Skip to main content
SpringerLink
Log in
Book cover

Behavioral Neurobiology of Psychedelic Drugs pp 333–360Cite as

A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD

  • Chapter

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 36))

Abstract

Hallucinogen persisting perception disorder (HPPD) is rarely encountered in clinical settings. It is described as a re-experiencing of some perceptual distortions induced while intoxicated and suggested to subsequently cause functional impairment or anxiety. Two forms exist: Type 1, which are brief “flashbacks,” and Type 2 claimed to be chronic, waxing, and waning over months to years. A review of HPPD is presented. In addition, data from a comprehensive survey of 20 subjects reporting Type-2 HPPD-like symptoms are presented and evaluated. Dissociative Symptoms are consistently associated with HPPD. Results of the survey suggest that HPPD is in most cases due to a subtle over-activation of predominantly neural visual pathways that worsens anxiety after ingestion of arousal-altering drugs, including non-hallucinogenic substances. Individual or family histories of anxiety and pre-drug use complaints of tinnitus, eye floaters, and concentration problems may predict vulnerability for HPPD. Future research should take a broader outlook as many perceptual symptoms reported were not first experienced while intoxicated and are partially associated with pre-existing psychiatric comorbidity.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Abraham HD (1982) A chronic impairment of colour vision in users of LSD. Brit J Psychiatry 140:518–520

    Article  CAS  Google Scholar 

  • Abraham HD (1983) Visual phenomenology of the LSD flashback. Arch Gen Psychiatry 40:884–889

    Article  CAS  Google Scholar 

  • Abraham HD (1984) LSD flashbacks (In reply). Arch Gen Psychiatry 41:632–633

    Article  Google Scholar 

  • Abraham HD, Aldridge A (1993) Adverse consequences of LSD. Addiction 88:327–334

    Article  Google Scholar 

  • Abraham HD, Duffy FH (1996) Stable qEEG differences in post-LSD visual disorder by split half analysis: evidence for disinhibition. Psychiatry Res 67:173–187

    Article  CAS  Google Scholar 

  • Abraham HD, Duffy FH (2001) EEG coherence in post-LSD visual hallucinations. Psychiatry Res 107:151–163

    Article  CAS  Google Scholar 

  • Abraham HD, Mamen A (1996) LSD-like panic from risperidone in post-LSD visual disorder. J Clin Psychopharmacol 16:238–241

    Article  CAS  Google Scholar 

  • Abraham HD, Aldridge AM, Gogia P (1996) The psychopharmacology of hallucinogens. Neuropsychopharmacology 14:286–298

    Article  Google Scholar 

  • Alarcon RD, Dickinson WA, Dohn HH (1982) Flashback phenomena, clinical and diagnostic dilemmas. J Nerv Ment Dis 170:217–223

    Article  CAS  Google Scholar 

  • Aldurra G, Crayton JW (2001) Improvement of hallucinogen persisting perception disorder by treatment with a combination of fluoxetine and olanzapine: case report. J Clin Psychopharmacol 21:343–344

    Article  CAS  Google Scholar 

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental diseases (DSM-V), 5th edn. American Psychiatric Association Press, Washington, DC

    Google Scholar 

  • Baggott MJ, Coyle JR, Erowid E, Erowid F, Robertson LC (2011) Abnormal visual experiences in individuals with histories of hallucinogen use, a web-based questionnaire. Drug Alcohol Depend 114:61–67

    Article  CAS  Google Scholar 

  • Bernstein-Carlson EB, Putnam FW (1986) Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 174:727–735

    Article  Google Scholar 

  • Brimblecombe RW, Pinder R (1975) Hallucinogenic agents. Wright-Scientechnica, Bristol

    Google Scholar 

  • Carlson EB, Putnam FW (1993) An update on the dissociative experiences scale. Dissociation 6:16–27

    Google Scholar 

  • Cohen S (1960) LSD, side effects and complications. J Nerv Ment Dis 130:30–40

    Article  CAS  Google Scholar 

  • Cohen S (1977) Flashbacks. Drug Abuse Alcohol Newslett 6:1–4

    Google Scholar 

  • Dixon JC (1963) Depersonalization phenomena in a sample of college students. Br J Psychiatry 109:371–375

    Article  CAS  Google Scholar 

  • Ellis H (1898) Mescal: a new artificial paradise. Contemp Rev 73: 130–141 (reprinted in The Smithsonian Institution Annual Report 1898, 537–548)

    Google Scholar 

  • Fischer R (1971) The “flashback”: arousal-statebound recall of experience. J Psychedelic Drugs 3:31–39

    Article  Google Scholar 

  • Fischer R (1976) On the remembrance of things present: the state-bound and stage-bound nature of consciousness. Man-Environ Syst 6:131–136

    Google Scholar 

  • Goldman S, Galarneau D, Friedman R (2007) New onset LSD flashback syndrome triggered by the initiation of SSRIs. Ochsner J 7:37–39

    PubMed  PubMed Central  Google Scholar 

  • Grinspoon L, Bakalar J (1997) Psychedelics reconsidered, 3rd edn. The Lindesmith Center, New York

