Depersonalization: a selective impairment of self-awareness

Depersonalization is characterised by a profound disruption of self-awareness mainly characterised by feelings of disembodiment and subjective emotional numbing. It has been proposed that depersonalization is caused by a fronto-limbic (particularly anterior insula) suppressive mechanism--presumably mediated via attention--which manifests subjectively as emotional numbing, and disables the process by which perception and cognition normally become emotionally coloured, giving rise to a subjective feeling of 'unreality'. Our functional neuroimaging and psychophysiological studies support the above model and indicate that, compared with normal and clinical controls, DPD patients show increased prefrontal activation as well as reduced activation in insula/limbic-related areas to aversive, arousing emotional stimuli. Although a putative inhibitory mechanism on emotional processing might account for the emotional numbing and characteristic perceptual detachment, it is likely, as suggested by some studies, that parietal mechanisms underpin feelings of disembodiment and lack of agency feelings.     

Depersonalization disorder: a functional neuroanatomical perspective

Clinical reports of depersonalization suggest that attenuated emotional experience is a central feature of the condition. Patients typically complain of emotional numbness and some patients ascribe their feelings of unreality to a lack of affective "colouring" in things perceived. Recent neuroimaging and psychophysiological studies support these assumptions as they show both attenuated autonomic responses in depersonalization, and decreased activity within neural regions important for the generation of affective responses to emotive stimuli. Furthermore, findings from neuroimaging studies indicate increased prefrontal cortical activity in depersonalised patients, particularly within regions associated with contextualization and appraisal of emotionally-salient information rather than mood induction per se. Taken together, these finding suggest that symptoms of depersonalization, and in particular emotional numbing, may be related to a reversal of normal patterns of autonomic and neural response to emotive stimuli.     

Interoceptive Cue Exposure for Depersonalization: A Case Series

Cognitive-behavioral treatment for panic disorder relies heavily on interoceptive exposure. Specifically, therapists induce physical symptoms associated with panic in order to produce habituation to those sensations. Many common symptoms of panic are easily induced, such as increased heart rate and dizziness. However, depersonalization is a difficult symptom to induce in the office. Three uncontrolled cases are presented here where a novel intervention, the use of 3D glasses, was used to successfully induce depersonalization with positive effect. The application of the procedure resulted in rapid habituation within session, and all three patients had significant reductions in panic following treatment. Additional research is necessary to examine the application of this, and other, novel methods for inducing depersonalization as part of a comprehensive approach to treating panic and other psychiatric conditions where depersonalization is present.     

Functional analysis of problem behavior: a review

Functional analysis methodology focuses on the identification of variables that influence the occurrence of problem behavior and has become a hallmark of contemporary approaches to behavioral assessment. In light of the widespread use of pretreatment functional analyses in articles published in this and other journals, we reviewed the literature in an attempt to identify best practices and directions for future research. Studies included in the present review were those in which (a) a pretreatment assessment based on (b) direct observation and measurement of (c) problem behavior was conducted under (d) at least two conditions involving manipulation of an environmental variable in an attempt (e) to demonstrate a relation between the environmental event and behavior. Studies that met the criteria for inclusion were quantified and critically evaluated along a number of dimensions related to subject and setting characteristics, parametric and qualitative characteristics of the methodology, types of assessment conditions, experimental designs, topographies of problem behaviors, and the manner in which data were displayed and analyzed.     

Mand compliance as a contingency controlling problem behavior: A systematic review

Bowman et al. (1997) described a dynamic contingency in which severe problem behavior was evoked by adult noncompliance with a variety of child mands, which occurred at high rates, and was reinforced by adult compliance with subsequent mands. They discovered this phenomenon with 2 children for whom standard functional analyses were inconclusive. In recent years, similar contingencies have been shown to influence problem behavior, but the manner in which they have been arranged and described has varied across studies. The purpose of this literature review is to (a) describe contingencies involving mand compliance and the circumstances under which they have been evaluated, (b) summarize procedural variations in analysis and treatment, and (c) discuss what is known and yet to be discovered about the contingency as it relates to problem behavior. Future research focused on improving technology for analyzing and treating problem behavior suspected to be sensitive to mand compliance is discussed.     

Functional analysis and treatment of adult problem behavior: A review

Functional analysis (FA) methodology has been deemed the best practice in the field of applied behavior analysis. The data collected in an FA allows behavior analysts to develop the most effective and ethical behavior interventions. With the diagnosis for individuals with autism on the rise along with the forecast of adults who will need support, it may be time to take stock of the available literature. The purpose of this review was to evaluate the behavior analytic research over the last 25 years (1997–2022) on FA and treatment for adults who engage in severe problem behavior. Utilizing specific inclusion and exclusion criteria resulted in the identification of 28 articles. These articles were examined across participant characteristics, target behavior, FA type, FA settings, interventions, generalization, and maintenance. Implications on adult FA and treatment are discussed along with recommendations for practitioners who desire to support this population.     

