Högskolan i Skövde

Depersonalization-Derealization Disorder (DPD) is a complex dissociative condition marked by persistent or recurrent experiences of emotional numbing, disembodiment, and detachment from the self or surroundings. Despite its profound impact on daily functioning, the neurobiological mechanisms underlying DPD remain underrecognized. This systematic review synthesizes findings from ten peer-reviewed functional magnetic resonance imaging (fMRI) studies to explore the neural correlates and large-scale brain network disruptions associated with DPD. Consistent evidence points to reduced activity in emotion-processing regions, including the amygdala and anterior insula, alongside increased activation in prefrontal areas involved in cognitive control and emotional regulation. These patterns support the hypothesis of top-down modulation, wherein emotional signals are cognitively acknowledged but remain physiologically blunted. In addition, several studies revealed disrupted connectivity within and between key networks most notably the Default Mode Network (DMN), Frontoparietal Network (FPN), and Sensorimotor Network (SMN) which are essential for maintaining self-awareness, interoceptive integration, and bodily perception. These neurofunctional abnormalities reflect the subjective phenomena frequently reported by individuals with DPD: emotional detachment, a disrupted sense of self, and the feeling of being a passive observer in one’s own life. The findings converge to suggest that DPD is not merely a psychological reaction, but a disorder rooted in identifiable disruptions to the brain’s emotional and self-processing architecture. Recognizing these patterns may guide the development of more precise, neuroscience-informed interventions for those affected.