What Happens in Your Brain During Mental Dissociation? A Quest Towards Neural Markers of a Unified Sense of Self

  • Stephanie Cacioppo
Personality and Impulse Control Disorders (R Lee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Personality and Impulse Control Disorders


Whether you feel dissociated from the rest of the world or from yourself, you feel some kind of mental dissociations. Each form of mental dissociations varies in symptomatology and associated deficits. Nevertheless, psychiatrists, neurologists, and neuroscientists have discussed, for decades, the possibility of a holistic neural mechanism underlying the core feature of mental dissociations, i.e., disruption of a unified sense of self and a failure to accurately integrate multisensory information between self and social environment. Recently, functional and electrical neuroimaging studies shed light on this question by pointing to a correlation between the core symptomatology of mental dissociations and temporo-parietal junction (TPJ)—an area involved in sense of self, agency, perspective taking, and multimodal integration of somatosensory information. Interestingly, results also suggest that each specific aspect of each form of mental dissociation is associated with brain areas that are specific to that domain.


Brain Dissociation Sense of self Social disconnection Social connections Embodiment/disembodiment Electrical neuroimaging Functional neuroimaging Mirror neuron system (MNS) Temporo-parietal junction (TPJ) Social self Loneliness Out-of-body experience Interpersonal processes 


Compliance with Ethical Standards

Conflict of Interest

Dr. Stephanie Cacioppo declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Cacioppo JT, Patrick B. Loneliness: human nature and the need for social connection. New York: W. W. Norton & Company; 2008.Google Scholar
  2. 2.•
    Blanke O, Faivre N, Dieguez S. Leaving the body and life behind: out-of-body and near death experience. In: Layreys S, Gosseries O, Torroni G, editors. The neurology of consciousness, vol. Chapter 20. 2nd ed. 2016. p. 323–47. This chapter provides an overview of the literature on this topic and extends review to near death experiences.Google Scholar
  3. 3.
    Sierra M. Depersonalization: a new look at a neglected syndrome. Cambridge, UK: Cambridge University Press; 2009.CrossRefGoogle Scholar
  4. 4.
    Benson AJ. Spatial disorientation—common illusions, third edition. Aviation Med Butterworth Heinmann Oxford. 1999;1:437–54.Google Scholar
  5. 5.
    Tormes FR, Guedry FE. Disorientation phenomena in naval helicopter pilots. Aviat Space Environ Med. 1974;46:387–93.Google Scholar
  6. 6.
    Cicogna PC, Bosinelli M. Consciousness during dreams. Conscious Cogn. 2001;10:26–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Cacioppo JT, Hawkley LC, Ernst JM, Burleson M, Berntson GG, Nouriani B, et al. Loneliness within a nomological net: an evolutionary perspective. J Res Pers. 2006;40:1054–85.CrossRefGoogle Scholar
  8. 8.
    Cacioppo JT, Hughes ME, Waite LJ, Hawley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging. 2006;21:140–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci. 2009;13(10):447–54.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Spitellie PH, Holmes MA, Domino KB. Awareness during anesthesia. Anesthesiol Clin North Am. 2002;20:555–70.CrossRefGoogle Scholar
  11. 11.
    Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707.CrossRefPubMedGoogle Scholar
  12. 12.
    Sandin RH. Awareness 1960–2002, explicit recall of events during general anaesthesia. In: Advances in modelling and clinical application of intravenous anaesthesia. Berlin: Springer; 2003. p. 135–47.CrossRefGoogle Scholar
  13. 13.
    Muldoon SJ, Carrington H. The phenomena of astral projection. London: Rider & Co.; 1969.Google Scholar
  14. 14.
    Diagnostic and statistical manual of mental disorders (5th ed.) American Psychiatric Association. 2013.Google Scholar
  15. 15.
