# DP/DR root causes



## ParaSpeed (Apr 29, 2012)

Hi Everyone
I was just wondering if anyone has researched into the causes of DP/DR other than anxiety or drug induced.
If someone has looked into the physical/neurological basis for DP/DR would you be kind enough to list these please?
Thanks


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## kate_edwin (Aug 9, 2009)

I dont think there are any. there are some neuro and physical things that mimic dp but they aren't dp, like partial seizures, and migraine aura


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## ParaSpeed (Apr 29, 2012)

kate_edwin said:


> I dont think there are any. there are some neuro and physical things that mimic dp but they aren't dp, like partial seizures, and migraine aura


Thanks kate_edwin, 
i guess in those cases there would be very obvious symptoms related to the neuro condition on top of DP/DR?


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## Guest (Aug 3, 2012)

GAH, I lost my reply!!!!

I would like to counter this by stating that neurological reserach worldwide is looking into states of consciousness, the concept of self-awareness, our consciousness of our own existence. Also, neurology is still looking into perceptual phenomena such as deja-vu, out of body sensations, etc.

One example posted by an individual on this board who is working with Dr. Blom in the Netherlands:
_*[The cenesthesiopathies].
J D Blom, A Neven, Y Aouaj, B Jonker, H W Hoek

Tijdschrift voor psychiatrie 01/2010; 52(10):695-704.*_

*Abstract*
"Up till a century ago the classic concepts of cenesthesis and cenesthesiopathy played a *major role in the conceptualisation of aberrant somatosensory sensations and disturbances in the sensation of physical existence.*

Although these concepts are considered obsolete by a number of authors, the conceptual work of the German psychiatrist Gert Huber and the results of modern neuroimaging studies point to the need for a re-evaluation of the concepts cenesthesis and cenesthesiopathy.

Background information was obtained from PubMed, Embase and the medical historical literature. By way of illustration, two cases are presented: the first is a *female patient with a strongly diminished sense of physical existence *(hypocenesthesiopathy) and the second is a male patient with such pronounced somatosensory sensations that he believed he was being transformed into a werewolf (hypercenesthesiopathy, clinical lycanthropy).

On the basis of the literature and the two case studies, it is shown that the concepts of cenesthesis and cenesthesiopathy may be helpful in the conceptualisation of *disorders of the sensation of bodily existence *brought about by aberrant somatosensory sensations.

In the cases of peculiar and unexplained physical symptoms, the cenesthesiopathies should be part of the differential diagnosis. Particularly if patients have longlasting, medication-resistant forms of cenesthesiopathy, it is strongly recommended that such patients undergo neuroimaging and are given an EEG so that treatable somatic conditions can either be demonstrated or ruled out."
_*Source: PubMed*_
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I constantly bring up the researcher V.S. Ramachandran at U.C. San Diego (GOD I FORGOT HOW TO SPELL SAN DIEGO -- that's scary!) who is looking into these phenomena, along with phantom limbs, etc. Stroke victims with these symptoms are being studied. Such individuals merit more imaging studies, and the results reveal much of what goes on in the brain when someone experiences these sensations.

Darn, I also forgot the link. But this can be researched on PubMed.

*My faith in UNDERSTANDING this ... I'm not looking for a cure in my lifetime (being 53) ... I think will lead to things like deep brain stimulation and other treatments that haven't even been discovered.*

*I am not saying we have these disorders*, but understanding these phenomena can only lead to understanding our own perceptual distoritions.

My faith is in neurology. Neurology has proven that schizophrenia, bipolar, OCD, schizoaffective disorders, etc. are indeed NEUROLOGICAL. We need to understand HUGE complexities in the brain -- interaction of Nature/Nurture. And for example many with schizophrenia do not respond to treatment, others -- you would never know they have schizophrenia. We are NOT talking simply "chemical imbalance" but miswired circuitry, physical brain changes, genetics.

This will take time as you can't crack open a skull unless you are doing some form of brain surgery. Strange sensations including DP/DR have been caused by deep brain stimulation related to treating things like chronic tinnitus!!!!! Sensations that were uncomfortable enough to make the patient beg to stop the DBS.


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## Guest (Aug 3, 2012)

Also look up neurological phenomena such as Cotard's and Capgras syndromes. NO we don't have these, but they are odd glitches in the brain.

