Past and Future Explanations for Depersonalization and Derealization Disorder: A Role for Predictive Coding

Abstract

Depersonalization (DP) and derealization (DR) refer to states of dissociation in which one feels a sense of alienation in relation to one’s self and environment, respectively. Whilst transient episodes often diminish without treatment, chronic experiences of DP and DR may last for years, with common treatments lacking a strong evidence base for their efficacy. We propose a theoretical explanation of DP and DR based on interoceptive predictive coding, and discuss how transient experiences of DP and DR may be induced in the non-clinical population using virtual reality. Further, we review the use of heartbeat evoked potentials in detecting the neural correlates of DP and DR allowing for an objective measure of these experiences in the non-clinical population. Finally, we discuss how the induction and detection of transient experiences of DP and DR in the non-clinical population could shed light on how the brain constructs one’s sense of self and reality.

Depersonalization disorder as a systematic downregulation of interoceptive signals

“…Our model represents a theoretical and computational advance of previous conceptualisations (e.g., 63 ) within an active inference framework. In line with Gatus and colleagues 10 we propose that DPD arises as a consequence of the suppression of interoceptive signals (deemed unreliable) whilst other sensory modalities remain intact. As illustrated by our simulation, to account for the prediction errors generated by incoherent streams of information, multisensory integration processes rely on sensory input from modalities other than interoception (e.g., exteroception, proprioception).…”

“…Several attempts to explain the aetiology of DPD have been made in recent years 10 . One model, developed by Sierra and David 11 , suggests that DPD may arise as a consequence of an increased cognitive control of the subjective affective experience.…”

“…As frequently reported in the literature 8 , DPD symptoms can arise as a consequence of an intense experience, such as severe stress, panic attacks or drug use and this is more common among individuals with a history of high trait anxiety, panic attacks, and childhood trauma 65 , 66 . In a more recent predictive coding conceptualization of depersonalization and derealization, Gatus and colleagues 10 suggested that these disorders may be the result of imprecise interoceptive predictions arising from traumatic experiences and leading to an over-weighting of other sensory modalities. An alternative explanation is the one put forward by Ciaunica and colleagues 67 .…”

The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic

“…Following the International Society for the Study of Trauma and Dissociation ( 2011a , b ), five symptoms of dissociation can be identified: depersonalization, derealization, dissociative amnesia, identity confusion, and identity alteration (Sar, 2014 ). Depersonalization can be described as the sense of being detached from or not feeling in one's body, and it can represent what is often referred to as an “out-of-body” experience (Guralnik et al, 2000 ; Simeon et al, 2001 ; Gatus et al, 2022 ). Derealization is the sense of feeling detached from the world or the sense of the world not being real.…”

“…Derealization is the sense of feeling detached from the world or the sense of the world not being real. It can be an association with a description of the world as being phony, foggy, far away, or as if seen through a veil (Steinberg and Steinberg, 1995 ; Gatus et al, 2022 ). Dissociative amnesia can be described as the inability to recall relevant autobiographical information that is not related to ordinary oblivion.…”