Feeling unreal: Cognitive processes in depersonalization

Objective: Depersonalization disorder is characterized by a detachment from one's sense of self and one's surroundings that leads to considerable distress and impairment yet an intact testing of reality. Depersonalized individuals often report difficulties in perception, concentration, and memory; however, data on their cognitive profiles are lacking. Method: Fifteen patients with depersonalization disorder were compared to 15 matched normal comparison subjects on a comprehensive neuropsychological test battery that assessed cognitive function, Results: The subjects with depersonalization disorder showed a distinct cognitive profile. They performed significantly worse than the comparison subjects on certain measures of attention, short-term visual and verbal memory, and spatial reasoning within the context of comparable intellectual abilities. Conclusions: The authors propose that depersonalization involves alterations in the attentional and perceptual systems, specifically in the ability to effortfully control the focus of attention. These early encoding deficits are hypothesized to have a deleterious effect on the short-term memory system; they manifest as deficits in the ability to take in new information but not in the ability to conceptualize and manipulate previously encoded information.