Symptoms of depersonalisation/derealisation disorder as measured by brain electrical activity: A systematic review

TL;DR

This systematic review examines electrophysiological research on depersonalisation/derealisation disorder (DPD), highlighting potential neural biomarkers and emphasizing the importance of interoceptive-exteroceptive signal integration in understanding DPD symptoms.

Contribution

It provides a comprehensive overview of EEG and other electrophysiological markers related to DPD and proposes future research directions for diagnostic biomarker development.

Findings

EEG power spectrum and ERP components show potential as biomarkers

Interoceptive and exteroceptive signal integration impairments are linked to DPD symptoms

Electrophysiological tools could improve DPD diagnosis

Abstract

Depersonalisation/derealisation disorder (DPD) refers to frequent and persistent detachment from bodily self and disengagement from the outside world. As a dissociative disorder, DPD affects 1-2% of the population, but takes 7-12 years on average to be accurately diagnosed. In this systematic review, we comprehensively describe research targeting the neural correlates of core DPD symptoms, covering publications between 1992 and 2020 that have used electrophysiological techniques. The aim was to investigate the diagnostic potential of these relatively inexpensive and convenient neuroimaging tools. We review the EEG power spectrum, components of the event-related potential (ERP), as well as vestibular and heartbeat evoked potentials as likely electrophysiological biomarkers to study DPD symptoms. We argue that acute anxiety- or trauma-related impairments in the integration of interoceptive and exteroceptive signals play a key role in the formation of DPD symptoms, and that future research needs analysis methods that can take this integration into account. We suggest tools for prospective studies of electrophysiological DPD biomarkers, which are urgently needed to fully develop their diagnostic potential.