Depersonalization in gender dysphoria: widespread and widely unrecognized

Zinnia JonesI’m going to list some descriptions of certain feelings, and I’d like for any trans or gender-questioning readers to think about whether they’ve felt anything similar to this over the course of their lives.

  • A sense of detachment or estrangement from your own thoughts, feelings, or body: “I know I have feelings but I don’t feel them”
  • Feeling split into two parts, with one going through the motions of participating in the world and one observing quietly: “There is this body that walks around and somebody else just watches”
  • Feeling as if you have an “unreal” or absent self: “I have no self”
  • Experiencing the world as distant, dreamlike, foggy, lifeless, colorless, artificial, like a picture with no depth, or less than real
  • Being absorbed in yourself and experiencing a compulsive self-scrutiny or extreme rumination
  • Having an ongoing and coherent dialogue with yourself
  • Feeling like a veil or glass wall separates you from the world
  • Emotional or physical numbness, such as a feeling of having a head filled with cotton
  • Lacking a sense of agency – feeling flat, robotic, dead, or like a “zombie”
  • Inability to imagine things
  • Being able to think clearly, but feeling as if some essential quality is lacking from your thoughts or experience of the world
  • A sense of disconnectedness from life, impeding you from creative and open involvement with the world

These are taken directly from clinical descriptions of depersonalization and derealization, symptoms which are generally characterized as “feelings of unreality” (American Psychiatric Association, 2013; Sierra, 2009; Steinberg, Cicchetti, Buchanan, Hall, & Rounsaville, 1993; Medford, 2012). This is not a matter of “delusion” – while these are considered dissociative symptoms, individuals who experience them without other dissociative conditions typically have an intact grasp of reality. They’re able to recognize and understand the real world in a normal way, but their experience of life and of their own existence takes on an “unreal” sensation.

Despite the reduced emotionality of those with depersonalization, they often find these feelings to be deeply unpleasant and distressing, and can suffer “extreme emotional pain” as a result (Medford, 2012; American Psychiatric Association, 2013). An additional challenge is that the subjective experience of depersonalization can be “particularly difficult for patients to describe, and can sometimes go unnoticed or can be experienced by patients habituated to it as ‘normal’” (Steinberg et al., 1993).

Depersonalization symptoms can also occur in the context of untreated gender dysphoria, yet this is not widely recognized among the public or in most literature on transness and transitioning. Descriptions of depersonalization-like experiences feature prominently in many trans people’s recountings of their lives prior to transition, and these symptoms can heavily impact their general quality of life. But with very little attention given to depersonalization as a discrete symptom experienced by many with gender dysphoria, some trans people may struggle to recognize that this could be an indicator of dysphoria, and may not be aware that they could find relief via transitioning.

 

Narratives of depersonalization in gender dysphoria

The most-read article I’ve ever written, “‘That was dysphoria?’ 8 signs and symptoms of indirect gender dysphoria”, was my initial attempt to describe a sense of pervasive discomfort and unease that didn’t seem to be directly connected to any matters of gender, but which subsided entirely once I started transitioning. Since I published this post in September 2013, numerous trans people across the web have noted that my descriptions resonate strongly with their own experiences, sometimes with an almost uncanny similarity.

While some of the feelings I listed align more closely with depression and anxiety – both of which I’ve been treated for since transitioning – many now stand out as clear examples of depersonalization symptoms. I wasn’t aware of the phenomenon of depersonalization at the time, yet much of this post reads like a textbook definition of it: a feeling of unreality, distance from emotions, splitting into a “participator” and “observer”, sensations of numbness, feeling like a robot, lack of agency, separation from the world by a “veil”, ongoing critical self-dialogue, and the misconception that this was simply normal for me.

A sense of misalignment, disconnect, or estrangement from your own emotions. I could almost never cry at all, even when I wanted to. I would feel like crying, I would know on some level that I should be crying, but I just couldn’t make it happen. When I rarely did manage to cry, that was even worse. … And I dreaded crying, because afterward and for the next day or so, I would be smothered in this horrible feeling of emotional deadness. It felt like my head was full of concrete, like my consciousness was trying to wade through molasses, and it was a feeling that seemed to be genuinely physical in nature.

