St. Anns Hospital, Canford Cliffs, Poole, Dorset. U.K.

AN I N V E S T I G A T I O N O F C E R T A I N F A C T O R S
CONCERNED I N T H E
AETIOLOGY OF DEPERSONALIZATION

G. SEDMAN

Depersonalization, which is the experience of a feeling of unreality in the

self or in the environment, is a common but ill-understood symptom reported
by psychiatric patients.
Theories of depersonalization abound, but in general they may be cate-
gorized as: those which regard it as organic; those which regard it as a
disturbance of a particular psychological function; those which consider it
a form of schizophrenia; and finally, analytic theories. The present study is
concerned with certain aspects of two of these views, namely ( a ) the organic
hypothesis and, (b) the hypothesis which regards depersonalization as a
disturbance of a particular psychological function.
The organic hypothesis stems largely from Mayer-Gross (1935) who re-
garded depersonalization as a preformed functional response of the brain,
which could be released by various factors. Incorporating this view, Haug
( 1936) believed that depersonalization was always associated with a change
in the level of consciousness, though this is, however, not readily recognisable
when depersonalization occurs in the functional psychoses. Experimental
studies on the relationship between consciousness and depersonalization are
virtually non-existent though certain studies (Sedman & K e n n a (1963) and
(1965)) have tended to negate the hypothesis that depersonalization is a
result of an altered level of consciousness.
There are vaned hypotheses which regard depersonalization as a disturb-
ance of particular psychological functions-thus: Earlier workers Krishaber
(1872), Ribot (1882), and Taine (1870) had regarded depersonalization
as a disturbance of sense perception, others such as Pick (1904), Oesterreich
(1910), and Loewy (1908), as an affective or emotional disorder, while
Janet (1903) regarded the hyperactivity of the memory as the important
factor. Likewise Schilder (1914) stressed the importance of increased self-
observation, as did LHermitte ( 1939), who attempted to relate depersonal-
ization to a disturbance of the body schema.
 192

DEPERSONALIZATION
Before proceeding further, more detailed consideration of depersonalization
phenomena is necessary. Strictly speaking, depersonalization is the term used
to designate a peculiar change in the awareness of the self, in which the
individual feels as if he is unreal. I t is often accompanied by a similar change
in the awareness of the external world by the subject, to which the term
derealisation was ascribed by M a j o t h e r (1935). This peculiar change has in
particular an unpleasant quality, a feature stressed by Ackner (1954). Other
symptoms, such as disturbances of the body schema, subjective time disorder,
a lack of feeling, hypo-hondriacal pre-occupation, and more rarely, d6j& vu,
metamorphosia or autoscopy may occur in the same individual. Some of these
symptoms, in particular body schema disturbances, are included under
the term depersonalization by some workers (Seidner (1963), von Mering
(1951) ). Depersonalization has also been used in a quite different context
to include schizophrenic passivity experiences (Langfeldt (1960) ) .
Transient depersonalization experiences are not uncommon in normal
subjects, even spontaneously (Roberts ( 1960), Dixon ( 1963)) ; in states of
fatigue (Mayer-Gross (1935)); after prolonged sleep deprivation (Bliss et al.
(1959)); under the influence of hallucinogenic drugs ( G u t t m a n & Maclay
( 1935) ) ; under conditions of sensory deprivation (Reed & Sedman ( 1964)) ;
nor are children immune (Salfield ( 1958)) . I t remains conjectural whether
such experiences are phenomenologically the same as the severe and often
intractable states of depersonalization met with in psychiatric practice.
There have been mattempts to create a specific depersonalization syndrome
(Shorvon (1946), R o t h (1959, 1960), R o t h & Harper (1960)), though the
bulk of evidence supports the view that it is a non-specific symptom occurring
in a variety of psychiatric disorders. However, there are cases in which de-
personalization appears almost as an isolated symptom and in which other
aetiological factors are not prominent (Davison ( 1964) ) .
I t has long been known that certain personality types are more liable to
develop depersonalization, and it has been shown by Sedman, Kenna & Reed
in a series of investigations that there is a statistically significant association
between depressed mood, insecure (obsessional) personality type and deper-
sonalization in a variety of psychiatric disorders (Sedman & K e n n a (1963,
1965 a, b), Sedman & Reed (1963) ). These studies confirmed earlier sug-
gestions by Mayer-Gross (1935) and Shoruon (1946). The role of an
alteration of affect in the aetiology of depersonalization has also attracted
considerable attention. The common clinical association of depression and
depersonalization has been stressed by Ackner (1954) who described a de-
pressive depersonalization syndrome. Other authors such as R o t h and his
co-workers (1959, 1960), have stressed the role of anxiety rather than depres-
 193

sion of mood, and this receives some support from Dixon (1963) in relation
to depersonalization experiences in normal subjects.
Having presented a brief survey of the problem, it is now possible to present
the scope and aims of the present investigation. This study is concerned
primarily with elucidation of the role of certain of the above-mentioned
variables which are considered to be of importance in the aetiology of deper-
sonalization, in particular the personality of the individual patients, the
influence of the mood of depression, the role of anxiety, and finally whether
there is any detectable concomitant alteration in consciousness.

METHOD
Experimental Design
The experimental design was as follows:
a) A group of patients reporting depersonalization phenomena as a prom-
inent symptom were investigated in respect of the variables under con-
sideration, namely, their personality structure, affective state (mood and
anxiety) , and of their ability to perform on certain psychometric tests which
might reflect some alteration in consciousness. The same group of patients
were retested during a phase of remission from the depersonalization state.
b) A second group of patients, none of whom reported depersonalization,
but all of whom exhibited depression of mood as a prominent symptom,
were tested in the same way and retested when their mood had returned
to normal.
c) A third group of patients, none of whom reported depersonalization, but
all of whom exhibited anxiety as a prominent symptom, were tested in the
same way and retested during a phase in which they were no longer
anxious.

By design, groups (b) and (c) were matched to ( a ) in respect of age and
sex incidence in order to eliminate these as other possible variables. Compari-
son of the groups in question would thus allow the inter-relationship of the
individual variables to be studied.

Tests Used in this Investigation

A more detailed account of the particular problems relating to the variables
under consideration cannot be included here. It can be assumed that the
particular tests used were so chosen because of the fact that they had been
used in similar studies or had special reference to the subject matters. These
details are available elsewhere ( S e d m a n (1967)). All subjects were given the
following on test and retest,
 194

1. Psychometric Tests
( a ) Cancellation Test: (Clarke 1965).
This test consisted.of pied material, using 8 letters 0, a, d, b, y, 1, p, q, in
rows of 38 letters. The subjects were asked to perform a number of tasks
simultaneously, namely, ( a ) to cancel every p (or q ) , (b) ring every tenth
p (or q ) , (c) to underline every sequence of alike letters, and ( d ) make a
mark at certain time intervals of one minute over the ten minutes of the test.
Scoring took into aczount the performance in terms of both accuracy and
number of responses of the total task and each of the sub-tasks.

