# Out of body experiences and panic attacks



## MidwestMike (Dec 17, 2014)

So I am back to school this week and honestly 2015 has been punching me in the face. After New Years I started to become more isolated and depressed you could say. I wouldn't come out of my room for pretty much anything and just not talk to anyone. I was becoming more irritable and didn't feel like myself. Granted I haven't totally felt like myself since October 100% but this was like I feel into a deep DEEP depression and all reality was fading away. Sunday night I didn't sleep one bit but still went to school. In first hour i felt a but weird but I got over it after like a few minutes I was comfortable. Until right after second hour I was at my locker and I thought to myself "is this my life, is this real?" and I ask myself that a lot but when I did this time I went into this out of body panic attack and was totally messed up. I was walking in circles in the hallway and everything was moving almost in slow version. I also had a bit of ringing in my head. I walked to the office and sat there for 30 minutes until I called and went home. I kept thinking to myself when i came home "is this heaven?" "did i die?" "am i in a dream?" and before i know these answers went true it just felt like it but this time I was getting really scared at these questions. I also kept asking myself is the medication I'm taking (Fluoxetine) isn't kicked in yet or its having negative effects on me. I have been taking it since the start of break (December 20th) and all the side effects have gone away pretty much. Today was a bit better than yesterday but I felt numb and dissociated and asked myself a bunch of times those questions. I felt like an alien crash landed on earth. For a second before lunch today I saw the world in slow mo and I told myself "stop thinking that" and it went away so i guess i have some control which is good! But I sometimes look at people and ask "wow what this life and what are these people" and just think deep and scare myself.


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## Meticulous (Jul 30, 2013)

I relate to the alien landing on Earth feeling. I used to feel as if I belonged in a different dimension/reality, and this would make me anxious because I couldn't escape whatever reality we are living in. As time progressed, I learned to accept that this is the only reality I will ever know, so why fight it? Instead I'm going to make the best of it, and realize how fascinating this life really is. Treat your body with respect and I assure you things will change!


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## Dr B (Apr 23, 2014)

Hi Mike

Interesting story, but its not an out-of-body experience. Its important to be clear on that as the type of dissociation that occurs in DP is embodied. OBEs are disembodied. I used to have a lot of posts around here explaining the difference, but alas, the previous admin deleted everything in a religious rant against science.

I hope to return soon and put some discussions up on these differences. On the whole, research suggests that people with DPD do not have OBEs - or if they do, then they likely also have migraine, migralepsy or epilepsy - which causes them.


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## MidwestMike (Dec 17, 2014)

Dr B said:


> Hi Mike
> 
> Interesting story, but its not an out-of-body experience. Its important to be clear on that as the type of dissociation that occurs in DP is embodied. OBEs are disembodied. I used to have a lot of posts around here explaining the difference, but alas, the previous admin deleted everything in a religious rant against science.
> 
> I hope to return soon and put some discussions up on these differences. On the whole, research suggests that people with DPD do not have OBEs - or if they do, then they likely also have migraine, migralepsy or epilepsy - which causes them.


thank you for explaining this to me!


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## Dr B (Apr 23, 2014)

You are welcome, and thank you for sharing the interesting experience. I'm working on some theories at the moment that seek to fractionate the unitary notion of 'dissociation'. There are, to my mind, a number of different types of dissociation. The distinction between DPD and OBE is a good example - where in one case the distorted reality is reported from an embodied egocentric perspective (often deep inside oneself), and the other, by definition, is a vivid experience of the world from a completely different perspective. The implication is that these variants have differing underlying brain mechanisms (over and under neural inhibition for example).


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## sunshinita (Aug 13, 2013)

I can totally relate to the alien on Earth feeling and that I don't belong here on Earth,in this reality feeling, can't shake it off. As for out of body experience I had it once when I got high from weed - my first and only time I got high and it was exactly as if I left my body and watched everything from up high/ above my body-very scary sensation.It was 4 months before I got my first DP crisis. With dp I feel stuck in my mind, in my head but not OUT of my body entirely.There is a difference indeed.

I am not sure if it's right to say that the deep inside oneself thoughts are egocentric, they are opposite to egocentric, because it's like you've lost your 'ego', there is no 'ego' anymore,there is no more 'me' as a human,'me' feels unnatural and existence is uncomfortable.


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## MiketheAlien (Nov 7, 2013)

Is that a real picture of you Dr. B?


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## 35467 (Dec 31, 2010)

No, I think it is an actor. Dr.B is a male


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## MiketheAlien (Nov 7, 2013)

Lol, I was just joking, but thanks for clarifying. ;-)


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## Dr B (Apr 23, 2014)

sunshinita said:


> I can totally relate to the alien on Earth feeling and that I don't belong here on Earth,in this reality feeling, can't shake it off. As for out of body experience I had it once when I got high from weed - my first and only time I got high and it was exactly as if I left my body and watched everything from up high/ above my body-very scary sensation.It was 4 months before I got my first DP crisis. With dp I feel stuck in my mind, in my head but not OUT of my body entirely.There is a difference indeed.
> 
> I am not sure if it's right to say that the deep inside oneself thoughts are egocentric, they are opposite to egocentric, because it's like you've lost your 'ego', there is no 'ego' anymore,there is no more 'me' as a human,'me' feels unnatural and existence is uncomfortable.


DPD patients, on the whole do display signs of hyper-egocentric processing. A good example is the over-salience placed on internal bodily sensations, thoughts, and the resultant anxiety from that. It is well known, though often referred to as either an 'attentional-bias' or 'hyperreflexivity'. I appreciate what you are saying but the excessive thoughts around a loss of the self, are themselves a thought of self . Its one of the many contradictions in DPD. Another good one being that DPDers have a suppressed emotional response, yet have higher anxiety (emotion) because of it.......there are good neuroscientific explanations for these, but this goes beyond the current discussion.


