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. 2014 Jun 26;9(6):e98769.
doi: 10.1371/journal.pone.0098769. eCollection 2014.

How do you feel when you can't feel your body? Interoception, functional connectivity and emotional processing in depersonalization-derealization disorder

Lucas Sedeño  1 , Blas Couto  1 , Margherita Melloni  1 , Andrés Canales-Johnson  2 , Adrián Yoris  3 , Sandra Baez  1 , Sol Esteves  3 , Marcela Velásquez  3 , Pablo Barttfeld  4 , Mariano Sigman  5 , Rafael Kichic  6 , Dante Chialvo  7 , Facundo Manes  8 , Tristan A Bekinschtein  9 , Agustin Ibanez  10
Affiliations

How do you feel when you can't feel your body? Interoception, functional connectivity and emotional processing in depersonalization-derealization disorder

Lucas Sedeño et al. PLoS One. .

Abstract

Depersonalization-Derealization Disorder (DD) typically manifests as a disruption of body self-awareness. Interoception -defined as the cognitive processing of body signals- has been extensively considered as a key processing for body self-awareness. In consequence, the purpose of this study was to investigate whether there are systematic differences in interoception between a patient with DD and controls that might explain the disembodiment symptoms suffered in this disease. To assess interoception, we utilized a heartbeat detection task and measures of functional connectivity derived from fMRI networks in interoceptive/exteroceptivo/mind-wandering states. Additionally, we evaluated empathic abilities to test the association between interoception and emotional experience. The results showed patient's impaired performance in the heartbeat detection task when compared to controls. Furthermore, regarding functional connectivity, we found a lower global brain connectivity of the patient relative to controls only in the interoceptive state. He also presented a particular pattern of impairments in affective empathy. To our knowledge, this is the first experimental research that assesses the relationship between interoception and DD combining behavioral and neurobiological measures. Our results suggest that altered neural mechanisms and cognitive processes regarding body signaling might be engaged in DD phenomenology. Moreover, our study contributes experimental data to the comprehension of brain-body interactions and the emergence of self-awareness and emotional feelings.

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Conflict of interest statement

Competing Interests: We confirm that Dante Chialvo & Mariano Sigman are PLOS ONE Editorial Board members, though this does not alter our adherence to PLOS ONE Editorial policies and criteria, as detailed online in your guide for authors: http://www.PLOSone.org/static/editorial.action#competing.

Figures

Figure 1
Figure 1. Cambridge Depersonalization Scale (CDS).
Subscales and Total Raw Scores. Higher scores in the first four subscales represent a higher presence of experiences from each of the DD main symptoms (all significant, except for Emotional Numbing). Frequency and duration refer to all DD symptoms. Total score is a product of the sum of the measures, and its established score cut off is 70. * expressed significant differences between DD patient and control sample.
Figure 2
Figure 2. Heartbeat Detection Task (HBD).
The Accuracy Index can vary between 0 and 1, with higher scores indicating better interoceptive sensitivity. * indicates significant differences between JM and the control sample.
Figure 3
Figure 3. Resting-state networks.
Most-often reported networks in previous research that contain groups of brain regions highly correlated with each other.
Figure 4
Figure 4. Networks connectivity matrices.
(A) Averaged correlation matrices for JM, control sample and conditions. Bottom rows shows t-values for test-t between JM and the control group. (B) T-value distributions for JM (red) and the IAC sample (blue).
Figure 5
Figure 5. Global Graph Theory Analysis.
Columns indicate each resting-state condition, and rows indicate each graph metric. The Y-axis shows raw metric scores, and the X-axis shows the range of thresholds, from 50 to 800, in steps of 50 (excluding extreme values where networks disaggregate). Boxes indicate significant and trend differences between JM and the control sample. Blue shadows represent controls' standard deviation area.
Figure 6
Figure 6. Local Graph Theory Analysis − Interoceptive macro-state.
Columns indicate each ROI from the interoceptive-emotional network, and rows indicate each graph metric. The Y-axis shows raw metric scores, and the X-axis shows the range of thresholds, from 50 to 800, in steps of 50 (excluding extreme values where networks disaggregate). Boxes indicate significant and trend differences between JM and the control sample. Blue shadows represent controls' standard deviation area.
Figure 7
Figure 7. Interpersonal Reactivity Index (IRI).
Subscales raw scores. * indicates significant differences between the DD patient and the control sample.
Figure 8
Figure 8. Empathy for pain task (EPT).
Neutral condition results: (A) categorization accuracy in percent; (B) reaction time in seconds of Harmful behavior and (C) average pain rating scores for each question after scenes of the neutral condition. Intentional condition results: (D) average empathy-related judgments scores for each question after scenes of this condition. * expressed significant differences between the DD patient and control sample.
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References

    1. Lee WE, Kwok CH, Hunter EC, Richards M, David AS (2012) Prevalence and childhood antecedents of depersonalization syndrome in a UK birth cohort. Soc Psychiatry Psychiatr Epidemiol 47: 253–261. - PMC - PubMed
    1. Hunter EC, Sierra M, David AS (2004) The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol 39: 9–18. - PubMed
    1. Association AP (2013) Diagnostic and statistical manual of mental disorders (5th ed.): Arlington, VA: American Psychiatric Publishing.
    1. Sierra M, David AS (2011) Depersonalization: a selective impairment of self-awareness. Conscious Cogn 20: 99–108. - PubMed
    1. Phillips ML, Sierra M (2003) Depersonalization disorder: a functional neuroanatomical perspective. Stress 6: 157–165. - PubMed

Publication types

Grants and funding

This research was partially supported by grants CONICYT/FONDECYT Regular (1130920 and 1140114), Foncyt-PICT 2012-0412, Foncyt-PICT 2012-1309, CONICET and INECO Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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