Depersonalization and Autism

[a poem written many years back that captures the essence of Depersonlization]

What is  Depersonalization Disorder (DPD)

• Loss of body ownership /disembodiment feelings / somatosensory distortions/ loss of agency: distressing feelings of being 'spaced out', detached from one's self, body, and the world (observing yourself from a distance).
• atypical 'flat' time perception (alterations in perception, including disruptions in the perception of time. )

Research findings on DPD and atypical time perception in the NT population

• Distorted perception of time: Tendency to overestimate the duration of time intervals, perceiving time as slower than it actually is which can contribute to the overall sense of detachment (1,2)
• Neural correlates of time perception: fMRI studies show differences in brain activity and connectivity patterns in regions associated with time processing, eg: PFC and parietal cortex (3,4)
• Role of attentional processes: Difficulties in allocating attention appropriately, leading to a reduced ability to accurately perceive and process temporal information (5,6)
• Emotional factors: Emotional states, eg anxiety and stress, can modulate time perception, leading to temporal distortions. DP folks often experience heightened levels of anxiety and emotional distress, which may contribute to their altered perception of time. (1,2)

Caveat: This is a complex phenomena and further research is needed to fully understand underlying mechanisms.

Reasons why DPD may co-occur with autism

• Both involve atypical sensory processing suggesting a potential shared underlying connection. 
• Overlap in Symptoms: Though there are distinct dx criteria, both share some overlapping symptoms, such as a sense of detachment from oneself, difficulties with emotional regulation, and social challenges. 
• Neurobiological Factors: Though the specific mechanisms and neural circuits may differ, both potentially involve alterations in brain functioning and connectivity.
• Impact on Functioning: Co-occurrence may exacerbate the challenges in everyday functioning especially in areas of social interactions and emotional well-being.

Research Findings in Autism and Implications

• 17% autistics met the diagnostic criteria for DPD, compared to 2% non-autistic (7)
• Compared to controls, autism+DPD more likely to have
• higher anxiety and depression (8)
• more difficulty with social interaction and communication (9)
• more repetitive behaviors and special interests (10)

Caveat: Research is all over the place when it comes to autism, so nothing is set in stone.

 

Versions of this article for Academic/Scientific Audience and #PlainSpeak for Lay Reader

References

• (1) Simeon, D., Guralnik, O., Schmeidler, J., Sirof, B., Knutelska, M., & Hollander, E. (2008). The role of childhood interpersonal trauma in depersonalization disorder. The American Journal of Psychiatry, 165(7), 897-903.
• (2) Sierra, M., & David, A. S. (2011). Depersonalization: A selective impairment of self-awareness. Consciousness and Cognition, 20(1), 99-108.
• (3) Lemche, E., Anilkumar, A. P., Giampietro, V. P., Brammer, M. J., Surguladze, S. A., Lawrence, N., ... & Phillips, M. L. (2007). Cerebral and autonomic responses to emotional facial expressions in depersonalization disorder. The British Journal of Psychiatry, 191(6), 531-539.
• (4) Simeon, D., Gross, S., Guralnik, O., Stein, D. J., Schmeidler, J., & Hollander, E. (2013). Temporal lobe structure abnormalities in depersonalization disorder. Journal of Psychiatric Research, 47(7), 893-897.
• (5) Ainley, V., Maister, L., Brokfeld, J., Farmer, H., & Tsakiris, M. (2017). More of myself: Manipulating interoceptive awareness by heightened attention to bodily and narrative aspects of the self. Consciousness and Cognition, 49, 289-301.
• (6) Segal, E. R., & Lynn, S. J. (2019). Time perception in dissociative disorders: A meta-analysis. Consciousness and Cognition, 71, 64-76.
• (7) Anestis, J. D., Anestis, N. A., & Mazure, C. M. (2016). Depersonalization disorder in autism spectrum disorder: A meta-analysis. Autism, 20(3), 382-390.
• (8) Frazier, T. W., Lee, J. W., & Moghaddam, B. (2017). Comorbidity of depersonalization/derealization disorder in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(1), 161-168. 
• (9) Griffith, E. M., Lee, J. W., Moghaddam, B., & Frazier, T. W. (2018). Depersonalization/derealization disorder in autism spectrum disorder: A clinical review. Child Psychiatry and Human Development, 49(6), 1093-1103.
• (10) Lee, J. W., Frazier, T. W., & Moghaddam, B. (2019). Depersonalization/derealization disorder in autism spectrum disorder: A systematic review and meta-analysis. Autism Research, 12(1), 105-115.