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## Dr B (Apr 23, 2014)

MiketheAlien said:


> Is that a real picture of you Dr. B?


No


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## Dr B (Apr 23, 2014)

Mayer-Gross said:


> No, I think it is an actor. Dr.B is a male


No its not an actor.


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## Dr B (Apr 23, 2014)

MiketheAlien said:


> Lol, I was just joking, but thanks for clarifying. ;-)


wink....hahaha......its me at weekends.....


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## sunshinita (Aug 13, 2013)

"there are good neuroscientific explanations "- well there are 'theories' but there are no real explanations why and how anxiety/dpd/depression happens. Sorry but science knows no sh*t. The imbalance theory is also just a theory, there is no scientific proof because they can't measure serotonin/norepinephrine/dopamine levels in a living human being. It is still a mystery, even to scientists.


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## Dr B (Apr 23, 2014)

sunshinita said:


> "there are good neuroscientific explanations "- well there are 'theories' but there are no real explanations why and how anxiety/dpd/depression happens. Sorry but science knows no sh*t. The imbalance theory is also just a theory, there is no scientific proof because they can't measure serotonin/norepinephrine/dopamine levels in a living human being. It is still a mystery, even to scientists.


I'm sorry, but you are completely wrong in everything you say. Just because you may not be aware of the science, does not mean it does not exist. Even more so that just because you may not accept it, does not make it false.

You also do not seem to understand the word 'theory' in a scientific sense. A scientific theory is not just an idea, opinion, or supposition. It is not just whimsy. Scientific theories are based in evidence-based reasoning, justified by logical argument - neither of which you engaged in with your post. It is the pursuit of the most reasonable explanation consistent with the evidence of highest quality. In this sense they are 'explanations'. Our understanding of DPD is very comprehensive, but it is far far from complete. To say science knows shit, is just to show everyone here how ignorant you are to science and the explanations.

You can measure lots of things in the living brain, including the role and function of brain areas, fMRI bold responses, DTI connectivity, endogenous chemical imbalances (contrary to what you say), bayesian integration, brain oscillations, direct effects of brain stimulation, emotional reactivity, eye movements, reaction times - all in real time in the real living brain. Sorry, but your conception of science is ridiculous as are your arguments against it.

Like I say, our understanding is far from complete, but we know more than we ever have and great progress has been made.


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## sunshinita (Aug 13, 2013)

Sorry but what you are saying is ridiculous, you can measure a lot of things in the living brain but you can't measure someone's serotonin levels in a living human being. If it was possible no doctor would prescribe med after med TILL one works,there would be brain chemistry analysis first, then prescriptions. And don't mistake theory for evidence, they are very very different things. Even psychiatrists admit that the whole concept about chemical imbalance in the brain is just a theory and not a given fact. If it was proven there wouldn't be any problem fixing it with balancing the levels, not just guessing which med will help and trying one after another. I talk about hormones like serotonin,norepinephrine, dopamine, etc. ,I never said that nothing can be measured the brain, please don't put words in my mouth that were never said! I am waiting for you to tell me how our brain serotonin levels can be measured ,not the overall serotonin in the body through blood testing ,I am very excited to hear about it. And also, what is the proper amount of serotonin which is considered 'normal'?


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## Dr B (Apr 23, 2014)

You are quite mistaken and you ignored everything i said - dont know why you're getting hung up on serotonin as there are lots of ways to measure it in animals and humans - but i gave you evidence of the broader picture - which you ignored. To be fair, I dont mistake theory for evidence (and you provided no evidence that i did) - but you dont understand either - espicially theory as i stated above.

Psychiatrists? Give me a break.

I never put words in your mouth, just showed you how the words that were in your mouth were wrong and not well founded. You made a huge statement about science based on serotonin.....what an overstatement. Dont get hung up on serotonin...its way more complicated than that and I myself never mentioned it. So who's putting words in someones mouth now? Sorry, but you're confused about what i actually said and what you think i said. Your logic over why some medics / psychiatrists prescribe different meds is also flawed as often this is guided by patient descriptions and these are not always optimal. In addition, symptoms change and some meds dont work for some people, but do for others and these complex interactions are not well known a-priori. I'm not a medic, but i think you need your expectations to be managed. Drugs are part of treatment, and have positive effects for lots of people, but some people are resistant to them, or may respond differently to different combinations. A good treatment programme is one tailored to the individual, and this takes time.

PS - some have tried to use PET with limited though reasonable success, to look at serotonin - but its not my main thing - though the existence of such studies goes against some of what you say. I personally think PET is a little overly indirect for studies of this type. However, to honestly present the research I must say others disagree and think it is a very useful and direct measure.

Perreau-Linck E, Beauregard M, Gravel P, et al. In vivo measurements of brain trapping of α-[11C]methyl-L-tryptophan during acute changes in mood states.

_J Psychiatry Neurosci _2007;32:430-4.

PPs - α-[11C]methyl-L-tryptophan is a tracer for the synthethis of serotonin, and because its in vivo I think that means your argument is busted?.


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## sunshinita (Aug 13, 2013)

I was stuck on serotonin because I was giving you an example. I didn't conclude that science doesn't know anything at all. I was referring to depersonaliziation, anxiety and depression ,what really causes it , they have their theories and that's all, and that the chemical imbalance is just a theory, thousand of studies and no single PROOF, I didn't make a statement based on serotonin, so jokes not on me. I am not the one that's mad here, you are so eager to defend science but still no cure, just explanations based on theories.....

So don't be angry at me for pointing the obvious here, science doesn't provide us with a cure at that moment, nor with proven facts about dp-that is my statement, I just used another rude expression and you got upset. Never said that I don't accept science HA, science is a powerful thing just not in this case which i am referring to. Don't make global conclusions when I am talking about something concrete here.


