Depersonalization disorder as a systematic downregulation of interoceptive signals

Abstract

Depersonalisation disorder (DPD) is a psychopathological condition characterised by a feeling of detachment from one's own body and surrounding, and it is understood as emerging from the downregulation of interoceptive afferents. However, the precise mechanisms that drive this ‘interoceptive silencing’ are yet to be clarified. Here we present a computational and neurobiologically plausible model of DPD within the active inference framework. Specifically, we describe DPD as arising from disrupted interoceptive processing at higher levels of the cortical hierarchy where the interoceptive and exteroceptive streams are integrated. We simulated the behaviour of an agent subjected to a situation of high interoceptive activation despite the absence of a perceivable threat in the external environment. The simulation showed how a similar condition, if perceived as inescapable, would result in a downregulation of interoceptive signals, whilst leaving the exteroceptive ones unaffected. Such interoceptive silencing would force the agent to over-rely on exteroceptive information and would ultimately lead to the DPD phenomenology. Finally, our simulation shows that repeated exposure to similar situations over time will lead the agent to increasingly disengage from bodily responses even in the face of a less triggering situation, explaining how a single episode of depersonalization can lead to chronic DPD.

Chasing Bodily-Self Ghost: Interoception-Aided Hypnosis in the Treatment for Depersonalization-A Case Study

“…A newer way of clarifying the relationship between Hypnosis and dissociation relies on the concept of Interoception. This concept is tied to depersonalization [9], further demonstrated in the following lines. It also illuminates the rationale for using hypnotic suggestions to treat DPRD.…”

“…It also illuminates the rationale for using hypnotic suggestions to treat DPRD. Recently, several researchers proposed that presence disorders, such as DPRD, are due to deficient interoceptive processes [9,11]. Interoceptive processes include awareness, sensitivity, accuracy, and emotional evaluation of internal processes [12,13].…”

The Temporal Dynamics of Dissociation: Protocol for an Ecological Momentary Assessment and Laboratory Study in a Transdiagnostic Sample

“…Current neurobiological and clinical models posit that dissociation functions to automatically and nonvoluntarily regulate affect following perceived threat (APA, 2022;van der Kolk, 1987;Lanius et al, 2010;Saini et al, 2022). We use affect as the "umbrella term for states that involve relatively quick good-for-me bad-for-me discriminations" (p. 3,Gross,in press).…”

“…During a dissociation, increased parasympathetic activity and increased negative feedback at the hypothalamus and pituitary (HPA) axis have been theorized to gradually shutdown physiological reactivity (Scalabrini et al, 2020;Schauer & Elbert, 2010). At the same time, dissociative states may function as automatic affect regulation strategies through nonvoluntarily and quickly deflecting attention away from internal and external perceived TEMPORAL DYNAMICS OF DISSOCIATION 6 threats, altering the cognitive processing of threat-related material by a disruption of the normal integration of thoughts, sensations, and perceptions in a way that prevents threatening information from being further processed, as well as influencing appraisal processes by disrupting the development of mental representations of distressing stimuli and sustaining automatic and rigid threat appraisals (Gross, 2015;see Cavicchioli et al, 2021;Saini et al, 2022 for a discussion). In consequence, self-reported distress should decrease in the short-term, which may then reinforce the dissociative response pattern (Keane et al, 1985).…”

Depersonalization affects self-prioritization of bodily, but not abstract self-related information.

“…Interestingly, the experience of a “split” between the self and the body—described as feeling trapped in one’s head (mind) and outside one’s body (Ciaunica, Charlton, & Farmer, 2021)—is one of the most frequently cited symptoms in depersonalization disorder (DPD; Sierra & David, 2011). Empirical support for disrupted bodily sensory processing comes from studies that demonstrate atypical physiological responses in people with DP (Dewe et al, 2018; Owens et al, 2015; Saini et al, 2022; Sierra et al, 2002). Moreover, several studies have found that people with DP may experience changes in the integration of multisensory body-related signals, for instance being more susceptible to the rubber hand illusion (Kanayama et al, 2009; see also Braithwaite et al, 2017) and mirror-pain synesthesia (Bowling et al, 2019).…”