Röder Christian H, Michal Matthias, Overbeck G, van de Ven Vincent G, Linden David E J
Department of Psychosomatic Medicine and Psychotherapy, Johann Wolfgang Goethe University, Frankfurt, Germany.
Psychother Psychosom. 2007;76(2):115-21. doi: 10.1159/000097970.
Depersonalization (DP) is characterized by persistent or recurrent episodes of detachment from one's self with reduced pain perception being a common feature. Alterations in the body schema similar to the cortico-limbic disconnection syndrome of pain asymbolia are suggested to be responsible for DP. In this study we used hypnosis to induce DP in healthy subjects and to examine neural patterns of pain perception in the state of DP by means of functional magnetic resonance imaging (fMRI).
Pain perception was investigated in 7 healthy subjects with high susceptibility to hypnosis in three different mental states: waking state (N-W), hypnotic relaxation (H-R) and hypnotic DP (H-DP). Pain was induced with electrical stimulation to the median nerve at the right wrist. fMRI measurements were performed during all states.
Nociceptive stimuli led to an activation of the well described pain network including somatosensory and insular regions and the cerebellum. Activation was markedly reduced in the contralateral somatosensory cortex, parietal cortex (Brodmann area 40, BA40), prefrontal cortex (BA9), putamen and the ipsilateral amygdala during H-DP. Subjects also reported a significant decrease in pain intensity from N-W to H-DP.
Pain response during H-DP was reduced in sensory and affective pain-related areas, reflecting the diminished intensity of the perceived pain. Moreover, a network of cortical and subcortical areas that have been implicated in the perception of the own body was less responsive during DP, which might point to a specific neural mechanism underlying the 'out-of-body' experience. Although the small number of subjects does not allow a generalization of our findings, H-DP seems to be a promising tool for the investigation of psychological and biological mechanisms of self-inflicted injuries as well as the mind-body interplay within the realm of psychosomatic disorders.
人格解体（DP）的特征是持续或反复出现自我脱离感，疼痛感知降低是其常见特征。有人认为，类似于疼痛失认症的皮质-边缘系统断开综合征的身体图式改变是导致DP的原因。在本研究中，我们使用催眠在健康受试者中诱导出DP，并通过功能磁共振成像（fMRI）检查DP状态下的疼痛感知神经模式。
对7名高度易受催眠影响的健康受试者在三种不同心理状态下的疼痛感知进行了研究：清醒状态（N-W）、催眠放松状态（H-R）和催眠性人格解体状态（H-DP）。通过对右手腕正中神经进行电刺激来诱发疼痛。在所有状态下均进行fMRI测量。
伤害性刺激导致了包括体感区、脑岛区域和小脑在内的已被充分描述的疼痛网络的激活。在H-DP期间，对侧体感皮层、顶叶皮层（布罗德曼区40，BA40）、前额叶皮层（BA9）、壳核和同侧杏仁核的激活明显减少。受试者还报告说，从N-W到H-DP，疼痛强度显著降低。
H-DP期间感觉和情感疼痛相关区域的疼痛反应降低，反映出所感知疼痛强度的减弱。此外，在DP期间，与自身身体感知有关的皮质和皮质下区域网络反应性较低，这可能指向“体外”体验背后的特定神经机制。尽管受试者数量较少，无法将我们的研究结果推广，但H-DP似乎是一种很有前景的工具，可用于研究自我伤害的心理和生物学机制以及心身疾病领域中的身心相互作用。
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