Understanding DPDR: A New Perspective from Recent Research. Saini et al. (2022) in Scientific Reports.

DPDR is a condition where individuals feel detached from their body (depersonalization) or the world (derealization), as if observing themselves or an unreal environment. These distressing feelings can cause anxiety and disrupt emotional connection. Often misunderstood and misdiagnosed, DPDR remains challenging to treat, but a recent paper offers new insights into its development and potential treatments.

The New Model of DPDR

In a new theoretical model, researchers explain DPDR as a result of the brain’s response to conflicting sensory information, particularly between what we feel inside our body (interoception) and what we experience from the outside world (exteroception). This model suggests that DPDR is linked to a process called interoceptive silencing, where the brain suppresses or “silences” internal body signals in response to confusion or stress. Here’s a breakdown of how this works:

1. Conflicting Sensory Information:

The brain constantly receives two kinds of sensory input:

• Interoceptive signals: These are signals coming from within the body, such as the heart rate, hunger, pain, or breathing.
• Exteroceptive signals: These are sensory signals from the outside world, such as what we see, hear, and touch.

Normally, the brain integrates both types of signals to create a coherent experience of the self and the world. For example, if someone is nervous, their heart rate increases, and they might also feel anxious in response to an external event (like a stressful situation). The brain processes these signals together to form a unified perception of the self and the environment.

However, sometimes these signals don’t match up. For instance, a person might feel anxious or stressed (which would increase their heart rate) but not have any external trigger for that feeling. In this case, there is a mismatch or incoherence between the interoceptive signals (internal feelings of anxiety) and exteroceptive signals (the absence of any external threat). This causes the brain to experience high prediction errors, or confusion, because it cannot make sense of the conflicting information.

2. Interoceptive Silencing:

To cope with this confusion, the brain may suppress or “silence” the interoceptive signals (like the heart rate or other internal bodily sensations). This means that even though the body is experiencing stress or anxiety, the brain tries to block out these internal sensations, focusing more on external signals (like what is happening in the environment). This silencing of body signals can lead to a feeling of disconnection from the self, because the person no longer feels like their body is the source of their experiences.

This is the key idea in the model: when the brain silences internal bodily signals, the person feels less connected to their body and their sense of self becomes fragmented. This process can lead to feelings of depersonalization (detachment from oneself) or derealization (detachment from the world), which are hallmark symptoms of DPDR.

3. Repetition and Habit Formation:

Over time, if a person is exposed to situations where interoceptive signals (like increased heart rate) are not matched by external signals (such as no visible danger), the brain may become more accustomed to silencing those body signals. This can make the person more likely to feel detached or disconnected even in less stressful situations. Essentially, the brain forms a habit of silencing internal signals, and this can lead to chronic DPDR episodes, where the person feels detached from their body or the world without any clear external reason.

4. The Role of Trauma in DPDR:

Trauma, particularly childhood trauma, can also play a significant role in the development of DPDR. For example, if a child experiences physical or emotional abuse, they may learn to dissociate or disconnect from their body as a way to cope with the overwhelming stress. This can lead to the habitual silencing of body signals in the future, even in situations that are not traumatic. A person with this history might still feel disconnected from their body, even when the situation is safe.

This helps explain why people with DPDR often experience depersonalization in response to triggers that might not seem harmful to others, such as a gentle touch from a loved one. The brain has learned to disconnect from bodily sensations in response to trauma, and this pattern can continue even in safer circumstances.

5. The Brain’s Role: The Insula:

One key brain region involved in this process is the insula, which is responsible for integrating both interoceptive (body-related) and exteroceptive (environment-related) sensory information. The new model suggests that the anterior insula plays a major role in interoceptive silencing in DPDR. In normal circumstances, the insula helps us integrate body signals with external perceptions to create a sense of self. However, when the brain starts silencing internal signals, this integration is disrupted, leading to a dissociated sense of self.

6. Implications for Treatment:

The new model has important implications for how we can treat DPDR. Since DPDR seems to arise from disrupted sensory processing, one way to treat it might be to help patients reconnect with their bodies and integrate sensory information more effectively. Here are some possible treatment approaches:

• Mindfulness and Body Awareness: Techniques that encourage patients to pay attention to their body’s signals (e.g., mindfulness or yoga) could help them become more aware of their internal states and reduce feelings of detachment.
• Multisensory Integration Therapy: Therapy that helps individuals integrate both their internal body sensations and external sensory experiences could help restore a more coherent sense of self.
• Interoceptive Exposure: Gradually exposing patients to interoceptive sensations (like increased heart rate or other bodily feelings) in a controlled way could help reduce the tendency to silence these signals over time.
• Trauma-Focused Therapy: For those with a history of trauma, therapies that address dissociation and help process past traumatic experiences could also be important for recovery.

Conclusion

This new model of DPDR offers a fresh perspective on how the condition develops and why it is so distressing for those who suffer from it. It suggests that DPDR arises from a process called interoceptive silencing, where the brain blocks out body signals to cope with conflicting sensory information. Over time, this creates a fragmented sense of self, leading to the feeling of being detached from one’s own body and the world around them.

Understanding DPDR in this way opens up new treatment possibilities, such as therapies focused on reconnecting with the body and improving the integration of sensory information. By addressing the underlying sensory disruptions, individuals with DPDR may be able to regain a more unified sense of self. This model also helps explain how trauma, particularly childhood abuse, can contribute to DPDR by teaching the brain to dissociate from the body as a coping mechanism.

In summary, this new approach to understanding DPDR provides hope for better diagnosis, treatment, and support for those struggling with this often – misunderstood disorder. With the right interventions, individuals with DPDR can work towards feeling more connected to themselves and the world around them.