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## Dr B (Apr 23, 2014)

> I was stuck on serotonin because I was giving you an example.


I know, but i questionned the legitimacy of it as you based an entire world view on it. But fair enough.



> I didn't conclude that science doesn't know anything at all.


I'm sorry, but you did just that. You stated science 'knows shit' - please go back and re-read. I accept that you want to re-clarify that - which is great.



> I was referring to depersonaliziation, anxiety and depression ,what really causes it , they have their theories and that's all, and that the chemical imbalance is just a theory, thousand of studies and no single PROOF,


No, you are wrong and again you dont understand the word 'theory' and your use of the term 'proof' is unfortunate. Theories are based on evidence and are a forms of proof. Some better than others. Theories are not a simple throw away thing - i mentioned this above, please read. The are not whimsy and opinion, they are more than that (scientific ones are).



> I didn't make a statement based on serotonin, so jokes not on me.


You did.



> I am not the one that's mad here, you are so eager to defend science but still no cure, just explanations based on theories.....


Science is not about cure. Medicene is. Science is about uinderstanding, and with that, we hope, more effective treatments will come. There is no such thing as a single cure as DPD/DR is not a single thing - so again, you need to manage your expectations. There are many cases of sufferers leading full and happy lives as a result of treatment (drug based or not). Not a cure, but a return to a state that reduces its dominance in life.



> So don't be angry at me for pointing the obvious here,


I'm not angry and you're not posting the obvious, just your own ill-informed opinion.



> science doesn't provide us with a cure at that moment,


read the above - i've answered this and corrected your error.



> nor with proven facts about dp-that is my statement, I just used another rude expression and you got upset.


I'm far from upset, i dont like it when misinformation is propagated. This must be addressed as a lot of people will read this and if they rely on your points above and earlier, they will be misled.

No worries, its fine. You started out making big claims, and I've rebutted them all. Food for thought. Take it easy.


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## sunshinita (Aug 13, 2013)

you just love insulting people, and you just love love love quoting just some parts, not the whole things I said, that's not childish at all.. You didn't rebut anything, you just chose what to quote and didn't even bother to consider my point of view,you attacked me with calling me ill-informed, not aware of science..You know very well that I was referring to dp and anxiety when talking about 'science knows no shit', but you chose to ignore that part and just emphasize on the expression itself, because it's easier to prove me wrong, isn't it


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## Dr B (Apr 23, 2014)

> you just love insulting people, and you just love love love quoting just some parts, not the whole things I said,


I've never insulted you. I've stated facts. You might not like them - but that does not make them an insult. You made two main claims when you waded into this and both have been shown to be false. I even cited evidence to show your claims about serotonin are false. This is not an insult - its fact. Your other claim was that science 'knows shit' and I've explained to you why that is unfair and inaccurate as well. If you go back and look, you were the one wading in with an agressive tone. I'm never scared off from engaging if i feel I must.



> You didn't rebut anything, you just chose what to quote and didn't even bother to consider my point of view,


Wrong. I've rebutted you and dealt with your points. Your serotonin point is demonstrably false and your view of science is also demonstrable false. No selective quoting. Facts. You might not like them, but as i said above, that does not make them false.



> you attacked me with calling me ill-informed, not aware of science.


its not an attack if its true. I have shown you were ill informed on the two claims you made I never once attacked you.



> You know very well that I was referring to dp and anxiety when talking about 'science knows no shit',


No I did not, but even if that were the case, you are still demonstrable wrong. We can measure endogenous chemicals in the living brain.



> but you chose to ignore that part and just emphasize on the expression itself, because it's easier to prove me wrong, isn't it


Its easy to show that you're wrong, when you so blatantly are. I've dealt with all your points. You are just plucking at straws because you are out of your depth. What parts have I ignored? You only made two poorly expressed points, one about serotonin and one about science not knowing anything. I've dealt with both. I'm not sure how helpful our continued interaction will be. Look, I'm fine with it - but as a scientist, I'm not going to sit here and let you misrepresent the situation to the readers. Our interaction would have been more cordial if your initial interaction had been more reserved. You cannot agressively wade in and then moan that someone else is challenging you in the same way. Anyway, lets move on. I think I would agree with you that science has a lot to learn (had you said it that way). I would add though, that important insights have also been gleaned and science has a lot to offer. I think we should let others continue the discussion for the time being and see what they think

Take it easy.


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## inferentialpolice (Nov 26, 2012)

Dr B said:


> Hi Mike
> 
> Interesting story, but its not an out-of-body experience. Its important to be clear on that as the type of dissociation that occurs in DP is embodied. OBEs are disembodied. I used to have a lot of posts around here explaining the difference, but alas, the previous admin deleted everything in a religious rant against science.
> 
> I hope to return soon and put some discussions up on these differences. On the whole, research suggests that people with DPD do not have OBEs - or if they do, then they likely also have migraine, migralepsy or epilepsy - which causes them.


Happy New Year Dr. B ... Not sure how you are defining OBE -- would "seeing yourself outside your body, looking back at yourself" be an OBE under your definition?


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## Dr B (Apr 23, 2014)

inferentialpolice said:


> Happy New Year Dr. B ... Not sure how you are defining OBE -- would "seeing yourself outside your body, looking back at yourself" be an OBE under your definition?


I am defining it in the accepted scientific terms.

Which is basically expericieng the world from a vatage point outside of the physical self. It also needs to be utterly convincing and not 'as if' outside oneself - which is very different. It has nothing to do with 'seeing yourself' per-se, although that can happen. The crucial aspect is your perceiving self has shifted considerably in space outside of your physical self. So no, not quite the definition you provide.

