# Advice on rTMS for dissociative and visual symptoms?



## nickknows (Jan 7, 2020)

Hi, new here but long time DP & DR suffer 5+ years, onset from weed. My DP sorted its self out, when I cured my anxiety, I have very little emotion numbing, like I feel normal emotionally, in my own body and real but the Derealisation visual symptoms just never got better! I also have visual snow from taking modafinil, so both the Derealisation and Visual Snow have merged into a one f*cked visual outlook for me, everything I look at is constantly churning, tunnel visual and moving like static, kinda sucks 

Looking to get some rTMS because I have been reading it can help, any advice? Would it work for me, what should I tell or ask the practitioner?

Thanks!


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## 35467 (Dec 31, 2010)

rTMS for that symptom cluster is typically the right TPJ or the right angular gyrus. A trial a the right angular gyrus should be published soon and might address the locations for symptoms clusters more. Emotional numbing is related to the frontal lobes -with rTMS there like the right VLPFC. There are very few rTMS clinics that trys depersonalisation disorder and many of them have likely not read very much into the disorder. So, it is not that easy to get someone who can address this. I would wait for the publication of the french trial on angular gyrus because it will likely give the rTMS clinics more information to work with and understanding of the disorder.


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## LRD123 (Nov 1, 2019)

I have the same problem! I started to get tunnel vision or loss of peripheral vision (whatever you want to call it) in July and a few weeks later in August I woke up with what I now know to be visual snow. Both the tunnel vision and visual snow are progressively getting worse to the point I'm scared that I'm going to go blind honestly. I already have dizziness and with the added visual problems, I feel even more disoriented. I'm glad I'm not the only one with that problem!


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## curiousmind (Oct 31, 2019)

Where said:


> Isn't visual snow something everyone has but doesn't notice? That's just my impression. I know DP can make filtering out these visual phenomena harder, like with floaters and such. I have visual snow, and sometimes I actually get startled by floaters.


Yes, likely conditions such as tinnitus and visual snow are to be held accountable for deficits in subconscious attention. The percieved noise is subconscious in origin but somehow enters into the conscious attention of the individual. I mentioned this in another post. DPDR patients frequently report having tinnitus and visual snow, and vice versa: tinnitus and visual snow patients will often report feeling derealization. It is likely that all these symptoms are, at the core, to be held accountable to an impairment of similar and closely related brain regions/relationships in the brain. Likely everyone in the world has the propensity to perceive noise unnecessarily (tinnitus) or visual disturbances (visual snow), it isn't the symptoms in themselves that is the problem, but rather that a mechanism in the brain (likely regions in the occipital and temporal lobe/sensory cortex) usually filters these distracting signals out, but that this mechanism is disrupted resulting in those symptoms, or so the current theory goes. I speculate that phenomenologically, DPDR is similarly a disruption in attention in a similar way to as how tinnitus and visual snow are. As Patrick Mellor once described "sufferers of DPD often [...] report that their sensitivity to minute changes in their visual field is actually enhanced, along with a focus on minute features to the detriment of seeing larger scale patterns". Yet patients do this subconsciously.


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## curiousmind (Oct 31, 2019)

Where said:


> The attentional problem theory makes more sense to me than the defense mechanism one, though I guess they're not exclusive. What do you think?


Hard to say. There are aspects of the defence mechanism theory that make it undesirable.

Firstly, the defence mechanism theory implies that the nature of the disorder is positive, that it is there to serve you. While this statement may be a source of solace for many, a positive experience is far from what the patients describe this condition to be.

Secondly, even though the theory is a reasonable proposition that kickstarted the current research into the disorder, by now it has become increasingly irrelevant. With the fronto-limbic model being proposed in 2016, any explanatory claim (which the defence mechanism theory is) regarding DPDR has virtually become insignificant. Granted by the currently available research we are now able to discuss the disorder from more of a descriptive point of view, and so it isn't necessary for us or even for the researchers to discuss it from an explanatory point of view. We don't need to know why this disorder exists, we just need to know what is happening in the brain and the body so that we can look into how to treat it.

Also, the defence mechanism theory doesn't account for all the symptoms of DPDR. Given the fronto-limbic model, we now know to a greater degree of certainty that part of this disorder entails an inhibition of limbic structures by the prefrontal cortex (it is debated where exactly, it may be different on an individual basis) resulting in emotional numbing. So until this point, the theory seems reasonable. However, patients do not just report emotional numbing, but an array of other symptoms that are visual and auditory in nature, or are related to cognition such as memory. We also now are beginning to see (and this is why the French trial was conducted) that the prefrontal cortex does not just inhibit limbic structures responsible for the conscious perception of our emotions such as the insula, but that in its chain of commands the angular gyrus is also involved-a non-limbic structure... and so heres where the defence mechanism theory becomes inadequate. The AG is "involved in a number of processes related to language, number processing and spatial cognition, memory retrieval, attention, and theory of mind." [link]. It is highly unlikely that a region as such is dampened due to a protective mechanism. It seems more reasonable at this point to describe the disorder as a disrupted system of attention.


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## Trith (Dec 31, 2019)

nickknows said:


> Hi, new here but long time DP & DR suffer 5+ years, onset from weed. My DP sorted its self out, when I cured my anxiety,...


I am curious, how did you cure your anxiety? Could you give some details about the process?


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