The Psychiatric Lens on Extraordinary Experiences: Improving Care Without Misdiagnosis

Negro Elkha/AdobeStock

The field of psychiatry is tasked with the complex challenge of distinguishing psychopathology from extraordinary experiences that may be misinterpreted as signs of mental illness. While hallucinations and delusions are hallmark symptoms of various psychiatric disorders, research increasingly suggests that certain experiences—such as near-death experiences (NDEs), out-of-body experiences (OBEs), after-death communications (ADCs), and memories of past lives in young children—occur in individuals without any underlying psychopathology. These experiences, often profound and transformative, require careful differentiation from pathological states to avoid misdiagnosis and inappropriate treatment. The Division of Perceptual Studies (DOPS) at the University of Virginia is uniquely positioned to illuminate this important distinction. Housed within the department of psychiatry and part of a major academic medical center, DOPS faculty bring a multidisciplinary approach to studying extraordinary experiences, combining rigorous empirical research with psychiatric expertise. Over several decades, DOPS researchers have systematically investigated NDEs, OBEs, ADCs, and children who report past-life memories, documenting patterns that challenge conventional psychiatric and scientific interpretations. By leveraging this body of work, DOPS provides a framework for differentiating transformative, nonpathological experiences from those requiring clinical intervention.

This article explores how studying these phenomena within a psychiatric context can enhance diagnostic clarity, reduce the risk of misdiagnosis, and improve patient care. By acknowledging and investigating the reality of these experiences, psychiatry can foster a more nuanced understanding of human consciousness while ensuring that individuals who report such phenomena receive appropriate and informed care.

NDEs: Encounters With Death and Their Clinical Significance

In recent years, NDEs—transformative and potentially spiritual experiences reported by some individuals who come close to death, are in a medical crisis, or pronounced clinically dead and later resuscitated—have attracted attention in both academic and popular discourse. While there is no clinical definition of NDEs, researchers widely understand these experiences have perceptual features consistently reported in thousands of cases, across time periods and cultures. Typical features of these experiences include a sense of being outside of one’s body, feelings of peace (although some are experienced as distressing), vividness of senses, a life review, perceived encounters of deceased loved ones, and a mystical realm.^1,2

Many individuals who have had an NDE feel that they have experienced a glimpse of the afterlife and become convinced of the continuity of consciousness beyond death. While such perspectives may offer hope and an expanded view of reality, they cannot be verified in a conventional sense, nor are they necessarily the most relevant for clinicians. Regardless of their provocative implications and clinicians’ beliefs, NDEs are important to acknowledge in clinical practice. NDEs are not rare, with prospective studies estimating that 15% of patients with prolonged ICU stays,³ and 10% to 18% of cardiac arrest survivors report such experiences.^2,4 Especially when intense, NDEs can bring about profound transformations in values, spirituality, and outlook on life, including greater spiritual and pro-social orientations and reduced fear of death.^2,5 Due to the profoundness or unexpectedness of these experiences, which often occur in medical settings, patients sometimes choose to disclose their NDEs to health care providers.

Even when the NDE itself is pleasant, individuals may struggle to integrate it into their lives, particularly if it conflicts with their prior social, religious, or scientific worldviews.^6,7 Common challenges include significant changes in life priorities, a loss of identification with one’s prior self, resulting in strained relationships, a deep longing for the realm experienced during the NDE, which many feel is “home,” and struggles in communicating about the NDE for fear of rejection, ridicule, or a label of mental illness.^6,8-10

Clinical support may be necessary to help some patients process their NDE, given the changes such experiences engender and the absence of established hospital protocols. Support needs may be heightened among patients who have had intense NDEs, experienced stress before the NDE, or have a prior history of trauma.⁷ Common guidelines for health care professionals include normalizing and validating both the NDE and the resulting changes, avoiding pathologizing the experience or imposing personal beliefs, listening nonjudgmentally, and helping the individual explore the meaning of the experience.^6,11,12 Despite calls for clinician awareness about NDEs, education and supportive resources are largely absent from clinical care. This contributes to a “medical gap of care” for these patients—a gap that may be particularly evident in psychiatric care.^10,12,13

