From bodily numbness to social connection: unveiling the relationship between depersonalization, self-concept, and social touch

From bodily numbness to social connection: unveiling the relationship between depersonalization, self-concept, and social touch | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article From bodily numbness to social connection: unveiling the relationship between depersonalization, self-concept, and social touch Paula Celeste Salamone, Nadia Alejandra Dowzuk, Martina Nayla Gallo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4923651/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study explores the relationship between depersonalization symptoms, social touch seeking and acceptance, self-concept clarity, and psychological factors in a large sample of Argentinian participants (N = 273). In this online study, we assessed participants' acceptance of (or willingness to receive) touch from strangers, friends/family, and intimate partners. Replicating previous studies, we found a higher acceptance of touch from closer social bonds. Touch acceptance from intimate partners showed weak links with self-concept clarity and lower depersonalization symptoms. However, no definitive link between depersonalization symptoms and touch seeking or acceptance was found. Higher depersonalization symptoms were associated with increased social touch avoidance and decreased self-concept clarity. Mediation analyses indicated that social touch avoidance partially mediates the relationship between depersonalization and self-concept clarity. Additionally, depersonalization was associated with higher levels of anxiety, depression, and negative affect, and lower levels of positive affect and life satisfaction. Our results underscore the importance of considering touch in creating therapeutic interventions for depersonalization. Biological sciences/Psychology/Human behaviour Health sciences/Health care/Therapeutics Biological sciences/Neuroscience Biological sciences/Psychology Depersonalization symptoms Social touch seeking Self-concept Psychiatric symptomatology Touch acceptance Therapeutic interventions Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Our bodily presence in the world is important for the world to feel real 1 and to maintain functional social relationships. Understanding the boundaries of our and others’ bodies allows us to develop a comprehensive sense of self. The most basic and tangible sense of self are the boundaries of our body 2 and distinguishing them from others and the environment around us. There are conditions which cause alterations of the perception of the self for varying durations and different cognitive/perceptual domains. Schizophrenia, for example, has been posited as an instance of such self-alteration, with self-dysfunction fluctuating over time 3 , 4 . Similarly, there are distinct pathologies that can lead to continuous or episodic alterations of the perception of the self ( depersonalization disorder ) or its surroundings ( derealizatio n) 5 . Depersonalization disorder was first described at the end of the nineteenth century by Ludovic Dugas. It was officially recognized and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since its third edition (DSM-III) and continues as depersonalization-derealization disorder in the current DSM (5) with few changes. Today’s definition of depersonalization disorder involves symptoms related to 1) alterations in body ownership, 2) alterations in sense of agency, 3) disembodiment feelings, and 4) somatosensory distortions 5 . The prevalence of depersonalization disorder is estimated to be around 1–2% in the general population. It has further been described to occur in chronic (e.g. schizophrenia) or transient psychiatric disorders (e.g. anxiety, depression, among others). Noticeably, epidemiological studies demonstrate that temporary symptoms of depersonalization in the general population are common, with a lifetime prevalence rate ranging from 26–74% 6,7 . From previous research that has inquired into various aspects of self-perception 8 and alterations in psychiatric conditions, the role of touch as a means to study the self 9 has emerged. Through touch, we explore the limits of ourselves and the world, beginning already prenatally in the womb 5 , 10 . Additionally, receiving touch from others (namely, social touch) has the potential role of regulating our physiology and affect 11 , 12 , conveying information about the social environment and social connection, and providing sense of security 13 . Certain forms of social touch are considered affective touch, characterized by the subjective pleasure experienced when receiving physical contact. Social affective touch encompasses a wide range of behaviors involving both the reception and provision of touch, such as holding hands, hugging, or caressing. Extensive research has examined the neurophysiological foundations of a specific unmyelinated fiber that is most densely present in hairy skin, namely, C-tactile (CT) fibers. The CT fibers specifically activate in response to a soft gentle caress 14 which is typically associated with a subjective pleasurable sensation 15 . Social touch that involves C-tactile activation has been studied extensively in parental touch during infant development 13 , but also intimate romantic relationships in adults 16 , 17 . Soft gentle touch has the potential to regulate autonomic functions, e.g. decreasing heart rate, or increasing heart-rate variability. This has been shown both in infants and in adults (Croy, Fairhurst and McGlone, 2022; Candia-Rivera, et al. 2024). Additionally, it is thought that it plays an important role in developing the most basic form of selfhood 19 . CT-optimal social affective touch exhibits distinctions from similar non-social tactile stimulation produced by oneself, as evidenced by previous electrophysiology and neuroimaging studies 9 . The experiential contrast between receiving a cuddle from another person and self-administered tactile stimuli is a relatable phenomenon for many individuals. In this study from Boehme et al. 9 , it is also reported that participants displaying a more pronounced neural differentiation between self- and other-produced touch reported heightened clarity of self-perception. This correlation was established through an analysis with the self-concept clarity scale 20 . Individuals with depersonalization disorder express a propensity to seek physical contact during heightened depersonalization states. Patients describe an inclination to seek physical proximity with others, perceiving it as a means to temporarily anchor their sense of self: “When the depersonalization is very deep (…) I’ll also seek physical contact with whoever I’m with. It almost feels I need to be that other person because my own sense of self is not strong enough in that moment to sustain me” 21 . We found previously that healthy individuals during a pharmacologically induced dissociative state display reduced self-other distinction, particularly observing significant reductions in neural activations during social touch 22 . We further found an increase of touch seeking (based on self-report). This is in line with the citation above addressing the inclination towards seeking physical contact during depersonalization episodes. It underscores the observation that an alteration of the sense of self prompts an inclination to seek relief through physical connection with others. Notably, it is crucial to highlight that while individuals subjectively express a desire for social contact during depersonalization, to the best of our knowledge there are no empirical investigations regarding this phenomenon. Thus, we created an online study to test the relationship between depersonalization and touch. We hypothesized that participants with lower levels of social touch acceptance (i.e. willingness to receive touch) and lower seeking of social touch would present higher levels of depersonalization. In order to test this hypothesis, we used a task based on the Embody task 23 to measure the acceptance of social touch across body parts from individuals with different degrees of closeness (ranging from strangers to intimate partners). Additionally, we used questionnaires to assess social touch tendencies, other negative and positive psychological factors related to affective states, and satisfaction with life. Our investigation aims to shed light on the relationship between depersonalization disorder and social touch acceptance, particularly the nuanced role for the self-concept. With an increasing acknowledgment of the significance of bodily boundaries and self-perception, this study explores whether individual levels of depersonalization experience relate to daily life social touch experiences. The findings from this study not only contribute to our understanding of depersonalization but also extend the existing knowledge on the role of social touch in shaping self-perception. The potential implications of our research extend to clinical contexts and may inform therapeutic interventions for individuals experiencing depersonalization disorder. RESULTS Social touch acceptance assessment. The most distant social proximity (1, strangers) was the only condition in which 30.04% of participants conveyed an aversion to any form of touch from strangers marking 0 body parts. As expected, the most selected areas for stranger-initiated touch were the arms (64,47%) and hands (44.69%). For the condition of touch acceptance from friends and family, the area with least acceptance of touch was evidently in the pelvic region (1.47%), while the arms (96,34%) and hands (91.58%) also emerged as the most favored areas for contact. For touch acceptance from intimate/romantic partners (Fig. 1 B), all areas had a high percentage of touch acceptance (compared to the other relationship types). The feet were the least selected area (71.26%). The one-way ANOVA (F = 1440.401, p < 0.001) showed significant differences between relationship types. Posthoc Tukey test revealed significant differences between all comparisons (stranger - family/friend: t=-20.939, p < 0.001; stranger - intimate partner: t= -53.276, p < 0.001; and family/friend - intimate partner: t= -32.307, p = 0.001). As displayed in Fig. 1 C, participants found it acceptable to receive social touch on an increasing number of body areas the closer their relationship to the toucher was (stranger < friend-family < intimate partner). Association between the percentage of social touch acceptance and social touch seeking. The percentage of touch acceptance for the conditions showed significant correlations with STQ (Fig. 2 ). A higher percentage of acceptance of physical contact in all relationship cases was associated with an increased pursuit of social touch (see Fig. 2 ; strangers: rho=-0.400; p < 0.001, family/friends: rho=-0.437; p < 0.001, intimate partners: (rho=-0.436; p < 0.001). Association between Social Touch Acceptance and the Self Concept Clarity Scale (SCCS) The condition intimate partner was the only social touch acceptance condition to show a weak association with self-concept clarity (SCCS; rho = 0.146, p = 0.016), i.e. people with overall higher touch acceptance with the romantic partner had a clearer self-concept. The percentage of social touch accepted from a stranger (rho = 0.006, p = 0.917) or family/friend (rho = 0.034, p = 0.573) was not significantly associated to the self-concept clarity. Exploring associations between depersonalization, self, social touch, and psychological factors Depersonalization and Social Touch Symptoms of depersonalization were weakly associated with the percentage of social touch acceptance from the intimate partner (rho= -0.136, p < 0.025), i.e. people