In depersonalization disorder (DPD), a condition marked by a diminished sense of self and dampened emotional experience, functional MRI revealed that emotional processing is altered. Before treatment, patients showed reduced brain activity in the insula—a region linked to interoceptive awareness and feeling states—along with attenuated autonomic responses to emotional visual stimuli. After pharmacological treatment, clinical improvement in DPD symptoms was associated with increased insula activity. A right ventrolateral prefrontal cortex area also appeared to be involved in top-down inhibition of emotional responses. These findings connect emotional numbing in DPD to disrupted interoception and self-related processes.
Depersonalization, a dissociative disorder marked by altered self-perception and detachment from reality, is as common as schizophrenia or bipolar disorder yet often overlooked in psychiatry. This book reviews the condition from historical, conceptual, clinical, transcultural, pharmacological, and neurobiological angles. Recent neuroimaging studies offer new insights, opening opportunities for pharmacologic and psychotherapeutic symptom management. The work is relevant to psychiatrists, clinical psychologists, primary care practitioners, neurologists, and psychiatric nurses.
Depersonalization symptoms cluster into four distinct but related domains rather than forming a single syndrome. An analysis of responses to the Cambridge Depersonalization Scale from 138 patients diagnosed with depersonalization disorder identified four factors that together account for 73.3% of the variance: anomalous body experience, emotional numbing, anomalous subjective recall, and alienation from surroundings. This suggests that depersonalization is not a unitary condition but comprises separable psychopathological dimensions.