Psychedelic-Associated Depersonalization-Derealization Disorder.

Matthias Michal

doi:10.1007/7854_2025_599

Psychedelic-Associated Depersonalization-Derealization Disorder.

Matthias Michal

Current Topics in Behavioral Neurosciences 2026 DOI: 10.1007/7854_2025_599 (opens in new tab)

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AI-extracted from the abstract

Characteristics	Theoretical or philosophical paper Case report Peer reviewed
Interventions	psychoeducation challenging false causal attributions long-term psychotherapy
Duration	50-100 sessions
Topics	Anxiety
Keywords	Depersonalization Derealization Emotion Psychodynamic
Key points	Argues that depersonalization-derealization disorder is not caused by drug intoxication but results from avoidance of aversive emotional states and early attachment traumas, with psychedelics acting as a catalyst in vulnerable individuals.

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.

Comparable studies

Other theoretical and historical papers on anxiety, most cited first.

Study	Year	Design
Psychedelics as Medicines: An Emerging New Paradigm General population	2016	Theoretical or philosophical paper
Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance	2020	Theoretical or philosophical paper
Taking Psychedelics Seriously	2018	Theoretical or philosophical paper
How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale	2009	Theoretical or philosophical paper
Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics	2019	Theoretical or philosophical paper

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