A distressing near-death experience with veridical perceptions during coma: psychiatric and clinical reflections from a rare case

Summary. Background. Near-death experiences (NDEs) are profound subjective experiences that are reported by individuals who have been near death. These conscious experiences occur during critical states such as coma, cardiac arrest, or severe trauma. While the majority of NDEs are characterized by pleasant and often transformative elements like a sense of peace or connection to a higher consciousness, a significant minority of cases present with distressing, frightening, or even terrifying content. A key feature of NDEs is the out-of-body experience (OBE), where individuals feel as though they have left their physical body. Remarkably, some of these experiences include veridical perceptions, which are accurate observations of physical events that could not have been perceived from their unconscious state, and are later confirmed by third parties. Case report. We present the rare case of a 25-year-old woman who sustained a severe traumatic brain injury following a high-speed car accident, necessitating her placement in a medically induced pharmacological coma for 20 days. Upon her recovery of consciousness, the patient recounted a deeply frightening NDE (scoring 28/32 on the Greyson NDE Scale) that included an OBE with specific, accurate perceptions of events that occurred while she was unconscious. These perceptions were later verified by medical personnel. Notably, the patient subsequently reported significant psychological and behavioral changes, including the complete resolution of her pre-accident suicidal ideation. Conclusions. This case offers compelling evidence that challenges conventional reductionist models of consciousness, raising critical questions about its neurobiological basis. It also underscores the profound transformative potential of distressing NDEs and their implications for psychiatric practice. We discuss the importance of acknowledging and exploring these non-ordinary states of consciousness to better understand their psychological and neurobiological underpinnings.