(b) Simultaneous Addition Test: (Binet 1914)

The Simultaneous Addition Test devised by Binet (1914) invoIves the addi-
tion of numbers to an original set of three numbers, 6, 28, 43, each row
produced by the subject being covered after completion, so that the new
numbers have to be carried mentally by the subject. Binet originally suggested
that 1 should be added to each number but suggested that for more mature
subjects, they could be asked to add 3 to the first number, 1 to the second
and 2 to the third column. The former plan was adopted for the present
study, the timing of the test to be 6 minutes as Binet indicated.

(c) Digit Symbol Test (The Substitution Test) : (Kuufman 1966)

Kaufmans (1966) adaptation of the digit symbol test of the WAIS was
utilised to give ( a ) a simple measure of motor speed, involving copying 3
rows of numbers, and (b) a task involving the coding of symbols presented
visually, which again involves 3 rows of material, each comprising 18 symbols.
Kaufmans adaptation allows retesting using a different code to lessen any
learning influence and is easily scored to give a measure of both speed and
accuracy.

2. Subjective Aspects of Altered State of Consciousness

( a ) Linton-Lungs Questionnaire (1962)
The modification of the Linton & Lungs (1962) questionnaire used by
Levine & Ludwig (1965) consists of 70 items which can be divided into
groups related to ( 1) alteration in thinking, ( 2 ) disturbance of the time, (3)
loss of control, (4) changes in meaning, (5) changes in affect, (6) body
image disturbances, ( 7 ) somatic changes, and ( 8 ) others. The subjects are
asked to indicate yes or no to each item in turn.

3. Personality Structure of the Subjects

( a ) The Eysenck Personality Inventory EPI
The EPI (Eysenck & Eysenck (1964)) is a refinement of the earlier Maudsley
 195

Personality Inventory (MPI) (Eysenck (1960)) and gives a measure in two

dimensions of personality, namely Introversion-Extraversion ( E scale) and
Neuroticism (N Scale). It comprises a self-administrated questionnaire of
51 items and incorporates a Lie Scale. In the present work Form B was
utilised.

(b) The HOQ: (Caine & Hawkins 1963)

This questionnaire consists of 48 items purporting to measure a hysteroidf
obsessoid dimension of personality and was considered to relate more closely
to personality measures than to symptom measures (the test was originally
standardised on a group of neurotic patients in a mental hospital). There
is a very high level of agreement between the HOQ and the E scale of
the MPI. The subjects were asked to indicate whether each item is true or
false in its application to themselves. Scoring is simple, in that each hysteroid
item scores 1, thus a score of over 24 is hysteroid and under 24 is obsessoid.

4. Affectiue States of Subjects

(a) Beck Depression Inventory (1961)
An inventory described by Beck et al. (1961) and recently validated by
Metcalfe & Goldman (1965) was utilised. This consists of 21 features accom-
panying depressed mood, i. e. pessimism, sense of failure, guilty feeling,
crying, etc., which are rated by the subject as indicative of his present state
by items which score from 0-3. The total score gives a simple index of the
degree of depressed mood.

(b) Anxiety Level

Two scales were utilised in the present inquiry.
(i) N Scale of the Eysenck Personality Inventory.
The EPI has already been referred to above. The N or Neuroticism scale
is a measure of the basic personality traits of the individual, although the
authors of the test imply that the description of personality involved refers
to its phenotypic aspect, i. e. behavioural aspect. Neurotic individuals exhibit
a much higher score on this scale than normals, although there is little
difference in the mean scores of anxiety neurotics and obsessional neurot-
ics, a finding which is hardly surprising from a clinical point of view.
Neuroticism can be said to imply anxiety-proneness and there appears to
be ample evidence to support both the reliability and validity of the scale.
(ii) The Manifest Anxiety Scale (MAS): (Taylor 1953).
Taylors Manifest Anxiety Scale (1953) consists of items drawn from the
Minnesota Multiphasic Personality Inventory judged by clinicians to be indi-
cative of manifest (overt) anxiety. Fifty of the most discriminating hems were
utilised, partially revised and finally reduced to 28 items. The test includes
 196

questions directed both at basic personality traits and at overt anxiety symp-
toms. It has been shown to have a high coefficient of reliability. Further
studies hmave shown a high correlation with the N scale of the EPI.

PROCEDURE
The enquiry was carried out between January 1965 and May 1967.
A. T h e Test Situation
All the patients were selected by the author and personally interviewed. The
subjects were told that the research was concerned with the effect of nervous
symptoms on attention and concentration, and that they would be retested
when they felt better. The tests were all administered singly to one subject
at a time by the author, in his own room, so that external noise and inter-
ference was reduced to a minimum. The attention and concentration tests
were given first, to be followed by the personality questionnaires, all of which
were individually explained to the subjects.

B. Repetition of the Tests

(i) Order
In general most patients performed the tests initially when they were clinic-ally
at their worst and were retested when they were feeling better. However,
such is the nature of certain psychiatric disorders that a small number of
patients were tested in reverse order as regards the seventy of their clinical
state.

(ii) Time between Tests

Details are recorded under Results; in general the patients were retested
2 4 weeks apart, but occasionally the gap extended over 12 months.
C . Selection of the Groups
(i) The Depersonalization Group
As mentioned above under Experimental Design, only patients who ex-
hibited depersonalization phenomena as a prominent symptom were in-
vestigated. Although there are fairly broad interpretations of what should be
included under this term, the author accepted only patients who primarily
described a state of unreality either in terms of the self or their environment.
Without exception all the subjects affirmed the unpleasant quality of the
experience as stressed by Ackner (1954). In all cases detailed phenomeno-
logical enquiry was pursued and only unequivocal evidence of depersonaliza-
tion was accepted.
Most patients were seen while they were resident in the in-patient unit of
the University Department of Psychiatry, having been admitted there from the
 197

routine waiting list. One patient was seen initially at the University Student
Health Service by the author at a routine clinic, and the tests were adminis-
tered while he was an out-patient. Finally, one patient asked specially for an
appointment having heard of the authors interest in this particular symptom,
and his General Practitioner kindly referred him.

(ii) The Control Groups

As the Experimental Group was being collected, the two Control Groups of
patients exhibiting ( a ) marked depression of mood, and (b) marked anxiety
were also seen and the tests administered as described above. None of the
patients were informed that they were acting as controls. The Control Groups
were matched with the Experimental Group for sex, and as far as possible
for age and academic background. The Anxious Group which clinically
consisted of neurotic patients was closely matched with the Experimental
Group for these two variables, though matching for age between the De-
pressed Group and the Experimental Group proved much more difficult.
Clinically, most of the former group were suffering from depressive psychosis
and thus tended to be rather older than the other groups. Indeed, it appeared
to be very difficult to collect young people (particularly males) with marked
depression to match against the high proportion of young people in the
Experimental Group. No patient was included in the Depression Group
who showed any evidence of dementia, however slight.

D. Statistical Methods
This investigation used only non-parametric statistical methods because ( 1)
the nature of the population from which the scores were drawn cannot
readily be assumed, and (2) the scores resulting from the application of tests
are not truly numerical and hence parametric methods cannot be applied.
Statistical analysis of the data was undertaken in the following way:
A level of significance of p = 0.05 was chosen. Only those results are given
where this level was obtained or very closely approached.