Hope that helps.


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## inferentialpolice (Nov 26, 2012)

Thanks for the reply ... I wasn't aware there were accepted scientific terms defining OBE that required lack of reality testing so as to exclude "as if" subjective sense. In addition, I wasn't aware of literature establishing DP experiences of this nature being necessarily different than OBE as you've defined it. Do you have some citations to give a newer student of this field a leg up?


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## Dr B (Apr 23, 2014)

> Thanks for the reply ... I wasn't aware there were accepted scientific terms defining OBE that required lack of reality testing so as to exclude "as if" subjective sense.


Its fundamental. The 'as if' qualifiers are restricted to DPD and are a classic of the condition. Just about any scientific citation on the condition will tell you that. Sierra's book on depersonalization is a good starting place. There is also a good review article by Anthony David, circa 2011 I think in the journal Consciousness and Cognition on depersoanlization. This is one factor that makes the experiences very different. In the OBE, its very real, in DPD its dreamlike and 'as if' real. See also work by Gabbard, Twemlow & Jones from the 1980s on important phenomenological differences which have been known about for decades (hence the citations to 1980s papers).



> In addition, I wasn't aware of literature establishing DP experiences of this nature being necessarily different than OBE as you've defined it.


You may not be aware of it - but it's there!  The citations above (and many more) address this comprehensively. You dont get OBEes in DPD unless the patient has co-morbid factors (like migraine with aura or epilepsy). Experimental differences have also been demonstrated using objective tasks and clear differences emerge - such as on perspective-taking tasks. DPDers are not as fast / accurate as OBEers - which is consistent with the idea that OBEers have exocentric perspective-taking skills which may well be connected to their out-of-body hallucinations. DPDers dont have this - and of course, dont on the whole have OBEs



> Do you have some citations to give a newer student of this field a leg up?


Sure, do a Google on the authors above - loads to read from that. ^_^


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## inferentialpolice (Nov 26, 2012)

Dr B said:


> Its fundamental. The 'as if' qualifiers are restricted to DPD and are a classic of the condition. Just about any scientific citation on the condition will tell you that. Sierra's book on depersonalization is a good starting place. There is also a good review article by Anthony David, circa 2011 I think in the journal Consciousness and Cognition on depersoanlization. This is one factor that makes the experiences very different. In the OBE, its very real, in DPD its dreamlike and 'as if' real. See also work by Gabbard, Twemlow & Jones from the 1980s on important phenomenological differences which have been known about for decades (hence the citations to 1980s papers).
> 
> You may not be aware of it - but it's there!  The citations above (and many more) address this comprehensively. You dont get OBEes in DPD unless the patient has co-morbid factors (like migraine with aura or epilepsy).


The David/Sierra 2011 article in C&C is not useful in this matter as it simply states what they believe Gabbard et al concluded and provides the cite.

Going back to Gabbard et al, one sees their definition of out-of-body: "an altered state of consciousness in which one's mind or awareness is experienced as separate from one's physical body." The paper doesn't say this doesn't happen in DPD, and also doesn't say if it happens it is only in the context of migraine, etc. It does cite Noyes who is quoted as finding that "the subjective experience of frank detachment from the body is infrequent in depersonalization, characterizing only 19% of psychiatric patients who experienced depersonalization."

Gabbard does refine his terms in the middle of the paper to say regarding OBE: "by definition, the subject must have the feeling that his mind is separated from his body at a distance". (ie, nothing about "awareness" as in the original definition)

I can confirm through observation of clinical experience that OBE's in the original sense as used in the opening definition of Gabbard does occur in DPD (outside of migraines, epilepsy, etc), I suspect most typically in those who have been chronically abused, which also is the circumstance when such OBE experiences are calming as opposed to anxiety-provoking. Gabbard's study does not query or identify the abuse profile of the respondents, and thus I suspect that their discriminating phenomenological charts reflect a confounding. Of course, chronically abused usually have a dissociative disorder beyond DPD, though depersonalization is part and parcel of that more profound symptom complex, but if the researcher was looking only for DP/DR (SImon/Sierra/Braithwaite, etc) they will have confounded the patient class as well.


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## Dr B (Apr 23, 2014)

Hi



> The David/Sierra 2011 article in C&C is not useful in this matter as it simply states what they believe Gabbard et al concluded and provides the cite.


OK, I'll play.

You're wrong here. The article is a review article, not an experimental one. I'm sure you understand the difference. It's one of the best review articles out there (IMO). It is useful and you cannot so glibly pass it aside as you do - with no evidential argument whatsoever. What they 'believe' as you put it, is based on decade's worth of research - sorry that it makes your argument hard to make - but that's how it is. You are being more than disingenuous here, not sure why. I cited this article not because of definitions, but because they (as many others do) clearly talk about the 'as if' qualifiers that DPDers use in their descriptions. My own experience totally concurs with this. DPDers are dissociated - but not, on the whole, disembodied (unless migraine, epilepsy etc is also present).



> Going back to Gabbard et al, one sees their definition of out-of-body: "an altered state of consciousness in which one's mind or awareness is experienced as separate from one's physical body."


Again, go back and read my post. At no point did i refer to Gabbard, Twemlow and Jones in terms of definitions - I referred to them in terms of their papers that document clear phenomenological differences between the OBE and DPD. It's a good example paper in that sense. None of the researchers in mainstream cog neuro use their definitions and I never said they did, or indeed that I used them. Please try not to misrepresent the position of others.



> The paper doesn't say this doesn't happen in DPD, and also doesn't say if it happens it is only in the context of migraine, etc.


No, it highlights the phenomenological differences that do exist and that was my point. The other points come from later research and opinion (Sierra, David, Medford). Those Gabbard papers are 30 years old you know, things have moved on.