A feeling of just going through the motions in everyday life, as if you’re always reading from a script. Everything always seemed like it was somehow less real than it ought to be. I didn’t feel like I was my own person – I had no sense of myself as someone who could make my own choices and decisions as I wished. I often lacked that internal initiative that wants things and seeks things for no reason other than the fact that you simply want them and that’s that.

Since I didn’t want to do anything, I just did whatever was expected of me and said whatever was expected of me. That was all I ever did. I felt like an actor, being handed my lines by someone else, and I didn’t know how to be anything other than that.

It felt like my mind was constantly talking to itself without any interruption, and it was overanalyzing everything around me. Some second, parallel existence seemed to be running alongside my direct experience of consciousness: an inner monologue of sorts, but a very toxic one. I couldn’t stop thinking about everything – it was as though this loud voice in my head kept me from simply existing in the moment.

There always seemed to be some invisible skin separating me from the rest of reality – I could move around in the real world, interact with it, but never actually touch it or feel it.

For a few years, my emotions weren’t just blunted or dysfunctional – they went missing almost entirely. I felt nothing, day in and day out. And each day was the same, a robotic routine of just waiting for the time to pass.

When you don’t know what this is, or that it’s even an actual condition, it’s easy to mistake it for who you naturally are. … Because I viewed my lifelong unease in this way, I initially believed that I didn’t even experience dysphoria, and that I was already okay. I didn’t know there was anything wrong with me.

For me, these symptoms were something I could only discern as being separable from myself once they vanished upon starting HRT:

I could cry and feel good afterward, as if it replenished me rather than draining me of emotion. It was possible to feel things in all their detail and depth and texture, rather than being limited to either numbness or emotional overload. The skin of separation was gone, and life was a breeze: I was just happy, all day, without constantly intrusive thoughts distracting me and separating me from the world. I can truly care about everything I choose to work towards, because it matters now. I’m the normal person I always wanted to be, and I can get on with simply living. Finally, I was a whole human being. Nothing was wrong and nothing was missing anymore. I found what I was looking for, and it gave me back the life that dysphoria had taken from me.

My girlfriend Penny, a trans woman, described similar experiences before and after beginning HRT:

When it’s something you grow up with, it can be very difficult to realize that you’re not “supposed” to be feeling that way, that your normal is not the norm. Even recognizing what’s going on, finding the language to describe your feelings and experiences, is insufficient.

Seemingly intrinsic feelings of dread, hopelessness, and rootless melancholy melted away, lifting the lifelong haze that had clouded my vision of not just the world but even my own self.

A number of trans and questioning people on message boards and elsewhere mention many of these same themes, such as persistent emotional numbness, a sense that one’s feelings are somehow unreal, feeling robotic, seeing the world as distant or flat, separation into an observer of oneself, having an absent self, and feeling like less than a “real” person:

Complete lack of motivation, very discouraged and bleak. Can’t care about anything. … Can’t summon the willpower to ‘be a person’ to people, feeling sort of like a wall that provides yes or no answers. Nothing seems important. A feeling of disconnect from myself, as if my mind and body are two separate entities. My day-to-day goals hold no weight in my decision making. … Nearly all the time I feel generally apathetic to things, my external reactions are more of a formality than what I actually feel about something. A faint feeling that I’m acting like a person as if it’s a social requirement? – Reddit user haventa, 7 May 2016

Over time (when I hit the age of 13 or 14) it evolved into the numb feeling, where I would go through my days casually like some unconcerned outsider and on those days it felt more like a sequence of scenes in a movie than something that was an experience of my own. When I looked at my body and at bodies of other people, I saw just the meat, the blood running through their veins, etc. I often had a feeling that all the things and people around me are there just for show. My friends, my family, strangers on the subway, all of them just soulless husks. – Reddit user witchhunt32, 25 Jun 2017