1. The individuals of each group were compared against themselves be-

tween test and retest, i. e. in the Experimental Group the subjects per-
formance on a test or group of items for test was compared against their
individual performance when they were no longer depersonalized. The
Wilcoxon Matched-Pairs Signed Ranks Test (Siegel (1956)) utilises an in-
dividuals test and retest performances as a pair and takes into considera-
tion the direction and magnitude of differences within a pair. Comparison
of group performance between test and retest is achieved by a ranking pro-
cedure.
 198

2. The three groups were compared against each other so that overall
significant differences could be determined. The scores obtained when the
subjects were clinically at their worst, i. e. depersonalized in the Experimental
Group, depressed in the Control Group 1 and anxious in Control Group 2,
were compared first, followed by comparison of the scores obtained when
the subjects had recovered, and finally the three groups were compared as
to the amount of change in each score between test and retest. The Kruskal-
Wallis One-way Analysis of Variance (Siegel ( 1956) ) was used to test overall
differences. If overall significant differences between the three groups could
be demonstrated, it was then permissible and necessary to compare any two
of the three groups against each other. The Wilcoxon Two Sample Test
(Docurnenta G e i g y ) was used for this purpose.

RESULTS
A. Details of the Groups are given in Table 1 below.
Table 1. Description of the groups
Experimental Group Control Group 1 Control Group 2
(Depersonalization) (Depressed) (Anxious)

No. of Subjects 18 (6 males, 18 (6 males, 18 (6 males,

12 females) 12 females) 12 females)
Mean Age 3 1.O years "38.0 years 30.1 years
Age Range 19-57 years 19-54 years 1 7 4 6 years
Mean test-retest
period 6 weeks 2-5 weeks 2-5 weeks
Test-retest range 1-26 weeks 1-6 weeks 1-8 weeks
* Significantly higher than other groups (P < 0.05)

B. The comparison of individual groups against themselves, i. e. between

test and retest, is summarized in Tables 2 &3, parts ( 1) and ( 2 ) .

C . Inter-Group Comparisons
1. Using the Kruskal-Wallis One Way Analysis of Variance, an overall com-
parison between the three groups was carried out for the results of all tests
obtained from the subjects when they were all at their worst (i. e. deper-
sonalized, depressed, and anxious, respectively). There were only two results
which achieved the required level of significance, namely those obtained from
( a ) The Beck Inventory ( P < 0.05), and (b) The Linton-Langs Question-
naire (P < 0.02). Two-by-Two Comparisons were carried out and are shown
in Table 4. In an overall comparison of the individual Linton-Langs Subtests,
an overall statistically significant difference was obtained. The results are
shown in Tables 5 and 6 below.
 199

Table 2. Comparison of differences (between test and retest)

on questionnaires for each of the three groups
(significant findings only)

Experimental Group Control Group 1 Control Group 2

Depersonalized - Depressed - Anxious -
Test Non-depersonalized Less depressed Less anxious

Tests of anxiety Lowering of anxiety

N score EPI - P < 0.01 P < 0.005
MAS P<O.OI - P < 0.005
Tests of introversion Less introverted
(obsessoid) ratings
(a) E score EPI- P<0.025 -
(b) HOQ P<0.025 P < 0.025
Tests of depressed mood Less depressed
Beck P < 0.005 P < 0.005 P < 0.05
Tests of alteration in Lower rating
consciousness
Linton-Langs P < 0.005 P<O.OI P < 0.02
Lie scale EPI - - -
Linton-Langs Subtests Lower rating
Thinking P < 0.005
Time P < 0.01
Control P < 0.005
Meaning -
Affect -
Body Image P < 0.005
Somatic P < 0.005
Others
 200

Table 3 . Comparison of differences (between test and retest)

on Psycho-motor Tests for each of the three groups
(significant increases only)

Experimental Group Control Group I Control Group 2

Depersonalized Depressed - Anxious -
Test Non-depersonalized Less depressed Less anxious

Speed
Digit-Speed P < 0.025 P<0.005 P<0.005
Digit-Symbol P < 0.025 P < 0.005 -
Digit-Symbol
allowed for speed - P < 0.025 -
Cancellation Test Performance
Total Performance P < 0.025 P < 0.005 P < 0.005
Crossed ps correct P < 0.025 P < 0.005 P < 0.025
Sequences correct P < 0.05 P < 0.025 P < 0.025
Ringed ps correct
Time correct
-- P < 0.01
-
P < 0.005
-
Cancellation Test Efficiency
Total Efficiency P < 0.025 - -
Crossed ps efficiency P < 0.025 - P < 0.05
Sequences - - -
Ringed ps efficiency - - -
Time efficiency - - -

Binet Simultaneous Addition Performance

Total Performance - P < 0.005 -
Performance on column 1 - P < 0.005 -
Performance on column 2 - P < 0.005 -
Performance on column 3 - P < 0.005 -
Performance on separation
of columns 1 and 2 - P < 0.001 -
Performance on separation
of columns 2 and 3 - - -

Binet Simultaneous Addition Efficiency

Total Efficiency - - -
Efficiency on column 1 - P < 0.05 -
Efficiency on column 2 - - -
Efficiency on column 3 - - -
Efficiency on separation
of columns 1 and 2 P < 0.025 - -
Efficiency on separation
of coIumns 2 and 3 - - -
 20 1

Table 4. Inter-group comparisons on Beck and Linton-Langs questionnaires

(subjects at their worst)

Wilcoxon 2 Sample Test

Ti P
1 Beck
Experimental Group versus
Control 1 (Depressive) 291.5," Not Significant
Experimental Group versus
Control 2 (Anxious) 288* P < 0.005
Control 1 (Depressive) versus
Control 2 (Anxious) 278* P < 0.05
2. Linton-Langs
Experimental Group versus
Control 1 (Depressive) 268" P < 0.025
Experimental Group versus
Control 2 (Anxious) 241* P < 0.005
Control 1 (Depressive) versus
Control 2 (Anxious) 313"" Not Significant
* One tailTest
** Two tail Test

Table 5. Overall comparison on Linton-Langs subtests

(subjects at their worst). Kruskal-Wallis O n e - w a y
Analysis of Variance

Linton-Lane subtests

Thinking x 2 = 6.1, df = 2 P<0.05

Time Not Significant
Control x2 = 14.5, df = 2 P<O.OOl
Meaning Not Significant
Affect Not Significant
Body Image 2 2 = 7.0, df = 2 P<0.05
Somatic Not Significant
Others Not Significant
 202

Table 6. Inter-group comparison on Linton-Langs subtests

(subjects at their worst)
Wilcoxon 2 Sample Test

TI P
1. Thinking
Experimental Group versus
Control Group 1 (Depressive) 262.5* P < 0.025
Experimental Group versus
Control Group 2 (Anxious) 265, P < 0.025
Control Group 1 (Depressive) Venus
Control Group 2 (Anxious) 332** ATot Significant
2. ControE
Experimental Group versus
Control Group 1 (Depressive) 245.5, P < 0.005
Experimental Group versus
Control Group 2 (Anxious) 203* P <0.005
Control Group 1 (Depressive) versus
Control Group 2 (Anxious) 298** Not Significant
3. Body Image
Experimental Group versus
Control Group 1 (Depressive) 281.5* Xot Significant
Experimental Group versus
Control Group 2 (Anxious) 251* P < 0.005
Control Group 1 (Depressive) versus
Control Group 2 (Anxious) 309** Not Significant
* one tailed test
** two tailed test

2. The same procedure was carried out for the results of all tests obtained
from the subjects when they had clinically recovered. There were no results in
which a statistically significant difference between the groups could be
demonstrated.

