title: Depersonalization disorder: thinking without feeling.
abstract: Patients with depersonalization disorder (DP) experience a detachment from their own senses and surrounding events, as if they were outside observers. A particularly common symptom is emotional detachment from the surroundings. Using functional magnetic resonance imaging (fMRI), we compared neural responses to emotionally salient stimuli in DP patients, and in psychiatric and healthy control subjects. Six patients with DP, 10 with obsessive-compulsive disorder (OCD), and six volunteers were scanned whilst viewing standardized pictures of aversive and neutral scenes, matched for visual complexity. Pictures were then rated for emotional content. Both control groups rated aversive pictures as much more emotive, and demonstrated in response to these scenes significantly greater activation in regions important for disgust perception, the insula and occipito-temporal cortex, than DP patients (covarying for age, years of education and total extent of brain activation). In DP patients, aversive scenes activated the right ventral prefrontal cortex. The insula was activated only by neutral scenes in this group. Our findings indicate that a core phenomenon of depersonalization--absent subjective experience of emotion--is associated with reduced neural responses in emotion-sensitive regions, and increased responses in regions associated with emotion regulation.
authors.affiliation: Depersonalization Research Unit and Division of Psychological Medicine, Institute of Psychiatry, 103 Denmark Hill, SE5 8AF, London, UK. spmamlp@iop.kcl.ac.uk
authors.forename: M L
authors.initials: ML
authors.lastname: Phillips
authors.forename: N
authors.initials: N
authors.lastname: Medford
authors.forename: C
authors.initials: C
authors.lastname: Senior
authors.forename: E T
authors.initials: ET
authors.lastname: Bullmore
authors.forename: J
authors.initials: J
authors.lastname: Suckling
authors.forename: M J
authors.initials: MJ
authors.lastname: Brammer
authors.forename: C
authors.initials: C
authors.lastname: Andrew
authors.forename: M
authors.initials: M
authors.lastname: Sierra
authors.forename: S C
authors.initials: SC
authors.lastname: Williams
authors.forename: A S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D001288:Attention / Q000502:physiology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D003861:Depersonalization / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D009778:Occipital Lobe / Q000503:physiopathology; D010364:Pattern Recognition, Visual / Q000502:physiology; D013702:Temporal Lobe / Q000503:physiopathology; D013850:Thinking / Q000502:physiology