Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder

Background: Depersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach. Materials and Methods: We developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n=31) and healthy controls (n=29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness – II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks. Results: At baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness. Conclusion: Individual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body

Assessing responsiveness to direct verbal suggestions in depersonalization-derealization disorder

The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r = -.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r = .25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology

Symptom variability in depersonalization–derealization disorder: A latent profile analysis

Objective Depersonalization–derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups. Method We applied latent profile analysis to psychometric measures of anxiety, depersonalization–derealization, and dissociation in 303 DDD patients. Results The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety. Conclusion These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes

OBJECTIVE - Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired b-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS - We have conducted a meta-analysis of genome-wide association tests of ;2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS - Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10-8). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/ C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 3 10-4), improved b-cell function (P = 1.1 × 10-5), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10-6). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS - We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis