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Psychedelic iatrogenic structural dissociation: an exploratory hypothesis on dissociative risks in psychedelic use

Summary

This paper explores potential risks of psychedelic use in people who have experienced trauma, proposing that psychedelics might reactivate unprocessed traumatic memories and cause psychological instability. The authors suggest that while psychedelics show promise for treating depression and PTSD, people with trauma histories need careful screening and support before, during, and after use. They recommend body-focused therapies and strong social support to help safely integrate traumatic material that might surface during psychedelic experiences.

Background

Dissociation is a disruption of normal subjective integration of behavior, memory, identity, and consciousness that often develops as a protective mechanism in response to psychological trauma. The trauma model of structural dissociation proposes that severe or early-life trauma creates a division between the apparently normal personality (ANP) managing daily functioning and the emotional personality (EP) storing unprocessed traumatic memories. With the resurgence of psychedelic research for therapeutic applications, understanding how these substances interact with dissociative processes in trauma-exposed individuals is critical.

Objective

This paper introduces the hypothesis of Psychedelic Iatrogenic Structural Dissociation (PISD) to explore how psychedelics may reactivate dissociated traumatic material and increase psychological destabilization risk in trauma-exposed individuals. The authors propose that psychedelics could disrupt the balance between ANP and EP functioning, either facilitating trauma integration or increasing vulnerability to structural dissociation depending on individual and contextual factors.

Results

The paper identifies persistent adverse effects associated with psychedelic use including emotional dysregulation, identity fragmentation, derealization, and perceptual disturbances, particularly in individuals with early trauma histories. Recent clinical trials demonstrate therapeutic potential of psychedelic-assisted therapies for PTSD, depression, and substance use disorders, though safety concerns warrant careful assessment. Neurophysiological models suggest psychedelics may reconfigure dissociative processes through modulation of entrenched patterns, with outcomes dependent on individual vulnerabilities and contextual support.

Conclusion

Trauma-informed screening, preparation, and integration protocols are essential to enhance safety and efficacy of psychedelic therapies, particularly for vulnerable populations with dissociative vulnerabilities. Integration practices, body-focused therapies, and structured social support systems are proposed as key interventions to mitigate dissociative risks. Further research is needed to understand mechanisms by which psychedelics interact with structural dissociation and to develop evidence-based safeguards for trauma-exposed individuals.
  • Published in:Frontiers in Psychology,
  • Study Type:Theoretical Review,
  • Source: 40104426
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