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

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


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.


Hallucinogen Persisting Perceptual Disorder (HPPD) Drug-induced flashback Flashback LSD Hallucinogens Posttraumatic Stress Disorder (PTSD) Dissociation 



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.


Supported in part by an unrestricted grant by the HPPD Foundation (


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Laboratory for Integrative Psychiatry, Division of Alcohol and Drug AbuseMcLean HospitalBelmontUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Lev Hasharon Mental Health CenterPardesyaIsrael
  4. 4.Sackler Medical SchoolTel Aviv UniversityTel AvivIsrael
  5. 5.Senckenberg Institute for History and Ethics in MedicineGoethe-University Frankfurt/MainFrankfurtGermany

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