My emotions feel completely artificial at times. Even when provoked, My actions are always calculated, and it feels like a performance when I get mad or act on emotion. In fact, I always get mad in a rational way, and I only express my anger after deciding “I should get angry right now to assert myself.” I have a great ability to step back and observe my feelings from an objective standpoint. At times there’s a hypercritical monologue that runs alongside my life. It’s like that I haven’t grasped this is my life, and that the things surrounding me are real. – Reddit user Terracorner, 25 Jun 2017

I don’t think I’ve cried, like really cried, in a long time without having some piece of media- a film or a song, mainly- that’s extremely relatable to something I feel I should be crying about, and even then, I feel like I’m fighting my brain to continue as it tries to pull me away and shut it down. On top of all of that, I found out recently that when people finish crying they feel energised and refreshed or something, I just go back to feeling empty, and turned off… – Reddit user shoelaze, 2 May 2016

So, when I was younger (especially noticed this in high school), I absolutely had the experience of “this body moves around, somebody else watches” and of feeling things but also not feeling them at the same time. I remember once just bawling after a fight with my dad when I was in high school, and I walked into the bathroom so I could see myself cry, and thought “Ah yes. That is definitely me crying. Interesting how my face has gotten red.” And this was true pretty much constantly; there was a Me dispassionately observing my every waking moment, watching and considering my emotions or actions instead of participating in them. – Reddit user arco_darco, 25 Jun 2017

In that state, I was a dispassionate observer of my own life. The person who went through the motions wasn’t the observer-me. Whenever the acting-me felt any emotions, the observer-me recognized the emotions but didn’t feel them herself. Furthermore, the observer-me had complete control over the acting-me in the sense that the observer-me could deliberately detach any part of the mind so that neither of the selves could access it. … All these symptoms disappeared very rapidly after the start of HRT. About one month in I started to sense that I was more present in the present than before, and the reality appeared more substantial and vividly colored. It was like actually standing at some spot instead of watching a black-and-white TV broadcast of the situation. My compartmentalized mind merged during one unforgettable moment about five weeks into HRT, and I gained full access to all my emotions… – Reddit user calisthymia, 26 Jun 2017

At age 14 I experience hard derealization/depersonalisation, feeling that even my dreams were more real that life, that I looked at myself through a movie. Now it’s different, more like a numbness of all senses and feelings, my outer self playing this theater play for me to the out world. – Reddit user Korf74, 26 Jun 2017

What also alerted me to the fact that something was off was when I started training for Roller Derby and I realized I had no real sense of who I was. Pick a derby name related to something about you! I realized I knew nothing about myself and couldn’t describe who I was. At all. – Reddit user LeighDavidMaxwell, 26 Jun 2017

I have found myself asking: Is this only a dream? It is everything around me even real? I felt deja vu and sense of acting just every day. Also, internal dialogues are such a big part of me. – Reddit user intheabyss90, 26 Jun 2017

I was never really present in my life. Everything was grey, foggy, and not really there. Nothing really got through to me. Eventually I ended up talking to myself a lot in my head and eventually felt like I was two seperate people. I have been described as not being there at all. Post HRT it’s better; colour’s come back and I’m one person for sure now. Still working on the being fully there part; I drift off a lot. – Reddit user lapisblaze, 26 Jun 2017

All of my memories from when I was 7 through 24, are all in third person. Day to day, I felt like a zombie, just going through the motions. I was completely detached from my emotions and either was angry or felt nothing. – Reddit user addyftw1, 26 Jun 2017

i’d spend all day in school with my arms crossed in silence or just like going through the motions. feelings started to go eventually, i couldn’t find myself through the mask i was wearing, it was like i was suffocating. – Reddit user dysphoricdude, 3 May 2016

I find myself very detached from my emotions. It’s felt like that for me for a long time, probably since puberty. As a result, I’ve always thought that my brain chemistry was wrong, because there are many times where I want to really feel that emotion but somehow can’t. – Reddit user cheerbear02, 2 May 2016

Well for my dysphoria just felt like i was always smothered in some sort of heavy blanket or fog. Simple things seemed too tedious to do, always mentally exhausted from little things, and just an overall sense of being different…plus my emotions were totally whack. When i started taking steps towards transitioning, it kinda felt like that “fog” of mind was going away with every doctor and therapist visit – Reddit user einnaeJ, 3 Oct 2013

