Case Report: A possible association between significant dissociations after esketamine treatment and histrionic personality disorder

Dissociation—a disruption in the normal integration of psychological functions—is a common adverse effect of esketamine nasal sprays. Individuals with high trait dissociation face greater risk of severe induced dissociation. However, intense dissociation may also predict better therapeutic response. This case report describes a patient with histrionic personality disorder (HPD) who experienced an unusually intense and persistent dissociative reaction during esketamine therapy. The case suggests that certain HPD personality traits may heighten vulnerability to esketamine-induced dissociation, underscoring the need to identify patient-level factors that amplify dissociative responses for improved risk stratification and clinical care.

Study at a glance

Abstract

Dissociation is a complex and transdiagnostic phenomenon defined as a disruption of, or discontinuity in, the normal, subjective integration of one or more aspects of psychological functioning. Dissociation has been identified as one of the most frequently occurring adverse effects associated with the use of esketamine nasal sprays. Individuals with high trait dissociation may be at a higher risk of experiencing an induced dissociative state and a significantly higher risk of experiencing severe induced dissociation. High esketamine-induced dissociation may act as a predictor of optimal therapeutic response, rather than solely an adverse effect. This case report describes an unusually intense and persistent dissociative reaction in a patient with histrionic personality disorder (HPD) undergoing esketamine therapy. The patient's marked dissociation upon treatment initiation raises the possibility that certain personality traits characteristic of HPD may heighten vulnerability to esketamine-induced dissociation. By explicitly examining a potential link between HPD and dissociation severity, this case highlights the importance of identifying patient-level factors that may amplify dissociative responses. Such knowledge has practical clinical implications for risk stratification, patient education regarding expected side effects, ensuring increased attention during the procedure.