward an integrated understanding of human consciousness.

The Center is unique in its broad spectrum approach. Other groups tend focus either on cognitive neuroscience, philosophy or purely phenomenal experiential approaches, whereas the Center not only integrates these areas, but "thinks outside the box" of conventional wisdom which has thus far, at least, failed to make significant breakthroughs. The Center has also inspired other groups such as the Association for the Scientific Study of Consciousness and those who organize other conferences.

"How Do You Feel When You Can't Feel Your Body?"

Current Research -- Cognitive Neuroscience

How Do You Feel when You Can't Feel Your Body? Interoception, Functional Connectivity and Emotional Processing in Depersonalization-Derealization Disorder
Published: June 26, 2014
DOI: 10.1371/journal.pone.0098769
Link To Multiple Authors

“Depersonalization-Derealization Disorder (DD) typically manifests as a disruption of body self-awareness. Interoception −defined as the cognitive processing of body signals− has been extensively considered as a key processing for body self-awareness.

In consequence, the purpose of this study was to investigate whether there are systematic differences in interoception between a patient with DD and controls that might explain the disembodiment symptoms suffered in this disease.

To assess interoception, we utilized a heartbeat detection task and measures of functional connectivity derived from fMRI networks in interoceptive/exteroceptivo/mind-wanderi ngstates. Additionally, we evaluated empathic abilities to test the association between interoception and emotional experience.

The results showed patient's impaired performance in the heartbeat detection task when compared to controls. Furthermore, regarding functional connectivity, we found a lower global brain connectivity of the patient relative to controls only in the interoceptive state. He also presented a particular pattern of impairments in affective empathy.

To our knowledge, this is the first experimental research that assesses the relationship between interoception and DD combining behavioral and neurobiological measures. Our results suggest that altered neural mechanisms and cognitive processes regarding body signaling might be engaged in DD phenomenology. Moreover, our study contributes experimental data to the comprehension of brain-body interactions and the emergence of self-awareness and emotional feelings.”

See Full Article Here

How Different Are We From Animals?

This is a stunning, deeply moving story of an abused primate; the story of his journey from a dysfunctional outcast to a healthy member of his community. It raises many questions about the effects of abuse on humans and throws me for a loop regarding the Nature/Nurture debate.

I am so convinced at times that my symptoms are purely neurological, but I cannot forget that chronic verbal abuse, neglect, and constant overstimulation had a tremendous effect on my mental health. Nature and Nurture are inextricably linked.

What is very difficult for me in reading this story is that love can be so powerful, so healing.
I truly was not loved by my parents and had no real support system to make up for that. Brian the bonobo seems to have been rescued from a life of misery with a holistic approach that depended heavily on love and support.

I am stunned that I am somewhat envious, but this helps me keep the faith. It keeps me humble in the face of animals that are very much like us and we are very much like them.

Brian The Mentally Ill Bonobo And How He Healed
By Alexis C. Madrigal
It took a troop of apes, and a psychiatrist, and a little Paxil.

“Things were not looking good for Brian. He'd been kept from the affection of his mother—and all other women—and raised alone by his father, who sexually traumatized him. Normal social interactions were impossible for him. He couldn't eat in front of others and required a series of repeated, OCD-like rituals before he'd take food. He was scared of any new thing, and when he got stressed, he'd just curl up into the fetal position and scream.

He also hurt himself over and over, tearing off his own fingernails and intentionally cutting his genitals. He was socially outcast, left to clap his hands, spin in circles, and stare blankly at walls by himself.
Still, some other bonobos were kind to him. Kitty, a 49-year-old blind female, and Lody, a 27-year-old male, spent time with Brian. When he panicked, Lody sometimes led him by the hand to their playpen at the Milwaukee County Zoo.

After six weeks, the zookeepers knew they had to do something. They called Harry Prosen, who was the chair of the psychiatry department at the Medical College of Wisconsin, who took Brian on as his first non-human patient.”

Brian’s story comes from a new book: Animal Madness: How anxious dogs, compulsive parrots, and elephants in recovery help us understand ourselves by Laurel Braitman.

If these stories do not move you, you have no heart.

Click the title to read Brian’s story. Clicking on “Animal Madness” will direct you to the book on Amazon. Savor!

Depersonalization and Dizziness

My depersonalization experience has always been accompanied by dizzy spells. Before my DP/DR “took over” I woke up one morning feeling horribly dizzy and off-balance. Over the years I have heard DP sufferers mention dizziness as well. I have also had bouts of serious vertigo that come and go “out of the blue.”

I recently found this current article indicating this is probably not a coincidence, and may not simply be associated with anxiety. I also recall (though I will have to verify this) that the DSM-III mentioned dizziness as a symptom of depersonalization disorder.