    Google Scholar 

  • Halpern JH, Jr Pope HG (2003) Hallucinogen persisting perception disorder, what do we know after 50 years? Drug Alcohol Depen 69:109–119

    Article  Google Scholar 

  • Hasse HE, Waldmann H (1971) “Flashback”, Spontane psychotische Episoden als Folgeerscheinung des Phantasticagebrauchs Jugendlicher. Arch Psychiat Nervenkr 214:399–439

    Article  CAS  Google Scholar 

  • Heaton RK, Victor RG (1976) Personality characteristics associated with psychedelic flashbacks in natural and experimental settings. J Abnorm Psychol 85:83–90

    Article  CAS  Google Scholar 

  • Hermle L, Kovar KA, Hewer W, Ruchsow M (2008) Halluzinogen-induzierte psychische Störungen. Fortschr Neurol Psychiatr 76:334–342

    Article  CAS  Google Scholar 

  • Hermle L, Ruchsow M, Täschner KL (2015) Halluzinogen-induzierte Persistierende Wahrnehmungsstörung (HPPD) und Flashback-Phänomene-Differenzialdiagnose und Erklärungsmodelle. Fortschr Neurol Psychiatr 83:506–515

    Article  CAS  Google Scholar 

  • Holland D, Passie T (2011) Flashback-Phaenomene als Nachwirkung von Halluzinogeneinnahme VWB-Verlag, Berlin

    Google Scholar 

  • Holsten F (1976) Flashbacks, clinical and social significance 1.5–4 years after the first admission. Tidsskr f d norske Lægefor 96:876–878

    Google Scholar 

  • Horowitz MJ (1969) Flashbacks: recurrent intrusive images after the use of LSD. Am J Psychiatry 126:565–569

    Article  CAS  Google Scholar 

  • Horton JC, Trobe JD (1999) Akinetopsia from nefazodone toxicity. Am J Ophthalmol 128:530–531

    Article  CAS  Google Scholar 

  • Hughes MS, Lessell S (1990) Trazodone-induced palinopsia. Arch Ophthalmol 108:399–400

    Article  CAS  Google Scholar 

  • Ihde-Scholl T, Jefferson JW (2001) Mitrazapine-associated palinopsia. J Clin Psychiatry 62:373

    Article  CAS  Google Scholar 

  • Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE (2013) Monitoring the future national survey results on drug use, 1975–2012. In: Volume II: college students and adults ages 19–50. Institute for Social Research, The University of Michigan, Ann Arbor

    Google Scholar 

  • Kokoszka A (1992–1993) Occurrence of altered states of consciousness among students, profoundly and superficially altered states in wakefulness. Imagin Cogn Pers 12:231–247

    Article  Google Scholar 

  • Kokoszka H (1993) Flashbacks and schizophrenia. Irish J Psychol Med 10:37–39

    Article  Google Scholar 

  • Kraus RP (1996) Visual “trails” with nefazodone treatment. Am J Psychiatry 153:365–366

    Google Scholar 

  • Lerner AG, Gelkopf M, Oyffe I, Finkel B, Katz S, Sigal M, Weizman A (2000) LSD-induced hallucinogen persisting perception disorder treatment with clonidine, an open pilot study. Int Clin Psychopharmacol 15:35–37

    Article  CAS  Google Scholar 

  • Lerner AG, Shufman E, Kodesh A, Kretzmer G, Sigal M (2002) LSD-induced Hallucinogen Persisting perception disorder with depressive features treated with reboxetine, case report. Is J Psychiatry Relat Sci 39:100–103

    Google Scholar 

  • Malleson N (1971) Acute adverse reactions to LSD in clinical and experimental use in the United Kingdom. Brit J Psychiatry 118:229–230

    Article  CAS  Google Scholar 

  • Markel H, Lee A, Holmes RD, Domino EF (1994) LSD flashback syndrome exacerbated by selective serotonin reuptake inhibitor antidepressants in adolescents. L Ped 125:817–819

    CAS  Google Scholar 

  • Matefy RE, Hayes C, Hirsch J (1978) Psychedelic drug flashbacks, subjective reports and biographical data. Addict Behav 3:165–178

    Article  CAS  Google Scholar 

  • Matefy RE, Hayes C, Hirsch J (1979) Psychedelic drug flashbacks, attentional deficits? J Abnorm Psychol 88:212–225

    Article  CAS  Google Scholar 

  • Mayer-Gross W (1931) Über Synästhesien im Meskalinrausch. In: Anschütz G (Ed) Farbe-Ton-Forschungen Bd. III, pp 266–277. Hamburg Psychologisch-ästhetische Forschungsgesellschaft, Hamburg

    Google Scholar 

  • McGlothlin H, Arnold D (1971) LSD revisited: a ten-year follow-up of medical LSD use. Arch Gen Psychiatry 24:35–49

    Article  CAS  Google Scholar 

  • Morehead DB (1997) Exacerbation of hallucinogen-persisting perception disorder with risperidone. J Clin Psychopharmacol 17:327–328