with overall higher touch acceptance with the romantic partner had lower levels of depersonalization. However, this did not survive the correction for multiple comparisons. The other conditions did not show statistically significant results (stranger rho=-0.022, p = 0.723; family/friend rho = 0.004, p = 0.951). Depersonalization symptoms showed a weak association with social touch avoidance (STQ; rho = 0.146; p = 0.016), however this did not survive correction for multiple comparisons. Depersonalization and Self-Concept Clarity As anticipated, higher amounts of depersonalization symptoms were related to a diminished clarity in one’s self-concept, as shown by the statistically significant inverse correlation between depersonalization symptoms and the self-concept (SCCS; rho= -0.468, p < .001) (Fig. 3 .A). We performed a mediation analysis, which reinforced the significant total effect of depersonalization symptoms (CDS) on self-concept clarity (SCCS) (Effect = -0.294, p < 0.001). When controlling for the potential mediator, social touch avoidance (STQ), the direct effect of depersonalization on self-concept clarity remained significant (Effect = -0.281, p < 0.001). This indicates that depersonalization has a strong direct effect on self-concept clarity, even when considering social touch avoidance. Additionally, social touch avoidance had an indirect effect on the relationship between depersonalization and self-concept clarity (Effect = -0.013, BootCI [-0.032, -0.001]). Specifically: a) The relationship between CDS and STQ was significant (Effect = 0.073, p = 0.001), indicating that higher depersonalization symptoms are associated with higher social touch avoidance. b) The effect of STQ on SCCS was also significant (Effect = -0.184, p = 0.029), suggesting that higher social touch avoidance is associated with lower self-concept clarity. Thus, the indirect (mediating) effect of CDS on SCCS through STQ was significant, suggesting that part of the effect of depersonalization on self-concept clarity is mediated by social touch avoidance (see Fig. 3 .B). In contrast, we found no evidence of indirect effects of social touch acceptance affecting the relationship between depersonalization and self-concept clarity. Although the relationship between CDS and touch acceptance from intimate partners was marginally significant (Effect = -0.001, p = 0.071). Association with negative and positive psychological factors As expected, the presence of higher depersonalization symptoms predicted higher depressive (Rho = 0.578, p < 0.001) and anxiety (Rho = 0.447, p < 0.001) symptoms. Convergently, higher depersonalization symptoms were associated with higher presence of negative affect (PANAS negative: (rho = 0.479, p < 0.001) and lower levels of positive affect (rho= -0.281; p < 0.001). Furthermore, depersonalization symptoms also relate to lower general life satisfaction (Rho = -0.351, p < 0.001). All these analyses remain significant even after the application of correction for multiple comparisons (Fig. 4 ). DISCUSSION Our study aimed to untangle the complex interplay between depersonalization symptoms and the seeking and acceptance of social touch. We began by examining the convergence of social touch seeking and acceptance across different social bonds. Subsequently, we explored the relationship between depersonalization and various social touch and psychological tendencies, focusing on how depersonalization correlates with the seeking and acceptance of social touch, as well as its association with negative (anxiety, depression, mood) and positive (mood, satisfaction with life) affective states. In a large sample of Argentinian participants, we observed a convergence between seeking and accepting social touch across different social bonds. We replicate previous findings from other countries and cultures regarding socially accepted touch from varied social bonds across different body parts 24 , 25 . We found, as expected, that depersonalization symptoms strongly affect the sense of self, and this effect is partially mediated by social touch avoidance. However, we did not find a definitive association between depersonalization and either seeking or accepting social touch. Additionally, consistent with expectations, we identified clear links between depersonalization and higher levels of negative psychological factors, as well as lower levels of positive psychological factors. To our knowledge this is the first study in Latin America to find consistency across touch seeking and acceptance, meaning that people who seek more touch from others, also accept more touch of different degrees according to the level of social closeness. It is important to note that while the behaviors to seek touch from others (as measured by the STQ) and accept to receive touch (assessed through body maps) are correlated, these are present in different degrees in the population. Touch acceptance is very variable across participants and depends on further factors like physiological state, given context, and probably culture or social norms 12 . This study does not allow to interpret if subjects are imagining varied social scenarios, however, touch acceptance from different degrees of social closeness and body parts seems to be consistent with previous research on other cultures 23 , 26 . Our study replicates that touch acceptance depends on the emotional bond between the person receiving the touch with the “toucher”. However, compared to Suvilehto et al., (2015), where touch acceptance in a similar online setting was compared across five European countries, in our Argentinian sample, strangers are socially accepted to touch more than the hands. Although, around a third of the sample reported not accepting any touch from strangers, a large percentage of participants also accepted touch on the arms and to a much smaller degree to the face, torso, and legs. This could indicate a cultural difference that exists in Latin American countries, where in the young population (as the one assessed in this study), it is usual that strangers meeting in public events greet each other with one kiss on the cheek (cheek to cheek kiss, although it is not a generalized behavior), considerably alike some European countries when having a closer emotional connection with someone. Additionally, for young adults the main source of transportation is through public transport. Here, it is usually very crowded during peak hours, and it could be natural to touch arms shoulders or legs with your nearby travelling neighbor. Although this study did not present front and back bodies or more 3D space of body to be able to confirm this completely. It is important to also clarify the difference that in this study we did not ask about pleasantness ratings for the touch acceptance conditions, thus, it is still possible that as in the mentioned public transport example, participants find it acceptable and statistically normal to encounter touch in public transportation in peak hours, this might not reflect a pleasant form of touch. A cross-cultural study looked into another aspect of touch that showed cultural differences 25 . Here, they compared German and Chinese participants, and although both presented some cultural convergence in touched areas, their results also reflect some cultural differences in how comfortable people feel with touch. Germans were more comfortable with touch in some body parts that seem more intimate for some cultures, like the torso and less comfortable with touching hands, which was expressed as more comfortable for the Chinese participants. Exploring different attributes of touch, as seeking, accepting, liking, feeling comfort, or other, might be relevant to better characterize human functional and dysfunctional behavior. Additionally, it could be relevant to disentangle with which body part the toucher is producing the touch, as leg-to-leg contact sitting on public transportation might be acceptable and hand touching a leg in public transportation is less likely to be acceptable. Future studies with similar designs in social touch should look deeper into the importance of social context and characteristics of the toucher in order to assess the difference between social acceptance of touch and genuine pleasantness. As seen in Suvilehto et al., (2015), gender of the toucher might play a crucial role in touch acceptance as touch from men is less likely to be accepted in “taboo areas” of the body. Thus, it is possible that even with matched social context and touching body part, there will be a difference in touch acceptance and pleasantness for male and female touchers 27 . We found further support that touch appears to be related to a clearer sense of self, however, we only find this relationship for touch from intimate partners. Touch from others has previously been shown to be more pleasant and have greater autonomic effects compared to other forms of touch 17 , 18 . Additionally, the relationship between touch and self-concept clarity scale has previously been reported: the greater the neural differentiation of self- and other-touch the clearer the self-concept (see Supplementary results in Boehme et al. 9 ). However, it might be that receiving touch from close intimate relationships might be processed differently (e.g. due to higher salience or higher trust) than other types of social bonds, although to our knowledge this has not been studied previously on a neural level. Depersonalization symptoms are highly prevalent among the general population, often occurring outside the bounds of a formal diagnosis. Although some literature refers that up to 3% of the general population has a diagnosis, research also suggests that up to 70% of individuals may experience depersonalization symptoms at some point in their lifetime 6 , 7 , 28 . Additionally, these symptoms are particularly common among victims of abuse or maltreatment, and are often co-occurring with conditions such as depression, anxiety, and borderline personality disorder 29 further worsening their well-being. Despite subjective reports from people experiencing depersonalization that indicate a desire for social touch as a means of grounding themselves 21 , our study did not find a significant association between depersonalization symptoms and the seeking or acceptance of social touch. In fact, we find marginally threshold associations in the opposite direction. This could be attributed to the fact that our study did not evaluate people presenting a formal diagnosis of depersonalization or evaluated this in another culture. Although, in support of dimensional views of psychopathology, it opens the door to other explanations. One possibility is a mismatch between the subjective belief in the need for touch and actual objective behavior. Previous research has shown that some psychiatric symptoms are linked to discrepancies in metacognition, in the presence 30 or absence of objective performance variations 31 . It is also possible that people who experience depersonalization seek less touch in daily life but might actively seek out touch during an acute depersonalization episode. Another explanation could be that less daily tactile interaction could evoke more depersonalization symptoms, as the individual might fail to benefit from important somatosensory sensations which strengthen the bodily awareness and therefore also the sense of self. In fact, we show here that people with higher depersonalization present a diminished sense of self that is partially mediated by their social touch seeking behaviors. However, it is challenging to identify the causality empirically. Early life trauma mediated the presence of later on psychosis 32 , suggesting that traumatic events that produce alterations in self-concept