3. Finally the three groups were compared for the amount of change dem-
onstrable between test and retest, using the same method as in 1 and 2
above. There were three tests in which an overall statistically significant
result was obtained, namely ( a ) The Beck Inventory ( P < 0.01), (b) The
Linton-Langs Questionnaire ( P < 0.02), and (c) The Binet Simultaneous
Addition Test- (i) Total Performance (P < 0.05), and (ii) Performance on
Column 2 ( P < 0.05).
Two-by-Two Comparisons were carried out for the Beck Inventory and
Linton-Langs Questionnaire and are summarized in Table 7 below. Overall
comparisons were also undertaken for the Linton-Langs Subtests, and those
subtests which demonstrated statistically significant levels were examined by
further two-by-two tests. The findings are recorded in Tables 8 and 9 below.
Two-by-Two Comparisons were carried out for the two subtasks of the Binet
Simultaneous Addition Test in which statistically significant levels were ob-
tained and are summarized in Table 10.
 203

T a 3 e 7. Inter-group comparisons (test-retest differences) on Beck, Linton-Lungs

(Wilcoxon 2 Sample T e s t )
~

Ti P Comments

1 Beck
Experimental Group versus
Control Group 1 277.5 Not Significant No difference
Experimental Group versus Greatest negative change
Control Group 2 257.5 P<O.Ol in Experimental Group
Control Group 1 (Depressive) versus Greatest negative change
Control Group 2 (Anxious) 260 P<O.O2 in Control Group 1
2. Linton-Lungs
Experimental Group versus Greatest negative change
Control Group 1 260.5 P<0.05 in Experimental Group
Experimental Group versus Greatest negative change
Control Group 2 244 P<O.Ol in Experimental Group
Control Group 1 (Depressive) versus
Control Group 2 (Anxious) 318.5 Not Signlficant No difference

Table 8. Overall comparison on Linton-Langs subtests

(three groups) test-retest difference (Kruskal- Wallis)

Linton-Langs Subtests

Thinking ~2 = 6.5, df = 2 P c 0 . 0 5
Time Not Significant
Control Not Significant
Meaning ~2 = 15.5, df = 2 P<0.0005
Affect Not Significant
Body Image IVot Significant
Somatic Not Significant
Others Not Significant

Table 9. Inter-group comparisons (test-retest differences) on Linton-Langs subtests

(Wilcoxon 2 Sample T e s t )
Linton-Langs Subtests Comments

Thinking
Experimental Group versus
Control Group 1 T = 264 P<0.05 (2) Greater negative
Experimental Group versus change in
Control Group 2 T = 261.5 P<0.05 (2) Experimental Group
Control Group 1 versus than either
Control Group 2 Not Significant Control Groups
Control
Experimental Group verws
Control G r o u ~1 T = 245.5 P<O.Ol (2) Greater negative
Experimental Group vesus change in
Control Group 2 T = 213.5 P<O.Ol (2) Experimental Group
Control Group 1 versus than either
Control Group 2 Not Significant Control Groups
 201

Table 10. Inter-group comparisons on Binet Simultaneous Addition Test

(test-retest difference)

Wilcoxon 2 Sample Test Comments

1. Total Performance
Experimental Group versus
Control Group 1 Not Significant
Experimental Group versus
Control Group 2 Not Significant Control 2 showed
Control Group 1 versus least negative
Control Group 2 T = 254, P < 0.05 improvement
2. Pe:formance on Column 2
Experimental Group versus
Control Group 1 Not Significant Control 1 showed
Experimental Group versus greatest positive
Control Group 2 Not Significant change T-R, and
Control Group 1 versus Control 2 least
Control Group 2 T = 265, P<0.05 positive change

4. As an appendix to the main results an Item Analysis of the Linton-Langs

Questionnaire was carried out on the three groups with the subjects at their
worst. Table 11 summarizes the positive findings.

Table 11. I t e m analysis of Linton-Langs Questionnaire: Three groups (at their worst)
compared
For all 70 items, 3 X 2 x2 tests were d e d out, but only those results which
showed an overall significant differentiation a t the p<O.O5 level between the three groups
are included.
No. of subjects giving positive responses

Item Category Exp. Group Control 1 Control 2 ~2 df P

1 1" Control 17 7 8 14-2 2 p<O.OOl

2 4" Body Image 11 4 2 12-8 2 p<0.005
3 6 Control 18 12 12 7-7 2 p<0.025
4 20 Thinking 10 2 4 9-4 2 ~<0.005
5 32* Thinking 8 3 1 8-3
6 42 Control 13 7 6 6-5
7 43* Control a 2 0 11-5
8 47* Control 17 12 8 10-8 2 p<0.005
9 52" Control 9 2 1 12-8 2 p<0.005
10 57 Somatic 17 9 5 15-9 2 p<0.0005

* These items are singled out in the discussion as being more specific in this enquiry-
though not necessarily designed to elicit depersonalization.
 205

INTERPRETATION OF THE FINDINGS IN THE LIGHT OF

EXPERIMENTAL METHODS AND DESIGNS
It is perhaps easiest to start at the end and examine the three groups when
their subjects are clinically recovered (or at least are much better). None
of the tests we used at this stage differentiated between the three groups.
This finding itself may have far-reaching theoretical implications in that it
provides important verification that, during a return to the status quo, no
immediate distinction was apparent between subjects previously categorized
as depersonalized, depressed or anxious. I t is possible that our means of
measurement may have been imprecise, however, or that we may have been
measuring the wrong things.
Equally impressive is the fact that there are significant differences for each
group between test-retest (subjects at their worst-subjects improved) on
every questionnaire and psychomotor test used. This firstly provides verifica-
tion that some change has taken place in the subjects of each group and that
our clinical assessments of subjects at their worst-subjects improved has
some meaning. Secondly, it provides evidence that our measuring instruments
are sensitive to change, thus partially resolving our doubts concerning the
crudity of our measuring instruments. The findings go some way in validat-
ing the choice of tools; although, of course, all these tests have been pre-
viously found useful in similar fields of research, if not in this particular
subject.
Certain tests, in particular the Beck, the Linton-Langs and to a lesser
extent the Binet, make the greatest contribution in differentiating the groups.
Naturally our attention will be focused on the findings relating to these
tests, but firstly some comments are necessary on the tests which failed to
differentiate the groups, and these will be considered in turn.