Importantly, a patient’s NDE report—without other clinical symptoms—does not in itself indicate mental illness, despite accounts of these experiences being pathologized.^10,12 While psychiatric patients can also report NDEs, the incidence in that population is comparable with that in the general population, which argues against an association between NDEs and mental illness.¹⁴ Furthermore, psychiatric patients who came close to death and reported an NDE exhibited significantly less psychological distress than those who came close to death and did not experience an NDE.¹⁴ Acknowledging the sensitive nature of such phenomena, the APA recognized in the DSM-IV through its inclusion of the category of “Religious or Spiritual Problems” that while the aftermath of such experiences may require clinical support, the experiences themselves are not necessarily indicative of mental disorders.^6,15,16

OBEs: Transformative Potential and Clinical Challenges

Accounts of OBEs have been documented across cultures and centuries, often described in religious, mystical, and medical writings.¹⁷ In contemporary research, OBEs are defined as phenomenologically rich episodes in which an individual experiences their sense of self as existing outside of the physical body.¹⁸ While these experiences may sound extraordinary, systematic studies demonstrate they are not rare. Surveys consistently suggest that between 10% and 25% of the general population report at least one lifetime OBE.^19,20

Phenomenologically, OBEs can vary widely. Some common descriptions involve floating above one’s body and viewing it from above, but many report traveling to distant locations or perceiving nonordinary realms, meeting entities and deceased loved ones, and even finding answers to existential questions.¹⁸ OBEs have been reported in diverse contexts, including during sleep, meditation, trauma, anesthesia, or near-death states, as well as spontaneously in otherwise ordinary awake circumstances. In some cases, experiencers describe accurate perceptions of external events or environments, leading researchers to explore questions of veridical perception and consciousness beyond the body.^21,22

The psychological impact of OBEs is often profound and enduring. Many experiencers describe the event as life-changing, instilling a deepened spiritual outlook, a reduction in the fear of death, and greater empathy toward others.^23-25 A substantial number interpret OBEs as evidence that consciousness can exist independently of the body, which can foster resilience in the face of mortality and provide existential comfort.²⁶ For some individuals, the OBE represents a pivotal moment of meaning-making, catalyzing new values, lifestyle changes, or interest in spiritual and philosophical traditions.²⁷

However, OBEs are not universally perceived as positive. For children, for example, spontaneous OBEs may be frightening and confusing, particularly when they occur without cultural or familial frameworks for interpretation.²⁸ Some children interpret the sensation of leaving the body as akin to dying or being “taken away,” which can lead to sleep disturbances, anxiety, or existential fear if left unaddressed. Similarly, adults who lack understanding or support may interpret OBEs as signs of mental illness, which can contribute to secrecy, shame, or reluctance to disclose the experience.²⁹

In some cases, OBEs can overlap phenomenologically with depersonalization or dissociative symptoms,^30,31 underscoring the importance of careful psychiatric assessment. In dissociative states such as depersonalization or derealization, patients typically report feeling detached from their thoughts or surroundings, often accompanied by distress and a diminished sense of reality and agency.³² By contrast, OBEs are marked by a vivid sense of self experienced outside the physical body, with preserved identity and agency. Although they may occasionally be distressing or disorienting, they are more often described as profoundly meaningful or transformative rather than alienating.^18,23

Despite these challenges, research suggests that OBEs in otherwise healthy individuals do not mean psychopathology. Rather, they represent a distinct category of extraordinary but nonpathological experiences that can exert both beneficial and coping mechanisms for past trauma.^29,33 As with ADCs, NDEs, and children’s past-life memories described in this article, the key for psychiatry is not to dismiss or pathologize OBEs but to recognize their potential psychological significance. Clinicians who validate the experience while assessing for comorbid conditions can help individuals integrate OBEs in ways that enhance, rather than impair, mental health and well-being.