    Bünning S, Blanke O. The out-of body experience: precipitating factors and neural correlates. Prog Brain Res. 2005;150:331–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Blanke O, Landis T, Spinelli L, Seeck M. Out-of-body experience and autoscopy of neurological origin. Brain. 2004;127:243–58.CrossRefPubMedGoogle Scholar
  17. 17.
    Blanke O, Ortigue S, Landis T, Seeck M. Neuropsychology: stimulating illusory own-body perceptions. Nature. 2002;419:269–70.CrossRefPubMedGoogle Scholar
  18. 18.
    Arzy S, Seeck M, Ortigue S, Spinelli L, Blanke O. Induction of an illusory shadow person. Nature. 2006;443:287.CrossRefPubMedGoogle Scholar
  19. 19.
    Devinsky O, Feldmann E, Burrowes K, Bromfield E. Autoscopic phenomena with seizures. Arch Neurol. 1989;46:1080.CrossRefPubMedGoogle Scholar
  20. 20.
    Brugger P. Reflective mirrors: perspective-taking in autoscopic phenomena. Cogn Neuropsychiatry. 2002;7:179–94.CrossRefPubMedGoogle Scholar
  21. 21.
    Brugger P, Regard M, Landis T. Illusory reduplication of one’s own body: phenomenology and classification of autoscopic phenomena. Cogn Neuropsychiatry. 1997;2:19–38.CrossRefPubMedGoogle Scholar
  22. 22.
    Anzelotti F, Onofrj V, Maruotti V, Ricciardi L, Franciotti R, Bonanni L, et al. Autoscopic phenomena: case report and review of literature. Behav Brain Funct. 2011;7:2.CrossRefGoogle Scholar
  23. 23.
    Menninger-Lerchenthal E. Das Truggebilde der eigenen Gestalt (Heautoskopie, Doppelganger). Berlin: Karger; 1946.Google Scholar
  24. 24.
    Alvarado CS. Out-of-body experiences. Varieties of anomalous experiences. American Psychological Association, Washington, DC, 2000; pp. 183–218.Google Scholar
  25. 25.
    Fulanetto T, Bertone C, Becchio C. The bilocated mind: new perspectives on self-localization and self-identification. Frontiers Hum Neurosci. 2013;7:71.Google Scholar
  26. 26.
    Fere C. Report on autoscopic or mirror hallucinations and altruistic hallucinations. 1891. Epilepsy Behav. 2009;16:214–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Occhionero M, Cicogna PC. Autoscopic phenomena and one’s own body representation in dreams. Conscious Cogn. 2011;20:1009–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Lopez C, Blanke O. Neuropsychology and neurophysiology of self-consciousness. Multisensory and vestibular mechanisms, in Hirnforschung und Menschenbild. In: Holderegger A, Sitter-Liver B, Hess CW, Rager G, Holderegger A, Sitter-Liver B, Hess CW, Rager G, editors. Beiträge zur interdisziplinären Verständigung. Fribourg, Basel: Academic Press; 2007. p. 183–206.Google Scholar
  29. 29.
    Brugger P, Agosti R, Regard M, Wieser H-G, Landis T. Heautoscopy, epilepsy, and suicide. J Neurol Neurosurg Psychiatry. 1994;57:838–9.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Blackmore S. Out-of-body experiences in schizophrenia a questionnaire survey. J Nerv Ment Dis. 1986;174:615–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Arzy S, Mohr C, Michel CM, Blanke O. Duration and not strength of activation in temporo-parietal cortex positively correlates with schizotypy. Neuroimage. 2007;35:326–33.CrossRefPubMedGoogle Scholar
  32. 32.
    Lhermitte J. L’image de notre corps. Paris: Editions L’Harmattan; 1998.Google Scholar
  33. 33.
    Hecaen H, Green A. Sur l’heautoscopie. A propos de quelques cas recents. Encéphale. 1957;46:581–94.PubMedGoogle Scholar
  34. 34.
    Mohr C, Blanke O, Brugger P. Perceptual aberrations impair mental own-body transformations. Behav Neurosci. 2006;120:528.CrossRefPubMedGoogle Scholar
  35. 35.
