title: Autonomic response in depersonalization disorder.
abstract: BACKGROUND
  Emotional-processing inhibition has been suggested as a mechanism underlying some of the clinical features of depersonalization and/or derealization. In this study, we tested the prediction that autonomic response to emotional stimuli would be reduced in patients with depersonalization disorder.
  
  
  METHODS
  The skin conductance responses of 15 patients with chronic depersonalization disorder according to DSM-IV, 15 controls, and 11 individuals with anxiety disorders according to DSM-IV, were recorded in response to nonspecific elicitors (an unexpected clap and taking a sigh) and in response to 15 randomized pictures with different emotional valences: 5 unpleasant, 5 pleasant, and 5 neutral.
  
  
  RESULTS
  The skin conductance response to unpleasant pictures was significantly reduced in patients with depersonalization disorder (magnitude of 0.017 micro siemens in controls and 0.103 micro siemens in patients with anxiety disorders; P =.01). Also, the latency of response to these stimuli was significantly prolonged in the group with depersonalization disorder (3.01 seconds compared with 2.5 and 2.1 seconds in the control and anxiety groups, respectively; P =.02). In contrast, latency to nonspecific stimuli (clap and sigh) was significantly shorter in the depersonalization and anxiety groups (1.6 seconds) than in controls (2.3 seconds) (P =.03).
  
  
  CONCLUSIONS
  In depersonalization disorder, autonomic response to unpleasant stimuli is reduced. The fact that patients with depersonalization disorder respond earlier to a startling noise suggests that they are in a heightened state of alertness and that the reduced response to unpleasant stimuli is caused by a selective inhibitory mechanism on emotional processing.
authors.affiliation: Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ, England. M.Sierra-Siegert@iop.kcl.ac.uk
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sierra
authors.forename: Carl
authors.initials: C
authors.lastname: Senior
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dalton
authors.forename: Michael
authors.initials: M
authors.lastname: McDonough
authors.forename: Alison
authors.initials: A
authors.lastname: Bond
authors.forename: Mary L
authors.initials: ML
authors.lastname: Phillips
authors.forename: Anne M
authors.initials: AM
authors.lastname: O'Dwyer
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology; D001143:Arousal / Q000502:physiology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003861:Depersonalization / Q000175:diagnosis*; D004644:Emotions / Q000502:physiology*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006801:Humans; D008297:Male; D011930:Reaction Time / Q000502:physiology; D013216:Reflex, Startle / Q000502:physiology; D014796:Visual Perception / Q000502:physiology