ADCs: Common Experiences and Their Dual Impact on Grief

ADCs are experiences in which individuals spontaneously perceive contact with someone who has passed away. These encounters can manifest through various sensory modalities, including visual appearances, auditory messages, tactile sensations, olfactory cues, or intuitive feelings of presence. For instance, some individuals report vivid dreams of the deceased, hearing their voice, feeling a touch, or sensing their presence during daily activities.^34,35

Research suggests that ADCs are relatively common, with studies indicating that 25% to 60% of mourners experience some form of communication with deceased loved ones.^36,37 Nearly half (47%) of individuals who experienced ADCs with deceased partners or spouses acknowledged that these encounters facilitated their acceptance of the loss.³⁸ Additionally, a recent study reported that 81% of participants found their ADCs comforting, while 84% found them helpful in coping with bereavement.³⁷ The psychological impact of ADCs is often beneficial, providing reassurance, alleviating distress, and reducing feelings of loneliness.^37,39 Many individuals report that these experiences contribute to a continued sense of connection with the deceased, fostering emotional healing and, in some cases, diminishing fear of death by reinforcing beliefs in an afterlife.⁴⁰

While ADCs frequently serve as a source of comfort, they can also be associated with more complex emotional responses, particularly in cases of prolonged grief disorder. This condition, previously termed complicated grief, is characterized by an intense and persistent longing for the deceased, difficulty accepting the loss, and a pervasive sense of meaninglessness that persists beyond the typical period of adaptation.⁴¹ For some individuals, ADCs may reinforce an ongoing connection to the deceased that hinders the process of acceptance and adjustment.³⁴ In such cases, ADCs can contribute to prolonged grief symptoms by sustaining attachment-related distress, particularly if the individual interprets the ADC as an indication that the deceased is still accessible in a physical or relational sense.⁴² The personal and cultural context of the individual, as well as the nature of the ADC itself, play crucial roles in determining whether the experience fosters healing or complicates the grieving process.³⁷

ADCs are common experiences that can have a profound impact on bereavement, often providing emotional relief and a sense of connection with the deceased. However, their association with grief is complex, as they can also be linked to prolonged grief disorder in certain circumstances. Ongoing research, including the work of DOPS experts,³⁷ continues to elucidate these experiences, aiming to inform clinical approaches that support healthy grieving and emotional well-being.

Children’s Apparent Past-Life Memories: Impact on the Child and the Family

As often documented by the late television personality, Art Linkletter, kids do say the darndest things. Whether a child says something inappropriate due to an underdeveloped prefrontal cortex and its associated executive function,⁴³ or a young child mimics curse words she heard exclaimed by adults,⁴⁴ parents are often faced with reacting to—or ignoring—statements from their children. Parents also encounter common challenges related to what their children believe to be true, including imaginary companions,⁴⁵ fairies, monsters, and Santa Claus.^46,47 Less common than these traditional sorts of childhood experiences are the reports of young children seemingly recalling events from a life they claim to have lived before their current existence.

Although it may seem as fantastical as a child’s belief in monsters under the bed, for more than 60 years, DOPS researchers have rigorously investigated claims from thousands of children around the world detailing apparent memories of previous lives. Pioneered by Ian Stevenson, MD, the chair of UVA’s Department of Psychiatry in the 1960s,^48,49 the process of formally investigating so-called “cases of the reincarnation type” (CORT) continues today. Typically, children between the ages of 2 and 7 spontaneously start speaking about an apparent past life, including statements about how they died, how they lived, where they lived, and what kind of family they had, to name only a few examples.^50-52

Remarkably, researchers have been able to identify a deceased person whose life matches the child’s purported memories in 70% of investigated cases.⁵³ It is important to note that the unique nature of these cases does not make them entirely rare. A recently concluded study by DOPS researchers of 1000 American mothers (manuscript in preparation) resulted in a preliminary estimate of nearly 7% of parents reporting that their child expressed 3 or more (out of 11) of the kinds of statements and/or behaviors typically seen in CORT children (eg, describing mode of death, previous job, previous life).

Although researchers continue to explore the underlying cause of these extraordinary cases, it is clear that there are real consequences for these children and their families. For example, trauma plays a key role in the phenomenon. In a curated database of 2254 CORT cases investigated by DOPS researchers since the 1960s, 61% of children make statements about how they died in a previous life. Of those, 75% recall an unnatural—and often traumatic—death.⁵³ Moreover, nearly 20% of the database’s cases involve phobias in the child that are apparently linked to the previous person’s mode of death and/or a trauma that person experienced before their death.