might be related to more severe and chronic alterations of the self as in psychosis. In fact, another studyfound that individuals with more dissociation proneness had less self-concept integration 33 . There is also some support for causality from a study during periods of social isolation (as during the COVID-19 pandemic): here, lower amounts of social touch were related to more depersonalization experiences in an observational online study 34 . Thus, seeking positive social interactions and positive social touch might have a protective effect on the sense of self. We found an overall weak association between touch acceptance from the intimate partner and depersonalization; however, this effect did not survive multiple comparisons. This may be attributed to behavioral changes that occur only during acute dissociative episodes. Evaluating individuals with acute, enhanced dissociative symptoms is experimentally challenging, as spontaneous dissociative experiences are difficult to capture in a laboratory setting. However, pharmacological manipulation of subjective experiences can offer a comparable scenario. In a previous study from our group, we observed changes in touch-seeking behavior, as measured also by the Social Touch Questionnaire (STQ), following ketamine administration 22 . Participants reported increased touch-seeking behavior during the pharmacologically evoked dissociation compared to a within-subject placebo control session in a Swedish sample. Another potential factor is the cultural context of the studies. Most research on depersonalization and touch (separately) has been conducted outside of Latin America, leaving open the possibility of cultural differences affecting touch-seeking and acceptance behaviors. Cultural variations could influence how individuals with depersonalization symptoms perceive and engage in social touch. To address these complexities, future studies should include contrasting objective behaviors and subjective feelings of touch. A first step could be larger ecological momentary assessments, which do not rely as much on retrospective reporting. Researchers should also compare conditions involving the presence and absence of dissociative experiences in different countries. This approach will provide a clearer understanding of how touch processing may be related to dissociative symptomatology across different cultures. Additionally, comparing individuals with and without acute dissociative symptoms in various cultural contexts could help clarify the role of cultural factors in shaping these experiences. Our study found that higher depersonalization symptoms are significantly associated with various negative psychological factors. Specifically, higher depersonalization symptoms were associated with higher levels of depressive and anxiety symptoms. These findings are consistent with the literature, which indicates that depersonalization often co-occurs with other mental health conditions, particularly those related to mood and anxiety 6 , 7 . Additionally, higher depersonalization symptoms were correlated with higher levels of negative affect and lower levels of positive affect. These results suggest that individuals experiencing depersonalization are more likely to report feeling more negative emotions and fewer positive emotions. This aligns with the understanding that depersonalization can significantly disrupt emotional processing and overall affective experience 35 that could be the cause of such symptoms. Also, adverse life events as abuse or childhood mistreatment might be the cause of depersonalization as a coping strategy. Possible interventions in increasing positive affect, such as using mindfulness techniques could be a source of treatment. Furthermore, we found that higher depersonalization symptoms were associated with lower general life satisfaction. This relationship underscores the broad impact of depersonalization on an individual’s perceived quality of life and well-being. The persistent and distressing nature of depersonalization symptoms can erode one’s sense of self and thus also the fulfillment and contentment with life 36 . Thus, understanding and finding better treatment strategies that could help ground subjects to their self is of high importance. Cultural factors could also play a significant role in these dynamics. The particular touch seeking and accepting behaviors in different cultures might influence how individuals with depersonalization are affected. Future cross-cultural research should consider if cultures in which touch is more accepted have a positive or negative impact on mental health. If people with depersonalization report in other cultures to seek touch to feel grounded, then a culture more open to touch might serve as a protective factor. How does this balance out with a more vulnerable population as is the case in Latin America, where economic inequalities and higher health disparities exist alongside fewer programs promoting healthy lifestyles 37 , 38 ? This is still an unanswered question that is of relevance for creating therapeutic interventions. Our study provides insights into the complex dynamics between depersonalization disorder, social touch seeking and acceptance, self-clarity and psychological factors within an Argentinian context. We found that while depersonalization significantly impacts the sense of self and is linked to social touch avoidance, it does not strongly influence the seeking or acceptance of social touch despite discrepancies with self-reported behaviors from people with depersonalization in other cultures. Additionally, our findings highlight that depersonalization is associated with higher levels of negative psychological factors, such as anxiety and depression, and lower levels of positive psychological factors, including mood and life satisfaction. The observed cultural variations in social touch acceptance underscore the importance of considering cultural context in understanding these behaviors. Future research should further investigate the causal relationships between social touch, depersonalization, and psychological well-being across diverse cultural settings to better inform therapeutic interventions. These insights emphasize the potential for tailored treatment strategies that address both the psychological and cultural dimensions of depersonalization. MATERIALS AND METHODS We collected data using an online survey available in Spanish between June - December 2023. The study was advertised through different social media platforms. The study was performed in accordance with the Declaration of Helsinki and was approved by the Committee for the Evaluation of Responsible Conduct in Research at the Faculty of Psychology of the University of Buenos Aires (CEI23021). Participants The total sample comprised 273 subjects (83,15% female, 15,02% male, 1,83% non-binary), age range 18–67 years old (M = 29.47; SD = 12.16), of Argentine nationality and residing in the country. The majority of participants were University students or had University education (71%). 51% identified as being part of the middle economic class. The category of participants that answered what best described their status: being single, divorced and widow were grouped into “not in a relationship” (59%) and the categories married, in a stable relationship and living with partner were grouped into “in a relationship” (41%). All participants signed an informed consent in which they agreed to participate in the study, acknowledging that they would not receive diagnostic feedback and their full awareness that they could withdraw at any time. All participants were required to be of legal age. It is also noteworthy to clarify that all data was collected before a “heat wave” striking in Argentina, as extreme heat could be a confounding factor to how much touch participants are willing to accept from others. Description of forms Body maps to measure social touch acceptance across body parts Individuals were presented with a visual representation of the human body and were tasked with indicating the locations on their own body where they would find it acceptable to receive touch from different individuals: a) a stranger, b) a close family member or friend, and c) an intimate partner (see Fig. 1 A). Participants were required to choose from a predefined list of body regions, accompanied by a depiction of the reference body displaying these regions 39 . The chosen areas were broadly derived from earlier studies 23 , 40 and intentionally maintained a generic nature. Social Touch questionnaire (STQ) The questionnaire serves as an instrument for gauging emotions and attitudes concerning social touch, as outlined by Wilhelm et al. (2001). Comprising 20 items, respondents provide feedback on a 5-point Likert scale, ranging from 0 ('not at all') to 4 ('extremely'). Notably, a higher score is indicative of a reduced inclination towards seeking social touch. Cambridge Depersonalization Scale (CDS) To evaluate depersonalization symptoms, we utilized the adaptation of the original scale by Sierra and Berrios in 1996, adapted by Molina Castillo 42 . Comprising a 29-item questionnaire, it evaluates the frequency and duration of depersonalization experiences over the past six months. Each item is rated on two Likert scales: frequency (0–4) and duration (1–6). The sub-score for each item is the result of arithmetically summing the values obtained in both subscales. The total score of the CDS is the sum of the scores obtained in all items, resulting in a score range from 0 to 290. This final score reflects the overall intensity of depersonalization experiences. Self-Clarity Concept Scale The Self-Concept Clarity Scale (SCCS), developed by Campbell et al. (1996), aims to assess clarity in self-concept through 12 items rated on a 5-point Likert scale, ranging from 1 ("completely disagree") to 5 ("completely agree"), with a maximum score of 115 points. For this study, the Argentine version of the scale, comprising 23 items with response options equivalent to those of the original scale was utilized 43 . High scores in self-concept clarity are associated with well-being measures, such as self-esteem, achievement of long-term goals, conscientiousness, and greater satisfaction in romantic relationships. Conversely, low scores are linked to negative aspects, including conflict, indecision, body dissatisfaction, and an increase in self-harm, among others. Assessment of other Psychiatric Symptoms Patient Health Questionnaire (PHQ-9) by Kroenke et al. (2001) available in Spanish is a brief tool for assessing the presence and severity of depressive symptoms. It is a self-report scale comprising 9 items. Regarding the obtained score, the PHQ-9 is categorized into five groups: a score between 0 and 4 indicates the absence of depressive symptoms, 5 to 9 implies mild depressive symptoms, 10 to 14 indicates moderate depressive symptoms, 15 to 19 suggests moderately severe depressive symptoms, and a score higher than 20 indicates severe depressive symptoms. Generalized Anxiety Disorder Scale (GAD-7) developed by Spitzer et al. (2006) available in Spanish. This scale consists of 7 items and is used to measure symptoms of Generalized Anxiety Disorder. It is a brief self-report measure that assesses the frequency with which, over the past 2 weeks, individuals have experienced each of the seven core symptoms of Generalized Anxiety Disorder (GAD). Responses are rated on a 4-point Likert scale ranging from 0 to 3, with 0 representing "not at all," 1 "several days," 2 "more than half the days," and 3 "nearly every day." Assessment of Affect and Satisfaction with Life Scale (SWLS) The Satisfaction with Life Scale (SWLS; Diener et al. , 1985) is a brief assessment of a person´s overall