Psychedelic-Associated Depersonalization-Derealization Disorder.

Depersonalization (DP) and Derealization (DR) are perceptual changes where the self or surroundings feel unreal, common in mental disorders and central to depersonalization-derealization disorder (DDD). Classic psychedelic drugs often trigger DP/DR symptoms that usually resolve after the drug is eliminated, but DDD is frequently precipitated by drug intoxication, leading some to frame it as a 'never-ending trip.' This article argues that such a conclusion is reductionist, may foster false illness perceptions, hinder awareness of emotional conflicts, and erode self-efficacy. DDD is a mental disorder arising from avoidance of aversive emotional states, related to functional brain network alterations rather than organic damage.

Study at a glance

Abstract

Depersonalization (DP) and Derealization (DR) refer to perceptual changes of "as-if-character" where the self (→DP) or the surroundings (→DR) are experienced as unreal. These symptoms are highly prevalent in individuals with mental disorders. If these symptoms persist most of the day for months, the diagnosis of depersonalization-derealization-disorder (DDD) is likely. DDD is a common disorder with a high comorbidity with depression, anxiety disorders, and personality disorders.The intake of classic psychedelic drugs often elicits DP/DR symptoms, which cease in most cases when the drug is eliminated. DDD is frequently precipitated by drug intoxication (cannabis and classic psychedelics). Patients and some researchers assume, therefore, that drug intoxication is the cause of DDD and frame it as a "never-ending trip." Researchers base their assumption on the potential of psychedelics to elicit DP/DR symptoms and on case series of individuals reporting long-lasting uncomfortable symptoms after drug intake. Arguments are presented that demonstrate this is a reductionist conclusion and that this assertion may lead to false illness perceptions, hinder awareness of emotional conflicts, and erode patients' self-efficacy. The main arguments are that, first, DDD is a mental disorder resulting from the avoidance of aversive emotional states. DDD is related to functional alterations of brain networks rather than organic brain damage. Second, psychedelics act as a catalyst that accelerates the onset of DDD in vulnerable individuals by mobilizing complex anxiety-laden unconscious emotions from early attachment traumas.The treatment of DDD encompasses psychoeducation about the nature of the disorder, challenging false causal attributions to external causes (such as drug intake) and helping the patient experience and process their emotions adaptively. To achieve remission, patients usually need long-term psychotherapy of 50-100 sessions.