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Vannikov-Lugassi M, Shalev H, Soffer-Dudek N. From brooding to detachment: Rumination longitudinally predicts an increase in depersonalization and derealisation. Psychol Psychother 2021; 94 Suppl 2:321-338. [PMID: 32333727 DOI: 10.1111/papt.12279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/31/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Depersonalization-derealization (DEP-DER) is a dissociative experience which is related to psychopathology and distress. Yet, the aetiological factors leading to DEP-DER are not sufficiently clear. In this study, we suggest rumination as one possible antecedent. Thus, the goal of the study was to explore the longitudinal relationship between rumination and DEP-DER. DESIGN Longitudinal self-report study; mixed clinical and community sample. METHODS The study was conducted on 98 participants, 49 of them were diagnosed with depression, anxiety disorders, or obsessive-compulsive disorder, and the other 49 were healthy, matched community controls. The participants underwent a structured clinical interview and completed a battery of questionnaires. Then, the participants completed the same battery again once a month, for five additional assessment points (6 months in total). The data were analysed using multilevel linear modelling with time-lag analysis. RESULTS We found that levels of rumination and DEP-DER increased and decreased simultaneously, meaning that on assessments in which people reported that they tended to ruminate, they also reported higher levels of DEP-DER symptoms. In addition, we found support for a unidirectional association, consistent with our theoretical hypothesis. Specifically, rumination levels on a certain month longitudinally predicted a higher likeliness for reporting DEP-DER on the following month, even when controlling for the contemporaneous relationship. Conversely, DEP-DER symptoms did not longitudinally predict increased rumination. CONCLUSIONS These findings suggest that rumination may be an antecedent of DEP-DER, but not vice versa. Possible mechanisms to explain this link are discussed. PRACTITIONER POINTS Rumination and DEP-DER oscillate together over time; additionally, rumination predicts a longitudinal increase in DEP-DER. Clinicians noticing ruminative thought followed by decreased emotionality should distinguish between an authentic decrease of distress versus detachment. The findings provide one possible explanation for the frequency of DEP-DER symptoms in anxiety and depressive disorders. Poor sleep quality and emotion regulation difficulties should be explored as potential mediators explaining this link.
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Affiliation(s)
| | - Hadar Shalev
- Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Soroka Medical Center, Be'er Sheva, Israel
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Orrù G, Bertelloni D, Cesari V, Conversano C, Gemignani A. Targeting temporal parietal junction for assessing and treating disembodiment phenomena: a systematic review of TMS effect on depersonalization and derealization disorders (DPD) and body illusions. AIMS Neurosci 2021; 8:181-194. [PMID: 33709023 PMCID: PMC7940112 DOI: 10.3934/neuroscience.2021009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a fundamental aspect of the self. On the contrary, the sense of disembodiment, an alteration of one's sense of self or the sense of being localized out of one's physical body, is a prominent feature in specific dissociative disorders, namely depersonalization/derealization disorders (DPD). The aims of the study were to provide: 1) a qualitative synthesis of the effect of Transcranial Magnetic Stimulation (TMS), taking into account its use for therapeutic and experimental purposes; 2) a better understanding on whether the use of TMS could support the treatment of DPD and other clinical conditions in which depersonalization and derealization are displayed. To identify suitable publications, an online search of the PubMed, Cochrane Library, Web of science and Scopus databases was performed using relevant search terms. In addition, an in-depth search was performed by screening review articles and the references section of each included articles. Our search yielded a total of 108 records through multiple databases searching and one additional record was identified through other sources. After duplicates removal, title and abstract reading, we retained 16 records for the assessment of eligibility. According to our inclusion criteria, we retained 8 studies. The selected studies showed that TMS targeting the TPJ is a promising technique for treating disembodiment phenomena DPD and for inducing reversible disembodiment states in healthy subjects. These data represent the first step towards a greater understanding of possible treatments to be used in disembodiment disorders. The use of TMS over the TPJ appears to be promising for treating disembodiment phenomena.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Davide Bertelloni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy
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Sierk A, Daniels JK, Manthey A, Kok JG, Leemans A, Gaebler M, Lamke JP, Kruschwitz J, Walter H. White matter network alterations in patients with depersonalization/derealization disorder. J Psychiatry Neurosci 2018; 43:170110. [PMID: 29877178 PMCID: PMC6158023 DOI: 10.1503/jpn.170110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/01/2017] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. METHODS We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. RESULTS Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. LIMITATIONS To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. CONCLUSION In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.
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Affiliation(s)
- Anika Sierk
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Judith K Daniels
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Antje Manthey
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jelmer G Kok
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Alexander Leemans
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Michael Gaebler
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Jan-Peter Lamke
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Johann Kruschwitz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
| | - Henrik Walter
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler)
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Michal M, Adler J, Wiltink J, Reiner I, Tschan R, Wölfling K, Weimert S, Tuin I, Subic-Wrana C, Beutel ME, Zwerenz R. A case series of 223 patients with depersonalization-derealization syndrome. BMC Psychiatry 2016; 16:203. [PMID: 27349226 PMCID: PMC4924239 DOI: 10.1186/s12888-016-0908-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depersonalization-derealization syndrome (DDS) is an underdiagnosed and underresearched clinical phenomenon. In Germany, its administrative prevalence is far below the threshold for orphan diseases, although according to epidemiological surveys the diagnosis should be comparable frequent as anorexia nervosa for instance. Against this background, we carried out a large comprehensive survey of a DDS series in a tertiary mental health center with a specialized depersonalization-derealization clinic. To reveal differential characteristics, we compared the DDS patients, who consulted the specialized depersonalization-derealization clinic, with a group of patients with depressive disorders without comorbid DDS from the regular outpatient clinic of the mental health center. METHODS The sample comprised 223 patients with a diagnosis of depersonalization-derealization-syndrome and 1129 patients with a depressive disorder but without a comorbid diagnosis of DDS. DDS patients were described and compared with depressive outpatients in terms of sociodemographic characteristics, treatment history, treatment wishes, clinical symptomatology, prevailing psychosocial stressors, family history of common mental disorders and history of childhood trauma. RESULTS Despite the high comorbidity of DDS patients with depressive disorders and comparable burden with symptoms of depression and anxiety, the clinical picture and course of both patient groups differed strongly. DDS patients were younger, had a significant preponderance of male sex, longer disease duration and an earlier age of onset, a higher education but were more often unemployed. They tended to show more severe functional impairment. They had higher rates of previous or current mental health care utilization. Nearly all DDS patients endorsed the wish for a symptom specific counseling and 70.7 % were interested in the internet-based treatment of their problems. DDS patients had lower levels of self-rated traumatic childhood experiences and current psychosocial stressors. However, they reported a family history of anxiety disorders more often. CONCLUSION In consideration of the selection bias of this study, this case series supports the view that the course of the DDS tends to be long-lasting. DDS patients are severely impaired, utilizing mental health care to a high degree, which nevertheless might not meet their treatment needs, as patients strongly opt for obtaining disorder specific counseling. In view of the size of the problem, more research on the disorder, its course and its optimal treatment is urgently required.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
| | - Julia Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Regine Tschan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Klaus Wölfling
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Weimert
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Inka Tuin
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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