Three Cases of Depersonalization/Derealization Disorder Related to the Use of Classic Psychedelics

Symptoms of depersonalization and derealization are common during the acute effects of classic psychedelics and can persist, leading to depersonalization-derealization disorder (DDD) with distress and help-seeking behavior. Three cases of DDD after use of LSD, psilocybin, and 5-methoxy-dimethyltryptamine are presented, all treated at an outpatient clinic for post-psychedelic complications. Symptoms emerged shortly after exposure and lasted months. Psychotherapeutic interventions were helpful, while initial misdiagnoses delayed treatment in some cases. Psychotherapy should be prioritized for psychedelic-related DDD, with pharmacological treatment as a second-line option. Exploring the acute drug experience may validate patients and strengthen the therapeutic relationship, while revealing psychodynamic factors underlying individual pathologies.

Study at a glance

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.