Out-of-body experience, heautoscopy, and autoscopic hallucination of neurological origin

“The self has fascinated mankind from time immemorial [94] and its many concepts have been influenced by theology, philosophy, psychology [43,75,77], but also by clinical observations from neurology and psychiatry [41,58,73,74,50,89,90,93].”

“Examples of such conditions are somatoparaphrenia and associated anosognosia (Berlucchi and Aglioti, 1997, 2010; Vallar and Ronchi, 2009), phantom limb sensations (Giummarra et al., 2007), and out-of-body experiences (OBEs) (Blanke and Mohr, 2005).”

“Systematic experimental findings from the out of body illusions demonstrate that the perceived location of the self can be detached from that of the physical body, similar to reports from patients undergoing out-of-body experiences of neurological origin (Blanke and Mohr, 2005).”

“Thus, the large majority of patients with OBEs experience themselves to be seeing from an elevated and down-looking, first-person perspective (Blanke and Arzy, 2005; Blanke and Mohr, 2005), and this perspective is inverted and rotated by 180 with respect to their supine and upward-oriented physical body position (Lope…”

“…more by marshalling several sources of neuroscientific evidence that suggest that these strange experiences arise from abnormal self-processing in the temporo-parietal junction (TPJ), predominantly in the right hemisphere (for reviews see Blanke & Arzy 2005; Blanke & Mohr 2005; Mohr & Blanke 2005).”

“The main difference between these two experiences is the sense of disembodiment present in the former but not in the latter (Blanke and Mohr 2005).”

“…previous experimental (Blanke et al., 2005) and clinical findings on pathological forms of embodiment as well as disembodiment (Blanke et al., 2004; Blanke and Mohr, 2005), we here hypothesized that differences in self location (embodied vs disembodied) in the present experiment would be reflected…”

“…their own body looking at it from an altered egocentric perspective, people still report that the body they observe is their own, thus, they demonstrate intact body self-attribution, despite the fact that they are viewing the body from a 3PP (Blanke et al., 2002, 2004; Blanke and Mohr, 2005).”

“Further, somatoparaphenia, a neurological syndrome associated with dis-ownership of a body part, is most often associated with lesions in these regions [29], and right TPJ seizure focus is associated with OBEs [18,28].”

“In the case of autocopic hallucinations, lesion sites are mostly located in ight parieto-occipital and temporo-occipital cortex with ess involvement of the TPJ [13,15].”

“Questions such as “ I felt out of my body ” , can be unrelatable to the many people who have neither experienced nor heard about an autoscopic phenomena (Blanke and Mohr, 2005).”

“…disembodied self-location) and of seeing and perceiving the world and sometimes oneself from a location outside one's own physical body, as if taking a third-person perspective on one's body (Blanke, Landis, Spinelli, & Seeck, 2004; Blanke & Mohr, 2005; Blanke, Ortigue, Landis, & Seeck, 2002).”

“Moreover, selflocation may change the experienced position (between the position of the illusory and the physical body) and this may occur in rapid alternation [22,23].”

“It has been proposed that bodily self-consciousness is based on the brain’s multisensory integration of visual, vestibular, somatosensory, proprioceptive and motor signals (Haggard et al., 2003; Blanke et al., 2004; Blanke and Mohr, 2005).”

“Based on the criteria used previously (Brugger, 2002; Blanke and Mohr, 2005), we classified cases as having heautoscopy or autoscopic hallucinations based on the available data concerning the first-person perspective (e.g. from where the patients reported to perceive the world), self-location (e.g.…”

“Specifically, both FP and OBEs have been linked to lesions in the temporo-parietal junction (TPJ) and have been experimentally induced through electrical stimulation of the TPJ (Arzy et al. 2006; Blanke and Arzy 2005; Blanke and Mohr 2005; Blanke et al. 2005).”