Two examples of these trauma-related effects and phobias include the well-documented case of James Leininger, who, as a child, would experience recurring nightmares of dying in a fiery plane crash in World War II (his purported past life), and a Sri Lankan child who presented as severely phobic around water, which coincided with purported memories of drowning in a past life.⁵³ Separate from trauma and phobias, evidence also suggests that a child’s purported past-life memories as a member of the opposite sex significantly predict behaviors indicative of current gender nonconformity.⁵⁴ Despite these challenging experiences in childhood, a recent study of 2 dozen adults who were studied as CORT children decades prior showed that these children go on to lead normal, healthy, and productive lives.⁵⁵

For clinicians, it is certainly possible that a parent will want to discuss their concern for a child expressing such apparent memories, especially if our 7% estimate holds. In a 2024 DOPS study, more than 80% of mothers who went through a full CORT investigation of their child decades earlier stated how important it was for their experience to be validated without them or their child being pathologized. We also know that parents become frightened for their child’s safety as these cases develop over time.⁵⁶ These concerns among CORT parents are not different from the important needs of many individuals who have had spiritually transformative (yet often psychologically challenging) experiences.¹³

Concluding Thoughts

Extraordinary human experiences such as NDEs, OBEs, ADCs, and children’s past-life memories challenge psychiatry to move beyond a narrow illness-based lens and toward a more nuanced understanding of consciousness and well-being. While these phenomena can at times be distressing or overlap superficially with psychopathology, research demonstrates that in otherwise healthy individuals, they are not inherently pathological. Instead, they often carry profound psychological and spiritual significance, shaping values, reducing fear of death, and fostering resilience. For clinicians, the task is not to dismiss or pathologize these reports, but to listen attentively, validate the individual’s lived reality, and assess thoughtfully for co-occurring conditions. Integrating these perspectives into psychiatric care reduces the risk of misdiagnosis, strengthens the therapeutic relationship, and addresses the “medical gap of care” often reported by experiencers. By engaging with these phenomena respectfully, psychiatry can safeguard mental health and expand its horizons—recognizing that human consciousness is complex, multifaceted, and not fully captured by conventional diagnostic frameworks.

Dr Weiler is a neuroscientist and an assistant professor of psychiatry and neurobehavioral sciences at the University of Virginia. Dr Pehlivanova is a research assistant professor of psychiatry and neurobehavioral sciences at the University of Virginia. Dr Cozzolino is a research associate professor of psychiatry and neurobehavioral sciences at the University of Virginia. Dr Penberthy is the Chester F. Carlson Professor of Psychiatry and Neurobehavioral Sciences in the Department of Psychiatry and Neurobehavioral Sciences. She is also the associate director of the UVA Health Clinician Wellness Program and the codirector of the Effective Coping and Communication Skills for Clinicians Program.

References

1. Greyson B. The near-death experience scale. construction, reliability, and validity. J Nerv Ment Dis. 1983;171(6):369-375.

2. Van Lommel P, Van Wees R, Meyers V, Elfferich I. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet. 2001;358(9298):2039-2045.

3. Rousseau A-F, Dams L, Massart Q, et al. Incidence of near-death experiences in patients surviving a prolonged critical illness and their long-term impact: a prospective observational study. Crit Care. 2023;27(1):76.

4. Greyson B. Incidence and correlates of near-death experiences in a cardiac care unit. Gen Hosp Psychiatry. 2003;25(4):269-276.

5. Noyes R, Fenwick P, Holden JM, Christian SR. Aftereffects of pleasurable Western adult near-death experiences. In: Holden JM, Greyson B, James D, eds. The Handbook of Near-Death Experiences: Thirty Years of Investigation. American Psychiatric Association; 2009:41-62.

6. Greyson B. The near-death experience as a focus of clinical attention. J Nerv Ment Dis. 1997;185(5):327-334.

7. Pehlivanova M, McNally KC, Funk S, Greyson B. Support needs after a near-death experience: a quantitative study with experiencers. Psychology of Consciousness: Theory, Research, and Practice. American Psychiatric Association; 2025.

8. Hoffman RM. Disclosure habits after near-death experiences: Influences, obstacles, and listener selection. Journal of Near-Death Studies. 1995;14(1):29-48.

