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When you feel you are not there or here.

Depersonalization is characterised by a profound disruption of self-awareness mainly characterised by feelings of disembodiment and subjective emotional numbing.
It has been proposed that depersonalization is caused by a fronto-limbic (particularly anterior insula) suppressive mechanism – presumably mediated via attention – which manifests subjectively as emotional numbing, and disables the process by which perception and cognition normally become emotionally coloured, giving rise to a subjective feeling of ‘unreality’.
Our functional neuroimaging and psychophysiological studies support the above model and indicate that, compared with normal and clinical controls, DPD patients show increased prefrontal activation as well as reduced activation in insula/limbic-related areas to aversive, arousing emotional stimuli.
Although a putative inhibitory mechanism on emotional processing might account for the emotional numbing and characteristic perceptual detachment, it is likely, as suggested by some studies, that parietal mechanisms underpin feelings of disembodiment and lack of agency feelings.

Understanding and treating depersonalisation disorder
Nick MedfordMauricio SierraDawn BakerAnthony S. David


Recognising and diagnosing the condition may in itself have therapeutic benefits. Many patients express the sense that their problems are baffling and perhaps even unique – a recurring theme among patients attending our specialist depersonalisation clinic is the relief of discovering, first, that their problem is recognised and described by psychiatry and, second, that they are not the only individuals to suffer from the condition. For this reason alone, patients may benefit from referral to a specialist clinic. But we also hope that dissemination of information on depersonalisation through articles such as this will enable general psychiatrists to feel more confident about diagnosing and treating the condition. With regard to specific treatment interventions, both pharmacological and psychological approaches may be of value. We consider these separately here, although in practice it is often appropriate to combine them.

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