“When synchronous visuotactile stimulation is delivered on the back (Lenggenhager et al., 2007), most participants experience the illusion of looking at their body from the outside, similarly to what is reported in OBEs of neurological origin (Blanke and Mohr, 2005).”

“…body and that a body seen below is one's own, often despite lack of correspondence of physical appearance, mode of dress, age, hair style or color, and even when the body is viewed from behind (for reviews see Blanke et al., 2004; Blanke and Mohr, 2005; Brugger et al., 1997; Devinsky et al., 1989).”

“…et al., 1994), hypercapnia (Klemenc-Ketis et al., 2010), abnormal temporal lobe dysfunctions (Blanke et al., 2002, 2004; Britton and Bootzin, 2004; Blanke and Mohr, 2005; Arzy et al., 2006; Hoepner et al., 2013), administration of sedatives (Cobcroft and Forsdick, 1993; Osterman et al., 2001;…”

“1.1 Multisensory integration The TPJ is an area of convergence for somatosensory, auditory and visual evoked responses (Matsuhashi et al., 2004) and involved in sensorimotor integration (Blanke & Mohr, 2005).”

“First, several authors have noted that abnormal forms of the first-person perspective and self-location (such as in out-of-body experiences), occurring in neurological patients and healthy subjects, depend on body position and are more frequent in subjects that are lying supine and still than in subjects sitting or st…”

“This experience of feeling outside of the physical boundaries of one's body is called ‘disembodiment’ (Blanke and Mohr, 2005; De Ridder et al., 2005).”

“Sometimes during “out-of-body” experiences individuals report that they perceive their self as being embodied in two locations at the same time (so-called heautoscopy; O Blanke & Mohr, 2005).”

“In the same vein, clinical observations of out-of-body experiences (OBEs) suggest that localized cortical lesions can induce pathological changes of first-person perspective and self-location in space (Blanke et al., 2002, 2004; Blanke and Mohr, 2005; De Ridder et al., 2007).”

“…2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd European Journal of Neuroscience, 45, 1300–1312 Brugger, 2002; Blanke et al., 2004; Blanke & Mohr, 2005), even when the illusory body has a different appearance than the patient’s body (Brugger, 2002; Blanke & Mohr, 2005).”

“…et al., 2012; Ehrsson et al., 2004; Gentile et al., 2011; Petkova et al., 2011; Shimada et al., 2005; Tsakiris, 2010), and occipito-temporal regions like the body part-selective extrastriate body area (EBA; Arzy et al., 2006; Blanke and Mohr, 2005; Downing et al., 2001; Ionta et al., 2011).”

“…in the NDE group in comparison to controls, suggesting that a temporal lobe dysfunction may underlie NDEs; likewise, in a review of autoscopic hallucinations due to focal brain damage, a tendency of OBEs toward a higher rate of right temporal lobe lesions was found (Blanke and Mohr, 2005).”

“The most common manifestations are autoscopic phenomena , which are illusory own body perceptions including outof-body experience, autoscopic hallucination and heautoscopy (Blanke and Mohr, 2005; Brugger, 2002; Devinsky et al., 1989).”

“On the non-dominant side, the greatest number of responses were somatosensory (10 of 45, 22%), followed by sensory illusion/hallucinations (9 of 45, 20%).”

“Clinical studies showed that OBEs are linked to dysfunctions of the temporo-parietal junction (TPJ; Blanke et al., 2004; Blanke and Mohr, 2005), but also frontal, and parietal cortices (Lopez et al., 2010; Heydrich et al., 2011).”

“…be notably disrupted in pathological conditions affecting a single body part such as somatoparaphrenia (the denial of ownership of contralesional limbs, following brain damage) (Vallar and Ronchi, 2009) or the whole body, such as in the out-of-the-body experience phenomena (Blanke and Mohr, 2005).”

