Depersonalization: neurobiological perspectives

Depersonalization remains a fascinating and obscure clinical phenomenon. In addition to earlier Jacksonian neurobiological adumbrations, and conventional psychodynamic accounts, views started to be expressed in the 1930s that depersonalization might be a vestigial form of behavior, and since the 1960s that it might be a phenomenon related to the temporal lobe. Recent advances in the neurobiology of the limbic system, and the application of Geschwind's concept of disconnection in the corticolimbic system, have opened the possibility of developing testable models. This paper includes a review of these ideas and of the clinical features of depersonalization, particularly of its emotional changes, suggesting that they are important for the neurobiological understanding of depersonalization. It also draws attention to clinical similarities between the experiential narratives produced by patients suffering from depersonalization and those with corticolimbic disconnections. On the basis of this, a new model is proposed according to which the state of increased alertness observed in depersonalization results from an activation of prefrontal attentional systems (right dorsolateral prefrontal cortex) and reciprocal inhibition of the anterior cingulate, leading to experiences of "mind emptiness" and "indifference to pain" often seen in depersonalization. On the other hand, a left-sided prefrontal mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality, and lack of emotional coloring that would in turn, be reported as feelings of "unreality or detachment."     

Depersonalization in accident victims and psychiatric patients

A transient depersonalization syndrome was identified in nearly one third of persons exposed to life-threatening danger (accident victims) and close to 40% of a group of hospitalized psychiatric patients. Although the syndrome was similar in these populations, mental clouding developed more commonly among patients and alertness was more prominent among accident victims. Anxiety was significantly associated with the development of depersonalization among psychiatric patients and was almost certainly a factor in its appearance among accident victims. The findings suggest that this syndrome is a specific response to extreme danger or its associated anxiety.     

Dependent and self-critical depressive experiences among inner-city adolescents

The Adolescent Depressive Experiences Questionnaire was administered to 142 inner-city ninth graders. Based on theory, several potential correlates of dependency and self-criticism were selected for study, including depression, aspects of anxiety, locus of control, and facets of social behavior. Self-criticism showed stronger associations with depression and concerns about losing others' approval, while dependency showed stronger associations with diffuse tension and worry and sensitivity to others' behavior. The two depressive tendencies had comparable associations with physiological anxiety and external locus of control. These findings are discussed in terms of current perspectives on the symptomatic heterogeneity of depressive experiences.     

Providers' experiences caring for adolescents who smoke cigarettes.

Objective: To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Design: Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. Main Outcome Measures: Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. Results: Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. Conclusion: Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parenting their adolescents: the experiences of Jordanian immigrant women in California

Having their children enter adolescence presents new demands on the role functions of Jordanian immigrant women in the United States. Such demands require modifications in traditional parenting approaches. The authors attempted to uncover and describe the experiences of Jordanian immigrant mothers (N = 30) in parenting their adolescents in the United States. Content and narrative analysis revealed the dynamic processes that the mothers used in raising their children. They continuously attempted to balance the need for their teens to maintain a Jordanian ethnic identity and the need for them to become integrated into the new community. Their parenting was driven by an attempt to avoid loss of honor and bad reputation. Four aspects of the maternal role emerged from the analysis: mothering through nurturing the adolescents and promoting cultural identity, disciplining for cultural adherence, advocacy and mediation, and vigilant parenting. The findings support a dynamic interplay between cultural and structural conditions in shaping the experiences of Jordanian immigrant women.     

Influence of kinship social support on the parenting experiences and psychosocial adjustment of African-American adolescents.

The association of kinship support with psychosocial adjustment and parenting practices for 125 African-American adolescents (52 boys and 73 girls) in Grades 9–12 from single- and 2-parent households was assessed. Findings reveal that kinship support was positively associated with adolescent adjustment and with authoritative parenting practices in single- but not 2-parent households. Results also indicate that parenting practices mediated the effects of kinship support. When the effects of authoritative parenting practices were controlled, significant relations found between kinship support and adolescent adjustment were no longer apparent. The importance of kinship support for the functioning of African-American families and adolescents was discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Somatization and the vocabulary of everyday bodily experiences and concerns: a community study of adolescents

OBJECTIVE: To describe the frequency of everyday bodily experiences and health concerns in a general population of adolescents 12 to 16 years of age in Ontario and to explore whether the concept of "somatization," identified from those youths with many of these symptoms, is meaningful and related to other variables. METHOD: A representative sample of the population was obtained by stratified random sampling. Children with a chronic medical condition were excluded. Parents and their adolescent children filled out a series of questionnaires to measure health concerns, complaints, and more dramatic losses of function. Information was also collected on certain background factors, psychiatric problems, and impairments in adaptive functioning. RESULTS: Parents and youths endorsed the items with the same rank order of frequency, but there was virtually no agreement between parents and youths on the presence or absence of individual somatic symptoms. Users of medical services did not tend to have many more health concerns than others, and there was a weak relationship between the number of health concerns reported by a youth and both impairment in adaptive functioning and psychiatric problems. CONCLUSION: These data suggest that the concept of somatization has limited general value over and above a relationship with other psychiatric problems.     

