The Two-Stage Evacuation Model: Neurobiological Mechanisms of Depersonalization/Derealization as Hierarchical Autonomic Shutdown in Disorganized Attachment
Zenodo (CERN European Organization for Nuclear Research) February 23, 2026 Flemming Bust
Depersonalization and derealization (DP/DR) may result from a predictable two-stage autonomic shutdown sequence in people with disorganized attachment histories. Stage 1 involves loss of bodily awareness due to reduced anterior insula activity, shifting consciousness into excessive prefrontal cortex cognition. Stage 2 occurs when prefrontal processing is overwhelmed, triggering a dorsal vagal shutdown mediated by the ventrolateral periaqueductal gray and flooding of dynorphin/kappa-opioid receptors, producing the experience of depersonalization and derealization. The model proposes chronic depletion of the endocannabinoid anandamide as the missing link, removing a buffer that normally prevents this shutdown. Evidence includes drug-induced dissociation and opioid-receptor blocker reversal studies.