Autoscopic Hallucination Research Articles

Conectividad funcional en un paciente con alucinaciones complejas. Un caso de autoscopia

La autoscopia, del griego autos (sí mismo) y skopeo (mirar), son alucinaciones complejas durante las cuales el paciente experimenta una duplicación visual de su cuerpo. El presente artículo discute algunos correlatos de conectividad cerebral obtenida por resonancia funcional en reposo, en una paciente con epilepsia refractaria y alucinaciones autoscópicas durante sus crisis.
 El objetivo es presentar los hallazgos por neuroimágenes funcionales de una paciente que presenta alucinaciones del tipo autoscópico.
 Como parte del protocolo de evaluación de pacientes con epilepsia refractaria se realiza examen de videomonitoreo electroencefalográfico, imágenes de tomografía por emisión de positrones e imágenes de resonancia magnética funcional en reposo a una paciente que sufre alucinaciones autoscópicas durante las crisis. La información obtenida por estos estudios se correlaciona con la información clínica.
 En la paciente, el estudio de tomografía por emisión de positrones y el videomonitoreo electroencefalográfico indican alteraciones en el lóbulo occipital derecho, hallazgos que coinciden con reportes en la literatura sobre autoscopia. La sincronización neuronal, medida por resonancia funcional, es anormal en la misma región alterada en la tomografía por emisión de positrones, permitiendo relacionar el fenómeno autoscópico con cambios de la conectividad cerebral. La paciente cuenta con características clínicas de alucinación autoscópica. La resonancia magnética indica zonas con alteraciones de la dinámica cerebral que, en el caso de la paciente, coinciden con regiones reportadas en la literatura. El presente estudio aporta evidencias sobre el papel de los mecanismos de sincronización neuronal y la percepción de alucinaciones.

Heautoscopic hallucinations in first episode psychosis: report of one case and clinical overview

ABSTRACT Background Heautoscopic hallucinations are rare visual experiences consisting of the perception of the image of one’s own body or face within space. Method The point of view can be internal, like in front of a mirror, or external. Results Heautoscopic phenomena are classified among the disorders of somatoagnosia, or disorders related to the alteration of the body schema. It is not clear which sensory system is primarily involved in the generation of this alteration. Discussion This case report discusses a 21-year-old male student with first episode psychosis who presented heautoscopic hallucinations. His neurological and medical examinations were unremarkable. By explaining the theoretical background on the heterogeneity of autoscopic phenomena in psychiatric and neurological disease, our clinical observation contributes for the first time to enrich the literature on autoscopic hallucinations in patients with non-affective psychosis.

Common and distinct brain networks of autoscopic phenomena

ObjectiveAutoscopic phenomena (AP) are illusory own body reduplications characterized by the visual perception of a second own body in extrapersonal space, and include three main forms: autoscopic hallucination (AH), heautoscopy (HAS) and out-of-body-experience (OBE). Past research showed that lesions were heterogeneously distributed and affected many different brain regions within and across patients, while small case series suggested that AP lesions converge in temporo-parietal and parieto-occipital cortex. As only few studies investigated each form of AP separately, it remains unknown whether the three AP are characterized by common and distinct brain mechanisms. MethodsHere, we applied lesion network analysis in 26 neurological AP patients and determined their common and distinct functional connectivity patterns. ResultsWe report that all localize to a single common brain network at the bilateral temporo-parietal junction, further associated with specific patterns of functional connectivity, defining each type of AP. OBE resulted from a brain network connected to bilateral angular gyrus, right precuneus, and right inferior frontal gyrus, differing from AH with a brain network connected to bilateral precuneus, inferior temporal gyrus, and cerebellum. HAS resulted from a brain network connected to left inferior frontal gyrus, left insula and left parahippocampus. ConclusionThe present data identify the temporo-parietal junction as the common core region for AP and show that each form of AP recruits additional specific networks, associated with different sensorimotor and self-related sub-networks.