sense of satisfaction with their life. With 5 items, the possible scores range from 5 (low satisfaction) to 35 (high satisfaction). Score ranges can be interpreted as follows: extremely dissatisfied if the score is between 5 and 9, dissatisfied if it is between 10 and 14, slightly dissatisfied from 15 to 19, neutral if it is 20, slightly satisfied if it ranges from 21 to 25, satisfied if it goes from 26 to 30, and extremely satisfied from 31 to 35 points. The Spanish version of the Positive and Negative Affect Schedule (PANAS; Robles and Páez, 2003) validated in Argentina 48 is a scale with 20 items that provides information about positive and negative affect within a specific time frame. Each item is scored on a five-point Likert scale, ranging from 1 (very slightly or not at all) to 5 (extremely), with 10 items corresponding to a measure of positive affect and 10 to a measure of negative affect. Experiencing a high level of positive affect involves a state of enthusiasm, heightened energy, alertness, concentration, and enjoyment, while a low level is associated with feelings of sadness and lethargy. On the other hand, negative effects are related to subjective distress, encompassing a variety of aversive moods such as anger, contempt, disgust, fear, and nervousness. A low level of negative affect is associated with states of calmness and serenity. Statistical analyses For the body maps of social touch acceptance across body parts, we first calculated the descriptive statistics for the percentage of each body part that was selected per condition for the entire sample. Later, we extracted the percentage of total touch acceptance per condition and subject. The later index was used for further statistical analyses. A one-way ANOVA was employed to examine differences in social touch acceptance between 3 levels of closeness (stranger/friend-family/intimate partner). Tukey's post hoc analysis was conducted between conditions to explore significant differences among paired contrasts. For all association comparisons Spearman rank correlation coefficient (Rho) was used. Significance was considered at p < 0.05. However, in order to correct for multiple comparisons performed with depersonalization scale, a Bonferroni correction was manually applied to adjust the threshold of all comparisons to this scale. The resulting corrected p-value was set at p = < 0.005 to maintain a 95% level of significance for 10 comparisons. All prior analyses were performed using JASP Team (2024; Version 0.19.0). To analyze the relationship between depersonalization symptoms (CDS) and self-concept clarity (SCCS), we conducted first the Spearman’s rank correlation coefficient (rho). Then, we performed a mediation analysis to evaluate the mediating effect of social touch avoidance (STQ) on the CDS-SCCS relationship. The mediation analysis included calculating the total, direct, and indirect effects, with bootstrapped confidence intervals (BootCI) to determine the significance of the indirect effect. This mediation analysis was conducted using a standard software package (SPSS), and significance was set at p < 0.05. Raw statistical graphs and Figures were style edited using Adobe Illustrator (2019). Declarations AUTHOR CONTRIBUTIONS Paula C. Salamone: Experimental design, Formal analysis, Methodology, Visualization, Writing, Review & Editing; Nadia Alejandra Dowzuk: Data Collection, Data curation, Visualization, Formal analysis, Writing, Review & Editing; Martina Nayla Gallo: Data Collection, Data curation, Visualization, Formal analysis, Review & Editing; Rebecca Boehme: Experimental design, Formal analysis, Writing, Review & Editing. DATA AVAILABILITY STATEMENT Data can be available upon reasonable request to corresponding Author: [email protected] ACKNOWLEDGEMENTS This research was supported by the Svenska Vetenskapsrådet (VR) grant (2019-01873) awarded to RB and the Lions forskningsfond granted to PCS. 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Subjective versus objective cognition: Evidence for poor metacognitive monitoring in schizophrenia. Schizophr Res. 178 , 74–79 (2016). Palmer-Cooper, E. C. et al. Metacognition and psychosis-spectrum experiences: a study of objective and subjective measures. Schizophr Res. 262 , 214–216 (2023). Evans, G. J., Reid, G., Preston, P., Palmier-Claus, J. & Sellwood, W. Trauma and psychosis: The mediating role of self-concept clarity and dissociation. Psychiatry Res. 228 , 626–632 (2015). Chiu, C. D., Chang, J. H. & Hui, C. M. Self-concept integration and differentiation in subclinical individuals with dissociation proneness. Self Identity . 16 , 664–683 (2017). Ciaunica, A. et al. Zoomed out: digital media use and depersonalization experiences during the COVID-19 lockdown. Sci. Rep. 12 , 3888 (2022). Michal, M. et al. Depersonalization, mindfulness, and childhood trauma. J. Nerv. Ment Dis. 195 , 693–696 (2007). Ciaunica, A., Pienkos, E., Nakul, E., Madeira, L. & Farmer, H. Exploration of self-and world-experiences in depersonalization traits. Philos. Psychol. 36 , 380–412 (2023). Ibanez, A. et al. Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models. Nat. Aging 1–13 (2024). García-Arroyo, J. & Osca Segovia, A. Effect sizes and cut-off points: A meta-analytical review of burnout in Latin American countries. Psychol. Health Med. 23 , 1079–1093 (2018). Enmalm, A. & Boehme, R. Body Perception and Social Touch Preferences in Times of Grief. J. Loss Trauma. 1–24 (2024). Nummenmaa, L., Glerean, E., Hari, R. & Hietanen, J. K. Bodily maps of emotions. Proc. Natl. Acad. Sci. 111, 646–651 (2014). Wilhelm, F. H., Kochar, A. S., Roth, W. T. & Gross, J. J. Social anxiety and response to touch: incongruence between self-evaluative and physiological reactions. Biol. Psychol. 58 , 181–202 (2001). Molina Castillo, J. J. et al. Adaptación y validación al castellano de la Escala de Despersonalización de Cambridge. Actas Españolas Psiquiatr. 34 , (2006). Molina, M. F. & Iribarne, K. Adaptación de la Escala de Claridad en el Autoconcepto. Un estudio en estudiantes universitarios argentinos. Rev. Psicol. 30 , 40–53 (2021). Kroenke, K., Spitzer, R. L. & Williams, J. B. W. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 16 , 606–613 (2001). Spitzer, R. L., Kroenke, K., Williams, J. B. W. & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166 , 1092–1097 (2006). Diener, E. D., Emmons, R. A., Larsen, R. J. & Griffin, S. The satisfaction with life scale. J. Pers. Assess. 49 , 71–75 (1985). Robles, R. & Páez, F. Estudio sobre la traducción al español y las propiedades psicométricas de las escalas de afecto positivo y negativo (PANAS). Salud Ment . 26 , 69–75 (2003). Santángelo, P. R., Brandariz, R., Cremonte, M. & Conde, K. New evidence of the psychometric properties of panas in student population Argentina. Rev. Argentina Clin. Psicol. 28 , 752–760 (2019). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4923651","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":357286060,"identity":"970b1c3a-a61d-4aae-94d3-b7dcf0db7f20","order_by":0,"name":"Paula Celeste Salamone","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYHACxgMgkg/CsZFhI0YPWAtUZRoPyVoO8xBUbs5+xuDAD4Y6eTb204mPCyrO8/BJJDB/+IBHi2VPjsHBHobDhm08uZuNZ5y5zcMmkcAmOQOPFoMDOQYHeBgOMLYx5G6T5m2DaGHG5zyD828MDv5hqLNv438L1PLvHEgL8+c/+LTcyDEAepk5sU0CZEvDAZAWBml83rec8azgsIzB4eQ2ibebjXmOJfOw8Txsk+zBo8WcP3njwzcVdbb9/LkbH/PU2MnJtycf/vADn8OQSBhgbMDnLjTFo2AUjIJRMAqwAQBiMUZ5HmcOigAAAABJRU5ErkJggg==","orcid":"","institution":"Linköping University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Paula","middleName":"Celeste","lastName":"Salamone","suffix":""},{"id":357286061,"identity":"4f90537c-f8b2-4eec-a5a6-f4c4569e5e98","order_by":1,"name":"Nadia Alejandra Dowzuk","email":"","orcid":"","institution":"Universidad de Buenos Aires","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nadia","middleName":"Alejandra","lastName":"Dowzuk","suffix":""},{"id":357286062,"identity":"0bf58947-7555-4e71-9ff7-e2bb61e2e43f","order_by":2,"name":"Martina Nayla Gallo","email":"","orcid":"","institution":"Universidad de Buenos Aires","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Martina","middleName":"Nayla","lastName":"Gallo","suffix":""},{"id":357286063,"identity":"6b25bfaf-fa20-47ab-8b05-97d070a3821f","order_by":3,"name":"Rebecca Boehme","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Boehme","suffix":""}],"badges":[],"createdAt":"2024-08-16 08:32:45","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-4923651/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4923651/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65375103,"identity":"dc041495-7340-4c92-bca1-a7048f98ea6f","added_by":"auto","created_at":"2024-09-26 16:05:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1095083,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBody maps to measure social touch acceptance across body parts.\u003c/strong\u003e \u003cstrong\u003ea)\u003c/strong\u003e Task design. Participants were asked to select all body areas where they found it appropriate to receive touch from others for different relationship categories or select 0= no body parts should be touched.\u003cstrong\u003e b) \u003c/strong\u003ePercentage of participants that accept touch in each body part. Darker colors indicate that a higher percentage of participants selected an area, specific percentages can be seen in the pie-chart below. \u003cstrong\u003ec)\u003c/strong\u003e Percent of acceptance of touch across the whole body per participant. Each dot indicates one participant for each relationship type. Significant results at p \u0026lt; 0.001 are marked with asterisk (*).\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4923651/v1/0a84ac1a2cd0d3911a0c380e.png"},{"id":65375104,"identity":"c7085e47-34ea-4f3e-af37-cb3a0672c6c3","added_by":"auto","created_at":"2024-09-26 16:05:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":556378,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation between Social Touch Acceptance Assessment and Social Touch Aversion (STQ).\u003c/strong\u003e Higher scores on the STQ imply greater social avoidance. Thus, participants with higher values for social touch seeking (lower STQ) also exhibited a higher percentage of social touch acceptance (body maps) across different relationships. Dots indicate values per subject.\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4923651/v1/36e72c2de27881569d33b988.png"},{"id":65375110,"identity":"2b1d5a37-f4ac-46ca-820d-10d2a304d697","added_by":"auto","created_at":"2024-09-26 16:05:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":653671,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation between Depersonalization (CDS), Self-concept clarity (SCCS), and social touch avoidance (STQ).\u003c/strong\u003e \u003cstrong\u003ea)\u003c/strong\u003e Individual correlations. b) Mediation analyses evaluating the mediating effect of STQ on the CDS – SCCS relationship. Dots indicate individual data-points (subjects).\u003c/p\u003e","description":"","filename":"OnlineFigure3mediation.png","url":"https://assets-eu.researchsquare.com/files/rs-4923651/v1/34eb924faf78d919f87332ab.png"},{"id":65375109,"identity":"fca9765e-6385-4de1-a89a-016d084aaff7","added_by":"auto","created_at":"2024-09-26 16:05:46","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":650169,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation between depersonalization (CDS) and other negative and positive psychological factors.\u003c/strong\u003e Dots indicate individual data-points (subjects). All correlations are significant at p \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4923651/v1/237dfc9d892e7968f67402aa.jpeg"},{"id":73856253,"identity":"d0c95b52-06a8-4293-9ae8-d5eff8f0af23","added_by":"auto","created_at":"2025-01-15 10:24:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2440774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4923651/v1/e8deccc0-27e6-40be-8754-51e23015f272.