It has to be said that the side effects of psychoactive substances can be unpredictable at times. Brain chemistry, physical constitution, mental health, life experience and susceptibility to changes in perception lead to very different results in different people. Although the majority of people feel that they have received benefits from entheogens and psychedelics, there are others that find themselves struggling with after effects and even persisting disorders as a result. Hallucinogen Persisting Perception Disorder (HPPD), Depersonalization Disorder (DPD), Derealisation Disorder (DPDR) and feelings of existential crisis are common.

Although unclear exactly how common this is, it certainly happens to some. In some instances, Depersonalization disorder and existential crisis can be caused by traumatic experiences, but the effects are similar or the same. The foundations of a person’s reality or belief systems may be shaken, leading to a sense of meaninglessness or detachment from their usual sense of reality.

Sense of self is generally generated through ego, and while some people experience a positive, expanded sense of self after using entheogens and psychoactive substances (such as DMT, ayahuasca, psilocybin, San Pedro, LSD and even cannabis), others may not be ready for the magnitude of the perceptions they bring.

So what do HPPD, DPD and existential crisis look and feel like? In this article we’ll present a synopsis on each, and share the documented experience of someone who developed symptoms of all these conditions at once. We will also offer a perspective on how to manage such disorders and see the bigger picture. What seems to be a disorder now may well be less alarming in the future; it may even be a valuable growth experience.

Hallucinogen Persisting Perception Disorder (HPPD)

HPPD causes people to experience visual flashbacks, distortions and/or hallucinations after ingesting a psychoactive substance. For example, the perception of time, space, shape, size and colour may become distorted. It seems that there are be more instances of this related to LSD use, going by anecdotal reports.

As the symptoms can be overwhelming and stressful, they can lead to dysfunction and anxiety in daily life. Sufferers of HPPD may find that their field of vision seems warped in some way, since the visual distortions won’t correspond to their ingrained perception of everyday reality. There are two types of HPPD:

Type 1: HPPD is experienced as random and brief flashbacks

Type 2: HPPD is experienced as ongoing changes to vision, although they may be intermittent

Depersonalisation disorder (DPD) / Derealisation disorder (DR)

DPD/DR are dissociative disorders characterised by a recurring or persistent sense of ‘depersonalisation’ or ‘derealisation’, which simply means to be detached or disconnected from your sense of self or your reality. A person may lose the sense of time or space, or feel that they are not present ‘in their body’ – perhaps without a determinable location at all. As this is quite common during powerful DMT and ayahuasca experiences, it makes sense that for some, that perception can persist. The disorders can also be caused by PTSD/traumatic life experiences.

Depersonalisation often evokes a sense of observing oneself rather than being grounded in the body. Emotional detachment is also normal in depersonalisation, which understandably makes it difficult to communicate with and relate to others. Sufferers may also struggle to associate things that were once automatically associated.

It seems that depersonalisation is surprisingly common: according to the National Alliance on Mental Illness, almost 50 percent of American adults will experience depersonalisation on at least one occasion during their lives. For some, it becomes a persisting disorder. Derealisation is similar but pertains more to the perception of the external world being ‘unreal’. A person may feel that the environment lacks spontaneity or depth. They may struggle to decide upon what is actually ‘real’.

Existential Crisis

An existential crisis happens when (for whatever reason) a person starts to question their entire existence or the meaning of it. It can occur after a strong psychedelic experience in which the usual sense of reality was shattered, but a coherent new perception was not formed. It can also happen after traumas, confusing events, disillusionment or unmet expectations in life. Midlife crisis is a familiar example of this.

A person may become overwhelmed when contemplating the nature of reality, trying to decide whether their life or reality even has a point at all. Existential crisis can lead to confusion, depression and even a sense of dread about what happens after death. They might be concerned about the longevity and substance of a seemingly pointless life, therefore losing interest in activities and relationships. Meaninglessness can be very difficult to come to terms with, but obsessively searching for a point to reality can be exhausting and fruitless.