The Existence of Autoscopic Hallucination ?- A Case Report and Review of Literature

The Existence of Autoscopic Hallucination ?- A Case Report and Review of Literature

An unusual Case of Autoscopic Hallucination: A Case Report and Review of Literature

An unusual Case of Autoscopic Hallucination: A Case Report and Review of Literature

28.4 FLEXIBLE BODY BOUNDARY AND ALTERED MAPPING OF THE BODILY SELF IN THE SCHIZOPHRENIA SPECTRUM: CAUSES, PROCESSES AND POTENTIAL INTERVENTION

BackgroundOur sense of embodied self depends on continuous spatiotemporal integration and predictive coding of multisensory signals to yield a stable internal landscape. However, schizophrenia is characterized by inconsistent mapping of the physical and parasomatic body space, autoscopic hallucinations and flexible body self boundary. We aimed to elucidate the specific roles of exteroceptive, proprioceptive and interoceptive systems in generating self disturbances. Lastly, if schizophrenia represents one end of the spectrum of bodily self disorders, it is also important to understand what lies at the other extreme end, represented by those whose prediction coding is honed to perfection from years of training (athletes) to gain insight into potential remediation strategies.MethodsIn Study 1, components of bodily self-disturbances were examined in individuals with schizophrenia (SZ), matched controls (CO) and prodromal participants (P) with tasks that assessed tactile perception (2-point discrimination task), susceptibility to proprioceptive-tactile illusions, multisensory integration, visual body mapping of emotions (emBODY), and interoceptive awareness (heartbeat detection task). Phenomenological dissociative experiences were captured with a novel picture-based inventory (BODI). In Study 2, we recruited healthy participants with extraordinary expertise to coordinate interoceptive, proprioceptive and exteroceptive signals to perform physical tasks (athletes), and compared their embodiment of emotions with that of matched controls and individuals with schizophrenia.ResultsIndividuals with schizophrenia and prodromal participants were impaired in interoceptive awareness, exteroceptive tactile discrimination, and audio-visual integration compared with matched control groups. SZ and P also showed increased sensitivity to proprioceptive illusions, which was associated with increased dissociative experiences and positive syndromes. Bodily sensations associated with emotions were reduced in SZ and P compared to CO. Importantly, the spatial locations of embodied emotions were different in SZ compared with CO. Interestingly, athletes showed highly precise localization of embodied emotions compared with matched controls. Self-disturbances were exacerbated by social isolation regardless of diagnosis.DiscussionThese results suggest that mapping of internal signals to the experience of external world is inconsistent or incoherent, contributing to fragmented and discontinuous self experience in persons with schizophrenia. More specifically, proprioceptive prediction errors seem to contribute to abnormally flexible self boundary. Diminished access to interoceptive signals may lead to reduced mapping of bodily sensations. Embodied emotions were reduced in SZ and P compared to CO. Athletes seemed to have much more precisely tuned awareness of embodied emotions. These results are consistent with the framework of increased internal neural noise in schizophrenia, which could lead to both weakened and poorly integrated interoceptive, proprioceptive and exteroceptive signaling, and a fragmented sense of self. Athletes data suggest that it may be possible to remediate bodily self disturbances via physical training. These findings underscore the importance of bringing back the body to psychiatry.

Functional and Neural Mechanisms of Out-of-Body Experiences: Importance of Retinogeniculo-Cortical Oscillations

Current research on the various forms of autoscopic phenomena addresses the clinical and neurological correlates of out-of-body experiences, autoscopic hallucinations, and heautoscopy. Yet most of this research is based on functional magnetic resonance imaging results and focuses predominantly on abnormal cortical activity. Previously we proposed that visual consciousness resulted from the dynamic retinogeniculo-cortical oscillations, such that the photoreceptors dynamically integrated with visual and other vision-associated cortices, and was theorized to be mapped out by photoreceptor discs and rich retinal networks which synchronized with the retinotopic mapping and the associated cortex. The feedback from neural input that is received from the thalamus and cortex via retinogeniculo-cortical oscillations and sent to the retina is multifold higher than feed-forward input to the cortex. This can effectively translate into out-of-body experiences projected onto the screen formed by the retina as it is perceived via feedback and feed-forward oscillations from the reticular thalamic nucleus, or “internal searchlight”. This article explores the role of the reticular thalamic nucleus and the retinogeniculo-cortical oscillations as pivotal internal components in vision and various autoscopic phenomena.

PHANTOM PHENOMENA

Peter Brugger, born 1957 in Zurich, Switzerland. Acquired a teacher's Diploma for Elementary and High School levels before studying biology at Zurich University. Dissertation on Subjective Randomness: Implications for Neuropsychology...