> It does cite Noyes who is quoted as finding that "the subjective experience of frank detachment from the body is infrequent in depersonalization, characterizing only 19% of psychiatric patients who experienced depersonalization."


Yes, but there has been considerable work since then, and none of this was about definition (in terms of my intended meaning when I cited Gabbard). The definition by Blackmore and the one by Irwin are the most useful, - but I prefer the Blackmore one as its more efficient, condensed and clear. That's the one I prefer to use - but both focus on the crucial phenomenological aspect of experiencing the world from another location / perspective outside of / remote to, the physical self. That's the crucial principle. We can argue over precision in the definition, but it must contain those elements for the OBE.



> Gabbard does refine his terms in the middle of the paper to say regarding OBE: "by definition, the subject must have the feeling that his mind is separated from his body at a distance". (ie, nothing about "awareness" as in the original definition)


As noted, I never related to those papers for their definition - so your point is utterly irrelevant. I think you're being semantic over the use of 'awareness' as well here, but like i say, the whole point is irrelevant to my earlier post where I refer clearly to these papers in the context of phenomenological differences between the experiences.



> I can confirm through observation of clinical experience that OBE's in the original sense as used in the opening definition of Gabbard does occur in DPD (outside of migraines, epilepsy, etc), I suspect most typically in those who have been chronically abused, which also is the circumstance when such OBE experiences are calming as opposed to anxiety-provoking.


I can confirm that you are wrong here. You are using a dated and never fully endorsed definition. Please point to published research as that would be helpful, after all, that's what you ask of others so its only fair (and not obscure clinical drivel please - proper science). My own experience, personal conversations with neuropsychiatrists in the UK (including Medford, a leading researcher in the field), and the published comments of Prof David etc, all concur with each other quite clearly. OBEs, on the whole, do not occur in DPD - the type of dissociation is different (Braithwaite et al., 2013).

However, OBEers may score high on the anomalous-body-experience subscales of depersonalization - but it is not logical to assume they are the same thing.



> Gabbard's study does not query or identify the abuse profile of the respondents, and thus I suspect that their discriminating phenomenological charts reflect a confounding. Of course, chronically abused usually have a dissociative disorder beyond DPD, though depersonalization is part and parcel of that more profound symptom complex, but if the researcher was looking only for DP/DR (SImon/Sierra/Braithwaite, etc) they will have confounded the patient class as well.


If you actually read the papers, you'd realise that your argument does not stack up here. The whole 'abused' link is soooooooo clincial psycho-babble to many and I'm one of those many. DPD cannot be reduced to abuse alone and I can't believe you think it can be. With respect, you are out of date in terms of the very latest neuroscience on this topic.


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## Dr B (Apr 23, 2014)

The way terms like dissociation, disconnection, disembodiment, have been used in the past is also unfortunate. Hopefully, new research will help clear these things up.


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## inferentialpolice (Nov 26, 2012)

Doc B,

When I said the C&C article was not useful in this matter, the matter I was referring to was whether or not OBE was rare in DPD. On that, in the section entitled "Disembodiment feelings" the C&C article states only that "out of body experiences and autoscopic hallucinations .. are rare in depersonalization (Gabbard, Twemlow, & Jones, 1982)." So to assess what led these authors to say they were rare, the C&C article refers us onward to the 1982 article, which is where I went, and worked with the definition provided there in order to have context to what must be meant.

Going with the Blackmore definition, which you suggest, the 2013 article you mentioned on page 794 quotes that definition as follows:

"The OBE can be defined as an experience where the individual 'perceives his/her environment from a perspective outside of their physical body' (Blackmore, 1982)".

This definition doesn't seem as heavily qualified as the conditions you mentioned earlier, and it seems to fit with a seminal question asked in Dissociative Disorder depersonalization assessment: "Have you ever felt that you were watching yourself from a point outside of your body, as if you were seeing yourself from a distance?" (SCID-D diagnostic interview, question 38)

I am sorry to learn that someone working physiologically is reticent about a trauma model of causation for dissociative experiences (that are not otherwise explained medically -- eg, brain lesions, drugs, etc).

Regarding a trauma basis for depersonalization, you would likely be most interested in trauma's impact on Neuro-development/Neuro-functioning, which one can then map into the sort of symptom/causation chain you are apparently studying. You can see a representative sample of articles on that at: http://ge.tt/5gHXQAp1?c

As I read the postings of sufferers on this list, and on reddit's /r/dpdr, commonly they describe adverse childhood experiences in their background. In my readings on therapeutic interventions, sucessfully addressing these adverse experiences according to dissociation treatment principles leads to abatement of the dissociative symptoms.

The point about higher order dissociatives is an important one -- they are the ones who qualify for DPD diagnosis BUT if assessed further would be labeled higher up on the dissociative spectrum. This class of misattributed patient can confound physiologic studies, particularly if they are DID, as many physiologic changes happen with changes in self states. As for such self-state switching effects on vision, an area of your interest, I refer you to four papers on psychophysiological manifestations of state switching:

http://ge.tt/9spf6yt?c


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## Dr B (Apr 23, 2014)

> When I said the C&C article was not useful in this matter, the matter I was referring to was whether or not OBE was rare in DPD. On that, in the section entitled "Disembodiment feelings" the C&C article states only that "out of body experiences and autoscopic hallucinations .. are rare in depersonalization (Gabbard, Twemlow, & Jones, 1982)." So to assess what led these authors to say they were rare, the C&C article refers us onward to the 1982 article, which is where I went, and worked with the definition provided there in order to have context to what must be meant.


They are also talking about their own experience. Sierra also mentions it in his book. Medford has confirmed it personally to me on numerous occasions. I also mentioned that previously.



