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J Psychiatry Neurosci. 2018 Aug;43(5):347-357.

White matter network alterations in patients with depersonalization/derealization disorder.

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From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (Sierk, Manthey, Lamke, Kruschwitz, Walter); the Institute of Cognitive Neuroscience, University College London, London, UK (Sierk); the Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands (Daniels); the Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands (Kok); the PROVIDI Lab, University Medical Center Utrecht, Utrecht, the Netherlands (Leemans); and the Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (Gaebler).



Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date.


We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure.


Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology.


To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation.


In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.


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