Feeling Unreal: A PET Study of Depersonalization Disorder
Abstract
OBJECTIVE: The goal of this study was to assess brain glucose metabolism and its relationship to dissociation measures and clinical symptoms in DSM-IV depersonalization disorder. METHOD: Positron emission tomography scans coregistered with magnetic resonance images of eight subjects with depersonalization disorder were compared to those of 24 healthy comparison subjects. The two groups did not differ in age, sex, education, performance on a baseline neuropsychological battery, or performance on a verbal learning task administered during [(18)F]fluorodeoxyglucose uptake. A cortical analysis by individual Brodmann's areas was performed. RESULTS: Compared to the healthy subjects, subjects with depersonalization disorder showed significantly lower metabolic activity in right Brodmann's areas 22 and 21 of the superior and middle temporal gyri and had significantly higher metabolism in parietal Brodmann's areas 7B and 39 and left occipital Brodmann's area 19. Dissociation and depersonalization scores among the subjects with depersonalization disorder were significantly positively correlated with metabolic activity in area 7B. CONCLUSIONS: Depersonalization appears to be associated with functional abnormalities along sequential hierarchical areas, secondary and cross-modal, of the sensory cortex (visual, auditory, and somatosensory), as well as areas responsible for an integrated body schema. These findings are in good agreement with the phenomenological conceptualization of depersonalization as a dissociation of perceptions as well as with the subjective symptoms of depersonalization disorder.
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In chronic depersonalization disorder, patients demonstrated significantly lower metabolic activity in the right middle/superior temporal gyrus and higher metabolism in parietal and occipital areas; metabolic activity in area 7B was positively correlated with clinical depersonalization scores.
“in a PET study by Simeon and colleagues (2000), patients with chronic depersonalization disorder demonstrated significantly lower metabolic activity in the right middle/superior temporal gyrus (BA21/22) and higher metabolism in the parietal and occipital areas (BA7, 39, and 19)—metabolic activity in area 7B was positively correlated with clinical depersonalization scores [83].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [83]
Altered glucose metabolism in tempo-parietal regions may play a role in "feeling unreal".
“Altered glucose metabolism in tempo-parietal regions may play a role in “feeling unreal” [83]”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [83]
In Niedtfeld et al. (2013), for a smaller subsample of 42 BPD patients, scores on the DES predicted larger GMV in the middle temporal gyrus.
“For a smaller subsample of 42 BPD patients, scores on the DES could be included, which predicted larger GMV in the middle temporal gyrus [150•]—a region previously implicated in dissociation [83, 84].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [83]
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- Authors
- Simeon, D., Guralnik, O., Hazlett, E. A., Spiegel-Cohen, J., Hollander, E., & Buchsbaum, M. S.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Venue
- American Journal of Psychiatry
- Published
- 2000-11-01
- Volume
- 157
- Issue
- 11
- Pages
- 1782-1788
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2151649836
- Cited by
- 320
- References
- 38
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 13 · 2022: 10 · 2021: 5 · 2020: 34 · 2019: 10 · 2018: 16 · 2017: 17 · 2016: 43 · 2015: 10 · 2014: 14 · 2013: 16 · 2012: 12
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-55582, R01MH040071, R29MH055582, MH-40071)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- depersonalization disorder, dissociation, brain glucose metabolism, Brodmann areas, superior temporal gyrus, middle temporal gyrus, parietal cortex, occipital cortex, sensory cortex, body schema
- MeSH terms
- Adult, Brain, Cerebral Cortex, Depersonalization, Female, Glucose, Gyrus Cinguli, Humans, Male, Neural Pathways, Occipital Lobe, Parietal Lobe, Tomography, Emission-Computed, Prefrontal Cortex, Fluorodeoxyglucose F18
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