Autonomic response in depersonalization disorder.
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.
Sierra
Mauricio
M
Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ, England. M.Sierra-Siegert@iop.kcl.ac.uk
Senior
Carl
C
Dalton
Jeffrey
J
McDonough
Michael
M
Bond
Alison
A
Phillips
Mary L
ML
O'Dwyer
Anne M
AM
David
Anthony S
AS
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