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Cognitive & Neurobiological Processes

Depersonalisation Research Unit

Depersonalisation Disorder (DPD) constitutes, according to the Psychiatric Diagnostic and Statistic Manual (DSM) IV, ‘a feeling of detachment or estrangement from one’s self. The individual may feel like an automaton or as if he or she is living in a dream or a movie. There may be a sensation of being an outside observer of one’s mental processes, one’s body or parts of one’s body.’ People who experience depersonalisation may, at the same time, experience de-realisation, the sense that the external world is strange or unreal.

People with a major psychiatric disorder, including severe anxiety or panic disorder, depression, post traumatic stress disorder, obsessive compulsive disorder and schizophrenia, and people with neurological conditions such as migraine and epilepsy, can experience depersonalisation as a symptom. People who do not have mental health or neurological problems can also experience depersonalisation when they are in states of fatigue, fear, stress, emotional turmoil or meditation, or after taking drugs like cannabis or Ecstasy.

The Depersonalisation Research Unit within the Section of Cognitive Neuropsychiatry carries out research to better understand depersonalisation both as an illness and a symptom.

People with DPD are recruited to studies through the only specialist clinic for depersonalisation in the UK, based at The Maudsley Hospital, where members of the Research Unit undertake clinical work. People are referred here from all over the country. The Research Unit now holds a database of information given by more than 400 people who have DPD.

One of the research team has developed the Cambridge Depersonalisation Scale, a resource for researchers in the field to measures people’s experience of depersonalisation.

There are many theories about what causes depersonalisation. It might be induced by overwhelming anxiety or an early traumatic event. In these circumstances, becoming detached from one’s body may seem a useful means of coping, but in some people, the depersonalisation then may become autonomous and a chronic disorder. Neurological theories include a disruption in the parts of the brain that integrate incoming sensory information with our internal representation of the Self (the temporal lobes). A specific part of the temporal lobe, the amygdala, which is responsible for processing emotion, may be crucial.

Two of the Unit’s completed studies using functional Magnetic Resonance Imaging (fMRI) have shown significant differences in the way people who experience DPD and the way healthy controls process emotional stimuli and remember emotional words.

The Unit’s research has also shown that people with DPD have a low skin conductance response to unpleasant stimuli: this suggests an inhibitory mechanism on emotional processing. Skin conductance is when the skin momentarily becomes a better conductor of electricity because external or internal stimuli are physiologically arousing and help create an emotional response: measuring arousal is an important component of measuring emotion.

Other studies of people with DPD have found evidence of disrupted feelings of empathy for others; differences in heart rates; and differences in levels of hormones that deal with stress.

There is not yet evidence-based treatment for depersonalisation. Over the years, in-depth psychotherapy, electroconvulsive treatment, antipsychotic medication and antidepressants have all been tested. Two of the Unit’s recent studies have yielded promising results that are being further investigated: these involved Cognitive Behaviour Therapy and, in another trial, participants took lamotrigine, an anti-convulsant medication.

Members of the Section of Cognitive Neuropsychiatry are the authors of a book about using cognitive behaviour therapy for depersonalisation. Overcoming Depersonalisation and Feelings of Unreality, A Self-Help Guide Using Cognitive Behavioural Techniques (by Dawn Baker, Elaine Hunter, Emma Lawrence & Anthony David with contributions by Mauricio Sierra & Nick Medford) was published in 2007 by Constable and Robinson as part of the consumer-friendly CBT-based Overcoming Series. Visit www.constablerobinson.com/.

A member of the research unit has published an up-to date review of depersonalization and this provides a reference book on depersonalization dealing with the subject from a wide range of perspectives covering historical, conceptual, clinical, trans-cultural, pharmacological and neurobiological factors. Depersonalization: A New Look at a Neglected Syndrome (by Mauricio Sierra, 2009, Cambridge University Press). Visit http://www.cambridge.org/gb/knowledge/isbn/item2327426/?site_locale=en_GB.

Written information detailing the results of the Units research projects, and other studies in depersonalisation dating back to the 1930s are listed in the Papers, Articles, Books section.

Patient referrals should be sent to Dr Mauricio Sierra-Siegert:

Institute of Psychiatry
Department of Psychosis Studies, PO68
De Crespigny Park
London SE5 8AF
 
Patients wanting more information on how to be referred should contact the Team Secretary; 0207 848 0138
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