    Article  CAS  Google Scholar 

  • Naditch MP (1974) Acute adverse reactions to psychoactive drugs, drug usage, and psychopathology. J Psychoactive Drugs 22:305–311

    Google Scholar 

  • Naditch MP, Fenwick S (1977) LSD flashbacks and ego functioning. J Abnormal Psychol 86:352–359

    Article  CAS  Google Scholar 

  • Nichols DE (2004) Hallucinogens. Pharmacol Ther 101:131–181

    Article  CAS  Google Scholar 

  • Parish E (1894) Über die Trugwahrnehmungen mit besonderer Berücksichtigung der internationalen Enquete über Wachhalluzinationen bei Gesunden. Schr Ges psychol Forsch 7(8):1–154

    Google Scholar 

  • Passie T (1997) Psycholytic and psychedelic therapy Research: A complete international bibliography. Laurentius Publishers, Hannover

    Google Scholar 

  • Passie T, Halpern JH (2014) The pharmacology of hallucinogens (Chapter 14). In: Ries RK, Fiellin DA (eds) Principles of addiction medicine, 5th edn. Lippincott Williams & Wilkins, NY

    Google Scholar 

  • Passie T, Schneider U, Borsutzky M, Breyer R, Emrich HM, Bandelow B, Schmid-Ott G (2013) Impaired perceptual processing and conceptual cognition in patients with anxiety disorders: a pilot study with the binocular depth inversion paradigm. Psychol Health Med 18:363–374

    Article  Google Scholar 

  • Sandison RA, Whitelaw JD (1957) Further studies in the therapeutic value of lysergic acid diethylamide in mental illness. J Ment Sci 103:332–342

    Article  CAS  Google Scholar 

  • Shor RE (1960) The frequency of naturally occurring “hypnotic-like” experiences in the normal college population. Int J Clin Exp Hypn 8:151–156

    Article  Google Scholar 

  • Siegel RK, Jarvik ME (1975) Drug-induced hallucinations in animals and man. In: Siegel RK, West LJ (eds) Hallucinations: behavior, experience, and theory. Wiley, New York, pp 81–162

    Google Scholar 

  • Stanton MD, Bardoni A (1972) Drug flashbacks, reported frequency in a military population. Am J Psychiatry 129:751–755

    Article  CAS  Google Scholar 

  • Strassman RJ (1984) Adverse reactions to psychedelic drugs, a review of the literature. J Nerv Ment Dis 172:577–595

    Article  CAS  Google Scholar 

  • Studerus E, Kometer M, Hasler F, Vollenweider FX (2011) Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies. J Psychopharmacol 25:1434–1452

    Article  CAS  Google Scholar 

  • Substance Abuse and Mental Health Services Administration (SAMHSA) (2011) Results from the 2010 national survey on drug use and health: summary of national findings. Substance Abuse and Mental Health Services Administration, Rockville

    Google Scholar 

  • Wolfradt U, Oubaid V, Straube ER, Bischoff N, Mischo J (1999) Thinking styles, schizotypal traits and anomalous experiences. Pers Indiv Differ 27:821–830

    Article  Google Scholar 

  • World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. World Health Organization, Geneva

    Google Scholar 

  • Young CR (1997) Sertraline treatment of hallucinogen persisting perception disorder. J Clin Psychiatry 58:85

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Vicka Corey, Ph.D. for numerous helpful comments and suggestions to an earlier draft of the manuscript.

Conflict of interest:

The authors declare that there is no conflict of interest.

Funding:

Supported in part by an unrestricted grant by the HPPD Foundation (www.hppdfoundation.org).

Author information

Authors and Affiliations

  1. Laboratory for Integrative Psychiatry, Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Oaks Building, Belmont, MA, 02478-1064, USA

    John H. Halpern & Torsten Passie

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    John H. Halpern & Torsten Passie

  3. Lev Hasharon Mental Health Center, Pardesya, Israel

    Arturo G. Lerner

  4. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel

    Arturo G. Lerner

  5. Senckenberg Institute for History and Ethics in Medicine, Goethe-University Frankfurt/Main, Frankfurt, Germany

    Torsten Passie

Authors
  1. John H. Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arturo G. Lerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Torsten Passie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John H. Halpern .

Editor information

Editors and Affiliations

  1. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA

    Adam L. Halberstadt

  2. Psychiatric University Hospital, Heffter Research Center Zurich, University of Zurich, Zurich, Switzerland

    Franz X. Vollenweider

  3. Division of Chemical Biology and Medicinal Chemistry, University of North Carolina, Chapel Hill, NC, USA

    David E. Nichols

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Halpern, J.H., Lerner, A.G., Passie, T. (2016). A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD. In: Halberstadt, A.L., Vollenweider, F.X., Nichols, D.E. (eds) Behavioral Neurobiology of Psychedelic Drugs. Current Topics in Behavioral Neurosciences, vol 36. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2016_457

Download citation

Publish with us

Policies and ethics

Search

Navigation