The Two-Stage Evacuation Model: Neurobiological Mechanisms of Depersonalization/Derealization as Hierarchical Autonomic Shutdown in Disorganized Attachment

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.

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Abstract

This paper proposes the Two-Stage Evacuation Model, a neurobiologically grounded theoretical framework reframing Depersonalization/Derealization (DP/DR) as a predictable, hierarchical autonomic shutdown sequence in individuals with disorganized attachment histories. Stage 1 (Somatic-to-Cortical Flight) involves evacuation of interoceptive awareness via anterior insula hypoactivation, forcing conscious processing into prefrontal cortex hyper-cognition. Stage 2 (Cortical-to-Dissociative Collapse) occurs when PFC processing capacity is overwhelmed, defaulting to ventrolateral periaqueductal gray (vlPAG)-mediated dorsal vagal shutdown and dynorphin/kappa-opioid receptor (KOR) flooding — producing the phenomenological experience of depersonalization and derealization. The paper introduces the ECS-Depletion Hypothesis as the missing mechanistic bridge: chronic anandamide depletion via FAAH upregulation removes the tonic inhibitory buffer that prevents disinhibited vlPAG activation, while early life stress simultaneously sensitizes the KOR system. The model predicts differential vulnerability across ABM attachment profiles, with the Special Forces profile (disorganized/vlPAG-dominant) uniquely predisposed to the full two-stage sequence. Pharmacological validation includes KOR agonist-induced dissociation (Salvinorin A) and naloxone/naltrexone reversal studies. Clinical implications support a strict hardware-first intervention sequence: ECS restoration before interoceptive re-entry before cognitive consolidation. Part of the ABM Blueprint Independent Research Series. For clinical tools and implementation, visit abm-blueprint.org. This preprint has not been peer-reviewed. Published under open access for scholarly discussion. Paper 23 in the ABM Blueprint Independent Research Series. The Two-Stage Evacuation Model introduces the ECS-Depletion Hypothesis as a novel mechanistic bridge between disorganized attachment and dissociative collapse — a contribution absent from existing DP/DR literature. ORCID: 0009-0002-3770-5007.