Catatonia involves both observable clinical signs and internal subjective experiences, yet the latter is understudied. Analyzing electronic health records of 1,456 patients with validated catatonia from a London mental health trust, the most common signs were mutism, immobility/stupor, and withdrawal. Cluster analysis yielded negative and positive clinical features; principal component analysis identified three components: parakinetic, hypokinetic, and withdrawal. The parakinetic component associated with women, neurodevelopmental disorders, and longer admissions; hypokinetic with catatonia relapse; withdrawal with men and mood disorders. Among 68 patients with phenomenological data, 35% expressed fear, but 72% provided a meaningful narrative explanation involving hallucinations, delusions, or non-psychotic rationales, suggesting subjective experiences are varied and often explanatory.
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 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.