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From bodily numbness to social connection: unveiling the relationship between depersonalization, self-concept, and social touch","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOur bodily presence in the world is important for the world to feel real \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e and to maintain functional social relationships. Understanding the boundaries of our and others\u0026rsquo; bodies allows us to develop a comprehensive sense of self. The most basic and tangible sense of self are the boundaries of our body \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and distinguishing them from others and the environment around us. There are conditions which cause alterations of the perception of the self for varying durations and different cognitive/perceptual domains. Schizophrenia, for example, has been posited as an instance of such self-alteration, with self-dysfunction fluctuating over time \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Similarly, there are distinct pathologies that can lead to continuous or episodic alterations of the perception of the self (\u003cem\u003edepersonalization disorder\u003c/em\u003e) or its surroundings (\u003cem\u003ederealizatio\u003c/em\u003en) \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDepersonalization disorder was first described at the end of the nineteenth century by Ludovic Dugas. It was officially recognized and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since its third edition (DSM-III) and continues as depersonalization-derealization disorder in the current DSM (5) with few changes. Today\u0026rsquo;s definition of depersonalization disorder involves symptoms related to 1) alterations in body ownership, 2) alterations in sense of agency, 3) disembodiment feelings, and 4) somatosensory distortions \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The prevalence of depersonalization disorder is estimated to be around 1\u0026ndash;2% in the general population. It has further been described to occur in chronic (e.g. schizophrenia) or transient psychiatric disorders (e.g. anxiety, depression, among others). Noticeably, epidemiological studies demonstrate that temporary symptoms of depersonalization in the general population are common, with a lifetime prevalence rate ranging from 26\u0026ndash;74% \u003csup\u003e6,7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrom previous research that has inquired into various aspects of self-perception \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and alterations in psychiatric conditions, the role of touch as a means to study the self \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e has emerged. Through touch, we explore the limits of ourselves and the world, beginning already prenatally in the womb \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Additionally, receiving touch from others (namely, social touch) has the potential role of regulating our physiology and affect \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, conveying information about the social environment and social connection, and providing sense of security \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCertain forms of social touch are considered affective touch, characterized by the subjective pleasure experienced when receiving physical contact. Social affective touch encompasses a wide range of behaviors involving both the reception and provision of touch, such as holding hands, hugging, or caressing. Extensive research has examined the neurophysiological foundations of a specific unmyelinated fiber that is most densely present in hairy skin, namely, C-tactile (CT) fibers. The CT fibers specifically activate in response to a soft gentle caress \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e which is typically associated with a subjective pleasurable sensation \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Social touch that involves C-tactile activation has been studied extensively in parental touch during infant development \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, but also intimate romantic relationships in adults \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSoft gentle touch has the potential to regulate autonomic functions, e.g. decreasing heart rate, or increasing heart-rate variability. This has been shown both in infants and in adults (Croy, Fairhurst and McGlone, 2022; Candia-Rivera, et al. 2024). Additionally, it is thought that it plays an important role in developing the most basic form of selfhood \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. CT-optimal social affective touch exhibits distinctions from similar non-social tactile stimulation produced by oneself, as evidenced by previous electrophysiology and neuroimaging studies \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The experiential contrast between receiving a cuddle from another person and self-administered tactile stimuli is a relatable phenomenon for many individuals. In this study from Boehme et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, it is also reported that participants displaying a more pronounced neural differentiation between self- and other-produced touch reported heightened clarity of self-perception. This correlation was established through an analysis with the self-concept clarity scale \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIndividuals with depersonalization disorder express a propensity to seek physical contact during heightened depersonalization states. Patients describe an inclination to seek physical proximity with others, perceiving it as a means to temporarily anchor their sense of self:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When the depersonalization is very deep (\u0026hellip;) I\u0026rsquo;ll also seek physical contact with whoever I\u0026rsquo;m with. It almost feels I need to be that other person because my own sense of self is not strong enough in that moment to sustain me\u0026rdquo;\u003c/em\u003e \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe found previously that healthy individuals during a pharmacologically induced dissociative state display reduced self-other distinction, particularly observing significant reductions in neural activations during social touch \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. We further found an increase of touch seeking (based on self-report). This is in line with the citation above addressing the inclination towards seeking physical contact during depersonalization episodes. It underscores the observation that an alteration of the sense of self prompts an inclination to seek relief through physical connection with others. Notably, it is crucial to highlight that while individuals subjectively express a desire for social contact during depersonalization, to the best of our knowledge there are no empirical investigations regarding this phenomenon.\u003c/p\u003e \u003cp\u003eThus, we created an online study to test the relationship between depersonalization and touch. We hypothesized that participants with lower levels of social touch acceptance (i.e. willingness to receive touch) and lower seeking of social touch would present higher levels of depersonalization. In order to test this hypothesis, we used a task based on the Embody task \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e to measure the acceptance of social touch across body parts from individuals with different degrees of closeness (ranging from strangers to intimate partners). Additionally, we used questionnaires to assess social touch tendencies, other negative and positive psychological factors related to affective states, and satisfaction with life.\u003c/p\u003e \u003cp\u003eOur investigation aims to shed light on the relationship between depersonalization disorder and social touch acceptance, particularly the nuanced role for the self-concept. With an increasing acknowledgment of the significance of bodily boundaries and self-perception, this study explores whether individual levels of depersonalization experience relate to daily life social touch experiences. The findings from this study not only contribute to our understanding of depersonalization but also extend the existing knowledge on the role of social touch in shaping self-perception. The potential implications of our research extend to clinical contexts and may inform therapeutic interventions for individuals experiencing depersonalization disorder.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eSocial touch acceptance assessment.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The most distant social proximity (1, strangers) was the only condition in which 30.04% of participants conveyed an aversion to any form of touch from strangers marking 0 body parts. As expected, the most selected areas for stranger-initiated touch were the arms (64,47%) and hands (44.69%).\u003c/p\u003e \u003cp\u003eFor the condition of touch acceptance from friends and family, the area with least acceptance of touch was evidently in the pelvic region (1.47%), while the arms (96,34%) and hands (91.58%) also emerged as the most favored areas for contact.\u003c/p\u003e \u003cp\u003eFor touch acceptance from intimate/romantic partners (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB), all areas had a high percentage of touch acceptance (compared to the other relationship types). The feet were the least selected area (71.26%).\u003c/p\u003e \u003cp\u003eThe one-way ANOVA (F\u0026thinsp;=\u0026thinsp;1440.401, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) showed significant differences between relationship types. Posthoc Tukey test revealed significant differences between all comparisons (stranger - family/friend: t=-20.939, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; stranger - intimate partner: t= -53.276, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; and family/friend - intimate partner: t= -32.307, p\u0026thinsp;=\u0026thinsp;0.001). As displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC, participants found it acceptable to receive social touch on an increasing number of body areas the closer their relationship to the toucher was (stranger\u0026thinsp;\u0026lt;\u0026thinsp;friend-family\u0026thinsp;\u0026lt;\u0026thinsp;intimate partner).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssociation between the percentage of social touch acceptance and social touch seeking.