Psychedelic-Associated Depersonalization-Derealization Disorder.
Level 5 - mechanism / opinion, no new human data
Narrative review and theoretical perspective with no new empirical data or systematic synthesis.
PubMed 40952420 · doi:10.1007/7854_2025_599
What was done
This paper provides a theoretical review and clinical perspective examining the relationship between classic psychedelic drug use and the development of depersonalization-derealization disorder (DDD). It critiques the view that drug intoxication causes DDD as a "never-ending trip" and proposes a psychodynamic and neurofunctional model for its onset and psychotherapeutic treatment.
What was found
The abstract reports no quantitative experimental or epidemiological data. Conceptually, it argues that DDD arises from emotional avoidance and functional brain network alterations rather than structural brain damage, with psychedelics acting as catalysts that mobilize unresolved attachment trauma and anxiety. It states that treatment requires challenging external drug attributions and typically entails 50 to 100 sessions of long-term psychotherapy.
Why it matters
As psychedelic use expands in clinical and recreational settings, framing post-psychedelic depersonalization as a functional, treatable psychiatric disorder rather than permanent drug-induced brain damage may help guide psychotherapy and patient illness perceptions.
Limits
The paper is a conceptual narrative review without a systematic search methodology, meta-analysis, or primary data. The clinical assertions, including the proposed etiology involving attachment trauma and the requirement of 50 to 100 therapy sessions for remission, reflect theoretical models and expert clinical opinion rather than controlled empirical trials.