It’s like this is how I’ve lived my entire life, I don’t know any different. I often tell my wife that I think of it like Pleasantville, and I’m still monochrome, but I’ve seen that it’s possible to live in color! – Reddit user Chloe_Stark, 25 Jun 2017

The cliché is that you’re a woman trapped in a man’s body, but it’s not that simple. It’s a feeling of detachment from your body and from yourself. And it’s shitty, man. It’s really fucking shitty. – Laura Jane Grace, 2012

It’s almost impossible to explain. But it’s so destructive. It’s the worst. It stops us dead: it’s the dysphoria that comes along and fucks everything, undoes the hard work, undermines our confidence, undermines our identities. It pulls the rug out from under our personal realities. It’s actual hell. – tg101.blogspot.com

Many of these individuals have spent years living what feels like an incomplete life, struggling to make sense of painful feelings of internal emptiness and a sense of dislocation from the external world. I can attest that it’s a very short step from there to seeking out unsafe ways of feeling even briefly alive, or concluding that life may not be worth living at all. The distress we experience as a result of this is very real – and being unaware of the potential benefits of transitioning in treating depersonalization can mean spending many more unnecessary years having to cope with this feeling of being a void, living in a void.

 

Effects of transitioning on depersonalization symptoms

Depressive and anxious symptoms are highly prevalent among trans people, and these are significantly reduced following treatment with HRT (Costa & Colizzi, 2016). A handful of studies have also examined depersonalization and broadly dissociative symptoms in trans people, though usually not in much detail. These studies consistently find that rates of dissociative symptoms, including depersonalization, are elevated in trans people, and that this declines following medical transition (hormone therapy and/or surgery).

  • Walling, Goodwin, & Cole (1998) found that scores on the Dissociative Experiences Scale (DES) were significantly lower in trans people who had reassignment surgery compared to trans people who had not, most significantly on the subscale of depersonalization.
  • Wolfradt & Neumann (2001) studied trans women who had completed reassignment surgery, finding that their levels of depersonalization symptoms were comparable to cisgender male and female controls.
  • Kersting et al. (2003) compared the scores of trans people (only 17.1% of whom had surgery) to those of cis controls on an expanded version of the DES. Trans people had a mean score of 18.33 on the depersonalization subscale, whereas the cis control group had a mean score of 2.80. Those trans people who had surgery showed a mean depersonalization score of 10.95, compared to 19.85 for those who did not have surgery. However, the authors note that the overall trans group’s elevated depersonalization score was primarily due to their answers to one DES item having to do with body sensations (“Some people have the experience of feeling that their body – or parts of their body – does not seem to belong to them”). When this item was excluded, the mean depersonalization score for the trans group overall fell to 8.37.
  • Bandini et al. (2013) found that trans people who had not undergone genital surgery showed elevated scores on the depersonalization subscale of the Body Uneasiness Test (BUT) compared to cis male and female controls, while trans people who had undergone surgery scored similarly to cis controls.
  • Fisher et al. (2014) studied trans men and trans women who had not undergone surgery, finding that trans women on hormones showed a significant drop in BUT depersonalization scores compared to trans women who weren’t on hormones, but trans men did not exhibit a significant difference.
  • Colizzi, Costa, & Todarello (2015) noted that trans people show a lifetime prevalence of any dissociative disorder of 29.6%, compared to 12.2% of the general population. In their longitudinal study, trans people’s mean DES depersonalization subscale score decreased following HRT (19.05 at baseline vs. 9.31 at followup), but showed no further drop following surgery (9.31 vs. 9.66). However, when the “feeling that their body does not belong to them” item was excluded from the depersonalization subscale, their baseline score fell from 19.05 to 12.72.

While existing studies are sparse, the literature offers evidence that, much like depression and anxiety, depersonalization is a distinct symptom experienced by many trans people that can be effectively treated by transitioning. A large part of the reported elevation in these symptoms appears to be due to elements of bodily estrangement that may be inherent to feelings of gender dysphoria, but depersonalization remains high even when this is omitted.

