Depersonalization disorder

Abstract

Abstract In depersonalization disorder, patients feel detached from experience and report feeling ‘as if’ experience is not happening to them. There is no deficit of cognition or interoception, but there is a characteristic flattening or absence of affective feeling.The nature of the avatar as an anchor of allostatic inference, neurally realized by circuitry centred on the insula, provides an explanation. The posterior insula is a hub of bodily self modelling. The anterior insula is a hub that: (1) integrates bodily signals with higher-level cognitive and emotional processing and (2) in the process becomes a key substrate for self attribution of affective experience. When the anterior insula is unpredictably and intractably hypoactivated, the subject still feels her bodily experience as her own, but the affective dimension of self modelling is absent. She reports the result in the language of depersonalization.