Three Cases of Depersonalization/Derealization Disorder Related to the Use of Classic Psychedelics

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.