 

Hypotheses and future research directions

Several possible mechanisms have been proposed to explain the effect of transitioning on depersonalization symptoms.

1. Bodily congruence with gender due to physical changes. Researchers have contended that reductions in dissociative symptoms following transition may be due to the changes induced by medical changes, bringing the body’s physical form into alignment with gender identity: “dissociative symptoms may be considered as a reaction to the non-satisfaction connected to their incongruent image. Instead, hormone therapy induces desired changes in GD patients’ body features and shape and this could translate into a better quality of life for the patient himself” (Colizzi et al., 2015).

However, this was contradicted by the finding that patients whose bodies already largely aligned with their genders still exhibited similar levels of these symptoms: “the few patients who passed in their desired gender role without hormonal treatment did not show a lower prevalence of dissociative symptoms than all the other patients, both at baseline and follow-up” (Colizzi et al., 2015).

2. Psychological significance of making progress in transition. Relief of psychiatric symptoms upon beginning transition has also been attributed to a kind of “placebo effect”, in terms of excitement or enthusiasm about taking major steps toward actualizing one’s gender: “the initiation of the hormonal treatment could have a psychological meaning which per se could be fundamental in reducing distress” (Colizzi et al., 2015).

3. Short-term direct action of hormones on dissociative symptoms. This possibility is the least strongly supported by published studies, but is supported by the anecdotally reported experiences of some trans people on HRT. While changes in physical development typically only begin after 1–3 months of HRT and can take years to reach their full extent (Hembree et al., 2009), trans people have sometimes noted positive changes in mood beginning within a few weeks of starting hormones, including feelings of happiness, calmness, a stronger experience of emotions, a sense of normality, feeling that the world is “clearer” or “brighter”, feeling “alive”, or dramatically “feeling better than ever” (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28).

Speaking personally, I noticed the lifting of depersonalization symptoms within one to two weeks after beginning HRT, and this was something that I had simply never felt before – neither during previous transition milestones such as coming out and presenting as a woman full-time, nor at any other point. Nothing has ever come close before or since. The difference felt almost undeniably chemical; merely being excited about major events in my life had never caused such a noticeable and unexpected change. Scott at Slate Star Codex has also noted that estrogen can act on NMDA receptors, which are implicated in dissociative symptoms broadly, although the potential role of such a mechanism in gender dysphoria is highly speculative.

While Colizzi et al. (2015) had a followup time of about 12 months after starting HRT, tracking depersonalization symptoms over a shorter period of 1–2 months could help establish whether these changes can indeed occur even more rapidly. The possibility of vivid short-term changes in depersonalization symptoms also suggests that a brief trial of HRT could be of diagnostic value for some gender-questioning individuals, allowing for the opportunity to see whether hormones have beneficial psychological and emotional effects before any lasting physical changes take place.

 

The significance of recognizing gender dysphoric depersonalization

In terms of the public’s general understanding of the experience of gender dysphoria, the element of depersonalization tends to be almost totally absent. While themes of feeling “trapped in the wrong body”, becoming “comfortable in one’s skin”, or “making the outside match the inside” are typically prominent, far less attention is given to the pervasive and severe emotional pain of dissociative symptoms that often accompany dysphoria – the sheer suffocating emptiness of life; the total starvation of any genuine experience of emotion; the desperate wish to find some way of simply feeling like a part of the real world.

Failing to comprehend the significance of these symptoms, and the relief we can find in transitioning, can easily lead cis people to underestimate the importance of living as our selves and receiving the care we need. For many of us, this is absolutely irreplaceable, something that cannot be subject to negotiation and something that we would never, ever give up. This is so much more than a matter of being “comfortable” – it’s a question of being consigned to a lifetime of lifelessness, or finally escaping from that all-consuming veil and touching reality for the first time. Transitioning is about more than just being a man or a woman. It’s about being a person.