A Case of Schizophrenia with Multiple Unusual Symptoms: A Case Report from Iran

We intend to report a case of Schizophrenia whom was presented with multiple rare and interesting symptoms. He showed perseveration, autoscopic hallucination and confabulation. The patient is a 23 years old man that his problems started about five years ago with bizarre behavior; self-talking, autoscopic hallucination, seeing himself at past. In this exacerbation; had poverty of content of thought, commanding auditory hallucination and elementary visual hallucination. About Autoscopic hallucination, our current data mentions this fact that several brain mechanisms are involved in Autoscopic Hallucination, hence we suggest that since Schizophrenia accompanies with several brain changes, these changes led to Autoscopic Hallucination in this patient. Our patient's confabulation is Schizophrenic confabulation that is due to his poverty of content of thought and is not related to any neurological disorder.

Distinct illusory own-body perceptions caused by damage to posterior insula and extrastriate cortex

Recent research in cognitive neuroscience using virtual reality, robotic technology and brain imaging has linked self-consciousness to the processing and integration of multisensory bodily signals. This work on bodily self-consciousness has implicated the temporo-parietal, premotor and extrastriate cortex and partly originated in work on neurological patients with different disorders of bodily self-consciousness. One class of such disorders is autoscopic phenomena, which are defined as illusory own-body perceptions, during which patients experience the visual illusory reduplication of their own body in extrapersonal space. Three main forms of autoscopic phenomena have been defined. During autoscopic hallucinations, a second own body is seen without any changes in bodily self-consciousness. During out-of-body experiences, the second own body is seen from an elevated perspective and location associated with disembodiment. During heautoscopy, subjects report strong self-identification with the second own body, often associated with the experience of existing at and perceiving the world from two places at the same time. Although it has been proposed that each autoscopic phenomenon is associated with different impairments of bodily self-consciousness, past research on neurological patients and the development of experimental paradigms for the study of bodily self-consciousness has focused on out-of-body experiences and the association with temporo-parietal cortex. Here, we performed quantitative lesion analysis in the-to date-largest group of patients with autoscopic hallucination and heautoscopy and compared the location of brain damage with those of control patients suffering from complex visual hallucinations. We found that heautoscopy was associated with lesions to the left posterior insula, and that autoscopic hallucinations were associated with damage to the right occipital cortex. Autoscopic hallucination and heautoscopy were further associated with distinct symptoms and deficits. The present data suggest that the autoscopic hallucination is a visuo-somatosensory deficit implicating extrastriate cortex and is, despite the visual hallucination of the own body, not associated with major deficits in bodily self-consciousness. Based on the symptoms and deficits in patients with heautoscopy and the implication of the left posterior insula, we suggest that abnormal bodily self-consciousness during heautoscopy is caused by a breakdown of self-other discrimination regarding affective somatosensory experience due to a disintegration of visuo-somatosensory signals with emotional (and/or interoceptive) bodily signals. These brain mechanisms are distinct from those described for out-of-body experiences. The present data extend previous models of autoscopic phenomena and provide clinical evidence for the importance of emotional and interoceptive signal processing in the posterior insula in relation to bodily self-consciousness.

Autoscopic phenomena and one’s own body representation in dreams

Autoscopic phenomena (AP) are complex experiences that include the visual illusory reduplication of one's own body. From a phenomenological point of view, we can distinguish three conditions: autoscopic hallucinations, heautoscopy, and out-of-body experiences. The dysfunctional pattern involves multisensory disintegration of personal and extrapersonal space perception. The etiology, generally either neurological or psychiatric, is different. Also, the hallucination of Self and own body image is present during dreams and differs according to sleep stage. Specifically, the representation of the Self in REM dreams is frequently similar to the perception of Self in wakefulness, whereas in NREM dreams, a greater polymorphism of Self and own body representation is observed. The parallels between autoscopic phenomena in pathological cases and the Self-hallucination in dreams will be discussed to further the understanding of the particular states of self awareness, especially the complex integration of different memory sources in Self and body representation.

Abnormal self-location and vestibular vertigo in a patient with right frontal lobe epilepsy

We describe the case of a 33-year-old man with complex partial seizures characterized by the feeling of being projected outside his body, including dissociation of “mind and self from body” (disembodiment), followed by vestibular vertigo due to right frontal lobe epilepsy caused by an oligodendroglioma. We distinguish the patient’s ictal symptoms with respect to autoscopic phenomena (out-of-body experience, heautoscopy, autoscopic hallucinations) and vestibular phenomena of epileptic origin, and we discuss their neural origin with respect to vestibular and multisensory cortical mechanisms of bodily self-consciousness in temporoparietal and frontal cortex.