Tests of Anxiety
Two measures of anxiety were used in this enquiry, namely, the N score of
the Eysenck Personality Inventory (EPI) and the Manifest Anxiety Scale
(MAS) described by Taylor (1953). The a 4 S incorporates items which
clinically are more related to anxiety symptoms than to over-anxious
character traits. Subjects in all three groups exhibited high N and MAS
scores on first testing, clinical improvement being associated with a lowering
of anxiety. Significant decreases in anxiety scores (both MAS and N ) were
most apparent in the Anxious Group (Control 2 ) when they recovered, as
might be expected. This illustrates that these tests are sensitive to the meas-
urement of what clinically we regard as anxiety. The subjects of Control
Group 1 (depressive) when improved also showed a reduction of anxiety
scores, although a significant level of change was only evident on the N
 206

score of the EPI. The subjects of the Experimental Group when improved
also showed a reduction of anxiety scores, although in this instance a signifi-
cant level of change was evident in the MAS scores. This could be due to
a reduction in anxiety symptoms rather than a shift in basic anxiety
traits. What is more relevant is that although these shifts in anxiety level
occur in all groups, the tests fail to distinguish between the groups themselves,
whether the subjects were at their worst or had improved. This can only
imply that if anxiety plays an aetiological role in the occurrence of deper-
sonalization it is of relatively minor importance, for whilst depersonalized
cases are associated with high anxiety scores and these are lower when the
subjects lose their depersonalization feelings, this may be due to the presence
of one or another factor common to the depersonalized subjects, such as
the presence of a depressed mood. Thus the subjects in Control Group 1
(depressive) also have anxiety reduction as well as a lower depression rating
when they recover. Further, the depersonalized subjects do not have higher
or lower ratings on anxiety than either of the two Control Groups. Whereas
anxiety is a common accompaniment of depersonalization, the reverie does
not hold true.

Tests of Introversion (obsessoid) Ratings

What has been said in respect of anxiety, in general is repeated for tests of
introversion. The subjects of all three groups show shifts towards reduced
introversion ratings (or conversely become more extraverted) on recovery.
These shifts were most apparent in the Experimental Group, in that both
of the tests used, namely the E score of the EPI and the HOQ, showed
significant changes to have taken place. Whilst similar directions of change
took place in both Control Groups, only the HOQ achieved significant levels
in Control Group 1 and only the E score of the EPI achieved a significant
level in Control Group 2. Again such shifts towards extraversion could be
accounted for by factors shown to be common to all the groups, such as the
changes of affect (anxiety or depression). More relevant to theory, however,
is the finding that neither of these tests differentiate the groups themselves
either with the subjects at their worst or upon recovery.

Psychornotor Tests
(a) Digit Speed and Digit Symbol Substitution Tests
Neither the Digit-Speed Test nor the Digit-Symbol Test differentiated the
three groups, regardless of whether the subjects were at their worst or had
recovered. However, both these tests differentiated subjects in each individual
group from test to retest. From Table 3 it is clear that all groups showed an
increase in the motor speed (i. e. from the Digit-Speed Test) from subjects
 207

at their worst to subjects improved. The Digit-Symbol Substitution Test differ-

entiated only subjects in the Experimental Group and the Control Group 1
(depressive), and further, if this was adjusted for simple motor speed, only
the subjects in Control Group 1 showed increased performance upon im-
provement. This would imply that an increase in speed is quite non-specific
and that a lessening of depressed mood or a lowering of anxiety can bring
it about. The greatest change is observable in the depressive group where
an overall increase in performance took place on recovery, which suggests
that depressed mood is the most likely factor. One perhaps need not look
further than the accompanying psychomotor retardation of depressed mood
to account for the findings. Since there were significant shifts in depression
scores in both the Experimental and Anxious Groups, the increase in observ-
able speed in these groups, too, could be explained similarly, although it is
possible that anxiety levels are a contributing factor. What is apparent is
that any increase in performance on these tests in the Depersonalized Group
can be explained by the presence of other accompanying factors and is not
a measure of a difference between the depersonalized and non-depersonalized
states.

Cancellation Test
Our conclusion from the above is that a non-specific increase in speed took
place in each of the three groups between tests and retest. In general, the
findings relating to the cancellation test parallel and support this point of
view. The total performance and the performance on most of the subtests of
the cancellation test improved for each of ,the three groups when the subjects
recovered. A simple increase in motor speed, as observed in the Digit Speed
Test, could account for this. More important then, are the findings relating
to actual efficiency on this test, which of course are not dependent purely
upon motor speed, but take into account the number of errors made during
the test. Only in the Experimental Group was there an increase in efficiency
on recovery, and examination of the subtests revealed that this was ac-
counted for by increased efficiency in the central task, that is, to cross out
the pJs. The Control Group 1 (Depressive) showed no change in efficiency
at all, but the Control Group 2 (Anxious) showed a significant improvement
in efficiency on the major subtest (crossed ps) although the overall efficiency
was not improved. From this the most likely conclusion is that we can
eliminate any effect of depression as a factor, but accept that anxiety may
contribute in part to the improvement in efficiency. However, it is possible
that a real increase in efficiency due to a change from depersonalized state
to non-depersonalized state has taken place, or that this is due to an asso-
ciated common factor not yet considered. To some extent this evidence is
nullified by the inter-group comparisons, which failed to differentiate any of
 208

the groups, whether with the subjects at their worst or when recovered. And
perhaps more important still, the amount of change observable in each group
from test to retest showed no overall significant differences between the three
groups. We are left with grossly incomplete evidence of depersonalization
being a factor concerned in the efficiency on the cancellation test.

Binet Simultaneous Addition Test

Earlier this test has been indicated as one which can differentiate between
the three groups, and hence it requires special consideration. The striking
findings in fact relate to one of the control groups, namely Control Group 1
(depressive). Here there is a significant increase in the overall performance
and in the performance of four out of five subtests. This is in contrast to
both the Experimental Group and Control Group 2 (anxious), neither of
which showed significantly improved performances upon recovery. The test in
terms of efficiency, however, was less striking; none of the three groups
showed an increase in total efficiency. I n only one of five subtests for the
Experimental Group and for the Control Group 1 was there a n increase in
efficiency, findings which might be due to chance. I n almost all other respects
the findings are negative. There were no differences between the three groups
either with subjects at their worst or with the subjects improved. There was
an overalI difference in the amount of change (test-retest) between the three
groups and this was accounted for by a difference involving only the Con-
trol Groups, and was confined to performance results and not efficiency re-
sults. There it was found that Control Group 1 showed the greatest degree
of improvement in performing the test upon clinical improvement.
Finally we turn to two tests, the results of which are singled out as being
the most interesting and relevant.