> Going with the Blackmore definition, which you suggest, the 2013 article you mentioned on page 794 quotes that definition as follows:"The OBE can be defined as an experience where the individual 'perceives his/her environment from a perspective outside of their physical body' (Blackmore, 1982)".
> 
> This definition doesn't seem as heavily qualified as the conditions you mentioned earlier, and it seems to fit with a seminal question asked in Dissociative Disorder depersonalization assessment: "Have you ever felt that you were watching yourself from a point outside of your body, as if you were seeing yourself from a distance?" (SCID-D diagnostic interview, question 38)


This definition is entirely consistent with what I said before, it's the only one I've ever used in any of my research so I'm not sure why you say such a thing. Like I say, other definitions are thematically similar (Irwin) but less efficient.

You now also reveal a the essence of your confusion. The last point you make appears to centre around a confusion over this 'watching yourself' conception. Did you note the 'as if' qualifier in your definition - thats exactly my point!!!!! When they say 'as if' that does not mean 'I was'. OBEers NEVER say 'as if'. If you further ask DPDers about actually being 'outside' oneself and not *'as if* watching' oneself, they retract it or further qualify it. It's a confusion over the language. DPDers can confirm that its 'as if' watching myself, and still say, when questioned further, that they were still inside their body. You're making the classic mistake of 'literally' interpreting the words. As I said, a lot of more recent research has and is being done at the moment - which is shedding new light on this.



> I am sorry to learn that someone working physiologically is reticent about a trauma model of causation for dissociative experiences (that are not otherwise explained medically -- eg, brain lesions, drugs, etc).


It isnt the view of just 'someone'. Neuroscientific models are no starting to provide explicit testable models of DPD, and it has little to do with trauma. No one is denying that trauma has its role, but it is not necessary, that's the point.



> Regarding a trauma basis for depersonalization, you would likely be most interested in trauma's impact on Neuro-development/Neuro-functioning, which one can then map into the sort of symptom/causation chain you are apparently studying. You can see a representative sample of articles on that at: http://ge.tt/5gHXQAp1?c
> 
> As I read the postings of sufferers on this list, and on reddit's /r/dpdr, commonly they describe adverse childhood experiences in their background. In my readings on therapeutic interventions, sucessfully addressing these adverse experiences according to dissociation treatment principles leads to abatement of the dissociative symptoms.


I'm not convinced these are all DPD. They may well be dissociative, but not DPD. Again, it's the recent scientific evidence that is forcing a re-conception of dissociation with huge implications for theories, concepts, models and classification. Lots of things lead to an abatement of symptoms, even non-intervention in some cases.


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## inferentialpolice (Nov 26, 2012)

Oy vey! ... Here is how I understand the order of this discourse up till now:

1) You suggest that OBE definitially requires the perceiver to actually believe that they have disembodied

2) I question the definition that requires reality testing to have failed

3) You say its fundamental, but offer no reference definition, rather you claim that OBE is not something DPD folks have (unless accompanied by migraine, epilepsy, etc)

4) I look at papers that you reference re DPD and OBE, looking for their definition of OBE, but their's doesn't seem to require failed reality testing, and does acknowledge that DPD experience OBE, perhaps 19% of them.

5) You say that Gabbard is old school, and offer Blackmore for a definition

6) Like Gabbard, Blackmore's definition requires perceiving, but not failed reality testing, which is exactly how DPD assessment inquires about it

7) You've yet to show me a definition of OBE that requires the perceiver to actually believe that they have disembodied, and that that was the definition used in studies that spoke to phenomenological discrimination between DPD and non-DPD-OBE

8) *IF* one chose to define OBE as requiring failed reality testing, then yes, I would say that it is not "typical" as the subjective sense description of what a Dissociative would provide in description of their experience. However, I am still searching for a paper that defines OBE this way, and if you are aware of one, please let me know.


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## Dr B (Apr 23, 2014)

> Oy vey! ... Here is how I understand the order of this discourse up till now


To be honest, and fair, I don't think you do understand the discourse up till now, you've completely misrepresented my position numerous times and you think that passes for debate, opinion or 'making points'. It does not. Its intellectually dishonest. Therefore, I'm not sure this is going to be productive so I'll answer these points and let's see what others think.



> You suggest that OBE definitially requires the perceiver to actually believe that they have disembodied


You place your entire opinion on definitions - so clearly you're clinical or a psychiatrist and that's why I think we are not seeing eye to eye, so to speak. I go beyond definitions, as they are NEVER 100% useful or literal and can be problematic (though useful). It is certainly the case that people feel disembodied during the OBE and its striking nature comes from the conviction that they are out of body. There are no 'as if' qualifiers. That's what I've said all along. It's not a dream, not even a vivid one. Many OBEers express fear during the experience, as they think they are dying or they worry about getting back inside their body (especially if it's the first one, or a vivid one). However, after the experience they may negate this 'reality' or seek to explain it to themselves in some other way. So it's not that simple. 'During' the experience observers are generally convinced of being 'out of body' by definition. Afterwards, they seek to rationalize it.