Special thanks to Slate Star Codex for insights regarding sex hormones and dissociation.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Bandini, E., Fisher, A. D., Castellini, G., Lo Sauro, C., Lelli, L., Meriggiola, M. C., . . . & Ricca, V. (2013). Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness. Journal of Sexual Medicine, 10(4), 1012–1023.
  • Colizzi, M., Costa, R., & Todarello, O. (2015). Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real? Psychiatry Research, 226(1), 173–180.
  • Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatric Disease and Treatment, 12, 1953–1966.
  • Fisher, A. D., Castellini, G., Bandini, E., Casale, H., Fanni, E., Benni, L., . . . & Rellini, A. H. (2014). Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. Journal of Sexual Medicine, 11(3), 709–719.
  • Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. A., Gooren, L. J., Meyer, W. J. III, Spack, N. P., . . . & Montori, V. M. (2009). Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 94(9), 3132–3154.
  • Kersting, A., Reutemann, M., Gast, U., Ohrmann, P., Suslow, T., Michael, N., & Arolt, V. (2003). Dissociative disorders and traumatic childhood experiences in transsexuals. Journal of Nervous and Mental Disease, 191(3), 182–189.
  • Medford, N. (2012). Emotion and the unreal self: depersonalization disorder and de-affectualization. Emotion Review, 4(2), 139–144.
  • Sierra, M. (2009). Depersonalization: A new look at a neglected syndrome. New York, NY: Cambridge University Press.
  • Steinberg, M., Cicchetti, D., Buchanan, J., Hall, P., & Rounsaville, B. (1993). Clinical assessment of dissociative symptoms and disorders: the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). Dissociation, 6(1), 3–15.
  • Walling, D. P., Goodwin, J. M., & Cole, C. M. (1998). Dissociation in a transsexual population. Journal of Sex Education and Therapy, 23(2), 121–123.
  • Wolfradt, U., & Neumann, K. (2001). Depersonalization, self-esteem, and body image in male-to-female transsexuals compared to male and female controls. Archives of Sexual Behavior, 30(3), 301–310.

About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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16 Responses to Depersonalization in gender dysphoria: widespread and widely unrecognized

  1. Muíran Shíoraí says:

    Thank you, very cathardic experience reading it.

  2. D says:

    This is a very interesting analysis. I can see myself in more than a few of the Reddit comments:

    *Lack of emotion. It always feels like I have to fake them.
    * Memories almost don’t exist. My therapist is astounded that I can barely recall my childhood. Even what should be major events in my life (births of kids, wedding, etc.) are a distant blur.
    * Having that constant two-person internal conversation. I often address myself by name: “D, what do you want to do about xxx?” “Well, I think I need to do yyy first. And then …”

    Do other folks not have these conversations?

    • Gwen says:

      Re: memory, take a look at this site, and consider taking their survey. It’s for science!

      http://sdamstudy.weebly.com/

      They’re studying something they call Severely Deficient Autobiographical Memory, which describes an almost complete lack of autobiographical memory, as well as an inability to re-experience those memories from a first person perspective.

      As for the conversation, I have no idea if my inner dialogue counts as a conversation or not. Most of my daydreams take the form of a conversation, though.

  3. Gwen says:

    I’m transgender, experienced early childhood trauma, and probably have several of the symptoms you listed. I’ve never seen “inability to imagine” listed as a dissociation symptom, and I’m really curious what the source on that is, because I have an inability to imagine.

    Specifically, I’m incapable of visualizing or re-experiencing memories, a neurological condition called aphantasia. I’ve personally speculated it might be related to dissociation, but as far as I knew, there wasn’t any research supporting that. If you’re familiar with some, I’d be very interested in learning about it.

  4. D says:

    I’d like for any trans or gender-questioning readers to think about whether they’ve felt anything similar to this over the course of their lives.

    I’m either T or Q or some combination of the two.

    Inability to imagine things

    My entire life. I cannot picture objects or people, even my immediate family. I can, though, picture in my head text I read on a page. Even something I read years ago.

    A sense of detachment or estrangement from your own thoughts, feelings, or body: “I know I have feelings but I don’t feel them”

    Yep. All emotions are forced, faked. Other than a constant sense of frustration.

