Three Cases of Depersonalization/Derealization Disorder Related to the Use of Classic Psychedelics
Dario Jalilzadeh Masah, Derin Marbin, Tomislav Majić
SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice December 1, 2025 DOI: 10.1024/0939-5911/a000959 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Individuals with depersonalization-derealization disorder after psychedelic use |
| Intervention | Psychotherapy |
| Duration | Several months |
| Topics | Psilocybin |
| Keywords | Psychodynamics Depersonalization Distress Derealization Psychotherapist Psychological intervention Hallucinogen Typology Clinical psychology |
| Citations | 1 |
| Key findings | Psychotherapy should be prioritized for psychedelic-related depersonalization-derealization disorder, and exploring the acute drug experience may strengthen the patient relationship and reveal psychodynamic factors. |
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.