    Murray C, Fox J. The out-of-body experience and body image: differences between experients and nonexperients. J Nerv Ment Dis. 2005;193:70–2.CrossRefPubMedGoogle Scholar
  36. 36.
    Murray C, Fox J. Dissociational body experiences: differences between respondents with and without prior out-of-body-experiences. Br J Psychol. 2005;96:441–56.CrossRefPubMedGoogle Scholar
  37. 37.
    Terhune DB. The incidence and determinants of visual phenomenology during out-of-body experiences. Cortex. 2009;45:236–42.CrossRefPubMedGoogle Scholar
  38. 38.
    Braithwaite JJ, Samson D, Apperly I, Broglia E, Hulleman J. Cognitive correlates of the spontaneous out-of-body experience (OBE) in the psychologically normal population: evidence for an increased role of temporal-lobe instability, body-distortion processing, and impairments in own-body transformations. Cortex. 2011;47:839–53.CrossRefPubMedGoogle Scholar
  39. 39.
    Blackmore S. Beyond the body: an investigation of out-of-body experiences. Chicago: Academy Chicago Publications; 1992.Google Scholar
  40. 40.
    Blanke O, Mohr C. Out-of-body experience, heautoscopy, and autoscopic hallucination of neurological origin: implications for neurocognitive mechanisms of corporeal awareness and self consciousness. Brain Res Rev. 2005;50:184–99.CrossRefPubMedGoogle Scholar
  41. 41.
    Maillard L, Vignal JP, Anxionnat R, Taillandier-Vespignani L. Semiologic value of ictal autoscopy. Epilepsia. 2004;45:391–4.CrossRefPubMedGoogle Scholar
  42. 42.
    Ionta S, Martuzzi R, Salomon R, Blanke O. The brain network reflecting bodily self-consciousness: a functional connectivity study. Soc Cogn Affect Neurosci. 2014;9:1904–13.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Easton S, Blanke O, Mohr C. A putative implication for fronto-parietal connectivity in out-of-body experiences. Cortex. 2009;45:216–27.CrossRefPubMedGoogle Scholar
  44. 44.
    Bolognini N, Ladavas E, Farne A. Spatial perspective and coordinate systems in autoscopy: a case report of a “fantome de profil” in occipital brain damage. J Cogn Neurosci. 2010;23:1741–51.CrossRefPubMedGoogle Scholar
  45. 45.
    Lobel E, Kleine J, Leroy-Wilig A, Bihan D, Berthoz A. Functional MRI of galvanic vestibular stimulation. J Neurophysiol. 1999;80:2699–709.Google Scholar
  46. 46.
    Rizzolatti G, Fogassi L. The mirror mechanism: recent findings and perspectives. Phil Transac Royal Soc B Biol Sci. 2014;369:20130420.CrossRefGoogle Scholar
  47. 47.
    Arzy S, Thut G, Mohr C, Michel CM, Blanke O. Neural basis of embodiment: distinct contributions of temporoparietal junction and extrastriate body area. J Neurosci. 2006;26:8074–81.CrossRefPubMedGoogle Scholar
  48. 48.
    Heydrich L, Blanke O. Distinct illusory own-body perceptions caused by damage posterior insula and extrastriate cortex. Brain. 2013;136:790–803.CrossRefPubMedGoogle Scholar
  49. 49.
    Phillips ML, Medford N, Senior C, Bullmore ET, Suckling J, Brammer MJ, et al. Depersonalization disorder: thinking without feeling. Psychiatry Res. 2001;108:145–60.CrossRefPubMedGoogle Scholar
  50. 50.
    Lemche E, Surguladze SA, Giampietro VP, Anilkumar A, Brammer MJ, Sierra M, et al. Limbic and prefrontal responses to facial emotion expressions in depersonalization. Neuroreport. 2007;18:473–37.CrossRefPubMedGoogle Scholar
  51. 51.