“…and colleagues posits that during OBEs a triple sensory misintegration, with conflicting vestibular, visual, and somatosensory signals, may occur in multisensory brain regions such as the temporo-parietal junction (Blanke et al., 2002, 2004; Blanke and Mohr, 2005; Lopez et al., 2008; Blanke, 2012).”

“Lesions and transcranial magnetic stimulation (TMS)-induced disruptions to this region elicit out of body experiences (Blanke and Mohr 2005; Ehrsson 2007).”

“Previous studies in neurological patients have described heautoscopic symptoms (visual illusion of seeing one’s body from out of the body, often from above) as self-identification and self-location disorders, where impaired multisensory integration of bodily signals and disintegration of vestibular signals may be at t…”

“Similar results came from the study of autoscopic phenomena (e.g. Blanke and Mohr, 2005; Brugger, 2002), in which subjects report of viewing their own body in a position which is separated from the observer.”

“…feature of the OBE is that it is experienced as being extremely real at the time of the experience e with all the experiential qualities of three-dimensional veridical perception (Blackmore, 1982, 1987; Blanke and Mohr, 2005; Blanke et al., 2004; Brugger, 2002; Eastman, 1962; Mohr et al., 2006).”

“Yet, neuropsychological findings suggest that the left hemisphere might be dominant for the processing of body-parts [16,67], while own body illusions and deficits in corporeal awareness have been linked primarily to the right hemisphere [66,68].”

“Blanke O, Mohr C: Out-of-body experience, heautoscopy, and autoscopic hallucination of neurological origin.”

“Users reported the sensation of flying and out-of-body experiences (Blanke and Mohr, 2005).”

“This is telling, because lucid dreams have been proposed to be associated both with OBEs and with vestibular sensations such as flying (Blackmore 1988).”

“A more complex phenomenon of disembodiment combined with altered body ownership as a result of faulty multisensory integration is called the autoscopic phenomenon (Blanke and Mohr, 2005).”

“Other authors stressed the potential role of NMDA receptors [17], the temporo-parietal cortex, or REM-sleep intrusions and sleep paralysis associated with hypnagogic and hypnopompic experiences [12,18–21].”

“Blanke and Mohr (2005), for instance, include three features in their definition of OBEs: disembodiment (the feeling of being detached or independent of one’s physical body), perspective (possession of a distanced visuospatial perspective that is different from the one associated with the physical…”

“The MPS could be disrupted in brain injured patients, who are likely to be subject to autoscopic experiences (Blanke, Landis, Spinelli, & Seeck, 2004; Blanke & Mohr, 2005; Brugger, 2006; Devinsky, Feldmann, Burrowes, & Bromfield, 1989).”

“…impression of seeing a second own body in the extrapersonal space, defined autoscopic phenomena and autoscopic hallucinations (see Blanke and Mohr [157] for an in-depth presentation of these phenomena)—demonstrated that such bizarre experiences result from a disturbance of multisensory…”

“For instance, positive schizotypy (McCreery & Claridge, 1995) and paranormal belief (Tobacyk & Mitchell, 1987) have previously been shown to be higher in individuals reporting OBEs.”

“…by positron emission tomography (PET) (Simeon et al., 2000), and studies in neurological patients showed that damage to the TPJ may lead to disturbances in selfand body processing (Hécaen and Ajuriaguerra, 1952; Devinsky et al., 1989; Blanke et al., 2004; Blanke and Mohr, 2005; Arzy et al., 2006b).”

“As Rosen & Sutton [132] point out, consistently applying the same terminology to researchondreamsandwaking imagery, butalso autoscopicphenomena such as out-of-body-experiences [133] would be significant progress.”

“…(2) seeing what one takes to be one’s own body as perceived from an external viewing station (out-of-body autoscopy, OBA: Cheyne & Girard, 2009), or (3) a combination of OBF and OBA (i.e., viewing one’s physical body from the perspective of a disembodied ‘self’; see also Blanke & Mohr, 2005).”

