Background: Depersonalization (DP) is characterized by persistent or recurrent episodes of detachment from one’s self with reduced pain perception being a common feature. Alterations in the body schema similar to the cortico-limbic disconnection syndrome of pain asymbolia are suggested to be responsible for DP. In this study we used hypnosis to induce DP in healthy subjects and to examine neural patterns of pain perception in the state of DP by means of functional magnetic resonance imaging (fMRI). Methods: Pain perception was investigated in 7 healthy subjects with high susceptibility to hypnosis in three different mental states: waking state (N-W), hypnotic relaxation (H-R) and hypnotic DP (H-DP). Pain was induced with electrical stimulation to the median nerve at the right wrist. fMRI measurements were performed during all states. Results: Nociceptive stimuli led to an activation of the well described pain network including somatosensory and insular regions and the cerebellum. Activation was markedly reduced in the contralateral somatosensory cortex, parietal cortex (Brodmann area 40, BA40), prefrontal cortex (BA9), putamen and the ipsilateral amygdala during H-DP. Subjects also reported a significant decrease in pain intensity from N-W to H-DP. Conclusion: Pain response during H-DP was reduced in sensory and affective pain-related areas, reflecting the diminished intensity of the perceived pain. Moreover, a network of cortical and subcortical areas that have been implicated in the perception of the own body was less responsive during DP, which might point to a specific neural mechanism underlying the ‘out-of-body’ experience. Although the small number of subjects does not allow a generalization of our findings, H-DP seems to be a promising tool for the investigation of psychological and biological mechanisms of self-inflicted injuries as well as the mind-body interplay within the realm of psychosomatic disorders.

Eckhardt A, Hoffmann SO: Depersonalisation und Selbstverletzung. Z Psychosom Med Psychoanal 1993;39:284–306.
Steinberg M, Rounsaville B, Cicchetti D: Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview. Am J Psychiatry 1991;148:1050–1054.
Mayer-Gross W: On depersonalisation. Br J Med Psychol 1935;15:103–126.
Hunter EC, Sierra M, David AS: The epidemiology of depersonalisation and derealisation. A systematic review. Soc Psychiatry Psychiatr Epidemiol 2004;39:9–18.
Kocalevent RD, Fliege H, Rose M, Walter M, Danzer G, Klapp BF: Autodestructive syndromes. Psychother Psychosom 2005;74:202–211.
Michal M, Sann U, Overbeck G, Grabhorn R, Röder CH: Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie. Psychotherapeut 2005;50: 328–339.
Phillips ML, Medford N, Senior C, Bullmore ET, Suckling J, Brammer MJ, Andrew C, Sierra M, Williams SC, David AS: Depersonalization disorder: thinking without feeling. Psychiatry Res 2001;108:145–160.
Sierra M, Berrios GE: Depersonalization: neurobiological perspectives. Biol Psychiatry 1998;44:898–908.
Simeon D, Guralnik O, Hazlett EA, Spiegel-Cohen J, Hollander E, Buchsbaum MS: Feeling unreal: a PET study of depersonalization disorder. Am J Psychiatry 2000;157:1782–1788.
Berthier M, Starkstein S, Leiguarda R: Asymbolia for pain: a sensory-limbic disconnection syndrome. Ann Neurol 1988;24:41–49.
Schilder P, Stengel E: Asymbolia for pain. Arch Neurol Psychiatry 1932;25:598–600.
Blanke O, Landis T, Spinelli L, Seeck M: Out-of-body experience and autoscopy of neurological origin. Brain 2004;127:243–258.
Schilder P: The Image and Appearance of the Human Body. New York, International University Press, 1950.
Raz A, Shapiro T: Hypnosis and neuroscience: a cross talk between clinical and cognitive research. Arch Gen Psychiatry 2002;59:85–90.
Halligan PW, Athwal BS, Oakley DA, Frackowiak RS: Imaging hypnotic paralysis: implications for conversion hysteria. Lancet 2000;355:986–987.
Blakemore SJ, Oakley DA, Frith CD: Delusions of alien control in the normal brain. Neuropsychologia 2003;41:1058–1067.
Faymonville ME, Laureys S, Degueldre C, Delfiore G, Luxen A, Franck G, Lamy M, Maquet P: Neural mechanisms of antinociceptive effects of hypnosis. Anesthesiology 2000;92:1257–1267.
Hofbauer RK, Rainville P, Duncan GH, Bushnell MC: Cortical representation of the sensory dimension of pain. J Neurophysiol 2001;86:402–411.
Rainville P, Duncan GH, Price DD, Carrier B, Bushnell MC: Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 1997;277:968–971.
Schulz-Stubner S, Krings T, Meister IG, Rex S, Thron A, Rossaint R: Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm. Reg Anesth Pain Med 2004;29:549–556.
Derbyshire SW, Whalley MG, Stenger VA, Oakley DA: Cerebral activation during hypnotically induced and imagined pain. Neuroimage 2004;23:392–401.
Ploner M, Schnitzler A: Kortikale Repräsentation von Schmerz. Nervenarzt 2004;75:962–969.
Coghill RC, Sang CN, Maisog JM, Iadarola MJ: Pain intensity processing within the human brain: a bilateral, distributed mechanism. J Neurophysiol 1999;82:1934–1943.
