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 DOI: 10.5281/zenodo.18744797 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Keywords | Prefrontal cortex Startle reaction Cognition Periaqueductal gray Anterior cingulate cortex Shutdown Automatism medicine Cognitive psychology |
| Key points | Proposes that depersonalization/derealization in individuals with disorganized attachment histories results from a predictable two-stage autonomic shutdown sequence involving anterior insula hypoactivation, prefrontal cortex hyper-cognition, and dorsal vagal shutdown mediated by dynorphin/kappa-opioid receptor flooding. |
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.