Beck Depression Rating

When all three groups were clinically recovered, there was no overall differ-
ence in depression scores between the groups. In contrast, when the subjects
in each group were examined at their worst, it was evident that the Experi-
mental Group clearly resembled Control Group 1 (Depression) and that their
subjects had significantly higher ratings on depression than those of Con-
trol Group 2 (Anxious). The amount of change in scores between test and
retest was also significantly greater in the Experimental Group and Control
Group 1 than in Control Group 2, whereas no difference between the Ex-
perimental Group and Control Group 2 could be demonstrated. This finding
is of fundamental importance in that it emphatically isolates Control Group
2 and hence lessens the role of anxiety in depersonalization, while magnify-
ing the role of depression of mood.
 209

Linton-Lungs Questionnaire
The results concerning the Linton-Langs Questionnaire are also very striking
and equally of the utmost theoretical importance. When the three groups were
compared with the subjects recovered, no difference in ratings on this test
was apparent, whereas when the groups were compared with the subjects at
their worst, the subjects of the Experimental Group had significantly higher
ratings than either of the two Control Groups. (There was no such difference
demonstrable between the Control Groups themselves). Exactly the same
pattern was elicited when the subtests were studied, and it was evident that
three subtests-namely Thinking, Control, and Body Image-differen-
tiated the Experimental Group from the two Control Groups in this manner.
It was demonstrated that significant shifts occurred in the ratings on this test
for all three groups between test and retest, at highly significant levels.
The inter-group comparisons confirmed that the greatest shift took place
in the Experimental Group, but there was no difference between the two
Control Groups. When the subtests were scrutinized, Thinking and Con-
trol underwent the greatest shifts in the Experimental Group between sub-
jects at their worst and subjects improved. These findings amplify those
presented in Table 2 where it can be seen that the subjects in the Experimental
Group showed changes in rating in five out of eight subtests, but only two
and one subtests were involved in the Control Groups 1 and 2, respectively.
I n other words, the Linton-Langs Questionnaire on a number of points
clearly differentiates the Experimental Group from the two Control Groups.
The question arises-what does this mean, and any answers must first ex-
amine the nature of the test itself without accepting the initial premise that
it is a measure of alteration in consciousness.
The Linton-Langs Test contains a series of questions relating to a fairly
wide spectrum of psychiatric symptoms, but which are grouped for con-
venience by the authors into eight categories or subtests, there being, however,
different numbers of items in each category. The two subtests which attract
our focus of attention, namely, Thinking and Control, have 13 and 16
items, respectively.
An examination of the 13 items included in the subtest Thinking reveals
that, in all but two, the questions are of a very general nature and capable
of fairly broad individual interpretation. The two exceptions are (1) a ques-
tion relating to a specific form of schizophrenic thought disorder (Item 32:
Does it feel as if someone else were controlling your thoughts?) although
even here the indication of the words as if sufficiently broadens the inter-
pretation of the question, so that a number of non-schizophrenic patients
might give a positive answer, unless phenomenological enquiry on this point
was made, and (2) a question which is designed to elicit an obsessional thought
 210

disorder (Does one idea, thought, or image keep coming back again and
again?). None of the 13 items relate specifically, however, to a description of
part or whole of a depersonalization experience, so that one must conclude
that if this subtest differentiates depersonalized subjects from the control
subjects, depersonalized subjects, as a group, do experience or acknowledge a
wide variety of alterations in thinking.
Likewise, an examination of the 16 items included in the subtest Control
reveals that all but four are of a very general nature and capable of broad
interpretation. Two of the four exceptions, however, do describe deper-
sonalization phenomena more specifically: (Item 1: Have things felt unreal-
as if you were in a dream? and Item 47: At times have you felt that you
were withdrawing from reality or losing your hold on the real world?),
although Item 47 might have been aimed at eliciting a form of schizophrenic
experience. The remaining two exceptions (Item 43: Has it felt as if someone
or something else has taken control of your body? and Item 52: Does it feel
as if someone else were controlling your emotions and feelings?) more clearly
relate to schizophrenic passivity experiences, but again are capable of other
interpretations. I t might be argued that this subtest differentiates the de-
personalized group from the controls because of the inclusion of a number of
items which are themselves descriptive of the depersonalization phenomena.
But even in this subtest, such items are clearly in a minority.
A brief comment is also necessary on the subtest category Body Image.
This of course only differentiated the Depersonalized Group from the Anx-
ious Controls. Here four out of the ten items included in this category relate
to description of depersonalization (Items 4, 14, 25, 46) so that there is less
evidence of this subtest making a differentiation on more general grounds
and might only be due to a high proportion of items eliciting depersonaliza-
tion.
I n order to give the above remarks further authority, a separate investiga-
tion, namely an item analysis of the Linton-Langs Questionnaire, with the
three groups at their worst (depersonalized, depressed and anxious, respec-
tively) was undertaken at this point. The findings are included in Table 11.
Examination of these findings revealed that 10 out of 70 items differen-
tiated between the three groups at a significant level, and that in all cases
the greatest number of positive responses was elicited in the Depersonalized
Group. Six items belonged to the subtest category Control (16) two were
of the category Thinking ( 13), and one item each was of the categories
Body Image (10) and Somatic (11). (As a reminder, the number of
items in each category is indicated in brackets). These figures, of course,
both complement and amplify those already described; namely, that the subtest
categories Control and Thinking clearly differentiate the three groups.
Here tbs individual items which are mainly responsible are brought out.
 21 3
Table 11 also singles out by asterisk six items, already commented on above,
as being more specific in their enquiry. Of these, three are intimately con-
cerned with a description of depersonalization, namely, Items 1 and 47
(Control) and Item 4 (Body Image), and the other three were all aimed at
eliciting specific schizophrenic symptoms, although, as mentioned, all are
capable of other interpretations. Although intimate clinical details of these
subjects have not been given, other than that they were all experiencing de-
personalization, it must be here observed that in none of the eighteen sub-
jects had a diagnosis of schizophrenia been made. Since certain workers have
considered depersonalization to be a forme fruste of schizophrenia, it should
be clarified here and now that, with respect to using a diagnostic label such
as Schizophrenia, the author only feels certain of making a diagnosis of the
condition when symptoms of first rank importance (Schneider (1958) ) can or
have been unequivocally shown to occur. In none of these 18 patients could
such symptoms be demonstrated.
In other words, seven out of ten items which differentiate the Experimental
Group from the two Control Groups are not primarily concerned with a
description of depersonalization phenomena, thus removing any objection to
the test on the grounds that it differentiates purely by eliciting depersonaliza-
tion (and hence only confirms the original trichotomy).
Having accepted this, then two further conclusions are possible; firstly,
that depersonalized subjects are experiencing some form of total change in
their view of themselves and the outside world, and that this goes beyond
the more primary concept of an unreality experience. This would explain
the results obtained on a test like the Linton-Langs Questionnaire and still
only reflect the total clinical features of the depersonalization syndrome. Or
secondly, it could mean that these distinguishing features have one thing in
common, that is, they are associated with an alteration in consciousness since
there is abundant evidence that this test is sensitive to such changes when
given to subjects under the influence of various toxic processes (in particular,
drugs).
It might be better to state the evidence thus:-it has been shown that when
using the Linton-Langs Test, depersonalized subjects interpret or acknowl-
edge the presence of certain symptoms differently from depressive and anxious
controls, and in manner similar to that observable in subjects suffering from
states of mild degree of clouding of consciousness.
An association between depersonalization and clouding of consciousness is
not proven by such evidence, but it does warrant closer consideration.
In general, this enquiry produced more negative evidence of such an asso-
ciation than positive. There is little doubt that most psychomotor tests (not
excepting those used in this study) are particularly sensitive to organic cere-
bral changes of a chronic (dementia) or acute (confusional) nature. These
 212

tests do not differentiate depersonalized subjects from the controls in any

way. Again this could mean either that depersonalized subjects are not
suffering from even a minor degree of clouding of consciousness, or that these
particular tests are not sufficiently sensitive to detect it. The logical conclu-
sion from the latter is that some approach other than using psychological
tools would have to be invoked, and here the evidence from the Linton-Langs
Questionnaire suggests that such a step should be undertaken. This cannot
be pursued any further with the present enquiry, which has necessarily placed
certain restrictions upon itself, but clearly, investigation of this aspect needs
a fresh approach.