Why are out-of-body experiences interesting for philosophers?: The theoretical relevance of OBE research

After decades of only sparse scientific interest, we are currently witnessing a renaissance of empirical research into out-of-body experiences (OBEs) and full-body illusions. Being a philosopher of mind, I obviously have only a limited judgment of how good this research actually is from a purely scientific point of view. What I can do, however, is to draw attention to a series of theoretical aspects that make OBEs a particularly relevant target of investigation in the ongoing search for the neural correlate of self-consciousness and in the wider context of an empirically grounded theory of the human mind. Firstly, and most basically, this type of research has a great potential for conceptual differentiation. By more clearly distinguishing different types of neurological disorders affecting the sense of self, it will help to improve the taxonomy of selfrelated disorders. Introducing more fine grained conceptual distinctions will have diagnostic, and perhaps also therapeutic value, because it contributes to our taxonomy of hallucinations and deviant forms of self-modeling (see Metzinger, 2003, chapter 7) involving dimensions like ‘‘self-location’’ and ‘‘selfidentification’’. The four main types are autoscopic hallucination, heautoscopy, OBE, and the feeling of a presence – all due to multisensory disintegration and damage to temporo-parietal and temporo-occipital cortex (Blanke and Mohr, 2005; Blanke and Castillo, 2007). Autoscopic phenomena show that not only identification with and localization of body parts, but also of the global conscious representation of the entire body can be disturbed. In autoscopic hallucinations and heautoscopy patients see a second own illusory body in extrapersonal space, but the two phenomena differ in terms of self-identification

Body ownership and embodiment: Vestibular and multisensory mechanisms

Body ownership and embodiment are two fundamental mechanisms of self-consciousness. The present article reviews neurological data about paroxysmal illusions during which body ownership and embodiment are affected differentially: autoscopic phenomena (out-of-body experience, heautoscopy, autoscopic hallucination, feeling-of-a-presence) and the room tilt illusion. We suggest that autoscopic phenomena and room tilt illusion are related to different types of failures to integrate body-related information (vestibular, proprioceptive and tactile cues) in addition to a mismatch between vestibular and visual references. In these patients, altered body ownership and embodiment has been shown to occur due to pathological activity at the temporoparietal junction and other vestibular-related areas arguing for a key importance of vestibular processing. We also review the possibilities of manipulating body ownership and embodiment in healthy subjects through exposition to weightlessness as well as caloric and galvanic stimulation of the peripheral vestibular apparatus. In healthy subjects, disturbed self-processing might be related to interference of vestibular stimulation with vestibular cortex leading to disintegration of bodily information and altered body ownership and embodiment. We finally propose a differential contribution of the vestibular cortical areas to the different forms of altered body ownership and embodiment.

“Seeing oneself”: a case of autoscopy

Autoscopy is the experience of seeing an image of one’s body in external space. We describe the case of a patient who reported longstanding autoscopic hallucinations following post-eclamptic brain damage. The MR scan demonstrated damage involving the occipital cortex and the basal ganglia bilaterally. We hypothesize that the image was the result of aberrant plasticity mechanisms involving cortical areas that play a central role in high-order body or representation of oneself.

Perception and experience of the self in autoscopic phenomena and self -portraiture

Autoscopic phenomena are reduplicative experiences during which the subject has the impression of seeing a double in extracorporeal space either from an embodied or disembodied visuo-spatial perspective. Autoscopic phenomena include out-of-body experience (OBE), autoscopic hallucination (AH) and heautoscopy (HAS). In an out-of-body experience, subjects feel that their self, or centre of awareness, is located outside the physical body and somewhat elevated. It is from this elevated extracorporeal location that subjects experience seeing their body and the world. An autoscopic hallucination is defined as the experience of seeing a double of oneself in extracorporeal space without leaving one's body (no disembodiment). As compared to out-of-body experiences, individuals with autoscopic hallucination experience seeing the world from their habitual visuo-spatial perspective and experience their self, or centre of awareness, inside their physical body. During heautoscopy subjects also have the experience of seeing a double in extracorporeal space (as in autoscopic hallucination). However, it is difficult for the subject to decide whether he is disembodied or not and whether the self is localised within the physical body or in the double. The present review highlights recent findings concerning phenomenological and neuro-cognitive characteristics of autoscopic phenomena of neurological origin.These findings are compared with the pictorial phenomenology of self-portraits, which may also be described as reduplicative phenomenona because self-portraits contain the painter twice: as the painting painter and the painted painter (double). The comparative analysis between the three forms of autoscopic phenomena and self-portraits revealed several phenomenological similarities suggesting that some of the neuro-cognitive mechanisms of autoscopic phenomena might also be employed by artists of self-portraits as well as beholders of such works of art. Based on this analysis a division of the genre of self-portraiture in three major types of self-portraits is proposed that reflects the characteristics of out-of-body experience (OBE self-portraits), autoscopic hallucination (AH self-portraits) and heautoscopy (HAS self-portraits). It is argued that autoscopic phenomena, which have fascinated mankind from time immemorial, might add to our understanding of the central processes that mediate self-perception and self-experience in cognitive neuroscience as well as art history.

