Hallucinogen Persisting Perception Disorder DSM-5 292.89 (F16.983)

Hallucinogen Persisting Perception Disorder DSM-5 292.89 (F16.983)

DSM-5 Category: Hallucinogen Related Disorders

Hallucinogen Persisting Perception Disorder, earlier referred to as Post Hallucinogen Perception Disorder in DSM III, has been classified and termed as Hallucinogen Persisting Perception Disorder in DSM IV and DSM-5. According to DSM-5 (American Psychiatric Association [APA], 2013), Hallucinogen Persisting Perception Disorder is a condition in which a person, after the cessation of intake of hallucinogens, re-experiences certain disturbing visuals which were experienced while intoxicated with the hallucinogen. In simple words, it is a visual disorder which is a result of assimilation of hallucinogens or drugs. It is also referred to as flashbacks, and is mostly experienced after psychedelic drug use. Hallucinogen Persisting Perception Disorder is characterized by recurrences of visual interferences that include appearances of haloes, flashes of colors, false movement of objects in the visual field and images of moving objects. The interferences of visuals faced by people with this disorder are typically frequent, but may be occasional or severe in some cases.

Symptoms of Hallucinogen Persisting Perception Disorder

According to the DSM-5, Hallucinogen Persisting Perception Disorder is a psychiatric disorder and is distinct from the medical term - palinopsia. In Hallucinogen Persisting Perception Disorder, the interferences are often the result of the way the human brain collects and processes visual information. Average human beings who are not diagnosed with any visual disorders also experience and see light or some particles in the air called floaters when they stare at the blue sky or a brightly illuminated surface. These interferences, however, are normal. One of the main distinctions between the normal visualizations and the interferences characterized by Hallucinogen Persisting Perception Disorder is the intensity and the frequency in which they occur. People with this disorder experience visualizations that are frequent, and impinge upon their daily lives. Some of the symptoms, as characterized by DSM-5 (APA, 2013), include the following:

According to the DSM-5, people with this disorder generally find it difficult to differentiate colors and precisely name them. They may experience instances where the colors seem to be changing over time. Also, reports include the reduction in the ability of the eye to recognize the intensity of various similar colors. This results in the person failing to identify the exact color of a particular object. People may also experience or see flashes or bright visualization of light or bands of colors that appear and disappear alternatively.

Afterimages is another symptom of this disorder, wherein, when the person, after looking at a particular object for a while, moves away and stares at a blank space, sees a negative or positive visualization of the image. Another type of interference occurs when reading: Generally, people with this disorder tend to experience such visualizations when reading, where the words seem to move back and forth, certain alphabets suddenly vanish or positive or negative images appear. Symptoms also include the appearances of false or fake images within another image. For example, a window may appear to be full of faces or visuals which are completely non-existent.

People with this disorder also visualize some geometric patterns or shapes. For instance, they may see a particular object in various shapes, sizes and patterns.

Some of the other symptoms include static objects becoming dynamic - where the objects seem to sway in different directions; a rhythmic increase and decrease in the sizes of objects; and, appearances of static on a monochromatic surface.

Appearances of haloes that extend to a certain distance from the edge of the objects are another symptom of Hallucinogen Persisting Perception Disorder.

Prevalence and Course

The exact estimate of the prevalence of Hallucinogen Persisting Perception Disorder is unknown. However, according to DSM-5, the prevalence of this disorder among people who use drugs or individuals is approximately 4.2%. The same is the case with its course. While the duration of the persistence of this disorder may vary from person to person, the duration, as proposed by researchers, may last from weeks to months - or even years for some individuals.


Though the root cause of this disorder is still unclear, DSM-5 quotes that Hallucinogen Persisting Perception Disorder may be caused due to the intake of drugs. In contrast to the theory that defines the cause of this disorder to be genetic, it is generally thought to be caused due to the use of LSD and other psychedelics, such as certain species of mushrooms.

The cause for this disorder may also be categorized under two classifications. Under the first category, one of the causes that lead to the development of Hallucinogen Persisting Perception Disorder is the experimentation with drugs or hallucinogens (Abraham HD. Visual phenomenology of the LSD flashback. Arch Gen Psychiatry; 40: 884-889, 1983). It generally develops after the first use, and is stated to be the root cause of genetic origins. Under the second category, this disorder develops among people who have been using drugs or hallucinogens over a long period of time. Since a number of drugs are used for inducing hallucinations, it is usually difficult to determine which drug acts as the root cause of this disorder.

Diagnosis and Treatment of Hallucinogen Persisting Perception Disorder

Though there is no treatment available for Hallucinogen Persisting Perception Disorder, DSM-5 has characterized certain restriction criteria to rule out specific conditions - for better diagnosis of this disorder. Conditions that are to be overlooked for the diagnosis include drug effects, schizophrenia, stroke, brain tumors, head trauma, infections and neurodegenerative disorders. Further, DSM-5 states that neuroimaging results in diagnosing Hallucinogen Persisting Perception Disorder are negative.

Treating this disorder is very tedious. Since this disorder is the result of certain illegal drugs, psychologists and doctors usually turn down attending such cases. However, at the Annual Meeting of the Biological Psychiatry Society in 2012, Dr. Henry Abraham proposed that Tolcapone and Levocarb improved the symptoms of this disorder (Takovan & Erowid, 2009). These drugs, which are used in the treatment of Parkinson’s, however, are not approved for the treatment of Hallucinogen Persisting Perception Disorder.

There is no exact time estimate to finding a cure for this disorder. Reports claim that people either tend to adjust with the visualizations, or begin to respond negatively to any recurrences of visual interferences.


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

Knott, Laurence. (2011, April 20). Hallucinogen Persisting Perception Disorder (Blog Post). Retrieved from http://www.patient.co.uk/doctor/Hallucinogen-Persisting-Perception-Disorder.htm

Takovan & Erowid. (2009, November 26). HPPD FAQ (Frequently Asked Questions). Retrieved from http://www.erowid.org/psychoactives/health/hppd/hppd_faq.shtml#whatis

Leo H, Melanie S, Martin R, Anil B, Martin G (2013) Hallucinogen Persisting Perception Disorder (HPPD) and Flashback-are they Identical? J Alcoholism Drug Depend 1:121. doi: 10.4172/jaldd.1000121. Retrieved from http://www.esciencecentral.org/journals/hallucinogen-persisting-perception-disorder-hppd-and-flashback-are-they-identical-2329-6488.1000121.php?aid=14570


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