T h e findings in relation to current and previous work o n depersonalization

The present study is concerned with aspects of two main theoretical stand-
points: firstly the organic hypothesis, and secondly the hypothesis that de-
personalization is a disturbance of a particular psychological function. These
will be discussed separately but, as will be evident, they are linked in a num-
ber of ways.

(a) The Organic Hypothesis:

The origins of the Organic Hypothesis have been commented upon in the
introductory remarks. This hypothesis itself incorporates two facets, both of
which require amplification before discussing the present enquiry in this
particular context. Firstly it is recognized by Mayer-Gross (1935) as being a
pre-formed functional response of the brain. This involves a hierarchical
concept inherent in neurology since the studies of Hughlings Jackson (1884).
Mayer-Gross (1914) regarded his pre-formed functional response of the
brain as being in the same category as other non-specific pre-formed mech-
anisms such as the epileptic fit, delirium, states of semi-consciousness, cata-
tonic states, etc.
The second facet of the Organic Hypothesis of Depersonalization is that
which is concerned with the methods of release of such a pre-formed cerebral
mechanism. Here it is postulated that they have one thing in common,
namely some alteration in consciousness, either physiological or pathological.
This theory was expanded by Haug ( 1936).
Two main forms of evidence resulted from the present enquiry, and
although they are in one sense paradoxical, they can be equated. Firstly, if
the findings in relation to the psychomotor tests are considered, they are not
only overwhelmingly negative, but almost wholly consistent. Bearing in mind
that there are three forms of test, Digit Symbol Substitution, Cancellation,
and Simultaneous Addition (each with a certain number of subtests), in
only one minor instance was there any evidence that depersonalized subjects
perform any differently from depressive or neurotic controls. It must be
 213

emphasized that these tests have been selected as among the most likely to
detect alteration in consciousness. Yet it is quite clear that when such tests
are used in other experimental settings-such as in sensory deprivation ex-
periments and psychotomimetic drug research, they are in fact fairly sensitive
indicators of alteration in consciousness. This can be interpreted in two ways.
(1) That there is no evidence that alteration in consciousness plays a direct
role in the aetiology of depersonalization, or (2) that tests used are not
sufficiently sensitive-in other words, the order of magnitude of the altera-
tion in consciousness is proportionately much less than that observable in,
say, intoxication with L. S. D. There are sufficient grounds for rejecting the
second hypothesis, if not its corollary: (a) The tests have been shown to be
sensitive indicators in various fields of research; (b) The tests have in the
present study been shown to be sensitive to other factors, such as depressive
mood change and anxiety. It may be that one cannot entirely reject the
corollary, which regards depersonalization as a part of a very small shift of
consciousness; all we can say is that, if this is so, we are either not in a
position to measure such a shift, or that such a shift may involve something
quite different from wakefulness-sleep or wakefulness-cloudingcontinuum.
The second important piece of evidence from the present enquiry is in
one sense at variance with the findings from the psychomotor tests. The
Linton-Langs Questionnaire quite definitely differentiated the Depersonal-
ized Group from both Control Groups in two ways: The Depersonalized
Group had higher ratings than either of the Controls, and, upon recovery,
showed a greater shift (Iowering of ratings). More careful examination of
the test has already been made earlier in the discussion, and fairly tentative
conclusions reached. Linton-Langs ( 1962) designed this original question-
naire to assess a very wide range of responses that might be elicited during
L. S.D. intoxication. I n this it proved to be very successful, as can be judged
from a second study (1962) in which the questionnaire demonstrated its
effectiveness in distinguishing L. S. D. intoxication from placebo reactions
in a double-blind trial.
Levine & Ludwig (1965) have tried to put the Linton-Langs Questionnaire
to more practical test and in other than L. S. D. research. I t is quite clear
that they are using the test as a measure of 'clouding' of consciousness.
They were in fact comparing hypnosis, L. S. D., and psychotherapy, either
singly or in various combinations, and the test was shown to be a useful
index for separating the various conditions. One particular weakness of the
method is that, whereas it is evident that normal patients who have recovered
from anxiety states, depression, etc. produce very few positive responses, the
present study clearly demonstrated that neurotics and depressives (in a
general sense) also have fairly high ratings on this questionnaire. AIthough
these ratings are lower than those obtainable by depersonalized subjects,
 214

insufficient information is known about how mentally ill patients (other than
those with organic alterations in consciousness) respond. I have already
commented on some of the fairly broad interpretations possible for some
items, and one must agree with Guilford & Guilford (1936) that many factors
must be taken into account in any appraisal of subjective response. The
method has a more fundamental weakness in that even positive findings can
be interpreted in a rather circular manner. If we imply that depersonalized
subjects differ from two Control Groups in possessing a greater number
of positive items, it may be purely an internal validification of our original
separation of the depersonalized subjects from the others. If this is so, then
the Linton-Langs Questionnaire as used in this enquiry verifies the correct
selection of the case material, but does not necessarily imply any evidence of
clouding of consciousness. This point of view can therefore be successfully
equated with the findings on the psychomotor tests. On the evidence, this is
the point of view one feels inclined to accept. The alternative hypothesis is,
of course, that the Linton-Langs Questionnaire is a measure of alteration in
consciousness, because it has been shown to be useful in a particular field in
this context. Indeed, Levine & Ludwig (1965) would go as far as to suggest
that the total score is directly related to the degree of alteration in conscious-
ness. Furthermore, the high ratings of the Depersonalized Group exist because
some other change (to wit alteration in consciousness) is present in this
group and is not so apparent in Control Groups. This viewpoint would need,
therefore, to reject the psychomotor tests as being relatively insensitive
measures.
I have attempted to present the evidence for and against these hypotheses
as fairly as possible. It seems to me that the inherent weaknesses in the
Linton-Langs Questionnaire are such that the more likely hypothesis is the
one which accepts the negative findings on the psychomotor tests (tests which
are certainly reliable and very likely to be valid) and thus rejects evidence
for alteration in consciousness being a specific aetiological factor in deper-
sonalization. This hypothesis would be much more in keeping with the
established facts.

