On Perception and Consciousness in HPPD: A Systematic Review
Pieter J. Vis, Anneke E. Goudriaan, Bastiaan C. Ter Meulen, Jan Dirk Blom
Frontiers in Neuroscience August 11, 2021 DOI: 10.3389/fnins.2021.675768 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Case report Peer reviewed |
|---|---|
| Sample size | 97 |
| Population | People with HPPD described in case reports and case series |
| Topics | Anxiety |
| Keywords | Consciousness Perception Phenomenology philosophy Clinical psychology |
| Citations | 40 |
| Key findings | HPPD involves a broader range of symptoms than DSM-5 criteria suggest, including Alice in Wonderland syndrome features, non-visual symptoms, and perceptual symptoms not linked to prior intoxication, with co-occurring depression worsening prognosis. |
Abstract
Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic “flashbacks” is limited. We systematically evaluated original case reports and case series on HPPD to define its phenomenology, associated (psycho)pathology, and course. Our search of PubMed and Embase yielded 66 relevant publications that described 97 people who, together, experienced 64 unique symptoms of HPPD. Of these, 76% concerned symptoms characteristic of Alice in Wonderland syndrome, over 50% non-visual symptoms, and 38% perceptual symptoms not clearly linked to prior intoxication states. This is in contrast with the DSM-5 diagnostic criteria for HPPD. Even though less than half of the patients showed a protracted disease course of over a year, a third achieved remission. However, in patients with co-occurring depression (with or without anxiety) HPPD symptoms persisted longer and treatment outcomes were more often negative. Thus, unlike the acute stages of psychedelic drug intoxication, which may be accompanied by altered states of consciousness, HPPD is rather characterized by changes in the content of consciousness and an attentional shift from exogenous to endogenous phenomena. Since HPPD is a more encompassing nosological entity than suggested in the DSM-5, we recommend expanding its diagnostic criteria. In addition, we make recommendations for clinical practice and future research.