Achievement goals and daily school experiences among adolescents with Asian, Latino, and European American backgrounds.

The current study examined the fit of a 2 × 2 achievement goal model among a diverse sample of nearly 700 10th-grade students, distinguishing between both mastery and performance goals and approach and avoidance orientations. Additionally, relationships between achievement goals and GPA and intrinsic value of school were examined, and adolescents' interpretations of daily school experiences and feelings were found to mediate these relationships. Together, these findings suggest that experiences in adolescents' daily lives help explain the relationship between goals and achievement outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent and longitudinal effects of ethnic identity and experiences of discrimination on psychosocial adjustment of Navajo adolescents.

In this study, we examined concurrent and longitudinal relations among Navajo adolescents' ethnic identity, experiences of discrimination, and psychosocial outcomes (i.e., self-esteem, substance use, and social functioning). At Time 1, 137 Navajo adolescents (67 male, 70 female), primarily in Grades 9 and 10, completed a written survey assessing ethnic identity, discrimination experiences, and a range of internalizing and externalizing behaviors. Two years later, 92 participants completed the same survey again. Ethnic and cultural identification was assessed via the Multiethnic Ethnic Identity Measure (MEIM; Phinney, 1992) and the Orthogonal Cultural Identification Scale (OCIS; Oetting & Beauvais, 1990). At Time 1, MEIM Affirmation and Belonging, MEIM Exploration, and OCIS White American identification all demonstrated strong, positive associations with adaptive functioning for male and female adolescents, whereas discrimination experiences were linked to lower self-esteem and social functioning for male adolescents. By Time 2, fewer significant concurrent associations between ethnic identity and psychosocial functioning scores remained, and discrimination experiences emerged as the most consistent correlate of poorer psychosocial functioning for male adolescents. Controlling for Time 1 psychosocial functioning, relatively few direct effects of ethnic and cultural identification variables predicted psychosocial functioning longitudinally, but discrimination experiences demonstrated strong and consistent longitudinal links with boys' substance use. Finally, interaction effects assessing the moderating influence of ethnic and cultural identification on negative links between discrimination and psychosocial functioning suggested that embeddedness in and connection to Navajo culture and, in some cases, connection to White American culture, served as a buffer to the negative effects of discrimination experiences. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Renal carcinoma in adolescents

Renal adenocarcinoma is an infrequent tumor in children. The clinical and radiographic findings in 4 adolescents with such tumors are described. The surgical therapies of these patients and the possible role of adjunctive chemotherapy and radiotherapy are discussed.     

Depression in borderline adolescents

Etiologically, adolescents considered borderline by the criteria in common use are on a continuum between primarily biological and primary psychological disorders. Depression is common, and may be masked (in many cases of ulcer, anorexia, substance abuse, school avoidance) or overt (viz., early onset endogenous depression, hysteroid dysphoria, cases with severe deprivation). Illustrative cases are provided, along with recommendations for treatment.     

Pitcher's elbow in adolescents

Intraarticular and periarticular changes of the elbow secondary to the throwing motion have been documented in pitchers of all ages, Although others have focused attention on children, this study evaluates a group of 73 older pitchers (average age 17 years). Forty-two (58%) players reported pain while throwing at the time of evaluation (before interscholastic play) or developed pain during the season. However, only four (5%) missed one or more pitching rotations. No significant relationships were found between occurrence of symptoms and number of seasons played, individual pitching traits, asymmetry on physical examination, or asymmetry on radiographic evaluation of the elbow. In the symptomatic group there tended to be a slightly greater number of seasons' experience (average 7.8 seasons vs. 6.0 seasons) and more players with asymmetry upon physical examination. We believe this study supports the concept that increasing age and exposure, along with other factors as yet unquantitated, may determine the occurrence of symptoms in pitchers.     

Vertebral sarcoidosis in adolescents

Two cases of vertebral sarcoidosis in pediatric patients are presented. All such patients reported have been black, 13-15 years old, and have a history of back pain. Radiographs of the involved vertebrae show primarily lytic destruction with sclerotic borders in some of the lesions. Fungal infections, tuberculosis, pyogenic osteomyelitis, Hodgkin's disease and metastatic disease must be considered in every patient with vertebral sarcoidosis.     

Functional stridor in adolescents

The role of the perineal muscles in human penile erections is still controversial. The authors investigated surface electromyographic activity of the ischiocavernous muscles together with intracavernous pressure recordings during pressure stimulations of the glans penis. Successive glans stimulations were associated with ischiocavernous muscle contractions and increases in intracavernous pressure reaching two- to fourfold the systolic blood pressure. High correlation coefficients were found between electromyographic and intracavernous pressure amplitudes. Voluntary contractions were accompanied by intracavernous pressure peaks of similar durations, and areas delineated by integrated electromyographic and intracavernous pressure curves showed very high correlation coefficients. Anaesthesia of the dorsal nerve resulted in dramatic reductions of muscle activity and intracavernous pressures in response to glans stimulation. These results suggest that the activity of the muscles in response to pressure stimulation of the glans penis is important to augment rigidity during vaginal penetration and intercourse due to their ability to increase intracavernous pressures.