autoscopy

Autoscopy is a neurological and psychiatric phenomenon in which a person perceives a life-sized image or double of themselves in external space. The perceived figure resembles the observer and may move and gesture as the real person, sometimes interacting with the environment. Autoscopic experiences are distinct from ordinary visual imagery and from out-of-body experiences, though they can share underlying disruptions in self-perception.

Autoscopic phenomena are traditionally subdivided into autoscopic hallucinations and heautoscopy. Autoscopic hallucination refers to a clear, visual image of a self-double located outside the body, often in extrapersonal space, that is perceived as a visual copy without a problematic sense of identity. Heautoscopy involves a more complex phenomenology: the observer witnesses a double that may be indistinguishable from themselves and frequently experiences uncertainty about the figure’s identity, sometimes reporting that the image acts with autonomy or that it resembles someone else.

Clinical associations and proposed mechanisms: Autoscopic phenomena are most commonly reported in temporal lobe disturbances, including epilepsy, migraines with aura, and brain lesions, but they can occur in dementia, psychotic disorders, and after head injury. Neurobiological explanations emphasize disruptions in multisensory integration at the temporoparietal junction and related networks that integrate vision, proprioception, and embodiment, sometimes involving altered activity in mirror-sensory or parietal networks. External factors such as sensory deprivation or psychoactive substances can provoke or modulate these experiences.

Diagnosis and treatment: Diagnosis is clinical, based on patient descriptions and neurological assessment; imaging or EEG may be used to identify underlying brain conditions. Management focuses on treating the underlying cause (e.g., epilepsy, migraine, or neurodegenerative disease), with supportive care and, when appropriate, psychiatric or neurological interventions.