Depersonalization/derealization symptoms in vestibular disease

Fleur Yen Pik Sang ¹, Kathrine Jauregui-Renaud ^2*, David A Green ¹, Adolfo M Bronstein ¹ and Michael A Gresty ¹

¹ Department of Movement and Balance, Imperial College London, United Kingdom
² Instituto Mexicano del Seguro Social, Mexico

^* To whom correspondence should be addressed. E-mail: kjauren{at}data.net.mx.

Accepted 2 February 2006

Abstract

Background: Depersonalization is a subjective experience of unreality and detachment from the self often accompanied by derealization; the experience of the external world appearing to be strange or unreal. Feelings of unreality can be evoked by disorienting vestibular stimulation.

Objective: To identify the prevalence of depersonalization/derealization symptoms in patients with peripheral vestibular disease and experimentally to induce these symptoms by vestibular stimulation.

Methods: 121 healthy subjects and 50 patients with peripheral vestibular disease participated in the study. For comparison with the patients a subgroup of 50 age-matched healthy subjects was delineated. All completed: 1. A general medical health questionnaire 2. The General Health Questionnaire (GHQ-12). 3. The 28-item depersonalisation/derealization inventory of Cox & Swinson (2002). Experimental verification of 'vestibular-induced' depersonalization/derealization was assessed in 20 patients and 20 controls during caloric irrigation of the labyrinths.

Results: The frequency and severity of symptoms in vestibular patients was significantly higher than in controls. In controls the most common experiences were of 'déjà vu' and 'difficulty in concentrating/attending'. In contrast, apart from dizziness, patients most frequently reported Derealization symptoms of 'feel as if walking on shifting ground', 'body feels strange/ not being in control of self' and 'feel spacy or spaced out'. Items permitted discrimination between healthy controls and vestibular patients in 92% of the cases. Apart from dizziness, caloric stimulation induced depersonalisation/derealization symptoms which healthy subjects denied ever experiencing before, while patients reported that the symptoms were similar to those encountered during their disease.

Conclusions: Depersonalization/derealization symptoms are both different in quality and more frequent under conditions of non-physiological vestibular stimulation. In vestibular disease, frequent experiences of derealization may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference which makes the patient feel he is detached or separated from the world.

Keywords: derealization, dissociation, dizziness, vestibular

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