> I question the definition that requires reality testing to have failed


As you can see from what I've said above, reality testing has not failed, in an absolute sense. The OBE is not a delusion, it's a multi-sensory hallucination, with vivid three-dimensional characteristics, where it is 'perceptually convincing' which means it can be as realistic as real perception, and this be interpreted in a spiritual / mystical / supernatural way. If it was not felt as 'real' none of these interpretations would be predicted. The fact that the OBE is so associated with spirituality / supernatural themes goes totally against your question here. I'm not sure you really fully understand the approach from mainstream science on the OBE, as all of this is basic stuff - accepted by everyone working in the field. Most OBEers I talk to (and I've researched the area for many years) tell me that when it happened it was very striking, but then afterwards, because these people are rational, they question, for many years, what on earth it was (even if they know it's not supernatural)



> You say its fundamental, but offer no reference definition, rather you claim that OBE is not something DPD folks have unless accompanied by migraine, epilepsy, etc


More misrepresentation. I say the exocentric, disembodied perception is fundamental for the OBE. I offered full referenced definition so please stop misrepresenting my position - it is the sign of intellectual dishonesty. Blackmore, every publication she wrote on it (spanning over 15 years) uses a definition where the exocentric perspective is fundamental. Harvey Irwin does, I do, Olaf Blanke does, Peter Brugger does, and so on. To say I offered no referenced definition is disingenuous to say the least as I've discussed this all above and all you need to do is get to their webpages or do a Google to get their papers (which you claim you have done). You may ignore it, but it's wrong to say it's not there. Sorry, I'm not letting you get away with that. Show me a recent scientific (not clinical) publication where OBEs have been shown to occur in DPD, that stands up to scrutiny of the typical misunderstandings of the distinction between the two. Over to you. Let's see it.



> I look at papers that you reference re DPD and OBE, looking for their definition of OBE, but their's doesn't seem to require failed reality testing, and does acknowledge that DPD experience OBE, perhaps 19% of them


Wrong, you cited an old paper (I told you it was out of date) on the 19% issue - which even if true is still consistent with the idea that in 80% of cases OBEs dont happen in DPD.....however, I know of no published scientific (not clinical) paper arguing for OBEs in DPD that passes the test of not misunderstanding the important distinctions in the different forms of dissociation. Please regale me with these studies.

However, why would failed reality testing be in the definition? You see? You're picking at straws with a fetish for definitions. You think all the information should be in a definition - wrong and typical of the clinical view. As I said above, reality testing criteria are tricky here as the experience can be real during the experience, but are subjected to post-hoc rationalization afterwards - so it's not straightforward - it can be 'in flux'. That's probably why it's not in the definition. Blackmore does talk, at length in her books about the OBE being striking and real, so do Cook & Irwin in their work. So do the Gabbard papers (at least the ones I've read) about the striking nature of the OBE relative to the dulled nature of DPD. I'm sorry, but you could not be more wrong on this.



> You say that Gabbard is old school, and offer Blackmore for a definition


I said lots of work has been done (experimental science I mean - the literature you are unfamiliar with) since the Gabbard paper. Blackmore's definition is still used and appears helpful and accurate in a basic sense. But yet again, your entire world-view is centred on definitions because you dont understand scientific models, additional qualifications, and complex interactions of multi-sensory processes.



> Like Gabbard, Blackmore's definition requires perceiving, but not failed reality testing, which is exactly how DPD assessment inquires about it


Definitions again? Dear god.....you have nothing here. Look. I've answered the issue about reality testing, the fact you think it is a binary thing tells me you're out of date and a clinically-oriented person. If you actually bother to read Blackmore's books and papers (as I have) you will see she argues strongly that DPD is not a framework for understanding the OBE, the differences far outweigh the similarities. You missed that - because you have not read the full and proper debate - which you really need to do.



> You've yet to show me a definition of OBE that requires the perceiver to actually believe that they have disembodied, and that that was the definition used in studies that spoke to phenomenological discrimination between DPD and non-DPD-OBE


I have (Gabbard,Blackmore, etc) however, you expect to see it in the strict one sentence definition but those researchers discuss it as part of the wider context of what makes an OBE (broader phenomenology rather than strict definition) - please read. OBEs are striking when they happen, OBEers do not use 'as if' qualifiers - not one paper has EVER reported that. Again, please bring the papers that say otherwise. Let's see them.

My point all along is that feeling 'as if' one is out of body is not the same, at all, as actually feeling out of body. All the papers and researchers I've mentioned, if they were here, would agree with me, not you.



> IF one chose to define OBE as requiring failed reality testing, then yes, I would say that it is not "typical" as the subjective sense description of what a Dissociative would provide in description of their experience. However, I am still searching for a paper that defines OBE this way, and if you are aware of one, please let me know


I've fully answered your basic and unhelpful unitary notion of reality testing and why it does not work here (and indeed would not apply to many experiences). I think your view is overly simplistic and well out of date. I never mentioned reality testing - you did. I said people can be convinced they are out of body, true, while the experience is unfolding and taking place. Your fetish for definitions that answer absolutely everything is disturbing and ridiculous. All definitions for the OBE in the scientific mainstream put the exocentric nature of the experience front and centre. None of the definitions for anomalous body experiences in DPD do. Job done.

Dont forget those papers (wink)

I stand by what i say and its evidenced by my earlier discussions, evidence and citations, OBEs dont happen in DPD, unless co-morbidities are present and I know of know scientific research that evidences otherwise. This is the position of Blackmore, myself, Sierra, Medford, and David.

To summarise your arguments above - its simple, you provide no evidence outside of your own 'personal experience' - which is not the same thing, is it.


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## inferentialpolice (Nov 26, 2012)

Not a clinician, not a psychiatrist. -- so now according to you OBE's require being convinced at the time of the sensation that disembodiment is really happening, but subjects are allowed to later question it's reification (ie, allowed to express the experience "as if"). So in order to establish if someone who says "as if" in relating a past sensation had experienced an actual OBE, you must then ask them if at the time of the sensation they believed it was really happening. As I mentioned earlier, if one defined OBE to require that subjects believe that disembodiment actually happened at the time of the sensation, then that would be OK as a well-defined term that can be used unambiguously going forward, but under that definition it would require the study to clarify in interviewing the subject, despite any expressed "as if" sense expressed after the event, if they had previously at the time of the event believed disembodiment actually happened. From reading Gabbard and others, I don't believe that was part of any study design for any DPD subject or for (what you call an) OBE subject who expressed an "as if".