I hope for replication of this study and dissemination of this critical information which could lead to further understanding and treatment.

J Nerv Ment Dis. 2013 Jul;201(7):629-35. doi: 10.1097/NMD.0b013e3182982995.
Depersonalization experiences are strongly associated with dizziness and vertigo symptoms leading to increased health care consumption in the German general population.
Tschan R, Wiltink J, Adler J, Beutel ME, Michal M.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.

This study investigated the association of depersonalization (DP) experiences with dizziness and its impact on subjective impairment and health care use.

Trained interviewers surveyed a representative sample of 1287 persons using standardized self-rating questionnaires on dizziness, DP, and mental distress. Symptoms of dizziness were reported by 15.8% (n = 201). Thereof, 62.7% endorsed at least one symptom of DP, 40% reported impairment by symptoms of DP, and 8.5% reported clinically significant DP.

Regression analyses identified DP as a significant, independent predictor for dizziness symptom severity, health care use, and impairment by dizziness. With regard to the Vertigo Symptom Scale, DP explained 34.1% (p < 0.001) of the variance for severity of symptoms of dysfunction in the balance system. In conclusion, symptoms of DP, highly prevalent in patients complaining of dizziness and vertigo, were independently associated with increased impairment and health care use.

The presence of DP symptoms should actively be explored in patients complaining of dizziness.

[PubMed - indexed for MEDLINE]

"Study Discovers Internal Trigger for Panic Attack in the Previously Fearless"

Further understanding of panic and anxiety studying a woman who has no panic or fear!

Study Discovers Internal Trigger for Panic Attack in the Previously Fearless
Published: February 3, 2013
The New York Times

“In the past few years, scientists have learned a lot about fear from a woman who could not experience it. A rare illness had damaged a part of her brain known as the amygdala and left her eerily unafraid.
Both in experiments and in life, the woman, known as SM, showed no fear of scary movies, snakes, spiders or very real domestic assaults, death threats, and robberies at knife- and gunpoint.

Although she lived in an area “replete with crime, drugs and danger,” according to an earlier study, because she lacked a functioning amygdala, an evolutionarily ancient part of the brain long known to process fear, nothing scared her.

But recently SM had a panic attack. And the simple fact that she was able to feel afraid without a working amygdala, experts say, illuminates some of the brain’s most fundamental processes and may have practical value in the study of panic attacks.” Read More...

A Doctor's Blog On Depersonalization

Here is yet another resource for those with Depersonalization.

The Search For Self
Exploring Depersonalization Disorder
by Elena Bezzubova, M.D., Ph.D.

Elena Bezzubova received her M.D. summa cum laude and Ph.D. with a dissertation on depersonalization. She completed a residency in psychiatry and training in psychoanalysis. Her 30 years of clinical, teaching, and research experience includes inpatient and outpatient adolescents and adults, encompassing a broad range of mental health issues.

Throughout her career, depersonalization and identity disturbances have been a central focus of her practice and scholarship. She has taught child, adolescent, and adult psychiatry, psychoanalysis, history of psychiatry, social psychiatry, clinical psychology, literature and psychiatry, medical ethics, and the art of doctoring. She has published more than 50 book chapters and articles, and has organized and presented at numerous conferences around the world. Dr. Bezzubova maintains a private practice as a psychoanalyst in Newport Beach, CA, and teaches at the University California, Irvine, and the New Center for Psychoanalysis in Los Angeles.

Follow this interesting blog on Psychology Today.com HERE

Childhood Trauma Leaves Mark on DNA of Some Vicitims

More research on the the tremendous power of both Nature and Nurture.

Childhood Trauma Leaves Mark On DNA of Some Victims: Gene-Environment Interaction Causes Lifelong Dysregulation of Stress Hormones

Dec. 2, 2012 — Abused children are at high risk of anxiety and mood disorders, as traumatic experience induces lasting changes to their gene regulation. Scientists from the Max Planck Institute of Psychiatry in Munich have now documented for the first time that genetic variants of the FKBP5 gene can influence epigenetic alterations in this gene induced by early trauma.

In individuals with a genetic predisposition, trauma causes long-term changes in DNA methylation leading to a lasting dysregulation of the stress hormone system. As a result, those affected find themselves less able to cope with stressful situations throughout their lives, frequently leading to depression, post-traumatic stress disorder or anxiety disorders in adulthood.
Doctors and scientists hope these discoveries will yield new treatment strategies tailored to individual patients, as well as increased public awareness of the importance of protecting children from trauma and its consequences.
Many human illnesses arise from the interaction of individual genes and environmental influences. Traumatic events, especially in childhood, constitute high risk factors for the emergence of psychiatric illnesses in later life. However, whether early stress actually leads to a psychiatric disorder depends largely on his or her genetic predisposition. Read More...

