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Figures
- Fig. 1
Flowchart of the preprocessing pipeline using FreeSurfer (https://surfer.nmr.mgh.harvard.edu) and ExploreDTI (www.exploredti.com). CSD = constrained spherical deconvolution; EPI = echo-planar imaging.
- Fig. 2
Visualization of the trend found in the group comparison when using network-based statistics. At an initial-link threshold of plt = 0.005, a subnetwork was identified for which patients with depersonalization/derealization disorder (DPD) displayed lower fractional anisotropy (FA) (blue edges) as well as higher FA (red edges) than healthy controls (pFWE = 0.08). Patients showed relatively lower FA values between the left caudate, brainstem and the right amygdala, and higher FA between the left superior frontal gyrus, right medial frontal cortex and the right amygdala. FWE = family-wise error.
- Fig. 3
Visualization of the 2 most outstanding results of the group comparison when using a link-based controlling procedure. First, (A) patients with depersonalization/derealization disorder (DPD) showed significantly lower fractional anisotropy (FA) between the right middle temporal gyrus and the right supramarginal gyrus. (B) The FA values within this connection were negatively correlated with dissociative symptom scores across groups, as measured by the CDS-30. Second, (C) relative to controls, patients with DPD showed significantly lower FA values between the left temporal pole and the left superior temporal gyrus. (D) Dissociative symptom severity correlated negatively with FA values of this connection. CDS = Cambridge Depersonalization Scale; FDR = false discovery rate; MTG = middle temporal gyrus; SMG = supramarginal gyrus; STG = superior temporal gyrus.
Tables
DPD Control Characteristic n Mean ± SD n Mean ± SD 2-tailed t test p value Age, yr 23 30.61 ± 7.31 23 29.96 ± 7.99 t44 = 0.289 0.774 Handedness 23 0.76 ± 0.50 23 0.92 ± 0.15 t44 = −1.542 0.135 CDS-30 22 148.14 ± 43.10 23 9.61 ± 12.04 t43 = 14.543 < 0.001 CDS-State 23 926.96 ± 383.52 22 173.64 ± 254.40 t43 = 7.796 < 0.001 DES 22 442.27 ± 217.95 23 36.09 ± 39.05 t43 = 8.610 < 0.001 BDI-II 22 20.32 ± 11.27 23 2.48 ± 3.41 t43 = 7.120 < 0.001 STAI-T 22 56.23 ± 11.80 23 34.00 ± 11.37 t43 = 6.434 < 0.001 LSAS 22 442.27 ± 217.95 23 36.09 ± 39.05 t43 = 3.738 0.001 TAS-20 22 55.59 ± 8.66 23 52.00 ± 7.07 t43 = 5.785 < 0.001 ERQ 22 42.68 ± 8.98 23 39.52 ± 9.62 t43 = 1.138 0.262 KIMS 22 86.68 ± 19.71 23 124.39 ± 13.43 t43 = −7.531 < 0.001 DFS 22 70.36 ± 9.52 23 61.65 ± 9.24 t43 = 3.119 0.003 CTQ_sum 22 52.32 ± 17.52 23 44.22 ± 10.33 t43 = 1.878 0.069 CTQ_PA 22 6.36 ± 2.68 23 5.91 ± 1.91 t43 = 0.652 0.518 CTQ_PN 22 5.50 ± 2.76 23 4.00 ± 1.54 t43 = 2.241 0.032 CTQ_EA 22 11.00 ± 4.04 23 5.91 ± 1.91 t43 = 1.765 0.086 CTQ_EN 22 6.91 ± 5.86 23 4.57 ± 5.27 t43 = 1.411 0.165 CTQ_SA 22 6.45 ± 2.30 23 5.65 ± 1.72 t43 = 1.119 0.269 TMT-A 21 24.62 ± 5.52 21 24.90 ± 6.80 t40 = −0.150 0.882 TMT-B 21 51.38 ± 14.20 21 53.19 ± 18.59 t40 = −0.355 0.725 BDI = Beck Depression Inventory; CDS = Cambridge Depersonalization Scale; CTQ = Childhood Trauma Questionnaire; DES = Dissociative Experiences Scale; DFS = Questionnaire for functional and dysfunctional self-focused attention; DPD = depersonalization/derealization disorder; EA = emotional abuse; EN = emotional neglect; ERQ = Emotion Regulation Questionnaire; KIMS = Kentucky Inventory of Mindfulness Skills; LSAS = Liebowitz Social Anxiety Scale; PA = physical abuse; PN = physical neglect; SA = sexual abuse; SD = standard deviation; STAI-T = State-Trait Anxiety Scale, trait version; TAS = Toronto Alexithymia Scale, TMT = Trail Making Test.
Disorder Current, n Lifetime, n Anxiety disorders 11 11 Social anxiety disorder Panic disorder 2 3 Specific phobia 2 2 Obsessive–compulsive disorder 2 2 Generalized anxiety disorder 1 1 Mood disorders 2 10 Major depressive disorder Personality disorders 1 1 Emotionally unstable – impulsive type Emotionally unstable – borderline type 1 1 Anxious avoidant 1 1 Dependent 1 1 Other 0 1 Posttraumatic stress disorder Conversion disorder 0 1 Impulse control disorder 1 1 Eating disorder 0 3 Substance abuse disorder 0 1 Total comorbidity 17 19 DPD = depersonalization/derealization disorder.
- Table 3
Group comparison using link-based controlling procedure, controlled for age, sex and handedness*
Negative correlation between symptom scores and FA values BDI STAI-T CDS Significant components DPD ≠ HC† pFDR value — — ✓ Left temporal pole − − Left superior temporal gyrus < 0.001 — — ✓ Right middle temporal gyrus − − Right supramarginal gyrus 0.002 — ✓ ✓ Brain stem − − Left caudate < 0.001 ✓ ✓ ✓ Right medial OFC − − Right caudal ACC 0.001 — ✓ — Right inferior temporal gyrus − − Right lingual cortex < 0.001 — — — Right superior temporal gyrus + + Right banks of superior temporal sulcus < 0.01 — — — Left insula − − Left pars triangularis − − Left lateral OFC < 0.01 — — — Left caudal ACC − − Left medial OFC + + Right superior frontal gyrus < 0.01 — — — Left isthmus of the cingulate cortex + + Right cuneus + + Left superior parietal cortex < 0.01 ACC = anterior cingulate cortex; BDI = Beck Depression Inventory; CDS = Cambridge Depersonalization Scale; DPD = depersonalization/derealization disorder; FA = fractional anisotropy; FDR = false discovery rate; HC = healthy controls; STAI-T = State-Trait Anxiety Scale, trait version; OFC = orbitofrontal cortex.
↵* All components for which patients with DPD and controls displayed significantly different FA values are listed along with the respective p value. Ticks mark components for which a significant correlation was found with dissociative symptoms scores (CDS-30), trait anxiety (STAI-T), or depression (BDI).
↵† Minus signs between brain regions (− −) represent connections for which patients with DPD displayed lower FA values than controls; plus signs between regions (+ +) represent connections for which patients displayed higher FA values than controls.
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