Psychedelic iatrogenic structural dissociation: an exploratory hypothesis on dissociative risks in psychedelic use.
Frontiers in Psychology March 4, 2025 DOI: 10.3389/fpsyg.2025.1528253 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Altered states of consciousness |
| Keywords | Psychedelics Mental health Dissociation Therapeutic risks |
| Citations | 11 |
| Key findings | Psychedelics may increase the risk of psychological destabilization in trauma-exposed individuals by reactivating dissociated traumatic material, as proposed by the Psychedelic Iatrogenic Structural Dissociation (PISD) hypothesis. |
Abstract
This paper introduces the hypothesis of Psychedelic Iatrogenic Structural Dissociation (PISD), proposing that psychedelics may reactivate dissociated traumatic material, increasing the risk of psychological destabilization in trauma-exposed individuals. Grounded in structural dissociation theory, this framework suggests that psychedelics can disrupt the balance between daily functioning (the Apparently Normal Personality, ANP) and trauma-related responses (the Emotional Personality, EP), leading to the resurfacing of unintegrated memories. A review of recent studies highlights persistent adverse effects associated with psychedelic use, including emotional dysregulation, identity fragmentation, derealization, and perceptual disturbances, particularly among individuals with early trauma histories. To mitigate these risks and facilitate trauma processing, integration practices, body-focused therapies, and structured social support systems are proposed as key interventions. Additionally, emerging neurophysiological models suggest that psychedelics may reconfigure dissociative processes through the modulation of entrenched patterns, potentially facilitating trauma integration or increasing vulnerability to destabilization, depending on individual and contextual factors. These findings underscore the necessity of trauma-informed screening, preparation, and integration protocols to enhance the safety and efficacy of psychedelic therapies, particularly for vulnerable populations.
Comparable studies
Other narrative reviews on altered states of consciousness, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects. | 2020 | Review | |
| Psychobiology of Altered States of Consciousness. | 2005 | Review | |
| Intrinsic Brain Activity in Altered States of Consciousness | 2008 | Review | |
| Dynamic functional connectivity and brain metastability during altered states of consciousness | 2017 | Review | |
| A default mode of brain function in altered states of consciousness. | 2013 | Review |
Citations in the library
Cited by 11
- Recalled childhood trauma and post-psychedelic trajectories of change in a mixed-methods study Scientific Reports November 27, 2025
- Practitioner perspectives on extended difficulties and optimal support strategies following psychedelic experiences: a qualitative analysis. Harm Reduction Journal December 9, 2025
- The experience of recalled trauma during psychedelic experiences and perceived links to subsequent extended difficulties: A mixed-methods study Research Square August 21, 2025
- Psychedelics in Multiple Sclerosis: Mechanisms, Challenges, and Prospects for Neuroimmune Modulation and Repair. Cells November 26, 2025
- Beyond Access: The SIGNAL Model of Internal Guidance in Psychedelic Preparation and Integration Psychedelics July 1, 2026
and 6 more in the library
Cites 83
- Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry May 17, 2016
- The dissociative anaesthetics, ketamine and phencyclidine, selectively reduce excitation of central mammalian neurones by N‐methyl‐aspartate British Journal of Pharmacology June 1, 1983
- Trial of Psilocybin versus Escitalopram for Depression New England Journal of Medicine April 14, 2021
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder JAMA Psychiatry November 4, 2020
- Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology July 1, 2008
and 78 more in the library