Abuse Takes Toll On The Brain

Not that surprising, and we must find hope in brain plasticity and the ability of the brain to “rewire” itself. Yet, that is a long, hard journey. Prevention (if possible) is key.

Read the full article here:

Studies Report Early Childhood Trauma Takes Visible Toll on Brain
Published: October 16, 2012.  By  Society for Neuroscience

“Trauma in infancy and childhood shapes the brain, learning, and behavior, and fuels changes that can last a lifetime, according to new human and animal research released today. The studies delve into the effects of early physical abuse, socioeconomic status (SES), and maternal treatment. Documenting the impact of early trauma on brain circuitry and volume, the activation of genes, and working memory, researchers suggest it increases the risk of mental disorders, as well as heart disease and stress-related conditions in adulthood.

• Physical abuse in early childhood may realign communication between key "body-control" brain areas, possibly predisposing adults to cardiovascular disease and mental health problems (Layla Banihashemi, PhD, abstract 691.12, see attached summary).

• Rodent studies provide insight into brain changes that allow tolerance of pain within mother-pup attachment (Regina Sullivan, PhD, abstract 399.19, see attached summary).

• Childhood poverty is associated with changes in working memory and attention years later in adults; yet training in childhood is associated with improved cognitive functions (Eric Pakulak, PhD, abstract 908.04, see attached summary).

• Chronic stress experienced by infant primates leads to fearful and aggressive behaviors; these are associated with changes in stress hormone production and in the development of the amygdala (Mar Sanchez, PhD, abstract 691.10, see attached summary).

Another recent finding discussed shows that:
• Parent education and income is associated with children's brain size, including structures important for memory and emotion (Suzanne Houston, MA, see attached speaker's summary).”

J.D. Blom - Studies in Altered States of Consciousness

I have found (through a fellow DP sufferer) another doctor who I feel is moving in the right direction with research that may shed more light on Depersonalization Disorder.
Like Oliver Sacks, M.D. and V.S. Ramachandran, M.D., a new name, Dr. J.D. Blom has come to my attention -- psychiatrist in the Netherlands attempting to understand the definition of "Self."
He is also involved in delving deeper into schizophrenia, bipolar, and other illnesses which can cause hallucinations.
I was struck with his discussion of the cenesthesiopathies -- "… aberrant somatosensory sensations and disturbances in the sensation of physical existence." I have provided links to Abstracts on some of his current research. Read More...

Blood Test For Depression - One Step Closer

There is still the endless struggle to “legitimize” mental illness as a MEDICAL disorder. Current research is bringing us one step closer. Here is exciting news in the Los Angeles Times via the journal Translational Psychiatry.

Critical here is this study was conducted on teens. Here’s to stepping up to diagnosing those with predispositions and even distinguishing between different types of depression.
“Even among psychiatric disorders, depression is a difficult disease to diagnose. Its causes remain a mystery, its symptoms can't be defined with precision, and treatments are spotty at best.

But that may soon change. Scientists are looking for ways to identify patients with depression as reliably as they diagnose cardiovascular disease, diabetes and cancer. A new study takes a significant, though preliminary, step in that direction by demonstrating that a simple blood test can distinguish between people who are depressed and those who are not.”
. . .

"Once you have a measurable index of an illness, it's very difficult to say, 'Just pull yourself together,' or 'Get over it,' " said study leader Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine in Chicago. A federal report released last year estimated that as many as two-thirds of the nation's 2 million depressed teens are too embarrassed or ashamed to get help.

Visit this link to read the full article in The Los Angeles Times: Blood Test Looks Promising in Diagnosing Depression
By Melissa Healy, Los Angeles Times
April 17, 2012, 6:39 p.m.

DPD No Longer a Dissociative Disorder in DSM-5?

Medicine never stops evolving. This is a critical update on research that may redefine Depersonalization Disorder. This is a letter to the editor of Biological Psychiatry emphasizing a need to move DPD from the category of Dissociative Disorders in the DSM-5.

As I have noted before, my understanding of my own disorder is only as good as the latest research. Here is a sampling of comments from the letter. The entire study will be published soon. This is tantalizing information that may have a profound impact on research, treatment, and prevention of this terribly disabling syndrome.

This is certainly not the end of the road, but could guide us in the right direction. There is already enough dissension among those working on the new DSM-5.

Thanks again to the Depersonalization Research Unit at Kings College, London. Read More...

New DP Research at the IoP, London

Depersonalization Research Unit - Kings College, London
Testing a neurobiological model of depersonalization with Transcranial Magnetic Stimulation.

