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Psychedelic-Associated Depersonalization-Derealization Disorder.

Matthias Michal¹

¹Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany. michal@uni-mainz.de.

Current Topics in Behavioral Neurosciences

|September 15, 2025

Summary

Depersonalization-derealization-disorder (DDD) is a mental health condition often linked to avoiding emotions, not solely drug use. Psychedelics may trigger DDD in vulnerable individuals by surfacing deep-seated trauma.

Keywords:

Anxiety Depersonalization Derealization Emotion Psychodynamic

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Area of Science:

Psychiatry
Neuroscience
Psychology

Background:

Depersonalization (DP) and Derealization (DR) are perceptual disturbances where self or surroundings feel unreal.
These symptoms are common in mental disorders and can lead to depersonalization-derealization-disorder (DDD) if persistent.
DDD frequently co-occurs with depression, anxiety, and personality disorders.

Purpose of the Study:

To challenge the notion that drug intoxication is the primary cause of DDD.
To present arguments that DDD is a mental disorder rooted in emotional avoidance.
To explore the role of psychedelics as catalysts in vulnerable individuals.

Main Methods:

Review and analysis of existing research on DP/DR symptoms and DDD.
Examination of the relationship between psychedelic drug use and DDD onset.
Theoretical argumentation based on psychological and neurobiological frameworks.

Main Results:

DDD is argued to stem from avoiding aversive emotional states and involves functional brain network alterations, not organic damage.
Psychedelics may act as catalysts, accelerating DDD onset in susceptible individuals by mobilizing repressed emotions and trauma.
The assumption of drug intoxication as the sole cause is deemed reductionist and potentially harmful.

Conclusions:

DDD is a complex mental disorder linked to emotional processing and avoidance, not simply a consequence of drug intake.
Psychedelics can precipitate DDD in vulnerable individuals by triggering underlying emotional conflicts and traumas.
Effective DDD treatment involves psychoeducation, challenging false attributions, and long-term psychotherapy for emotional processing.