“Accordingly, we suggested that OBEs might not only be mediated by the TPJ as suggested recently (Blanke and Mohr, 2005; Blanke et al., 2005), but also depend on frontal lobe functioning and processing (Devinsky et al., 1989).”

“…several SAS might co-exist in concordance to the observation that several FORs can be simultaneously represented in typical (Furlanetto et al., 2013) as well as atypical neuro-cognitive processing (i.e., in heautoscopy, Brugger et al., 1997; Blanke and Mohr, 2005; Braithwaite et al., 2013).”

“The absence of autoscopy in the present patient is also in line with literature indicating that autoscopy is associated with occipitotemporal lesions [6].”

“…has been variously called out-of-body experience (OBE), heautoscopy, and autoscopic hallucination – the impression that the whole body assumes spatial locations separated from its physical position (Blanke and Mohr, 2005; Brugger, 2002, 2006; Brugger et al., 2000; Dening and Berrios, 1994).”

“Disrupting this region during waking with magnetic [50] or electrical [51] stimulation can induce out-of-body experiences, defined as a subjective sensation of being outside one’s own body, which may occur with or without viewing the own body [49,52].”

“Their mechanisms are still poorly understood, although Blanke has been able to demonstrate a dysfunction of the temporoparietal areas previously described, with the additional involvement of certain occipital areas in the case of autoscopic hallucinations (Blanke and Mohr, 2005).”

“Though one would expect differences between brain activity occurring in conjunction with normal thought and activity accompanying hallucinations and OBEs, reliable differences in resting brain activity when an individual is not engaged in directed cognition would support a predisposition for transliminality-related tr…”

“…of one’s own body was close to heautoscopy since in this manifestation of the autoscopic phenomena patients find it difficult to figure out whether they are disembodied or not, and whether the self is localized within the physical body or in the autoscopic body (Blanke & Mohr, 2005: 187).”

“The vestibular system – similar to interoceptive signalling (see Tsakiris et al., 2011) – plays an important role in anchoring the self to the body (e.g. Bonnier, 1905; Blanke et al., 2002, 2004; Blanke, 2004, 2012; Blanke & Mohr, 2005).”

“Thus, during out-of-body experiences patients generally perceive a full human body and out-of-body experiences have been linked to the right TPJ (Blanke et al. 2005; Blanke and Mohr 2005).”

“As compared with OBEs, individuals with AH experience to see the world from their habitual visuo-spatial perspective and experience their ‘self’, or center of awareness inside their physical body” (Blanke & Mohr, 2005, p. 186, my emphasis).”

“…in Human Neuroscience www.frontiersin.org February 2014 | Volume 8 | Article 70 | 1 In contrast, shifted body perception of neurological origin (Blanke and Mohr, 2005) or pharmacologically induced (Morgan et al., 2011; Wilkins et al., 2011) can lead to ambiguous embodiment whereas people…”

“When the perspective of the subject is entirely relocalized in the projected double and thus the subject has the vivid sensation of being ‘‘out-of-the-body’’ and can ‘‘see’’ the physical body from a distant and elevated perspective, the condition is called ‘‘out-ofbody experience’’ [32,67,68].”

“Heautoscopy of neurological origin has been related to pathological activity patterns primarily localized at the temporoparietal-junction (TPJ; Blanke and Mohr, 2005; see Figure 1).”

“feeling of body projection, elevation and floating) have often been associated with out-of-body experiences [10,76,45], it has been proposed that vestibular signals play a crucial role in the neurophysiological mechanisms underpinning self-location [61,74].”

“…and vestibular information (Brugger et al., 1997). e v Interestingly, out-of-body experiences are frequently associated with vestibular sensations, such as the feeling of floating in the room, levitation and lightness (Blanke and Mohr, 2005; Blanke et al., 2004; Heydrich and Blanke, 2011).”

“Neurological evidence showed that the occurrence of OBEs in neurological patients is associated with disturbed otholithic processing (Blanke and Mohr, 2005).”