The demystification of autoscopic phenomena: Experimental propositions

Autoscopic phenomena (AP) are rare, illusory visual experiences during which the subject has the impression of seeing a second own body in extrapersonal space. AP consist of out-of-body experience, autoscopic hallucination, and heautoscopy. Recent neurologic reports support the role of multisensory integration deficits of body-related information and vestibular dysfunctions in AP at the temporo-parietal junction. A caveat to test the underlying neurologic and cognitive mechanisms of AP has been their rare and spontaneous occurrence. Recent evidence linked AP to mental own-body imagery engaging brain mechanisms at the temporo-parietal junction. These recent observations open a new avenue for testing AP-related cognitive mechanisms in selected clinical and normal populations. We review evidence on several clinical syndromes (psychosis, depression, anxiety, depersonalization, body dysmorphic disorder), suggesting that some of these syndromes may relate to AP-proneness, thereby leading to testable propositions for future research on body and self processing in addition to AP.

Reflective mirrors: Perspective-taking in autoscopic phenomena

Introduction. “Autoscopic phenomena refer to different illusory reduplications of one's own body and self. This article proposes a phenomenological differentiation of autoscopic reduplication into three distinct classes, i.e., autoscopic hallucinations, heautoscopy, and out-of-body experiences (OBEs). Method. Published cases are analysed with special emphasis on the subject's point of view from which the reduplication is observed. Results. In an autoscopic hallucination the observer's perspective is clearly bodycentred, and the visual image of one's own body appears as a mirror reversal. Heautoscopy (i.e., the encounter with an alter ego or doppelgänger), is defined as a reduplication not only of bodily appearance, but also of aspects of one's psychological self. The observer's perspective may alternate between egocentric and “alter-ego-centred”. As a consequence of the projection of bodily feelings into the doppelgänger (implying a mental rotation of one's own body along the vertical axis), original and reduplicated bodies are not mirror images of one another. This also holds for OBEs, where one's self is not reduplicated but appears to be completely dissociated from the body and observing it from a location in extracorporeal space. It is argued that perspective-taking in a spatial sense may be meaningfully related to perspective-taking in a psychological sense. The mirror in the autoscopic hallucination is a “cognitively nonreflective mirror” (Jean Cocteau), both spatially and psychologically. The reflective abilities of the heautoscopic mirror are better developed, yet frequent shifts in the observer's spatial perspective render the nature of psychological interactions between self and alter ego highly unpredictable. The doppelgänger may serve a transitivistic (i.e., own suffering is transferred to the alter ego) or aggressive function when this behaviour is directed against a patient. The mirror in an OBE is always reflective: It allows the self to view both space and one's psychological state from a detached but stable perspective. Conclusions. Spatial perspective-taking should be more thoroughly assessed in patients reporting autoscopic phenomena. By elucidating the interactions between spatial phenomenology and psychological function, we may gain important insights into the relationships between the self, its body, and phenomenal space.

Illusory Reduplication of One's Own Body: Phenomenology and Classification of Autoscopic Phenomena

Autoscopic phenomena involve the illusory reduplication of one's own body. The literature on the topic is widely scattered and suffers from considerable terminological and conceptual inconsistencies. This article proposes a classification scheme based on phenomenological criteria. Along with examples of illustrative cases, we outline the main features of autoscopic hallucinations, heautoscopy proper, the feeling of a presence, the out-of-body experience, and negative and inner forms of autoscopic phenomena. We also discuss the need for a differentiation of autoscopic phenomena from reduplicative paramnesias and the misidentification syndromes. Finally, the concept of a neuromatrix (Melzack, 1990) is proposed as a starting point for the understanding of the neuronal mechanisms underlying autoscopic phenomena.

Sensory deprivation in autoscopic illusion, and Joseph Conrad's "The secret sharer".

The role of sensory deprivation and sensory monotony in autoscopic illusion and autoscopic hallucination is discussed. Other factors—especially intrapsychic conflict—also seem to be involved. The relationships of these factors are considered, using Conrad'sThe Secret Sharer as a basis of reference.