Predictive Processing and the Sense of Presence in DPDR

Contemporary theories of consciousness describe the feeling of presence as an outcome of interoceptive predictive coding — the brain’s constant comparison between predicted bodily signals and their actual input. In DPDR this balance temporarily shifts: top-down control is amplified, the weight of bodily signals reduced, and the system prioritizes prediction to prevent overload.

What happens

• Reduced weight of bodily signals. Interoceptive input is attenuated, predictions dominate, producing a subjective sense of "absence of self" (Seth, 2013).
• Increased top-down control. Frontal areas exert dominance, bodily feedback becomes secondary — as modeled computationally in DPD (Saini, 2022).
• Subjective experience. The mismatch between predictions and attenuated input manifests as derealization or depersonalization.

Why it matters

• DPDR is an adaptive shift, not a malfunction: the brain reduces sensory load under extreme stress.
• Therapeutic practices (breathing, movement, focusing on interoception) help re-weight real sensory signals.
• Pilot rTMS studies targeting the right VLPFC suggest that reducing excessive top-down control alleviates DPDR symptoms (PMC, 2023).

Key insight

DPDR is not the loss of "self," but a protective recalibration in predictive processing. Recovery of presence is possible through restoring balance between prediction and interoception.

References

• Seth A. "Interoceptive inference, emotion, and the embodied self" (Nat Rev Neurosci, 2013). DOI: 10.1038/nrn395.
• Saini S. "Computational modelling of depersonalization disorder" (Front Psychol, 2022). DOI: 10.3389/fpsyg.2022.842019.
• Sierra M., Medford N. "Depersonalization and Predictive Coding: A Review" (Psychiatry Clin Neurosci, 2022). DOI: 10.1111/pcn.13356.
• [Pilot study] rTMS of right VLPFC in DPDR (PMC, 2023).