The role of the vestibular system in depersonalization and derealization: Evidence from a systematic review

Background: Emerging evidence indicates an association between vestibular dysfunction and Depersonalization/Derealization (DD) symptoms. However, substantial heterogeneity in the studied populations, experimental paradigms, and assessment methodologies limits clear conclusions regarding the involvement of the vestibular system in the onset of DD symptoms. Objective: To clarify the contribution of the vestibular system to DD symptoms in vestibular patients and healthy individuals undergoing vestibular stimulation. Methods: Following PRISMA guidelines, we reviewed studies examining: (1) DD symptoms in vestibular patients, and (2) DD symptoms in healthy individuals during vestibular stimulation. Results: Twenty-three studies met the inclusion criteria. Among these, 86.9% reported DD symptoms either in patients with vestibular disorders (14/15) or in healthy individuals during vestibular stimulations (6/8). Additionally, 82.61% of the studies identified an association between DD symptoms and anxiety or spatial disorientation. Conclusions: Together, these findings indicate that vestibular alterations may contribute to the emergence of DD symptoms. Anxiety and spatial disorientation were found to frequently co-occur suggesting an interaction between vestibular processing, affective regulation, and spatial cognition. This association can be interpreted within a neurofunctional framework, which posits that vestibular alterations disrupt multisensory integration in parietotemporal, insular, and hippocampal regions, contributing to the core phenomenology of DD.