(b) The hypothesis that depersonalization is a disturbance of particular

psychological function:
Mention has been made of a number of psychological theories of depersonal-
ization; those of interest to us assume that there was some alteration in the
subjects emotional state which made him perceive the world differently.
Special emphasis must be placed upon the common affective changes of
Depression and Anxiety. There are many striking accounts of the associa-
tion between depressed mood and depersonalization; indeed, Ackner in-
cluded Depressive Depersonalization Syndrome as one of his categories of
 215

depersonalization syndromes. I t is, however, abundantly clear that in this

context he sees depersonalization as part of a descriptive difficulty facing
the patient and cites Lewis (1934) who suggested that in depressive states
there may be no more than a verbal difference between experiences of loss of
interest and inability to enjoy on the one hand, and feelings of unreality on
the other. A closer look at Lewiss paper will reveal that he is not quite as
committed on this point as Ackner would imply.
I t is evident from the present findings that the depersonalized subjects
report in addition many depressive symptoms, as reflected in the high scores
on the Beck Inventory. When the subjects improve and become non-deper-
sonalized, depression of mood score decreases significantly. I n both Control
Groups, however, there are significant shifts in the same direction, so that
this evidence alone is insufficient proof of a casual connection between de-
pression of mood and depersonalization. When inter-group comparisons are
made, the DepersonaIized Group bears a striking resemblance to the Depres-
sive Control Group in two ways. Firstly, both these groups have significantly
higher depression ratings than the Anxious Groups and secondly, as im-
provement occurs, both show significantly greater shifts (to lower ratings)
than the Anxious Control Group, ending with depression ratings which
are not significantly different in the three groups. The Beck Questionnaire
could not, in fact, differentiate the Depersonalized Group from the De-
pression Group in any way, whereas a clear distinction is apparent between
the Depersonalized Group and the Anxious Controls. From this one may
safely assume that depression of mood is an important associate of the de-
personalized state. The theoretical idea put forward by MacCurdy (1925)
that this is due not to the mood change, per se, but rather to the accompany-
ing retardation cannot be substantiated from the psychomotor tests used
in the enquiry. It is, however, still feasible that some other factor common
to depression of mood and depersonalization is the major factor, though
this enquiry provides no hints as to which this might be, nor are the various
theoretical standpoints much more helpful. Attention must then turn to any
discoverable differences between the Depersonalized Group and the De-
pressive Controls. The most obvious factor to examine would be a personality
factor, but this particular enquiry failed to demonstrate any personality
differences between any of the three groups. I t is true that there was a
significant shift away from high introversion or obsessional scores in the
Depersonalized Group, but this was evident in the Control Groups too, and
is explicable in terms of lessening of depression and anxiety as improvement
occurs. These are in keeping with the findings of Coppen & Metcalfe
(1965) in M. P. I. scores on recovery from depressive illness. However, it is
important to recognise that in this study the Depersonalized Group does not
exhibit more obsessional traits than the Control Group of depressives. It
 216

might be argued in defence of the concept which allies obsessionality to de-

personalization that the Control Groups also had rather high loadings in
obsessional traits.
It seems, on balance, that while the present enquiry provides no definite
confirmation of an association between obsessionalism and depersonalization,
it cannot be entirely refuted either. The evidence does suggest that even a
depression of mood, plus obsessional personality, does not necessarily result in
depersonalization, and this implies the presence of at least one other factor.
Whether this is the pre-formed mechanism or not is open to question. It
is, however, interesting to note that in the studies on depression, where
evidence of depersonalization has been specially sought, there is a fairly
constant incidence reported, e. g. Lewis (1934) 30 %, Anderson (1936)
30 %, Hobson (1953) 20 %.
The second possible important factor, anxiety which has been mentioned
above under emotional state also requires examination. Whilst there are
certainly ample anecdotal accounts of depersonalization occurring in indi-
viduals during periods of undue or unusual stress accompanied by anxiety
symptoms (Crawshaw (1963) , Sours (1965)), the present findings produce
little support for any theoretical construct which assumes anxiety as an
important factor in the aetiology of depersonalization. Significant lowering of
anxiety scores did occur in the Experimental Group upon recovery, but both
Control Groups showed similar trends. Indeed, no inter-group differences
were apparent on the anxiety scales used, either on first testing or on retest.
Any reduction in anxiety scores in the Depersonalized Group could equally
well be explained by an association with the depressive state. Similarly, it is
evident that non-depersonalized Depressive Controls are equally as anxious as
the Depersonalized Group.

SUMMARY
This study is an investigation of certain factors thought to be involved in the
aetiology of depersonalization.
Depersonalization phenomena are defined and a brief outline of two of the
main theoretical standpoints is given.
The methodology is presented and in brief can be stated to consist of an
investigation of a group of 18 subjects whose psychiatric manifestations in-
cluded unequivocal evidence of depersonalization. These subjects were given
a variety of questionnaires, personality tests and psychomotor tests, all de-
signed to elicit information regarding the affective state of the individual,
his personality structure, and any evidence of a concomitant alteration in
consciousness. All these tests were repeated when the subjects no longer
exhibited depersonalization. Two Control Groups were utilized, each con-
 217
sisting of 18 subjects matched as far as possible with the Depersonalized Group
of subjects for age, sex and intellectual ability. The first Control Group
consisted of subjects with undoubted depression of mood and the second
Control Group consisted of subjects with marked anxiety. Both Control
Groups were retested when the subjects had recovered from their illnesses.
It was thus possible to determine the contribution of various factors con-
cerned in depersonalization.
The results are presented in a series of Tables.
These demonstrated that when the three groups are clinically recovered,
none of the battery of tests differentiate between them. There were, however,
significant differences in each of the three groups between test and retest
(subjects at their worst-subjects improved) on every questionnaire and
psychomotor test used. Certain tests, in particular the Beck depression in-
ventory, the Linton-Langs questionnaire and the Binet test, all differentiated
in some way between the three groups. Tests related to anxiety, however,
did not clearly differentiate the groups. I n relation to the possible theoretical
constructs considered, the Linton-Langs Questionnaire gave results which
were at variance with the other tests. The possible explanation of this is
discussed. I n general it was considered that there was no evidence that
alteration in consciousness played a direct role in the aetiology of deper-
sonalization. The results stress the importance of a depressed mood in de-
personalization, whereas anxiety seems to bear no significant relationship.
The findings are discussed in the context of the experimental method
utilized and in the light of previous work on the subject. A bibliography
follows.

REFERENCES
Ackner, B. (1954) : Depersonalization. I. Aetiology and phenomenology. 11. Clinical syn-
dromes. J. ment. Sci. 100, 838-872.
Anderson, E. W. (1936): Prognosis of depressions of later life. J. ment. Sci. 82, 559-
588.
Beck, A . R., C. H . Ward, M . Mendelson, J. Mock & J . Erbaugh (1961) : An inventory
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Received April 6, 1971. G. Sedrnan

M. D., Ph. D., M. R. C. Psych., D. P. M.
Consultant Psychiatrist
Herbert Day Hospital
Alumhurst Road
Westbourne, Bournemouth BH4 8EP
U. K.