Also, I tell everyone to read "The Man Who Mistook His Wife For A Hat" (self explanatory!!!!!) by Oliver Sacks, M.D.
and "A Brief Tour of Human Consciousness" by V.S. Ramachandran, M.D., Ph.D. Ramachandran is a world recognized neruologist. His studies into phantom limbs alone have led to great understanding and actual treatment for individuals who have lost limbs or who were born without limbs which cause horrible pain or strange sensations, even when they are gone.


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## kate_edwin (Aug 9, 2009)

Thanks kate_edwin,
i guess in those cases there would be very obvious symptoms related to the neuro condition on top of DP/DR?

no you can have those neuro disorders without dp but experience a similar...experience


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## miguelmalato (Jan 9, 2012)

ParaSpeed said:


> Hi Everyone
> I was just wondering if anyone has researched into the causes of DP/DR other than anxiety or drug induced.
> If someone has looked into the physical/neurological basis for DP/DR would you be kind enough to list these please?
> Thanks


My DP/DR was not drug induced, and yet it has revealed to be as powerful as anyone else's.


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## ParaSpeed (Apr 29, 2012)

miguelmalato said:


> My DP/DR was not drug induced, and yet it has revealed to be as powerful as anyone else's.


OK so with partial seizures, and migraine aura etc can DR( I maily have DR) be chronic ie 24/7?
...and how do you diffrentiate between DR arising from neuro and DR coming from anxiety?


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## ParaSpeed (Apr 29, 2012)

Dreamer* said:


> Also look up neurological phenomena such as Cotard's and Capgras syndromes. NO we don't have these, but they are odd glitches in the brain.
> 
> Also, I tell everyone to read "The Man Who Mistook His Wife For A Hat" (self explanatory!!!!!) by Oliver Sacks, M.D.
> and "A Brief Tour of Human Consciousness" by V.S. Ramachandran, M.D., Ph.D. Ramachandran is a world recognized neruologist. His studies into phantom limbs alone have led to great understanding and actual treatment for individuals who have lost limbs or who were born without limbs which cause horrible pain or strange sensations, even when they are gone.


so in plain english, would you know if there are documented neuro conditions (verified) causing DR?


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## Guest (Aug 4, 2012)

ParaSpeed said:


> OK so with partial seizures, and migraine aura etc can DR( I maily have DR) be chronic ie 24/7?
> ...and how do you diffrentiate between DR arising from neuro and DR coming from anxiety?


Difficult question. _*I would say that the EXPERIENCE is identical.*_ The brain (though it has a bazillion things going on) -- well we must share a limited number of similar experiences. How you get there may be from a different path, but I would hazard a guess that the symptoms are identical. One things that may be slightly different is drug induced vs. non drug induced (HPPD visual symptoms). I'm not sure, I have never taken drugs, and my experience is abuse, and a family history of mental illenss. (I was a child in the 1960s, so help for me was very limited).

Also, YES, there are neurological disorders that cause DP/DR, some transient/some chronic. Lyme's disease can cause DP/DR (chronic) in some people.

And finally, regardless of how many people see the CAUSE of their DP/DR it is OBVIOUSLY something not right in the brain, and I see that as clearly neurological. That doesn't mean it can't be treated, or that it doesn't go into remission, etc. Depends on many factors. In my case, I went untreated for years, was told I was incurable, never met anyone else with the disorder, didn't have the internet, my mother -- a psychiatrist -- made fun of my condition or told me I was faking it. I have an extremely poor coping mechanism ... I was raised in fear. It is very difficult to overcome that, though I persist, and have several times planned suicide to the last detail.

But even the ancient Greeks noted 4 main personality traits or "humours" -- Sanguine, Phlegmatic, Choleric, and Melancholic. I fall into Melancholic. They had it divvy into 4 main categories, but recognized different personality types and they witnessed all forms of mental illness.

In Dr. Mauricio Sierra's Medical Textbook on Depersonalization -- *Depersonalaztion: A New Look At A Neglected Syndrome*, Dr. Sierra notes that there are about 1-2% of the population who have CHRONIC 24/7 DP/DR. If you go to the Institute of London link, here in the links section you will see that the causes are various. In individuals with tumors the DP/DR can be chronic. In someone with a head injury it can be chronic.

In those who have stroke, migraine, epilsepsy, the DP/DR can be transient -- usually in an "aura" stage, indicating onset of the migraine/seizure/stroke. But DP/DR as a psychiatric condition has been misdiagnosed as a seizure disorder, and some seizure disorders have been misdiagnosed as psychiatric DP/DR. I would say however that the experience is identical, though obviously no one can truly understand the experience of another.