    Being absorbed in yourself and experiencing a compulsive self-scrutiny or extreme rumination

    Having an ongoing and coherent dialogue with yourself

    Yes and yes. Again, my whole life. I read “The Inner Game of Tennis” back in the late ’70s. It was about NOT having that dialog with yourself. It didn’t work for me.

    • Gwen says:

      Yup, I can’t see pictures or people in my mind, I can’t see my wife or son’s faces in my mind, and I’ve never been able to. I can’t even see text. Nothing visual in my mind whatsoever, unless I’m asleep and dreaming. I mentioned having aphantasia in one of my posts, and there seems to be a high rate of comorbidity between aphantasia and SDAM. I’m really fascinated by it.

      As for emotions, I feel like I can never tell if my emotions are real or faked. Like, I have no idea if I’m pretending or not, enough that I get distressed worrying about it. Dunno how similar that is to your experience.

  5. Trenchcoat Gnomes says:

    Funny thing, when I read your “‘That was dysphoria?’ 8 signs and symptoms of indirect gender dysphoria” article, I was recognized a lot of those items for what they were partly because I had a lot of experience with several forms of dissociation and had only just begun to sort it all out.

    Have had a long long history with depersonalization and derealization related to being trans and some other things on top of it. Early dysphoria was one of the biggest drivers for all forms of dissociation I experience, though not the only driver. The sort of detachment and the effects on my ability to sense/perceive the world set in in childhood and started getting much much worse starting at puberty. Other forms were similarly affected (more on this later on) but I wasn’t very aware of them or recognized them for what they were. Was the main reason I wanted to get on HRT. I didn’t have a word for the experience yet, but I knew it was something that set in at puberty and that it felt like HRT might at least help. It was pretty painful, not being able to sense things and the sort of fog on everything. It was in recent times that I realized how much harder it made to take care of myself back then. Body is kind of irreparably damaged from not taking care of it enough due to feeling a strong detachment, which still is there but is reduced thanks to HRT (it is still there due to another form of dissociation). Much harder to care about a meat sack than it is one’s body, basically.

    Starting HRT helped tremendously. A lot of it started evaporating nearly right away. But, in truth, it only peeled back one layer. There was a hell lot more layers to the onion left. It still felt amazing though, being able to see, hear, smell, taste, and feel more fully (yes, even feeling pain more fully was a good thing). Each increase in dose to reach the right levels improved things a bit more. Then had a bit of a static period and felt like most of the fog and whatnot was gone with only a little bit more to peel off. Oh, was I wrong. Finally recognized that what I had been experiencing was dissociation (had a word for it finally) and finally saw some of the other forms I was experiencing and started working on them (long story given that I had hints for ages but had dismissed it as temporary things that were over with). Learned grounding and amplification techniques which really taught me just how much I was still experiencing as well as better ways to clamp down on dissociation on days where it was really bad and reshape it on other days (as well as a few sliver linings). Eventually, this reduced my 24/7 depersonalization and derealization levels down another layer. Recently, started peeling back more layers with starting progesterone. Seems like another layer is peeled back every time I increase my dose, and I am happy to still have a few more dose increases before reaching target levels. One hard thing is that finally connecting with my senses and body has sometimes lead to distractions that I never had to deal with before. It is a bit of an adjustment, which is why I take things slowly now. Things like feeling stuff that was put into one’s body during a surgery. Kind of unnerving at first, but get used to it. Totally worth it though. Depersonalization and derealization took so much out of my life before. I don’t want to lose more years to it.