    Lemche E, Surguladze SA, Brammer MJ, Phillips ML, Sierra M, David AS, Williams SC, Giampietro VP. Dissociable brain correlates for depression, anxiety, dissociation, and somatization in depersonalization-derealization disorder. CNS Spectr. 2013; Sep 23: 1–8.Google Scholar
  52. 52.
    Medford N, Brierley B, Brammer M, Bullmore ET, David AS, Phillips ML. Emotional memory in depersonalization disorder: a functional MRI study. Psychiatry Res. 2006;148:93–102.CrossRefPubMedGoogle Scholar
  53. 53.
    Peplau LA, Perlman D. Perspectives on loneliness. In: Peplau LA, Perlman D, editors. Loneliness: a sourcebook of current theory, research and therapy. New York: Wiley; 1982. p. 1–8.Google Scholar
  54. 54.
    Weiss RS. Loneliness: the experience of emotional and social isolation. Cambridge, MA: MIT Press; 1973.Google Scholar
  55. 55.
    Cacioppo JT, Fowler JH, Christakis NA. Alone in the crowd: the structure and spread of loneliness in a large social network. J Pers Soc Psychol. 2009;97:977–91.PubMedCentralCrossRefPubMedGoogle Scholar
  56. 56.
    Cacioppo S, Cacioppo JT. Do you feel lonely? You are not alone: lessons from social neuroscience. Frontiers in Neuroscience for Young Minds, 2013; November 9.Google Scholar
  57. 57.
    Tillich P. The external now. In H. Feifel (Ed.) The meaning of death (pp. 30–38). New York: McGraw-Hill. 1959Google Scholar
  58. 58.•
    Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: clinical import and interventions. Perspect Psychol Sci. 2015;10:238–49. This article reviews the clinical import and interventions of loneliness.CrossRefPubMedGoogle Scholar
  59. 59.
    Booth R. Loneliness as a component of psychiatric disorders. Medscape Gen Med. 2000;2:1–7.CrossRefGoogle Scholar
  60. 60.
    Meares R, Gerull F, Stevenson J, Korner A. Is self disturbance the core of borderline personality disorder? An outcome study of borderline personality factors. Aust N Z J Psychiatry. 2011;45:214–22.CrossRefPubMedGoogle Scholar
  61. 61.
    Fromm Reichmann F. Loneliness. Psychiatry. 1959;22:1–15.PubMedGoogle Scholar
  62. 62.
    Young JE. Loneliness, depression and cognitive therapy: theory and application. In: Peplau LA, Perlman D, editors. Loneliness: a sourcebook of current theory, research and therapy. New York: Wiley; 1982. p. 379–406.Google Scholar
  63. 63.
    Heinrich LM, Gullone E. The clinical significance of loneliness: a literature review. Clin Psychol Rev. 2006;26:695–718.CrossRefPubMedGoogle Scholar
  64. 64.
    Weeks DG, Michela JL, Peplau LA, Bragg ME. The relation between loneliness and depression: a structural equation analysis. J Pers Soc Psychol. 1980;39:1238–44.CrossRefPubMedGoogle Scholar
  65. 65.
    Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago health, aging, and social relations study. Psychol Aging. 2010;25:453–63.PubMedCentralCrossRefPubMedGoogle Scholar
  66. 66.
    VanderWeele TJ, Hawkley LC, Thisted RA, Cacioppo JT. A marginal structural model analysis for loneliness: implications for intervention trials and clinical practice. J Consult Clin Psychol. 2011;79:225–35.PubMedCentralCrossRefPubMedGoogle Scholar
  67. 67.
    Cacioppo JT, Cacioppo S. Social relationships and health: the toxic effects of perceived social isolation. Soc Personal Psychol Compass. 2014;8:58–72.PubMedCentralCrossRefPubMedGoogle Scholar
  68. 68.
    Cacioppo JT, Cacioppo S, Boomsma DI. Evolutionary mechanisms for loneliness. Cognition Emotion. 2014;28:3–21.CrossRefPubMedGoogle Scholar
  69. 69.