The problem of language and thought in schizophrenia: A review

A slightly different version of this article will also appear as a chapter in H. J. Vetter & R. W. Rieber, (Eds.) (in press).The psychopathology of language and thought. New York: Plenum Press.     

Integrative aspects of problem theory: a review of applications

It is argued that people work on 6 interrelated general problems, called key problems, which are necessarily simply conceived and therefore open to a priori identification. Key problems demand separate attention, and, with children below 9 years of age and again between 10 and 17 years of age, and with adults in long-term groups, they receive attention 1 by 1, as focal problems, with intervening transitional phases, in a fixed sequence. Isolated societies stress 1 focal problem, and families and individuals tend to do the same. Humor and elated play worsen the problem. Brain lateralization helps in separating work on the 1st key problem from work on other problems, and failure to accomplish this contributes to mental disorder. The theory can be fitted to aspects of brain activity (as shown in the electroencephalograph), such as the change with age in theta coherence growth rate.     

Depersonalization: Standing in the Spaces Between Recognition and Interpellation

Depersonalization is the experience of profound estrangement and alienation from Self and Reality. Although highly prevalent in our postmodern world, the syndrome of depersonalization has been systematically understudied, misdiagnosed, and unsuccessfully treated. In this paper we summarize our theoretical conclusions after a decade-long empirical study of this population and discuss both etiology and recommendations for treatment. Our main objective here is to place what psychiatrically we would consider pathologies of personhood within the larger context of culture. We include a clinical vignette to demonstrate how we work with the premise that depersonalization is not only a private event. Perhaps more than other problems-in-living, it reveals the centrality of the individual's relationship to discourse, the State, and the culture in which we breathe. We discuss depersonalization and the dissociative structuring of the mind as psychological responses to particularly problematic experiences around subjection and conclude with the function of shame and humiliation in maintaining and resisting (in the political sense) this pressure to fragment.     

Efficiency in functional analysis of problem behavior: A quantitative and qualitative review

Originating in the mid-1960s, functional analysis (FA) has become the gold standard method for understanding the environmental variables that come to shape and maintain problematic behaviors such as aggression, self-injury, and property destruction. Over the decades, a number of studies have refined FA methods, attempting to improve the overall efficiency of the analysis through experimental design and procedural modifications. In the present review, we used ongoing visual-inspection criteria and basic probability theory to compare and analyze levels of efficiency across FA types. The multielement design and synthesized contingency analyses were about equally efficient with respect to the mean number of sessions conducted per function tested, and the trial-based and synthesized contingency analyses were the 2 most efficient with respect to the mean duration per function tested. We discuss the implications of these findings in the broader context of efficiency and provide recommendations for maximizing efficiency during an FA. We also discuss other qualitative procedural details that may influence the overall efficiency of an FA.     

Health-related stigma: rethinking concepts and interventions

As a feature of many chronic health problems, stigma contributes to a hidden burden of illness. Health-related stigma is typically characterized by social disqualification of individuals and populations who are identified with particular health problems. Another aspect is characterized by social disqualification targeting other features of a person's identity-such as ethnicity, sexual preferences or socio-economic status-which through limited access to services and other social disadvantages result in adverse effects on health. Health professionals therefore have substantial interests in recognizing and mitigating the impact of stigma as both a feature and a cause of many health problems. Rendering historical concepts of stigma as a discrediting physical attribute obsolete, two generations of Goffman-inspired sociological studies have redefined stigma as a socially discrediting situation of individuals. Based on that formulation and to specify health research interests, a working definition of health-related stigma is proposed. It emphasizes the particular features of target health problems and the role of particular social, cultural and economic settings in developing countries. As a practical matter, it relates to various strategies for intervention, which may focus on controlling or treating target health problems with informed health and social policies, countering the disposition of perpetrators to stigmatize, and supporting those who are stigmatized to limit their vulnerability and strengthen their resilience. Our suggestions for health studies of stigma highlight needs for disease- and culture-specific research that serves the interests of international health.     