Existential crisis and resulting depression tends to happen more frequently to life’s deep thinkers; the inquisitive, reflective or ambitious types. Unsurprisingly, these are often the same people who turn to entheogens and psychedelics to find answers. Again, it is common for existential crisis to be a response to certain thoughts or experiences, which once processed and integrated can actually yield positive results.

An experience with HPPD, DPD and existential crisis

Mike Robinson experienced all three disorders at once. For him, this was triggered by cannabis use and trauma. Here is what he has to say about it:

“I’ve been experiencing a very deep existential depression and dread with a strong sense of meaningless. This was triggered from depersonalisation (caused by a cannabis experience in which I met 'the void', followed by a trauma experience).

To go through an experience for almost a year where nothing in reality was real - not even myself - was terrifying. I had a complete loss of agency and sense of self, various time distortions and other dissociative experiences.

Existential crisis was triggered by my depersonalization experience. It sparked all sorts of existential thoughts and questions, as my mind tried to grasp the new reality I was experiencing. My main existential fear, for many reasons, has been a loss of the self after death - to go back to some sort of 'all'.

The symptoms of all three disorders first arose after a very psychedelic cannabis experience that triggered the derealisation from this. Four days later, whilst in this state, a traumatic event happened that brought on depersonalisation. In attempt to find relief, two days later I was prescribed an SSRI, but it first worsened the DP and DR, and subsequently I developed HPPD symptoms. I stopped the SSRI after 9 days as it was making things worse for me.

The cannabis acted like an extreme psychedelic for me. For example, I experienced major time distortions; I experienced all of eternity in under a minute, and my reality changed. I was outside of everything, and there were multiple versions and layers of reality expanding outwards from the tip of my nose. It is hard to put into words, Hard to explain, but the effects in the music video for The White Stripes “Seven Nations Army” best depict what I experienced. However, for me it was my room and the centre point was the end of my nose.

I somehow ‘time skipped’ to my bedroom, aiming to close my eyes and fall asleep or give in. At this point reality started to dissolve, as did I, and I was transported to 'the void'. My experience of the void was the opposite of existence. It didn't feel like 'nothing' because to have nothing, you would have to know what 'something' was. It was simply non-existence, beyond the concepts of physical matter and time. It felt like I spent an eternity here, and it was truly terrifying. In this void, I did not have my physical body; I didn’t know what or who I was. I was just experiencing this void and terror.

When somehow I eventually started to come out of it, I remember seeing a reel of my life playing like a movie below as I fell from the void. I didn’t understand it, nor know what 'I' was. My sense of self and being human was still totally gone.

'I', or I guess you could say my spirit/energy/essence fell into this movie reel at the point I had left the void. I was starting to return to my body. I had to try and force my memories to understand this reality again. But now these memories didn’t feel like memories; more like thought creations. It felt like I was creating this reality through 'memories' that didn’t actually exist before I thought them all into existence. It was an intense, wild trip that left me with all sort of questions afterwards.

After this experience I remained sober and medication free, but after three months I still had symptoms of DPD, DR and HPPD, including out of body experiences. For example, I was walking through the forest with two new friends on a sunny day, and somehow we got very lost.

During this time, I left my body and somehow experienced all of time and the entirety of the entire forest in one moment, but that moment had no time definition.

As neat as this sounds, it was another terrifying experience due to my spirit/energy/essence having nothing to contain it or hold onto, as my body would usually do. Instead it was desperately grasping for something to hold onto and ground itself. When I came out of this, I had apparently been functioning somewhat normally but quietly, while with my friends trying to find our way back.

When I returned to normality, I asked my friends how long we had been there for at that point. The answer was four hours, but I honestly had no concept of time or how long we had been there. If I had had to guess, I would have said around twenty minutes.