Here is a description of a neuroscientist who had a stroke, who describes a DP episode as her stroke commences.

*My Stroke of Insight: A Brain Scientist's Personal Journey *
_Jill Bolte Taylor, Ph.D., 2006_
Dissociation experienced by a young neuroscientist during a stroke. A story of courage and hope and a lesson in the plasticity of the brain -- the ability of the brain to heal.

_From Chapter Four, "The Morning Of The Stroke," Page 38_ -- [as a neuroscientist she is very familiar with dissociation and experiences it here herself)

"Immediately, I felt a powerful and unusual sense of dissociation roll over me. I felt so peculiar that I questioned my well-being. Even though my thoughts seemed lucid, my body felt irregular. As I watched my hands and arms [on my exercise machine] rocking forward and back, forward and back, in opposing synchrony with my torso, I felt strangely detached from my normal cognitive functions. It was as if the integrity of my mind/body connection had somehow become compromised.

Feeling detached from normal reality, I seemed to be witnessing my activity as opposed to feeling like the active participant performing the action. I felt as though I was observing myself in motion, as in playback of a memory. My fingers, as the grasped onto the handrail, looked like primitive claws ...

... I felt bizarre, as if my conscious mind was suspended somewhere between my normal reality and some esoteric space. Although this experience was somewhat reminiscent of my morning time in Thetaville, I was sure that this time I was awake. I felt as if I was trapped inside the perception of a meditation that I could neither stop nor escape ..."

[Sounds like DP/DR to me -- during a stroke, I forget how long she remained in this state. Other bad things were happening to her body. She couldn't understand or express language for example, etc., etc.]

-------------------------

I clearly identify with her description here. I have felt exactly the same. Never had a stroke. And she does call it dissociation. This did not remain however it took her years to recover from the stroke, with the help of INTENSE family support (her mom). It is interesting that she writes about this experience from the POV of a scientist, without much fear or emotion. She managed to call a friend, but couldn't speak. He being a fellow scientists knew something was wrong and came to her house and got her to a hospital.

------------------------

Also, see on my website the summary by Ramachandran on Capgras and Cotard's and how he sees chronic DP/DR as a "mini-Cotard's" -- a permanent state of being stuck in "fight/flight" -- "playing possum, where fMRI readings show a lowering of emotional responses. [too long to cut and paste here.]

http://www.dreamchild.net/Theories/theory.html

My theories keep changing, but I imagine myself trapped in "fight/flight" from years of chronic verbal abuse and neglect.

Finally, I had to see a neurologist for what my GP thought might be a familial tremor in my hands. When I was seeing the neurologist I asked him, "Do you have patients with chronic DP/DR. I have it? What helps them?" He said, yes I have 5 right now. I asked what was wrong with them. I think he said, 3 brain tumor patients, 2 severe head injuries, and one individual with severe epilepsy -- multiple seizures in a day. He also said, we don't know how to treat it in these patients. They do not respond to treatment. NOTE: in all of these cases there has been serious damage to the brain.

Also, see my blog on the site here. I blog a response like this, hoping someone will find it in a search. Unfortuantely new people come on here repeatedly, daily, and the same questions get asked over and over. Fortunately I can cut and paste.


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## Guest (Aug 4, 2012)

Bottom line. And I'm not sure why people attack me for this.

When a mental disorder affects quality of life -- something is going wrong in the brain. That means it's neurological. In the future, psychiatry will be subsumed under neurology. However that DOES NOT MEAN that therapy will go out of fashion.

Individuals with all sorts of problems need counseling -- for cancer, for having special needs children -- just sharing experiences with a professional.

I am never saying that anxiety, or depression, or panic DOESN'T cause DP/DR. I'm simply saying, it's pretty obvious to me that these symptoms are indeed neurological. Having neurological symptoms doesn't mean they can't be controlled and treated.

People with migraines, epilepsy, head trauma, etc. CAN BE HELPED. It isn't always easy, but it can be done.

The brain is malleable, it can compensate for things.

But it always amazes me. People wonder "how can a psychotic individual actually HEAR voices talking to him/her from outside his/her head?" Well consider that deaf individuals -- BORN deaf can get tinnitus, hear strange sounds. Where are those sounds generated? IN THE BRAIN! Also, anyone who has tinnitus will tell you ... and I have it ... not bad ... you HEAR something, but it is generated by irritated nerves that are firing of their own accord. That's NEUROLOGICAL.