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe percentage of touch acceptance for the conditions showed significant correlations with STQ (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher percentage of acceptance of physical contact in all relationship cases was associated with an increased pursuit of social touch (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; strangers: rho=-0.400; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, family/friends: rho=-0.437; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, intimate partners: (rho=-0.436; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between Social Touch Acceptance and the Self Concept Clarity Scale (SCCS)\u003c/h2\u003e \u003cp\u003eThe condition intimate partner was the only social touch acceptance condition to show a weak association with self-concept clarity (SCCS; rho\u0026thinsp;=\u0026thinsp;0.146, p\u0026thinsp;=\u0026thinsp;0.016), i.e. people with overall higher touch acceptance with the romantic partner had a clearer self-concept. The percentage of social touch accepted from a stranger (rho\u0026thinsp;=\u0026thinsp;0.006, p\u0026thinsp;=\u0026thinsp;0.917) or family/friend (rho\u0026thinsp;=\u0026thinsp;0.034, p\u0026thinsp;=\u0026thinsp;0.573) was not significantly associated to the self-concept clarity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eExploring associations between depersonalization, self, social touch, and psychological factors\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eDepersonalization and Social Touch\u003c/h2\u003e \u003cp\u003eSymptoms of depersonalization were weakly associated with the percentage of social touch acceptance from the intimate partner (rho= -0.136, p\u0026thinsp;\u0026lt;\u0026thinsp;0.025), i.e. people with overall higher touch acceptance with the romantic partner had lower levels of depersonalization. However, this did not survive the correction for multiple comparisons. The other conditions did not show statistically significant results (stranger rho=-0.022, p\u0026thinsp;=\u0026thinsp;0.723; family/friend rho\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.951).\u003c/p\u003e \u003cp\u003eDepersonalization symptoms showed a weak association with social touch avoidance (STQ; rho\u0026thinsp;=\u0026thinsp;0.146; p\u0026thinsp;=\u0026thinsp;0.016), however this did not survive correction for multiple comparisons.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDepersonalization and Self-Concept Clarity\u003c/h2\u003e \u003cp\u003eAs anticipated, higher amounts of depersonalization symptoms were related to a diminished clarity in one\u0026rsquo;s self-concept, as shown by the statistically significant inverse correlation between depersonalization symptoms and the self-concept (SCCS; rho= -0.468, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.A).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe performed a mediation analysis, which reinforced the significant total effect of depersonalization symptoms (CDS) on self-concept clarity (SCCS) (Effect = -0.294, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When controlling for the potential mediator, social touch avoidance (STQ), the direct effect of depersonalization on self-concept clarity remained significant (Effect = -0.281, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates that depersonalization has a strong direct effect on self-concept clarity, even when considering social touch avoidance.\u003c/p\u003e \u003cp\u003eAdditionally, social touch avoidance had an indirect effect on the relationship between depersonalization and self-concept clarity (Effect = -0.013, BootCI [-0.032, -0.001]). Specifically:\u003c/p\u003e \u003cp\u003ea) The relationship between CDS and STQ was significant (Effect\u0026thinsp;=\u0026thinsp;0.073, p\u0026thinsp;=\u0026thinsp;0.001), indicating that higher depersonalization symptoms are associated with higher social touch avoidance. b) The effect of STQ on SCCS was also significant (Effect = -0.184, p\u0026thinsp;=\u0026thinsp;0.029), suggesting that higher social touch avoidance is associated with lower self-concept clarity. Thus, the indirect (mediating) effect of CDS on SCCS through STQ was significant, suggesting that part of the effect of depersonalization on self-concept clarity is mediated by social touch avoidance (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.B).\u003c/p\u003e \u003cp\u003eIn contrast, we found no evidence of indirect effects of social touch acceptance affecting the relationship between depersonalization and self-concept clarity. Although the relationship between CDS and touch acceptance from intimate partners was marginally significant (Effect = -0.001, p\u0026thinsp;=\u0026thinsp;0.071).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAssociation with negative and positive psychological factors\u003c/h2\u003e \u003cp\u003eAs expected, the presence of higher depersonalization symptoms predicted higher depressive (Rho\u0026thinsp;=\u0026thinsp;0.578, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and anxiety (Rho\u0026thinsp;=\u0026thinsp;0.447, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) symptoms.\u003c/p\u003e \u003cp\u003eConvergently, higher depersonalization symptoms were associated with higher presence of negative affect (PANAS negative: (rho\u0026thinsp;=\u0026thinsp;0.479, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower levels of positive affect (rho= -0.281; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, depersonalization symptoms also relate to lower general life satisfaction (Rho = -0.351, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All these analyses remain significant even after the application of correction for multiple comparisons (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study aimed to untangle the complex interplay between depersonalization symptoms and the seeking and acceptance of social touch. We began by examining the convergence of social touch seeking and acceptance across different social bonds. Subsequently, we explored the relationship between depersonalization and various social touch and psychological tendencies, focusing on how depersonalization correlates with the seeking and acceptance of social touch, as well as its association with negative (anxiety, depression, mood) and positive (mood, satisfaction with life) affective states.\u003c/p\u003e \u003cp\u003e In a large sample of Argentinian participants, we observed a convergence between seeking and accepting social touch across different social bonds. We replicate previous findings from other countries and cultures regarding socially accepted touch from varied social bonds across different body parts \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. We found, as expected, that depersonalization symptoms strongly affect the sense of self, and this effect is partially mediated by social touch avoidance. However, we did not find a definitive association between depersonalization and either seeking or accepting social touch. Additionally, consistent with expectations, we identified clear links between depersonalization and higher levels of negative psychological factors, as well as lower levels of positive psychological factors.\u003c/p\u003e \u003cp\u003eTo our knowledge this is the first study in Latin America to find consistency across touch seeking and acceptance, meaning that people who seek more touch from others, also accept more touch of different degrees according to the level of social closeness. It is important to note that while the behaviors to seek touch from others (as measured by the STQ) and accept to receive touch (assessed through body maps) are correlated, these are present in different degrees in the population. Touch acceptance is very variable across participants and depends on further factors like physiological state, given context, and probably culture or social norms \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This study does not allow to interpret if subjects are imagining varied social scenarios, however, touch acceptance from different degrees of social closeness and body parts seems to be consistent with previous research on other cultures \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study replicates that touch acceptance depends on the emotional bond between the person receiving the touch with the \u0026ldquo;toucher\u0026rdquo;. However, compared to Suvilehto et al., (2015), where touch acceptance in a similar online setting was compared across five European countries, in our Argentinian sample, strangers are socially accepted to touch more than the hands. Although, around a third of the sample reported not accepting any touch from strangers, a large percentage of participants also accepted touch on the arms and to a much smaller degree to the face, torso, and legs. This could indicate a cultural difference that exists in Latin American countries, where in the young population (as the one assessed in this study), it is usual that strangers meeting in public events greet each other with one kiss on the cheek (cheek to cheek kiss, although it is not a generalized behavior), considerably alike some European countries when having a closer emotional connection with someone. Additionally, for young adults the main source of transportation is through public transport. Here, it is usually very crowded during peak hours, and it could be natural to touch arms shoulders or legs with your nearby travelling neighbor. Although this study did not present front and back bodies or more 3D space of body to be able to confirm this completely.\u003c/p\u003e \u003cp\u003eIt is important to also clarify the difference that in this study we did not ask about pleasantness ratings for the touch acceptance conditions, thus, it is still possible that as in the mentioned public transport example, participants find it acceptable and statistically normal to encounter touch in public transportation in peak hours, this might not reflect a pleasant form of touch. A cross-cultural study looked into another aspect of touch that showed cultural differences \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Here, they compared German and Chinese participants, and although both presented some cultural convergence in touched areas, their results also reflect some cultural differences in how comfortable people feel with touch. Germans were more comfortable with touch in some body parts that seem more intimate for some cultures, like the torso and less comfortable with touching hands, which was expressed as more comfortable for the Chinese participants. Exploring different attributes of touch, as seeking, accepting, liking, feeling comfort, or other, might be relevant to better characterize human functional and dysfunctional behavior.\u003c/p\u003e \u003cp\u003eAdditionally, it could be relevant to disentangle with which body part the toucher is producing the touch, as leg-to-leg contact sitting on public transportation might be acceptable and hand touching a leg in public transportation is less likely to be acceptable. Future studies with similar designs in social touch should look deeper into the importance of social context and characteristics of the toucher in order to assess the difference between social acceptance of touch and genuine pleasantness. As seen in Suvilehto et al., (2015), gender of the toucher might play a crucial role in touch acceptance as touch from men is less likely to be accepted in \u0026ldquo;taboo areas\u0026rdquo; of the body. Thus, it is possible that even with matched social context and touching body part, there will be a difference in touch acceptance and pleasantness for male and female touchers \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe found further support that touch appears to be related to a clearer sense of self, however, we only find this relationship for touch from intimate partners. Touch from others has previously been shown to be more pleasant and have greater autonomic effects compared to other forms of touch \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Additionally, the relationship between touch and self-concept clarity scale has previously been reported: the greater the neural differentiation of self- and other-touch the clearer the self-concept (see Supplementary results in Boehme et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e). However, it might be that receiving touch from close intimate relationships might be processed differently (e.g. due to higher salience or higher trust) than other types of social bonds, although to our knowledge this has not been studied previously on a neural level.