9. Hoffman RM. Disclosure needs and motives after a near-death experience. Journal of Near-Death Studies. 1995;13(4):237-266.

10. Holden JM, Kinsey L, Moore TR. Disclosing near-death experiences to professional healthcare providers and nonprofessionals. Spiritual Clin Pract (Wash D C). 2014;1(4):278-287.

11. Fracasso C, Greyson B, Friedman HL. Near‐death experiences and transpersonal psychology: Focus on helping near‐death experiencers. The Wiley‐Blackwell Handbook of Transpersonal Psychology. 2013:367-381.

12. Samoilo L, Corcoran D. Closing the medical gap of care for patients who have had a near-death experience. Narrat Inq Bioeth. 2020;10(1):37-42.

13. Brook MG. Struggles reported integrating intense spiritual experiences: results from a survey using the Integration of Spiritually Transformative Experiences Inventory. Psychology of Religion and Spirituality. 2021;13(4):464.

14. Greyson B. Near-death experiences in a psychiatric outpatient clinic population.Psychiatr Serv. 2003;54(12):1649-1651.

15. Lukoff D, Lu F, Turner R. Toward a more culturally sensitive DSM-IV. Psychoreligious and psychospiritual problems. J Nerv Ment Dis. 1992;180(11):673-682.

16. Turner RP, Lukoff D, Barnhouse RT, Lu FG. A culturally sensitive diagnostic category in the DSM-IV. J Nerv Ment Dis. 1995;183(7):435-444.

17. Alvarado CS. Out-of-body experiences. In: Cardeña E, Lynn SJ, Krippner S, eds. Varieties Of Anomalous Experience: Examining the Scientific Evidence. American Psychological Association; 2000:183-218.

18. Weiler M, Moreira-Almeida A, Monti MM. Distinguishing out-of-body experiences from lucid dreaming: a phenomenological analysis. Front Psychol. 2024;16:1600707.

19. Blackmore SJ. Out-of-body experiences, lucid dreams, and imagery: two surveys. J Am Soc Psych Res. 1982;76(4):301-317.

20. Palmer J. A community mail survey of psychic experiences. In: Watt C, Wiseman R, eds. Parapsychology. Routledge; 2017:3-33.

21. Weiler M, Acunzo DJ. What out-of-body experiences may tell us about the mind beyond the brain. Int Rev Psychiatry. 2024:37(2)120-129.

22. Tart CT. Six studies of out-of-body experiences. Journal of Near-Death Studies. 1998;17(2):73-99.

23. Weiler M, Acunzo DJ, Cozzolino PJ, Greyson B. Exploring the transformative potential of out-of-body experiences: a pathway to enhanced empathy. Neurosci Biobehav Rev. 2024;163:105764.

24. Shaw J, Gandy S, Stumbrys T. Transformative effects of spontaneous out-of-body experiences in healthy individuals: an interpretative phenomenological analysis. Psychology of Consciousness: Theory, Research, and Practice. American Psychiatric Association; 2023.

25. de Foe A. Consciousness Beyond the Body: Evidence and Reflections. Melbourne Centre for Exceptional Human Potential; 2016:331.

26. Moix J, Nieto I, De la Rua AY. Out-of-body experiences: interpretations through the eyes of those who live them. Front Psychol. 2025;16:1566679.

27. Greyson B. Out-of-body experiences. In: Cardeña E, Lynn SJ, Krippner S, eds. Varieties of Anomalous Experience: Examining the Scientific Evidence. American Psychological Association; 2006:313-332.

28. Weiler M. Navigating out-of-body experiences in childhood: a guide for parents. 2025. Online ahead of print.

29. Weiler M, Moreira-Almeida A, Monti MM. Are out-of-body experiences indicative of an underlying psychopathology? Pers Individ Dif. 2025;246:113292.

30. Mudgal V, Dhakad R, Mathur R, et al. Astral projection: a strange out-of-body experience in dissociative disorder. Cureus. 2021;13(8):e17037.

31. Mula M. Validity and reliability of the Structured Clinical Interview for Depersonalization–Derealization Spectrum (SCI-DER). Neuropsychiatr Dis Treat. 2008;4(5):977-986.