I don't know what you have against the concept of reality testing .. When someone says that they believed they actually disembodied, do you too believe that they did disembody?

And if you don't believe that they did, then wouldn't that mean the subject who claims reification had failed reality testing at least to the extent that they continue to believe actual disembodiment occurred?

How hard is a one sentence definition of OBE that says "The OBE can be defined as an experience where the individual perceives his/her environment from a perspective outside of their physical body AND the individual believed at the time of the event that they actually were disembodied from their physical self"? If that is what you and others have meant all along, why not go with it in writing, and why not build it explicitly into the experimental design? To do otherwise confounds results.


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## Dr B (Apr 23, 2014)

Let us just take a moment and reflect on you not bringing any citations or references, despite my repeated requests above, to justify and evidence any of your argument. Not a single one. Indeed, at no point in this discussion have you furnished your approach with science. Let's reflect on that for a moment.......

You are just spouting your ill informed opinion. I am discussing scientific evidence and theory from research. It's not the same thing. You completely ignore any request for you to 'put up or shut up' and you think it's OK to do that. No.



> Not a clinician, not a psychiatrist.


You are certainly of a clinical leaning and I know you don't practice science as you have a layman's understanding and fetish for definitions. This is a schoolboy error. Definitions change, they are not literal. They are a guide - a heuristic. You would know that if you were a professional. I'm not aware of a single definition that does not carry additional qualifying information. So you need to tread with care with definitions. The fundamental (my original point) component of a definition for the OBE is the exocentric / external perspective. You have to perceive being 'out-of-body' to have an out-of-body experience. In DPD feeling 'as if' you could be out-of-body, is something very different. As I've already explained numerous times, this is the current accepted wisdom of the main researchers in the field (Blanke, Brugger, Braithwaite, Blackmore, Irwin) - so I reckon your view is irrelevant. You are of course, most welcome to your own confusion - but don't pass it off as fact.



> so now according to you OBE's require being convinced at the time of the sensation that disembodiment is really happening, but subjects are allowed to later question it's reification (ie, allowed to express the experience "as if").


Firstly, no, not according to me at all. Are you actually reading my posts? For those of us that actually do research, including the names mentioned above and in previous posts, this is what we observe from OBEers. The experience can be convincing, but afterwards there can be (not always, but there can be) some form of rationalization. OBEs are NOT delusions in and of themselves. No - they don't later ascribe 'as if' to the experience - they never do and that's been my point all along. They are convinced they perceived the world from an external perspective, they just don't know what it means or how to interpret it. You seem to have a binary view that its either 'real' or 'as if' - not true.

Many people learn to accept, over time, that they have hallucinations. Many hallucinations are, by definition, perceptually real to the perceiver. But if you know its hallucination, you know not to accept it - but you don't go around saying your experience was 'as if'. Your experience was vivid and striking; it's just that you know, at a meta-cognitive level, it was not real. Patients with Charles-Bonnet syndrome do not describe their visual hallucinations 'as if' for example. What they see, is what they see, perceptually real to them, vivid and striking. But they 'know' its hallucination. They have insight. Their reality monitoring is intact and stable. DPDers do use, 'as if' a lot when describing phenomenology. OBEers don't. It's that simple.



> So in order to establish if someone who says "as if" in relating a past sensation had experienced an actual OBE, you must then ask them if at the time of the sensation they believed it was really happening.


I've said multiple times - OBEers don't use 'as if' qualifiers. If you actually read the papers (books as well) about OBEs you would know the answer to this. They describe the experience as feeling real - hyper-real sometimes. But that does not mean they later believe it to be real.



> As I mentioned earlier, if one defined OBE to require that subjects believe that disembodiment actually happened at the time of the sensation, then that would be OK as a well-defined term that can be used unambiguously going forward, but under that definition it would require the study to clarify in interviewing the subject, despite any expressed "as if" sense expressed after the event, if they had previously at the time of the event believed disembodiment actually happened. From reading Gabbard and others, I don't believe that was part of any study design for any DPD subject or for (what you call an) OBE subject who expressed an "as if".


The Gabbard studies evidence clear phenomenological differences between DPD and OBE. They argue that they are unlikely to be the same. All research since then has concurred on this view. Blackmore also talks about this in her book. The DPD researchers in the UK that I have spoken to have NEVER encountered an OBE being reported by DPD patients - not one! These researchers have not been, so far at least, overly interested in the OBE (because they don't encounter them!). Your 'definiton' above is and has been part of the view on OBEs for years - it's part of the broader qualification of OBEs. It must feel perceptually real at the time.



> I don't know what you have against the concept of reality testing .. When someone says that they believed they actually disembodied, do you too believe that they did disembody?


I have nothing against the concept of reality testing. I have everything against your conception of reality-testing, an all of none fixed affair - which it ain't! You don't understand the difference between perceptual realism and belief. Which explains your confusion.



> How hard is a one sentence definition of OBE


This shows your naivety and inexperience as discussed above. There are variants of the OBE which are not fully understood yet and until a more comprehensive evidence-base is established researchers keep definitions simple and add additional qualification in descriptions. You would know this - if you read the research.



> "The OBE can be defined as an experience where the individual perceives his/her environment from a perspective outside of their physical body AND the individual believed at the time of the event that they actually were disembodied from their physical self"? If that is what you and others have meant all along, why not go with it in writing, and why not build it explicitly into the experimental design? To do otherwise confounds results.


AS above, but you're using the word belief in a cavalier manner. What you outline here, with the exception of the word belief, is just a paraphrasing of my position which I've been arguing for throughout this discussion. You're welcome.

PS - there is no confounding of results.

PPS - did you find those papers I requested?

PPPS - I didn't think so.


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