\u003c/p\u003e \u003cp\u003eDepersonalization symptoms are highly prevalent among the general population, often occurring outside the bounds of a formal diagnosis. Although some literature refers that up to 3% of the general population has a diagnosis, research also suggests that up to 70% of individuals may experience depersonalization symptoms at some point in their lifetime \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Additionally, these symptoms are particularly common among victims of abuse or maltreatment, and are often co-occurring with conditions such as depression, anxiety, and borderline personality disorder \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e further worsening their well-being.\u003c/p\u003e \u003cp\u003eDespite subjective reports from people experiencing depersonalization that indicate a desire for social touch as a means of grounding themselves \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, our study did not find a significant association between depersonalization symptoms and the seeking or acceptance of social touch. In fact, we find marginally threshold associations in the opposite direction. This could be attributed to the fact that our study did not evaluate people presenting a formal diagnosis of depersonalization or evaluated this in another culture. Although, in support of dimensional views of psychopathology, it opens the door to other explanations.\u003c/p\u003e \u003cp\u003eOne possibility is a mismatch between the subjective belief in the need for touch and actual objective behavior. Previous research has shown that some psychiatric symptoms are linked to discrepancies in metacognition, in the presence \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e or absence of objective performance variations \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. It is also possible that people who experience depersonalization seek less touch in daily life but might actively seek out touch during an acute depersonalization episode.\u003c/p\u003e \u003cp\u003eAnother explanation could be that less daily tactile interaction could evoke more depersonalization symptoms, as the individual might fail to benefit from important somatosensory sensations which strengthen the bodily awareness and therefore also the sense of self. In fact, we show here that people with higher depersonalization present a diminished sense of self that is partially mediated by their social touch seeking behaviors. However, it is challenging to identify the causality empirically. Early life trauma mediated the presence of later on psychosis \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, suggesting that traumatic events that produce alterations in self-concept might be related to more severe and chronic alterations of the self as in psychosis. In fact, another studyfound that individuals with more dissociation proneness had less self-concept integration \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. There is also some support for causality from a study during periods of social isolation (as during the COVID-19 pandemic): here, lower amounts of social touch were related to more depersonalization experiences in an observational online study \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Thus, seeking positive social interactions and positive social touch might have a protective effect on the sense of self.\u003c/p\u003e \u003cp\u003eWe found an overall weak association between touch acceptance from the intimate partner and depersonalization; however, this effect did not survive multiple comparisons. This may be attributed to behavioral changes that occur only during acute dissociative episodes. Evaluating individuals with acute, enhanced dissociative symptoms is experimentally challenging, as spontaneous dissociative experiences are difficult to capture in a laboratory setting. However, pharmacological manipulation of subjective experiences can offer a comparable scenario. In a previous study from our group, we observed changes in touch-seeking behavior, as measured also by the Social Touch Questionnaire (STQ), following ketamine administration \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Participants reported increased touch-seeking behavior during the pharmacologically evoked dissociation compared to a within-subject placebo control session in a Swedish sample.\u003c/p\u003e \u003cp\u003eAnother potential factor is the cultural context of the studies. Most research on depersonalization and touch (separately) has been conducted outside of Latin America, leaving open the possibility of cultural differences affecting touch-seeking and acceptance behaviors. Cultural variations could influence how individuals with depersonalization symptoms perceive and engage in social touch.\u003c/p\u003e \u003cp\u003eTo address these complexities, future studies should include contrasting objective behaviors and subjective feelings of touch. A first step could be larger ecological momentary assessments, which do not rely as much on retrospective reporting. Researchers should also compare conditions involving the presence and absence of dissociative experiences in different countries. This approach will provide a clearer understanding of how touch processing may be related to dissociative symptomatology across different cultures. Additionally, comparing individuals with and without acute dissociative symptoms in various cultural contexts could help clarify the role of cultural factors in shaping these experiences.\u003c/p\u003e \u003cp\u003eOur study found that higher depersonalization symptoms are significantly associated with various negative psychological factors. Specifically, higher depersonalization symptoms were associated with higher levels of depressive and anxiety symptoms. These findings are consistent with the literature, which indicates that depersonalization often co-occurs with other mental health conditions, particularly those related to mood and anxiety \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdditionally, higher depersonalization symptoms were correlated with higher levels of negative affect and lower levels of positive affect. These results suggest that individuals experiencing depersonalization are more likely to report feeling more negative emotions and fewer positive emotions. This aligns with the understanding that depersonalization can significantly disrupt emotional processing and overall affective experience \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e that could be the cause of such symptoms. Also, adverse life events as abuse or childhood mistreatment might be the cause of depersonalization as a coping strategy. Possible interventions in increasing positive affect, such as using mindfulness techniques could be a source of treatment.\u003c/p\u003e \u003cp\u003eFurthermore, we found that higher depersonalization symptoms were associated with lower general life satisfaction. This relationship underscores the broad impact of depersonalization on an individual\u0026rsquo;s perceived quality of life and well-being. The persistent and distressing nature of depersonalization symptoms can erode one\u0026rsquo;s sense of self and thus also the fulfillment and contentment with life \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Thus, understanding and finding better treatment strategies that could help ground subjects to their self is of high importance.\u003c/p\u003e \u003cp\u003eCultural factors could also play a significant role in these dynamics. The particular touch seeking and accepting behaviors in different cultures might influence how individuals with depersonalization are affected. Future cross-cultural research should consider if cultures in which touch is more accepted have a positive or negative impact on mental health. If people with depersonalization report in other cultures to seek touch to feel grounded, then a culture more open to touch might serve as a protective factor. How does this balance out with a more vulnerable population as is the case in Latin America, where economic inequalities and higher health disparities exist alongside fewer programs promoting healthy lifestyles \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e? This is still an unanswered question that is of relevance for creating therapeutic interventions.\u003c/p\u003e \u003cp\u003eOur study provides insights into the complex dynamics between depersonalization disorder, social touch seeking and acceptance, self-clarity and psychological factors within an Argentinian context. We found that while depersonalization significantly impacts the sense of self and is linked to social touch avoidance, it does not strongly influence the seeking or acceptance of social touch despite discrepancies with self-reported behaviors from people with depersonalization in other cultures.\u003c/p\u003e \u003cp\u003eAdditionally, our findings highlight that depersonalization is associated with higher levels of negative psychological factors, such as anxiety and depression, and lower levels of positive psychological factors, including mood and life satisfaction. The observed cultural variations in social touch acceptance underscore the importance of considering cultural context in understanding these behaviors.\u003c/p\u003e \u003cp\u003eFuture research should further investigate the causal relationships between social touch, depersonalization, and psychological well-being across diverse cultural settings to better inform therapeutic interventions. These insights emphasize the potential for tailored treatment strategies that address both the psychological and cultural dimensions of depersonalization.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eWe collected data using an online survey available in Spanish between June - December 2023. The study was advertised through different social media platforms. The study was performed in accordance with the Declaration of Helsinki and was approved by the Committee for the Evaluation of Responsible Conduct in Research at the Faculty of Psychology of the University of Buenos Aires (CEI23021).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe total sample comprised 273 subjects (83,15% female, 15,02% male, 1,83% non-binary), age range 18\u0026ndash;67 years old (M\u0026thinsp;=\u0026thinsp;29.47; SD\u0026thinsp;=\u0026thinsp;12.16), of Argentine nationality and residing in the country. The majority of participants were University students or had University education (71%). 51% identified as being part of the middle economic class. The category of participants that answered what best described their status: being single, divorced and widow were grouped into \u0026ldquo;not in a relationship\u0026rdquo; (59%) and the categories married, in a stable relationship and living with partner were grouped into \u0026ldquo;in a relationship\u0026rdquo; (41%). All participants signed an informed consent in which they agreed to participate in the study, acknowledging that they would not receive diagnostic feedback and their full awareness that they could withdraw at any time. All participants were required to be of legal age. It is also noteworthy to clarify that all data was collected before a \u0026ldquo;heat wave\u0026rdquo; striking in Argentina, as extreme heat could be a confounding factor to how much touch participants are willing to accept from others.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDescription of forms\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eBody maps to measure social touch acceptance across body parts\u003c/h2\u003e \u003cp\u003eIndividuals were presented with a visual representation of the human body and were tasked with indicating the locations on their own body where they would find it \u003cem\u003eacceptable to receive touch\u003c/em\u003e from different individuals: a) a stranger, b) a close family member or friend, and c) an intimate partner (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Participants were required to choose from a predefined list of body regions, accompanied by a depiction of the reference body displaying these regions \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. The chosen areas were broadly derived from earlier studies \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e and intentionally maintained a generic nature.