DEPERSONALIZATION - NEUROBIOLOGICAL PERSPECTIVES

Depersonalization remains a fascinating and obscure clinical phenomeno n. In addition to earlier Jacksonian neurobiological adumbrations, and conventional psychodynamic accounts, views started to be expressed in the 1930s that depersonalization might be a vestigial form of behavio r and since the 1960s that it might be a phenomenon related to the tem poral lobe, Recent advances in the neurobiology of the limbic system, and the application of Geschwind's concept of disconnection in the cor ticolimbic system, have opened the possibility of developing testable models. This paper includes a review of these ideas and of the clinica l features of depersonalization, particularly of its emotional changes , suggesting that they are important for the neurobiological understan ding of depersonalization. It also draws attention to clinical similar ities between the experiential narratives produced by patients sufferi ng from depersonalization and those with corticolimbic disconnections. On the basis of this, a new model is proposed according to which the state of increased alertness observed in depersonalization results fro m an activation of prefrontal attentional systems (right dorsolateral prefrontal cortex) and reciprocal inhibition of the anterior cingulate , lending to experiences of ''mind emptiness'' and ''indifference to p ain'' often seen in depersonalization. On the other hand, a left-sided prefrontal mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality, and lack of emotional coloring th at would, in turn, be reported as feelings of ''unreality or detachmen t.'' (C) 1998 Society of Biological Psychiatry.