Verbal Abuse, Depersonalization, and the Innate Alarm and Defensive Systems: A Single Case Illustration of Treatment with Deep Brain Reorienting

This study aimed to a) discuss the neurobiological mechanisms of depersonalization as arising from activation at the brainstem level and b) assess the effectiveness of deep brain reorienting psychotherapy (DBR) with a patient presenting with depersonalization-derealization disorder (DDD). In the first part of the paper, we discuss verbal abuse as a severe form of relational trauma and how it can be connected to depersonalization. It is argued that suddenly aversive experiences engage the brainstem locus coeruleus in widespread noradrenergic activation of the thalamus and cortex such that the balance of functioning within the cortex becomes disturbed and a subjective experience of chronic depersonalization results. In the second part, the single-case study aims to provide initial evidence of how the patient experienced and responded to DBR therapy. Pre- and post-treatment measures consisted of instruments to measure depersonalization, social anxiety symptoms and quality of life. After 43 DBR sessions, the participant's depersonalization and comorbid symptoms decreased significantly. Patients with DDD may benefit from DBR. Future research is required to address generalizability to a larger population.