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocial Touch questionnaire (STQ)\u003c/h2\u003e \u003cp\u003eThe questionnaire serves as an instrument for gauging emotions and attitudes concerning social touch, as outlined by Wilhelm et al. (2001). Comprising 20 items, respondents provide feedback on a 5-point Likert scale, ranging from 0 ('not at all') to 4 ('extremely'). Notably, a higher score is indicative of a reduced inclination towards seeking social touch.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCambridge Depersonalization Scale (CDS)\u003c/h2\u003e \u003cp\u003eTo evaluate depersonalization symptoms, we utilized the adaptation of the original scale by Sierra and Berrios in 1996, adapted by Molina Castillo \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Comprising a 29-item questionnaire, it evaluates the frequency and duration of depersonalization experiences over the past six months. Each item is rated on two Likert scales: frequency (0\u0026ndash;4) and duration (1\u0026ndash;6). The sub-score for each item is the result of arithmetically summing the values obtained in both subscales. The total score of the CDS is the sum of the scores obtained in all items, resulting in a score range from 0 to 290. This final score reflects the overall intensity of depersonalization experiences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSelf-Clarity Concept Scale\u003c/h2\u003e \u003cp\u003eThe Self-Concept Clarity Scale (SCCS), developed by Campbell et al. (1996), aims to assess clarity in self-concept through 12 items rated on a 5-point Likert scale, ranging from 1 (\"completely disagree\") to 5 (\"completely agree\"), with a maximum score of 115 points. For this study, the Argentine version of the scale, comprising 23 items with response options equivalent to those of the original scale was utilized \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. High scores in self-concept clarity are associated with well-being measures, such as self-esteem, achievement of long-term goals, conscientiousness, and greater satisfaction in romantic relationships. Conversely, low scores are linked to negative aspects, including conflict, indecision, body dissatisfaction, and an increase in self-harm, among others.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of other Psychiatric Symptoms\u003c/h2\u003e \u003cp\u003e \u003cem\u003ePatient Health Questionnaire (PHQ-9)\u003c/em\u003e by Kroenke et al. (2001) available in Spanish is a brief tool for assessing the presence and severity of depressive symptoms. It is a self-report scale comprising 9 items. Regarding the obtained score, the PHQ-9 is categorized into five groups: a score between 0 and 4 indicates the absence of depressive symptoms, 5 to 9 implies mild depressive symptoms, 10 to 14 indicates moderate depressive symptoms, 15 to 19 suggests moderately severe depressive symptoms, and a score higher than 20 indicates severe depressive symptoms.\u003c/p\u003e \u003cp\u003e \u003cem\u003eGeneralized Anxiety Disorder Scale (GAD-7)\u003c/em\u003e developed by Spitzer \u003cem\u003eet al.\u003c/em\u003e (2006) available in Spanish. This scale consists of 7 items and is used to measure symptoms of Generalized Anxiety Disorder. It is a brief self-report measure that assesses the frequency with which, over the past 2 weeks, individuals have experienced each of the seven core symptoms of Generalized Anxiety Disorder (GAD). Responses are rated on a 4-point Likert scale ranging from 0 to 3, with 0 representing \"not at all,\" 1 \"several days,\" 2 \"more than half the days,\" and 3 \"nearly every day.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Affect and Satisfaction with Life Scale (SWLS)\u003c/h2\u003e \u003cp\u003eThe \u003cem\u003eSatisfaction with Life Scale\u003c/em\u003e (SWLS; Diener \u003cem\u003eet al.\u003c/em\u003e, 1985) is a brief assessment of a person\u0026acute;s overall sense of satisfaction with their life. With 5 items, the possible scores range from 5 (low satisfaction) to 35 (high satisfaction). Score ranges can be interpreted as follows: extremely dissatisfied if the score is between 5 and 9, dissatisfied if it is between 10 and 14, slightly dissatisfied from 15 to 19, neutral if it is 20, slightly satisfied if it ranges from 21 to 25, satisfied if it goes from 26 to 30, and extremely satisfied from 31 to 35 points.\u003c/p\u003e \u003cp\u003eThe Spanish version of the \u003cem\u003ePositive and Negative Affect Schedule\u003c/em\u003e (PANAS; Robles and P\u0026aacute;ez, 2003) validated in Argentina \u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e is a scale with 20 items that provides information about positive and negative affect within a specific time frame. Each item is scored on a five-point Likert scale, ranging from 1 (very slightly or not at all) to 5 (extremely), with 10 items corresponding to a measure of positive affect and 10 to a measure of negative affect. Experiencing a high level of positive affect involves a state of enthusiasm, heightened energy, alertness, concentration, and enjoyment, while a low level is associated with feelings of sadness and lethargy. On the other hand, negative effects are related to subjective distress, encompassing a variety of aversive moods such as anger, contempt, disgust, fear, and nervousness. A low level of negative affect is associated with states of calmness and serenity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eFor the body maps of social touch acceptance across body parts, we first calculated the descriptive statistics for the percentage of each body part that was selected per condition for the entire sample. Later, we extracted the percentage of total touch acceptance per condition and subject. The later index was used for further statistical analyses. A one-way ANOVA was employed to examine differences in social touch acceptance between 3 levels of closeness (stranger/friend-family/intimate partner). Tukey's post hoc analysis was conducted between conditions to explore significant differences among paired contrasts.\u003c/p\u003e \u003cp\u003eFor all association comparisons Spearman rank correlation coefficient (Rho) was used. Significance was considered at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. However, in order to correct for multiple comparisons performed with depersonalization scale, a Bonferroni correction was manually applied to adjust the threshold of all comparisons to this scale. The resulting corrected p-value was set at p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.005 to maintain a 95% level of significance for 10 comparisons. All prior analyses were performed using JASP Team (2024; Version 0.19.0).\u003c/p\u003e \u003cp\u003eTo analyze the relationship between depersonalization symptoms (CDS) and self-concept clarity (SCCS), we conducted first the Spearman\u0026rsquo;s rank correlation coefficient (rho). Then, we performed a mediation analysis to evaluate the mediating effect of social touch avoidance (STQ) on the CDS-SCCS relationship. The mediation analysis included calculating the total, direct, and indirect effects, with bootstrapped confidence intervals (BootCI) to determine the significance of the indirect effect. This mediation analysis was conducted using a standard software package (SPSS), and significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Raw statistical graphs and Figures were style edited using Adobe Illustrator (2019).\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaula C. Salamone: Experimental design, Formal analysis, Methodology, Visualization, Writing, Review \u0026amp; Editing; Nadia Alejandra Dowzuk: Data Collection, Data curation, Visualization, Formal analysis, Writing, Review \u0026amp; Editing; Martina Nayla Gallo: Data Collection, Data curation, Visualization, Formal analysis, Review \u0026amp; Editing; Rebecca Boehme: Experimental design, Formal analysis, Writing, Review \u0026amp; Editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData can be available upon reasonable request to corresponding Author: \u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Svenska Vetenskapsr\u0026aring;det (VR) grant (2019-01873) awarded to RB and the Lions forskningsfond granted to PCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eADDITIONAL INFORMATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no competing financial and non-financial interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLegrand, D. 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New evidence of the psychometric properties of panas in student population Argentina. \u003cem\u003eRev. Argentina Clin. Psicol.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e, 752\u0026ndash;760 (2019).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depersonalization symptoms, Social touch seeking, Self-concept, Psychiatric symptomatology, Touch acceptance, Therapeutic interventions","lastPublishedDoi":"10.21203/rs.3.rs-4923651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4923651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study explores the relationship between depersonalization symptoms, social touch seeking and acceptance, self-concept clarity, and psychological factors in a large sample of Argentinian participants (N\u0026thinsp;=\u0026thinsp;273). In this online study, we assessed participants' acceptance of (or willingness to receive) touch from strangers, friends/family, and intimate partners. Replicating previous studies, we found a higher acceptance of touch from closer social bonds. Touch acceptance from intimate partners showed weak links with self-concept clarity and lower depersonalization symptoms. However, no definitive link between depersonalization symptoms and touch seeking or acceptance was found. Higher depersonalization symptoms were associated with increased social touch avoidance and decreased self-concept clarity. Mediation analyses indicated that social touch avoidance partially mediates the relationship between depersonalization and self-concept clarity. Additionally, depersonalization was associated with higher levels of anxiety, depression, and negative affect, and lower levels of positive affect and life satisfaction. Our results underscore the importance of considering touch in creating therapeutic interventions for depersonalization.\u003c/p\u003e","manuscriptTitle":"From bodily numbness to social connection: unveiling the relationship between depersonalization, self-concept, and social touch","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-26 16:05:41","doi":"10.21203/rs.3.rs-4923651/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0453d6a5-c9e4-4735-b66d-49a2bceaf679","owner":[],"postedDate":"September 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":38008141,"name":"Biological sciences/Psychology/Human behaviour"},{"id":38008142,"name":"Health sciences/Health care/Therapeutics"},{"id":38008143,"name":"Biological sciences/Neuroscience"},{"id":38008144,"name":"Biological sciences/Psychology"}],"tags":[],"updatedAt":"2025-01-15T10:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-26 16:05:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4923651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4923651","identity":"rs-4923651","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}