HPPD

So you think you have Hallucinogen Persisting Perception Disorder. Now what?

In the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, HPPD is defined by the following diagnostic criteria:

A. Reexperiencing one or more of the perceptual symptoms that were present while under the influence of a hallucinogen after the hallucinogen has worn off or use has stopped.

B. The reexperiencing symptoms cause clinically significant distress or impairment to functioning.

C. The symptoms are not better explained or attributable to another medical condition or mental disorder.

Unfortunately, very little is know about HPPD, including how best to treat it. As psychedelics gain popularity in the media as agents of healing, use is increasing. Exploring potential harms of psychedelics, and who might be most at risk, has not been widely researched or discussed. In fact, there has been some backlash in the emerging field of psychedelic therapy against speaking about the potential risks and harms of psychedelics. This is incredibly unfortunate, especially for those who end up suffering from conditions like HPPD after being misled or misinformed about the risks of psychedelic use. I believe it is the responsibility of clinicians, doctors and researchers to be exploring risk of harm associated with psychedelic use alongside potential benefits. Both deserve equal attention.

In my psychotherapy practice, I have been offering psychedelic integration and harm reduction since 2016. Since then, I would estimate being contacted at least once a week by someone seeking help after a traumatic psychedelic experience and/or for help with HPPD. Most of the time, I had to turn people away due to my inability to provide a level of care needed. Many people were immensely suffering, in profound states of terror and desperation, unable to function, and desperate for help where no good help could be found.

More needs to be learned about HPPD, who is most at risk, and how best to treat it. It’s that simple, and that complex.

If you, or someone you love is suffering from HPPD, here is what I recommend based on my clinical experience:

  1. Meeting basic bodily needs is essential first and foremost, especially during acute stages of crisis. Sleep is critical. Regular meals, high in nutritious value is also critical.

    *In cases of insomnia or inability to eat, I strongly encourage seeking a medication evaluation from a medical doctor or psychiatrist. Medication can be tremendously helpful early on, and doesn’t have to be permanent.

  2. Hospitalization might be necessary. This is a hard one. Being hospitalized for mental or emotional issues comes with a whole slew of problems. However, some people suffering from severe HPPD might need a period of stabilization and intervention that only hospitalization provides. I wish we had a better alternative.

  3. Stress reduction techniques. Practice deep breathing to move through states of panic or anxiety. Exercise, including very gentle movement, can also be very helpful. Walking in nature, gentle yoga, chi gong, acupuncture, massage could also be very beneficial. I also recommend warm baths. Grounding or soothing essential oils. Anything that helps relax the body and regulate the nervous system will help ease distress.

  4. STAY AWAY FROM ALL NON-PRESCRIBED MIND ALTERING SUBSTANCES AND OVER-STIMULATING ENVIRONMENTS. These can be “triggers” that exacerbate or worsen HPPD symptoms. This doesn’t necessarily mean forever, but while suffering from HPPD, better to play it safe.

  5. Therapies such as Cognitive Behavioral Therapy and Dialectical Behavioral Therapy. These therapies are geared toward symptom reduction and management. This approach might not make the reexperiencing go away, but they can help reduce the distress caused by the reexperiencing.

  6. Try not to dwell on existential questions or concerns that have arisen in connection to what you are experiencing if they cause distress. There are no quick answers or solutions to these ideas or concepts, as many of them are as old as humanity. It might be useful to revisit lingering questions or ideas once there has been a year or more of stabilization.

There’s hope. I have known many people to recover from HPPD over time, or at least find a way to cope. The best resource I know of for HPPD is the Perception Restoration Foundation website: https://www.perception.foundation/

Unfortunately I am unable to work with folks experiencing an inability to function due to their HPPD symptoms, or who might be in crisis after a psychedelic experience. However, if you are stable, but wanting to further explore what you experienced in an expanded state of consciousness, please see my psychedelic integration page to learn more about how I might be able to help.