Three Cases of Depersonalization/Derealization Disorder Related to the Use of Classic Psychedelics
SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice – December 01, 2025
Source: OpenAlex
Summary
Depersonalization-derealization disorder (DDD) can follow psychedelic use, affecting individuals for months. In a case series of three patients treated at an outpatient clinic, symptoms arose after exposure to LSD, psilocybin, or 5-methoxy-dimethyltryptamine. Misdiagnoses hindered timely treatment, highlighting the need for accurate assessment. Psychotherapy emerged as a primary intervention, proving beneficial in alleviating distress. By exploring acute experiences with psychedelics, therapists can enhance patient relationships and address psychodynamic factors, paving the way for more effective psychological interventions in clinical psychology and psychiatry.
Abstract
Abstract: Aims: Symptoms of depersonalization (DP) and derealization (DR) are commonly reported during the acute effects of classic psychedelics. In some individuals, these symptoms persist, resulting in depersonalization-derealization disorder (DDD), associated with distress and help-seeking behavior. This case series seeks to underscore some of the diagnostic challenges and treatment complexities associated with psychedelic-associated DDD from a psychodynamic perspective. Case Report: We present three cases of DDD after the use of psychedelics – LSD, psilocybin and 5-methoxy-dimethyltryptamine – all of whom were treated at our outpatient clinic for post-psychedelic complications. Symptoms emerged shortly after psychedelic exposure and persisted for several months. Psychotherapeutic interventions proved to be helpful. In some cases, initial misdiagnoses delayed appropriate treatment. Conclusions: Psychotherapy should be prioritized in psychedelic related DDD, while pharmacological treatment ought to be considered as second-line option. Even if treatment is not distinct from DDD unrelated to the use of psychedelics, a thorough exploration of what was experienced during the acute drug effects may have validating effects and strengthen the patient relationship. At the same time, it may facilitate a deeper understanding of the psychodynamic factors underlying individual pathologies.