    Peplau LA, Russell D, Heim M. The experience of loneliness. In: Frieze IH, Bar Tal D, Carroll JS, editors. New approaches to social problems: applications of attribution theory. San Francisco, CA: Jossey-Bass; 1979. p. 53–78.Google Scholar
  70. 70.
    Victor CR, Scambler SJ, Bowling A, Bond J. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain. Aging Soc. 2005;25:357–75.CrossRefGoogle Scholar
  71. 71.
    Victor CR, Yang K. The prevalence of loneliness among adults: a case study of the United Kingdom. J Psychol. 2012;146:85–104.CrossRefPubMedGoogle Scholar
  72. 72.
    Griffin J. The lonely society? London: The Mental Health Foundation; 2010.Google Scholar
  73. 73.•
    Cacioppo JT, Cacioppo S, Capitanio JP, Cole SW. The neuroendocrinology of social isolation. Annu Rev Psychol. 2015;66:733–67. This article reviews the neuroendocrinology of loneliness.CrossRefPubMedGoogle Scholar
  74. 74.
    Cacioppo JT, Cacioppo S, Cole SW, Capitanio JP, Goossens L, Boomsma DI. Loneliness across phylogeny and a call for comparative studies and animal models. Perspect Psychol Sci. 2015;10:202–12. This article provides a clear review of the potential mechanisms of loneliness across phylogeny.CrossRefPubMedGoogle Scholar
  75. 75.•
    Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness. Psychol Bull. 2014;140:1464–504. This article reviews the neural bases of loneliness.CrossRefPubMedGoogle Scholar
  76. 76.
    Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10:227–37.CrossRefPubMedGoogle Scholar
  77. 77.
    Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012;74:907–14.PubMedCentralCrossRefPubMedGoogle Scholar
  78. 78.
    Cacioppo JT, Norris CJ, Decety J, Monteleone G, Nusbaum H. In the eye of the beholder: individual differences in perceived social isolation predict regional brain activation to social stimuli. J Cogn Neurosci. 2009;21:83–92.PubMedCentralCrossRefPubMedGoogle Scholar
  79. 79.
    Cacioppo S, Balogh S, Cacioppo JT. Implicit attention to negative social, in contrast to nonsocial, words in the Stroop task differs between individuals high and low in loneliness: evidence from event-related brain microstates. Cortex. 2015;70:213–33.CrossRefPubMedGoogle Scholar
  80. 80.
    Cacioppo S, Bangee M, Balogh S, Cardenas-Iniguez C, Qualter P, Cacioppo JT. Loneliness and implicit attention to social threat: a high performance electrical neuroimaging study. Cognitive Neuroscience 2015; Aug 14: 1–22.Google Scholar
  81. 81.
    Delgado MR, Miller MM, Inati S, Phelps EA. An fMRI study of reward-related probability learning. Neuroimage. 2005;24:862–73.CrossRefPubMedGoogle Scholar
  82. 82.
    Cacioppo S, Bianchi-Demicheli F, Frum C, Pfaus JG, Lewis JW. The common neural bases between sexual desire and love: a multilevel kernel density fMRI analysis. J Sex Med. 2012;9:1048–54.CrossRefPubMedGoogle Scholar
  83. 83.
    Rilling J, Gutman D, Zeh T, Pagnoni G, Berns G, Kilts C. A neural basis for social cooperation. Neuron. 2002;35:395–504.CrossRefPubMedGoogle Scholar
  84. 84.
    Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012;22:1975–9.PubMedCentralCrossRefPubMedGoogle Scholar
  85. 85.
    Kanai R, Bahrami B, Roylance R, Rees G. Online social network size is reflected in human brain structure. Proceed Royal Soc Biol Sci. 2012;279:1327–34.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral Neuroscience, Biological Sciences DivisionThe University of Chicago Pritzker Medical SchoolChicagoUSA

Personalised recommendations