Natality and mortality: rethinking death with Cavarero

In this article I rethink death and mortality on the basis of birth and natality, drawing on the work of the Italian feminist philosopher Adriana Cavarero. She understands birth to be the corporeal event whereby a unique person emerges from the mother’s body into the common world. On this basis Cavarero reconceives death as consisting in bodily dissolution and re-integration into cosmic life. This impersonal conception of death coheres badly with her view that birth is never exclusively material but always has ontological significance as the appearance of someone new and singular in the world of relations with others. This view of birth calls for a relational conception of death, which I develop in this article. On this conception, death is always collective, affecting all those with whom the one who dies has maintained relations: As such, our different deaths shade into one another. Moreover, because each person is unique in virtue of consisting of a unique web of relations with others, death always happens to persons as webs of relations. Death is relational in this way as a corporeal, and specifically biological, phenomenon, to which we are subject as bodily beings and as interdependent living organisms. I explore this with reference to Simone de Beauvoir’s memoir of her mother’s death from cancer. Finally I argue that, on this relational conception, death is something to be feared.     

Social problem solving in adolescents with suicidal behavior: a systematic review

There is an increasing focus on deficiencies in problem solving as a vulnerability factor for suicidal behavior in general and hence a target for treatment in suicide attempters. In view of the uncertainty of evidence for this in adolescents we conducted a systematic review of the international research literature examining the possible relationship between deficiencies in social problem-solving skills and suicidal behavior in this population. This was based on searching two electronic databases: Medline 1966 to September 2003 and PsychInfo 1887 to September 2003. Twenty-two studies of social problem-solving skills in adolescents with suicidal behavior were found. Most of these studies, which compared adolescent patients with suicide attempts versus either nonsuicidal psychiatric or normal controls, found evidence for problem-solving deficits in the attempters; however, few of the differences remain after controlling for depression and/or hopelessness. Because most of the studies are cross-sectional, it is difficult to differentiate between the possibilities that deficiencies in problem-solving skills lead to depression when adolescents are faced by adversity and hence to suicidal behavior, or whether depression is the main factor which undermines problem-solving skills. Future research, preferably with longitudinal research designs, is required to determine the nature of the association between problem-solving skills and suicidal behavior in adolescents. This has important implications for therapeutic interventions.     

A Deleuzian rethinking of time in healthy lifestyle advice and change

Time is a powerful but under‐examined element in healthy lifestyle advice, particularly in the promise of stable states of future health achievable through sustained lifestyle change. But such linear, sequential time frames reinforce notions of rational choice, personal control, and responsibility despite common experiences of diet and exercise regimens as non‐linear, effortful, and difficult to maintain. An over‐simplification of time thus contributes to the logic of blame when people fail to achieve healthy lifestyle goals, producing spoiled health identities and abject bodies as people struggle to sustain what can be unsustainable. Addressing these problems, we argue that Deleuze's philosophy offers tools to develop an alternative approach in health promotion. Deleuze affords a conceptualisation of multidimensional, embodied, and affective temporalities of health, which give rise to plural subjectivities and disrupt linear models of time. This framework affords a recognition of multiple time frames, such as histories and imagined futures that form part of a living present and shape lifestyle behaviours and identities. Deleuzian concepts that tie into his philosophy of time and form his process ontology, including monism and rhizomes, affect, becoming, and assemblages, are discussed in relation to health promotion. The article concludes that Deleuze offers a critical theory of time that enables a mapping of the ways that people embody multiplicity, non‐linearity, and fluidity as they negotiate healthy lifestyle advice. His concepts illuminate ways in which people can be oppressed and limited by discourses of healthy living, but also point to new, more affirmative directions for health promotion and healthy lifestyle advice.     

Neglected Burnout Dimensions: Effect of Depersonalization and Personal Nonaccomplishment on Organizational Commitment of Salespeople

As boundary spanners, salespeople experience stressful situations on a regular basis. Prolonged exposure to stress is known to lead to burnout. This research focuses on two neglected dimensions of burnout, namely, depersonalization and personal nonaccomplishment, specifically as they relate to salespeople. A sample of 221 French salespeople is used to explore the link between depersonalization and personal nonaccomplishment on a salesperson’s organizational commitment after controlling for emotional exhaustion, role conflict, and role ambiguity. Results from structural equation modeling indicate that role conflict positively influences depersonalization, whereas decision latitude has a negative influence. Decision latitude also negatively influences personal nonaccomplishment and role conflict moderates this relationship. Both depersonalization and personal nonaccomplishment negatively influence organizational commitment. Managerial implications are provided.     

Aperture viewing : A review and a synthesis

We argue that two processes are involved in the visual perception of shapes moving behind narrow apertures. “Retinal painting” occurs when the eyes are free to pursue the moving shape and when the traverse time across the aperture is sufficiently short to allow visual persistence of the temporally successive views. When pursuit eye movements do not occur, however, the shape may still be perceived if it moves relatively slowly. The latter kind of perception does not involve seeing all the parts of the shape simultaneously (as in the case with retinal painting) but we demonstrate that shapes seen in this way have some of the same properties as conventionally presented shapes. The discussion emphasises the relevance of these findings to general problems in movement perception.