Saab CY, Willis WD: The cerebellum: organization, functions and its role in nociception. Brain Res Brain Res Rev 2003;42:85–95.
Bingel U, Quante M, Knab R, Bromm B, Weiller C, Buchel C: Subcortical structures involved in pain processing: evidence from single-trial fMRI. Pain 2002;99:313–321.
Bingel U, Glascher J, Weiller C, Buchel C: Somatotopic representation of nociceptive information in the putamen: an event-related fMRI study. Cereb Cortex 2004;14:1340–1345.
Hiraga A, Sakakibara R, Mizobuchi K, Asahina M, Kuwabara S, Hayashi Y, Hattori T: Putaminal hemorrhage disrupts thalamocortical projection to secondary somatosensory cortex: case report. J Neurol Sci 2005;231:81–83.
Bornhovd K, Quante M, Glauche V, Bromm B, Weiller C, Buchel C: Painful stimuli evoke different stimulus-response functions in the amygdala, prefrontal, insula and somatosensory cortex: a single-trial fMRI study. Brain 2002;125:1326–1336.
Gelnar PA, Krauss BR, Sheehe PR, Szeverenyi NM, Apkarian AV: A comparative fMRI study of cortical representations for thermal painful, vibrotactile, and motor performance tasks. Neuroimage 1999;10:460–482.
Bongartz W: German norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A. Int J Clin Exp Hypn 1985;33:131–139.
Franke H: Die Symptom-Checkliste von Derogatis. Deutsche Version. Weinheim, Beltz, 1995.
Michal M, Sann U, Niebecker M, Lazanowsky C, Kernhof K, Aurich S, Overbeck G, Sierra M, Berrios GE: Die Erfassung des Depersonalisations-Derealisations-Syndroms mit der Deutschen Version der Cambridge Depersonalisation Scale (CDS). Psychother Psychosom Med Psychol 2004;54:367–374.
Bongartz W, Bongartz B: Hypnosetherapie. Göttingen, Hogrefe, 2000.
Schilder P: Selbstbewusstsein und Persönlichkeitsbewusstsein. Eine psychopathologische Studie. Berlin, Springer, 1914.
Prvulovic D, Hubl D, Sack AT, Melillo L, Maurer K, Frolich L, Lanfermann H, Zanella FE, Goebel R, Linden DE, Dierks T: Functional imaging of visuospatial processing in Alzheimer’s disease. Neuroimage 2002;17:1403–1414.
Friston KJ, Frith CD, Frackowiak RS, Turner R: Characterizing dynamic brain responses with fMRI: a multivariate approach. Neuroimage 1995;2:166–172.
Munk MH, Linden DE, Muckli L, Lanfermann H, Zanella FE, Singer W, Goebel R: Distributed cortical systems in visual short-term memory revealed by event-related functional magnetic resonance imaging. Cereb Cortex 2002;12:866–876.
Saab CY, Willis WD: The cerebellum: organization, functions and its role in nociception. Brain Res Brain Res Rev 2003;42:85–95.
Lin YY, Forss N: Functional characterization of human second somatosensory cortex by magnetoencephalography. Behav Brain Res 2002;135:141–145.
Blanke O, Landis T, Spinelli L, Seeck M: Out-of-body experience and autoscopy of neurological origin. Brain 2004;127:243–258.
Kelley WM, Macrae CN, Wyland CL, Caglar S, Inati S, Heatherton TF: Finding the self? An event-related fMRI study. J Cogn Neurosci 2002;14:785–794.
Lu CL, Wu YT, Yeh TC, Chen LF, Chang FY, Lee SD, Ho LT, Hsieh JC: Neuronal correlates of gastric pain induced by fundus distension: a 3T-fMRI study. Neurogastroenterol Motil 2004;16:575–587.
Wilder-Smith CH, Schindler D, Lovblad K, Redmond SM, Nirkko A: Brain functional magnetic resonance imaging of rectal pain and activation of endogenous inhibitory mechanisms in irritable bowel syndrome patient subgroups and healthy controls. Gut 2004;53:1595–1601.
Pitkänen A: Connectivity of the rat amygdaloid complex; in Aggleton JP (ed): The Amygdala. Oxford, Oxford University Press, 2000, pp 31–115.
Breiter HC, Etcoff NL, Whalen PJ, Kennedy WA, Rauch SL, Buckner RL, Strauss MM, Hyman SE, Rosen BR: Response and habituation of the human amygdala during visual processing of facial expression. Neuron 1996;17:875–887.
Strauss MM, Makris N, Aharon I, Vangel MG, Goodman J, Kennedy DN, Gasic GP, Breiter HC: fMRI of sensitization to angry faces. Neuroimage 2005;26:389–413.
Wedig MM, Rauch SL, Albert MS, Wright CI: Differential amygdala habituation to neutral faces in young and elderly adults. Neurosci Lett 2005;385:114–119.
Chudler EH: Response properties of neurons in the caudate-putamen and globus pallidus to noxious and non-noxious thermal stimulation in anesthetized rats. Brain Res 1998;812:283–288.
Koyama T, Kato K, Mikami A: During pain-avoidance neurons activated in the macaque anterior cingulate and caudate. Neurosci Lett 2000;283:17–20.
Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, Clauw DJ: Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain 2004;127:835–843.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.