HPPD

So You Think You Have Hallucinogen Persisting Perception Disorder (HPPD). Now What?

If you’ve landed here, you may be struggling with visual disturbances, anxiety, or a sense of detachment from reality following the use of hallucinogens. Maybe you’ve scoured forums, read conflicting opinions, or even sought medical advice, only to be met with confusion or dismissal. You’re not alone.

Hallucinogen Persisting Perception Disorder (HPPD) is a relatively rare but deeply distressing condition that can follow the use of psychedelic substances. Despite the increasing public and medical interest in psychedelics for mental health, the risks—especially persistent perceptual changes—are often downplayed. This leaves those suffering from HPPD feeling isolated, misunderstood, and desperate for answers.

So, what now?

Understanding HPPD: What We Know (and Don’t Know)

According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), HPPD is defined by three core criteria:

• A. The person experiences persistent perceptual disturbances that resemble those induced by hallucinogens, even after the drug has left their system.

• B. These disturbances cause significant distress or impair daily functioning.

• C. The symptoms cannot be explained by another medical or psychiatric condition.

HPPD is often misunderstood because it is neither a typical psychiatric disorder nor a simple neurological condition. It exists in a kind of gray area, making it difficult to diagnose and even harder to treat. While some people experience mild and manageable symptoms, others face severe, life-altering visual distortions, panic attacks, and depersonalization.

The Reality of Living With HPPD

For some, HPPD presents as subtle visual snow, lingering tracers, or color distortions that are mildly annoying but tolerable. For others, it manifests as overwhelming, nightmarish hallucinations, feelings of dissociation, and a constant state of anxiety.

Many people with HPPD report feeling detached from reality, struggling with existential fears, and losing their ability to function in daily life. What makes it worse is the lack of widespread medical understanding and treatment options. Because psychedelics are still largely associated with either countercultural movements or emerging therapeutic trends, the risks are often downplayed, leaving sufferers feeling gaslit or ignored.

Why Are We Not Talking About This More?

Psychedelics are experiencing a renaissance, with research exploring their potential for treating depression, PTSD, and other mental health conditions. While this is exciting, there’s an unfortunate reluctance to discuss the potential downsides.

HPPD is one of the few documented long-term risks of psychedelic use, yet it remains vastly under-researched. There’s even resistance within the psychedelic community to acknowledge it, perhaps out of fear that discussing risks will hinder progress toward legalization or acceptance of these substances in medicine.

But we cannot afford to turn a blind eye. Responsible discourse on psychedelics must include both the benefits and the risks. Ignoring conditions like HPPD leaves those suffering without support and undermines the credibility of psychedelic research.

What Can You Do If You Have HPPD?

If you or someone you love is experiencing HPPD, it’s important to know that while recovery can be slow and uncertain, it is possible. Many people see improvements over time, especially when they take proactive steps to support their nervous system and mental well-being.

Here’s what I recommend based on my clinical experience:

1. Prioritize Basic Bodily Needs

The body and nervous system are under immense stress when dealing with HPPD. Prioritizing physical health is essential.

• Sleep: Sleep is crucial for neurological healing. If insomnia is a problem, consider working with a doctor to explore safe sleep aids.

• Nutrition: A diet rich in whole foods, healthy fats, and essential nutrients can help regulate neurotransmitters and support nervous system recovery.

• Hydration: Proper hydration is critical, as dehydration can worsen symptoms like anxiety and visual disturbances.

If you’re unable to sleep or eat properly, seek medical evaluation. Temporary medication support may be necessary, and that’s okay.

2. Consider Hospitalization (If Needed)

Severe cases of HPPD can be debilitating to the point where hospitalization may be necessary. While psychiatric hospitals are not always ideal, they can provide a safe environment for stabilization if you’re experiencing extreme distress or suicidal thoughts.

If hospitalization is not an option, reach out to a trusted doctor, therapist, or support network to help create a plan for stabilization.

3. Implement Stress Reduction Techniques

HPPD symptoms tend to worsen under stress, so learning to regulate your nervous system is key.

• Deep breathing exercises (such as diaphragmatic breathing) can help reduce panic attacks.

• Gentle movement, like walking, yoga, or tai chi, can aid in grounding.

• Spending time in nature has been shown to lower anxiety and reset sensory overload.

• Warm baths, acupuncture, massage, and grounding essential oils can also be helpful.

Experiment with different approaches and find what soothes your system.

4. Avoid All Non-Prescribed Mind-Altering Substances

This includes not just psychedelics but also cannabis, stimulants, and even caffeine in some cases. These substances can worsen symptoms or prolong recovery.

This doesn’t necessarily mean you need to abstain forever, but in the acute stages of HPPD, it’s best to minimize anything that alters brain chemistry.

5. Consider Therapy (CBT & DBT)

While therapy won’t necessarily eliminate HPPD symptoms, it can help manage distress and improve coping strategies.

• Cognitive Behavioral Therapy (CBT) can help challenge catastrophic thinking patterns and reduce anxiety about symptoms.

• Dialectical Behavioral Therapy (DBT) provides emotional regulation skills to help manage fear and distress.

• Exposure therapy (in mild cases) may help individuals gradually acclimate to their visual disturbances without panic.

Finding a therapist experienced with HPPD or psychedelic-related issues may be difficult, but seeking a professional who specializes in anxiety disorders, trauma, or perceptual issues is a good starting point.

6. Avoid the Existential Rabbit Hole (For Now)

It’s natural for HPPD to trigger deep existential thoughts about the nature of reality, perception, and selfhood. While philosophical exploration is valuable, when combined with distressing symptoms, it can lead to spiraling anxiety.

If you find yourself ruminating on these questions to the point of distress, try to set them aside for now. There will be time to explore them once you’re more stabilized.

The Road to Recovery

Healing from HPPD takes time. Some people recover within months, while others take years. There is no single “cure,” but many individuals see gradual improvement, especially when they take steps to support their nervous system, reduce stress, and avoid further triggers.

You Are Not Alone

One of the hardest parts of HPPD is feeling isolated in your experience. It can feel like no one understands what you’re going through. But there are others out there who have recovered, and you can too.

Seeking out support groups, online forums, or therapists who acknowledge HPPD can be invaluable. Even though there’s no quick fix, having a community to share your experiences with can make the journey feel less lonely.

Final Thoughts

HPPD is real. It’s distressing. And it deserves more research, discussion, and acknowledgment from both the medical and psychedelic communities.

If you’re struggling, take it one day at a time. Prioritize your basic needs, seek support, and trust that your brain and body are capable of healing.

You are not broken. You are not alone. And with time, things can get better.

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.