The HPPD symptoms were another thing entirely. They made me feel constantly high, with head pressure and tinnitus. The first symptom was the walls and floors 'breathing'. I had this experience whilst on magic mushrooms 4 months prior which I enjoyed. This time it was very different; in my already overwhelmed state from DPD/DR ,the HPPD brought an immense amount of anxiety. It felt like a never ending trip. I was sober and should be feeling normal, but for a long time I was far from that. It felt horrendous.

In my house I had mostly artex ceilings, which seemed to make the visuals worse. At the initial onset, I looked at my curtains they seemed to continuously expand outwards, yet simultaneously never changing in width. It was mind bending. They kept growing and expanding outwards, yet never changed in width. It just didn’t make sense.

I would also experience trailing - when something would move across my field of vision and leave a large trail of itself behind. My hands would move and leave these trails, and I would also get a lot of ghosting vision/double vision. For some reason this was particularly bad when travelling in a car at night. I would see two road signs next to each other when there was only one, or multiple road lines when there was just one set. I also had static, like TV static, overlaid on most of my vision but it was incredibly pronounced when looking at the sky for some reason. It took all the beauty out of it and gave me feelings of regret and depression.

Today, I have largely recovered from the DPD, DR and HPPD, but the existential dread and depression hasn't left me. After these experiences I actually feel even more of a desire to try DMT in the hope of finding some insight into my existential dread, or even some peace or greater understanding. However, I am concerned that DMT might spark even more questions than answers, and I can’t risk sparking the DPD again.”

Are HPPD, DPD, DR and existential crisis something to worry about?

It might help to consider that although these disorders might be frightening, it is often possible to ground or balance the perception once again. It can often be a matter of integrating the new perception. Perception is malleable, which is why these disorders exist in the first place. Questioning the nature of one’s belief systems, assumptions and fears is a good start.

Existential crisis may be down to ego/mind trying to contain the uncontainable. The mind is trying to rationalise the experience, but when we can step out of needing to know, explain or contain, we can more easily accept the possible reality of inexplicable realms and even eternity - the biggest challenge to the human mind.

Whether something is perceived as ‘good’ or ‘bad’ may really depend on the end result, assuming one is reached. Processing and accepting traumatic experiences can often lead to spiritual growth and strength; eventually, an expanded sense of consciousness, awareness or a more open mind about what constitutes reality may arise. Therefore for many – and especially after psychedelic use – degrees of ego dissolution and shifting perspective may be natural, part of a process, and even beneficial.

It is possible that the biggest issue behind these experiences is fear of death. Fear of death is one of the most natural things in life because of the limited filters we are born with, and this is probably by design. Spiritually speaking, if it is true that our reality is an illusion of some sort (Maya), believing that you might cease to exist actually makes this 3D life more real and motivates us to live and experience fully (and therefore evolve spiritually) - even if these concepts are playing out unconsciously. Since the only constant is change, this makes sense.

When symptoms are overwhelming

That isn’t to say that there are no dangers when a person is suffering from one of the above disorders. Overwhelming symptoms may require monitoring and assistance from an experienced practitioner of some kind, whether it is a counsellor, shaman or Doctor. This is certainly the case with a disorder like HPPD.

It is wise to keep in mind that for some, using powerful substances such as DMT can cause existential angst. They may shatter the sense of meaning in this everyday reality, which can be too much for some people to process quickly and easily.

On the other hand, they may offer a glimpse into what may be the after life, or at the very least that there are other dimensions or realities other than this one. This is often an awakening experience and can be positively integrated into this reality. How a person interprets an experience is a very personal thing, and nobody can tell you what you will perceive or feel later.

Having said that, it is very common to hear that people have felt a strong sense of oneness and interconnectedness that brings them deep feelings of relied, wonder and joy. If you are generally comfortable with the idea of ‘no self’, you may be more likely to handle the experience well. Life never offers guarantees, and nor do the psychoactive substances we imbibe. As with most aspects of life, there is only one way to find out!

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HPPD, Depersonalisation, Derealisation, Existential Crisis and Psychedelics