Mutation-dependent responses to sleep and exercise in clonal haematopoiesis.

Depersonalization-derealization disorder (DPD) is a dissociative disorder involving profound disconnection and detachment from one’s sense of self (depersonalization) and environment (derealization). Depersonalization experiences are common in the general population, affecting up to 74% of individuals at some point in their lives and, therefore, can be conceptualized as a dimensional construct spanning from non-pathological to pathological experiences []. These experiences typically manifest as transient feelings of being on “autopilot,” feeling “spaced out,” or perceiving oneself or the environment as “unreal.” Despite being the third most common psychiatric symptom after depressed mood and anxiety, the underlying mechanisms and phenomenology of depersonalization experiences remain poorly understood [, ]. DPD is characterized by altered bodily experiences and disconnection from bodily signals, including physiological affective signals []. However, the full extent and phenomenology of this bodily disconnection remain unknown. Disconnection from emotional experiences has been consistently linked with depersonalization since early conceptualizations of the disorder []. Factor analyses have identified emotional numbing (i.e., “de-affectualization”) as a predominant feature of DPD [, ], with most DPD participants endorsing some level of attenuated emotion experience, including a blunting of emotion and loss of pleasure and/or affection []. Included in this factor is the reduced ability to experience some bodily sensations, suggesting some level of emotion disembodiment in DPD. Along those lines, the inability to detect or feel connected to internal signals more broadly, such as hunger and thirst signals, has been identified as a core mechanism underlying dissociative experiences, suggesting alterations in interoceptive processing []. The severity of emotional detachment varies significantly among individuals with DPD, ranging from a complete inability to feel distinct emotional states to experiencing emotions in a muted manner []. Furthermore, these individuals often experience a disconnect from their autobiographical memories, frequently describing minimal emotional resonance with past experiences and perceiving these memories from an observer’s perspective. This “emotional coloring” appears to be a core component of perceptual changes in DPD, contributing to the characteristic sensation that one’s reality is somehow artificial or unreal []. In DPD, individuals demonstrate reduced physiological response when viewing affective stimuli compared to control participants and patients with anxiety []. Similarly, Lawrence et al. [] measured physiological arousal, while participants read emotive diary extracts and found that individuals with DPD exhibited incongruent speech patterns to the emotional content (e.g., accelerated speech during the sad vignette). This research suggests some level of cognitive-physiological disconnect with affective processes in DPD, and some degree of reduced embodiment as individuals are less attuned to physiological signals and speech production associated with affective responses. Therefore, altered emotion processing may be an important driver in the conceptualization and maintenance of DPD.