Why are we doing this research?
Depersonalization disorder (DPD) is a poorly understood condition characterised by a chronic, distressing and often incapacitating alteration in the perception or experience of the self. The aim of this project is to refine and test our neuropsychological model of DPD which will open up a translational pathway to neurobiologically informed treatments. Our work has established that DPD is characterized by attenuated skin conductance responses (SCR), which are functionally related to reduced activation in brain areas underpinning affective responses, and by increased activation in prefrontal areas involved in emotion regulation.

What are we doing?
We are testing the hypothesis that DPD stems from dysfunctionally increased fronto-insula/limbic inhibitory regulation. We using MRI-guided repetitive transcranial magnetic stimulation (rTMS) in two, contrasting, participant-blind interventions (low and high frequency stimulation) in DPD patients and healthy volunteers. We will measure responses to emotional pictures, both objective – autonomic SCRs, and subjective - self-report arousal ratings, and these will be our co-primary outcomes. We predict that:

1. in DPD patients, low frequency (1 Hz) rTMS induced suppression of prefrontal activity will result in: increased SCRs to arousing pictures (i.e. emotional responses will be released from dysfunctional frontal inhibition) and increased subjective ratings of emotional arousal and reduced symptoms;

2. in healthy volunteers, high frequency (10 Hz) rTMS stimulation will activate the same prefrontal regions which will result in blunted subjective and autonomic responses resembling those of depersonalized patients.

For more information visit this link: Kings College, DP Research Unit, Institute of Psychiatry, London

DP Research Project - Participate!

Depersonalization, Stress, and Hormones
Research Participants Needed!

The Behavioral Endocrinology Laboratory at Hunter College is looking for volunteers with Depersonalization to participate in a study to better understand how stress affects hormone levels. In this study, participants complete questionnaires about their mood and emotions and complete a stress task. Saliva samples are also taken in order to assess hormone levels. This will be a first study in helping to determining whether persons with depersonalization may benefit from hormone treatments.

This study involves 1 visit for 1.5 hours for a clinical evaluation by Dr. Daphne Simeon and another visit for 2 hours of participation in the stress task and saliva samples. Participants receive up to $50 compensation for participation. No treatment will be provided as part of this study. All responses will remain completely confidential.

For more information or to arrange an appointment please contact Kai Monde at 212-650-3838 or kmonde@hunter.cuny.edu

"Anti-Anxiety Circuit" in the Brain

In the market for a new, functioning amygdala. Will consider any offer. Price negotiable.

Scientists discover anti-anxiety circuit in brain region considered the seat of fear
March 9, 2011

“Stimulation of a distinct brain circuit that lies within a brain structure typically associated with fearfulness produces the opposite effect: Its activity, instead of triggering or increasing anxiety, counters it.

That's the finding in a paper by Stanford University School of Medicine researchers to be published online March 9 in Nature. In the study, Karl Deisseroth, MD, PhD, and his colleagues employed a mouse model to show that stimulating activity exclusively in this circuit enhances animals' willingness to take risks, while inhibiting its activity renders them more risk-averse. This discovery could lead to new treatments for anxiety disorders, said Deisseroth, an associate professor of bioengineering and of psychiatry and behavioral science.”

Read the complete article HERE. We’re not just talking “brain chemistry” but brain circuitry. One more step in understanding the most complex organ in the body.

New DP Medical Text Available!

DP, the neglected syndrome
Dr. Mauricio Sierra, researcher and lecturer at the Institute of Psychiatry, King's College London, UK, has completed a new medical textbook dedicated solely to Depersonalization. It is now available!

A must-read for every mental health professional as well as every DP sufferer out there.

Comprehensive and eye-opening, this has been a long time coming! Thank you Dr. Sierra!


New Meds for DP?

Link to Abstract and Related Articles

Expert Rev Neurother. 2008 Jan;8(1):19-26.
Depersonalization disorder: pharmacological approaches.

Sierra M.
Depersonalization Research Unit, Institute of Psychiatry, King's College, Section of Neuropsychiatry P068, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. m.sierra-siegert@iop.kcl.ac.uk

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 studies suggest that opioid receptor antagonists such as naltrexone and naloxone are useful in at least a subgroup of patients. In spite of initial expectations, the use of lamotrigine as a sole medication has not been found useful.

However, open-label trials suggest that its use as an add-on treatment with selective serotonin reuptake inhibitors (SSRIs) is beneficial in a substantial number of patients. Similarly, the use of clonazepam, particularly in conjunction with SSRI antidepressants, appears to be beneficial in patients with high levels of background anxiety. In line with the stress-related model of depersonalization, those neurotransmitter systems of relevance to depersonalization are known to play important inhibitory roles in the regulation of the stress response.

PMID: 18088198 [PubMed - indexed for MEDLINE]