*Question: Why is neurological a dirty/taboo word?
Question: Why so much stigma attached to brain disorders?

I believe it is fear.
And it is understandable. Personally I will take any other disorder. If your brain isn't working properly, it makes EVERYTHING else in life difficult. And life isn't a walk in the park for anyone. Especially when you get older.*


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## gill (Jul 1, 2010)

I wouldn't doubt certain epileptic conditions could cause some dissociation; at least DR. I had a seizure once, after an injury; then was pretty spaced out for a few weeks. My perception was very out of wack, more so than normal. Temporal lobe got affected. I'm sure you'd know it if you had some epileptic condition though.

Think about what was happening in your life when it started...


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## ParaSpeed (Apr 29, 2012)

gill said:


> I wouldn't doubt certain epileptic conditions could cause some dissociation; at least DR. I had a seizure once, after an injury; then was pretty spaced out for a few weeks. My perception was very out of wack, more so than normal. Temporal lobe got affected. I'm sure you'd know it if you had some epileptic condition though.
> 
> Think about what was happening in your life when it started...


Thanks Gill
Here is the list of events (and symptoms) that has led to my current state.

I'll try and keep this short.

1) October 2010 my father passed away, felt very bereaved, tearful a lot for a long time. 
2) About 6 months later, around May 2011, I developed tinnitus and lots of tension around the head (like a tight band feeling) and neck tension. 
3) I searched on the Internet for causes/cures of tinnitus constantly for days on end and assumed the worse (brain tumour), I worried about this for weeks on end, and this made me anxious. 
4) Finally I went to see my ENT consultant about the tinnitus, who suggested an MRI scan for inner ears, and whilst waiting for the appointment (another few weeks) I felt very anxious. 
5) October 2011 had MRI scan, this came back normal. 
6) Around November 2011 (and again in April 2012) had blood tests done (thyroid function etc), all came back normal.
7) GP suggested anti-depressants in Dec 2011 (Citalopram 30mg)
8] Took these for about 3 months, had side-effects but no improvements in symptoms. 
9) Stopped medication 1st March 2012, had many withdrawal symptoms*

*The symptoms below started around September 2011
* 
a) Constant feeling of detachment, cut off from own experience, where one feels foggy, feeling as if you don't know where you are, but you do (these sensations appeared slowly over a period of few weeks

b] Feelings of disconnectedness/unfamiliarity, feeling distant and dreamlike sensations, as if the mind is not in the present, sometimes feel as my body is just doing things but my mind is disconnected, far away...sort of on autopilot (robotic) feeling. 
c) Can only describe the foggy feeling similar to the sensation when staring at something for a long time without blinking&#8230;difficult to describe (see links below)
d) Visual disturbance (perception) as if my I'm viewing the world through water, sort of fragmented vision...difficult to describe
e) Sometimes seeing flashing lights in dark places and when eyes closed 
f) Tearful almost everyday and feelings of dread, hopelessness, have lost all motivation 
g) Feel mentally drained, feeling of tight band around head and neck tension 
h) Feeling restless and feelings of trembling in body (internally) 
i) Feeling dizzy/light headed/unsteady and often feel cold, chilliness 
j) Sometimes sensitivity to light and sounds 
k) High pitched Tinnitus


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## ParaSpeed (Apr 29, 2012)

Dreamer* said:


> Difficult question. _*I would say that the EXPERIENCE is identical.*_ The brain (though it has a bazillion things going on) -- well we must share a limited number of similar experiences. How you get there may be from a different path, but I would hazard a guess that the symptoms are identical. One things that may be slightly different is drug induced vs. non drug induced (HPPD visual symptoms). I'm not sure, I have never taken drugs, and my experience is abuse, and a family history of mental illenss. (I was a child in the 1960s, so help for me was very limited).
> 
> Also, YES, there are neurological disorders that cause DP/DR, some transient/some chronic. Lyme's disease can cause DP/DR (chronic) in some people.
> 
> ...


thanks
Dr. Mauricio Sierra's and his team at Kings College London think that in the vast majority of people (in the absence of any disease) DP/DR is an automatic protective reflex of the mind during stress/anxiety...in some cases it just gets stuck because of additional anxiety caused by DP/DR symptoms...hence more anxiety...mre DP/DR...a vicious circle


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## gill (Jul 1, 2010)

That single traumatic experience may have been enough to cause the dissociation. It could be seen as protective mechanism in either a psychological or neurological sense, imo.