32. Sierra M, Berrios GE. Depersonalization: neurobiological perspectives. Biol Psychiatry. 1998;44(9):898-908.

33. Wright MJ, Cha VL, Streifert MR, et al. Risk factors for emergence of sudden unusual mental or somatic experiences and subsequent suffering. Clin Psychol Sci. 2025;13(5).

34. Beischel J, Mosher C, Boccuzzi M. Quantitative and qualitative analyses of mediumistic and psychic experiences. Threshold: Journal of Interdisciplinary Consciousness Studies. 2017;1:51-91.

35. Penberthy JK, St Germain-Sehr NR, Grams G, et al. Description and impact of encounters with deceased partners or spouses. Omega (Westport). 2023:00302228231207900.

36. Streit-Horn J. A systematic review of after-death communication experiences (ADCs) and their impact on individuals. Death Studies. 2011;35(7):573-600.

37. Penberthy JK, Pehlivanova M, Kalelioglu T, et al. Factors moderating the impact of after-death communications on beliefs and spirituality. Omega (Westport). 2023;87(3):884-901.

38. Holden JM, Greyson B, James D. The Handbook of Near-Death Experiences: Thirty Years of Investigation. Praeger Publishers; 2006.

39. Parkes CM. Bereavement: Studies of Grief in Adult Life. Tavistock Publications; 1972.

40. Fenwick P, Fenwick E. The Art of Dying. Bloomsbury Publishing; 2008.

41. Prigerson HG, Vanderwerker LC, Maciejewski PK. Prolonged grief disorder: a case for inclusion in DSM-V. Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. American Psychological Association; 2009:165-186.

42. Kampman H. Continuing bonds and prolonged grief: the impact of after-death communications on bereavement adaptation. Death Stud. 2022;46(5):1023-1038.

43. Best JR, Miller PH. A developmental perspective on executive function. Child Dev. 2010;81(6):1641-1660.

44. Jay KL, Jay TB. A child’s garden of curses: a gender, historical, and age-related evaluation of the taboo lexicon. Am J Psychology. 2013;126(4):459-475.

45. Majors K, Baines E. Children's play with their imaginary companions: parent experiences and perceptions of the characteristics of the imaginary companions and purposes served. Educational and Child Psychology. 2017;34(3):37-56.

46. Braswell GS, Rosengren KS, Berenbaum H. Gravity, God and ghosts? Parents’ beliefs in science, religion, and the paranormal and the encouragement of beliefs in their children. Int J Behav Dev. 2012;36(2):99-106.

47. Motoshima Y, Shinohara I, Todo N, Moriguchi Y. Parental behaviour and children's creation of imaginary companions: a longitudinal study. Eur J Dev Psychol. 2014;11(6):716-727.

48. Stevenson I. The evidence for survival from claimed memories of former incarnations. Part I. Review of the data. J Am Soc Psych Res. 1960;54:51-71.

49. Stevenson I. The evidence for survival from claimed memories of former incarnations. Part II. Analysis of the data and suggestions for further investigations. J Am Soc Psych Res. 1960;54:95-117.

50. Haraldsson E. Children Claiming Past-Life Memories: Four Cases in Sri Lanka. Félagsvísindastofnun Háskóla Íslands; 1991.

51. Stevenson I. Children Who Remember Previous Lives: A Question of Reincarnation. Revised ed. McFarland; 2001.

52. Tucker JB. Children's reports of past-life memories: a review. Explore (NY). 2008;4(4):244-248.

53. Tucker JB. Cases of the reincarnation type. Consciousness Unbound Liberating the Mind from the Tyranny of Materialism. Rowman & Littlefield Publishers. 2021:57-87.

54. Pehlivanova M, Janke MJ, Lee J, Tucker JB. Childhood gender nonconformity and children’s past-life memories. Int J Sex Health. 2018;30(4):380-389.

55. Pehlivanova M, Cozzolino PJ, Tucker JB. Impact of children’s purported past-life memories: a follow-up investigation of American cases. Front Psychol. 2024;15:1473340.

56. Cozzolino PJ, Pehlivanova M, Tucker JB. Children’s past-life memories: parental reactions over time. Journal of Near-Death Studies. 2025;42:10-26.