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## Guest (Aug 6, 2012)

ParaSpeed said:


> thanks
> Dr. Mauricio Sierra's and his team at Kings College London think that in the vast majority of people (in the absence of any disease) DP/DR is an automatic protective reflex of the mind during stress/anxiety...in some cases it just gets stuck because of additional anxiety caused by DP/DR symptoms...hence more anxiety...mre DP/DR...a vicious circle


I would tend to agree with this theory, and it's true Dr. Sierra recaps this theory -- it seems to be the most logical. I believe it is clearly a factor in my case. I was tormented and verbally abused and attacked since I can recall. I was always depressed and anxious, and experienced episodes of DP/DR since I was a little girl of 4 or 5. I have no siblings, no extended family (my parents were much older when I was born). I felt a sense of being worthless, and abandoned from the get go. I thought my chaotic, crazy existence was "normal." And I was to keep secrets (my mother throwing my father out of the house) for years.

However in answer to the specific question. Dr. Sierra has researched neurological disorders and found what he sees as DP/DR in these disorders, and I would say the experience is similar or identical to that of those of us with anxiety-based DP/DR. (As in my stroke illustration).

Example:
--------------------------------------------------------------------
*J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):530-2.*
*Separating depersonalisation and derealisation: the relevance of the "lesion method".*
Sierra M, Lopera F, Lambert MV, Phillips ML, David AS.
Source
Depersonalisation Research Unit, Institute of Psychiatry, Division of Psychological Medicine, 103 Denmark Hill, London SE5 8AZ, UK. [email protected]
Abstract

*OBJECTIVES:*

Depersonalisation (DP) and derealisation (DR) are often met with in patients with a wide range of localisable neurological conditions. This suggests that the "lesion method" might be a valid approach to study the neurobiology of DP/DR. However, the fact that anxiety can trigger DP/DR makes it difficult to establish whether the presence of DP/DR in neurological patients is mainly determined by coexisting anxiety or by lesion location. *To overcome this difficulty, we suggest the study of neurological phenomena, which although not considered as DP/DR, bear enough phenomenological resemblance with them as to warrant their use as models.*

*METHODS:*
One patient with "visual hypoemotionality" and another with "hemiasomatognosia" are described in detail together with a selective literature review.
RESULTS:

Complaints of patients with visual hypoemotionality are indistinguishable from those of patients with "visual derealisation". There is also a phenomenological overlap between "asomatognosia" and the symptom of "body alienation", which is a central feature of depersonalisation.

*CONCLUSIONS:*
Phenomenological similarities between visual hypoemotionality and DR suggest that a disruption of the process by means of which perception becomes emotionally coloured may be an underlying mechanism in both conditions. Likewise, phenomenological overlaps with asomatognosia suggest that DP might result from parietal mechanisms disrupting the experience of body ownership and agency. *These findings give validity to the notion that DP and DR may have distinct neurobiological mechanisms.*
PMID:
11909918
[PubMed - indexed for MEDLINE]

PMCID:
PMC1737835
-----------------------------------------------

*I guess I thought I was answering a specific question re: is DP/DR found in neurological conditions, or only those related to other mental illness/anxiety in particular. Yes, they exist. I believe the sensations are the same.*

If DP/DR are indeed seen in neurology patients as noted ... brain tumors and of course again, severe head trauma, migraine, and epilepsy, it stands to reason that there may be a COMMON PATHWAY. This research -- and Dr. Sierra is truly at the forefront of this work -- could/should lead to treatment of DP/DR in those of us that remains chronic in particular.

I can guess that I was born with a predisposition to anxiety and dissociation, and as an only child had even more time to have my "imaginary" worlds. I was left alone often. My abuse obviously kept me in a contant state of fight/flight/anxiety/fear. The end result, again, this is theory, is cortisol flowing through my body daily, "programming" my brain on a DAILY basis for YEARS since childhood to be in a constant state of "flight."

However, though there are individuals here who note they were anxious BEFORE their DP/DR became chronic, there are others who cannot pinpoint any event that triggered their symptoms, though a few have noted a serious head injury.

Also re: trauma. It has been said, it is not so much the trauma itself as HOW THE INDIVIDUAL INTERPRETS the trauma. This is why we see PTSD in SOME soldiers and not others. Shouldn't ALL of them, faced with death, destruction, horror on a daily basis, almost waiting to die every moment have PTSD? An answer could lie in what makes those individuals MORE RESILIENT.


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