    The main other form of dissociation I deal with is identity dissociation. My use of “I” here in the previous paragraphs is not exactly the most accurate, let’s say. Being trans increased dissociation levels in early childhood, which made a more conducive environment for identity dissociation to happen. Combine that with some other things and the struggles and traumas of that time, and the first split and switch happened (and before anybody starts speculating, my traumas were not abuse (for around 80%, that is the variety of trauma, but I am in that other 20%)). Was a long standing mystery to unawares me/us why there was such a sudden change in handedness, tastes, preferences, preferred gender expression, etc. all at the same time back then. There would be more splits to come (along with other people coming to be), though most of the rest were the result of self-repression over the years of childhood and possibly shortly after. I, specifically (not the group for which I have been using “I” this whole time) date back to shortly after puberty from an unsuccessful attempt to clamp down, isolate, and suppress the growing detachment from our body and the world (depersonalization and derealization). Really took till after being HRT for a bit to really be able to realize everything that had been going on (a lot of it was stopping glossing over things) and get a handle on things. Been a bit of a journey ending the remaining suppression, finding everyone, and forming a cooperative and more healthy group than we were before. Been very helpful, and did peel back another layer of depersonalization and derealization. Been hard sometimes, though. Body now feels a bit more like it is ours than before, which has helped a ton with taking care of it better just like starting HRT did. This might sound weird to some, but while we hate depersonalization and derealization (except for its few silver lining uses) and feel it has stolen years from us, we don’t feel the same way about our identity dissociation. Yeah, some things having to do with we it happened in the first place and the long lasting effects of that are pretty miserable. But just having the others here is actually nice and wouldn’t trade them for the world. Still more work to do (a lot) on the miserable and unhealthy things. Circling back. I do not think we would have been able to figure all of this out let alone deal with this and become healthier if it wasn’t for starting HRT and pulling back the first layer of depersonalization and derealization. And definitely wouldn’t have figured out some of the weird things in our history, including the small amount of gender and sexual fluidity that we have (while we have similar genders and orientations, they aren’t quite the same).

    • Violet says:

      Thank you for this! I feel like I’m walking on a similar path–I feel A LOT of resonance with what you’ve written. And somehow I knew exactly where your comment was going somewhere around the second paragraph :)

      For me HRT helps at a certain level–when I’m not otherwise dissociated, I feel amazing and alive for the first time ever–and my body is craving Progesterone in a way that i’ve come to trust as being important, so it’s cool to hear you mention that it peeled back a layer for you.

      I also feel I have parts/splits/multiple people, though I’m still unearthing everything and don’t have any kind of a handle on it right now. (Referring to myself as ‘we’ feels right, though, so that’s a real thing). I know that a lot of the parts (and the dissociation, on both a psychological and a physical level) are rooted in childhood trauma and CPTSD. CPTSD fits a narrative of healing that I’ve been living, and it captures a lot of my experience at an embodied level, below identities. Identity is a fluid thing for me, more of a tool than a reified thing to hold on to, so I don’t feel like I *need* a multiple identity… but it keeps coming up so I can’t keep denying it. Right now I need grounding and embodiment primarily, and my nervous system needs a lot of care and healing. I’m not sure where this journey will lead me once I have that internal safety and support… but when my body doesn’t feel like we’re dying I’m exciting for whatever is ahead :)

      My sense of gender is also “multiple” or “many”, and I don’t know how that relates yet.

      What are amplification techniques? I haven’t heard of that before.

      Also, I really, really appreciate “Trenchcoat Gnomes” <3

      • Violet says:

        One thing I want to add. CPTSD alone as a narrative and description of my experience is real and has been immensely helpful, but it isn’t the whole picture. Understanding it has been part of a greater process of spiritual awakening, and spiritual knowledge (knowing in the ‘not just rational knowledge’ sense) and tools have been essential ground for understanding my reality. Understanding that I am highly sensitive and empathic, but never learned to work with or have boundaries with these abilities, for example; learning how to feel and work with energy; magickal practice and techniques, along with other bits of consciousness exploration. Not to mention picking apart the ongoing trauma of separation and oppressions (layers of trauma alone), of capitalism, and ancestral traumas going back many many generations. It’s all part of the whole picture.

        Fun stuff. I want to be in a place where I’m not just surviving, but at this point I’ve mostly accepted that doing this work is going to be my life, and I’m learning to love it.

        This is good intro to CPTSD for anyone reading who isn’t familiar: http://www.crazyherbalist.com/blog//cptsd-allostatic-load-and-giving-no-fucks

      • Trenchcoat Gnomes says:

        Sorry it took a week for one of us to get back here. The person in here who wrote what you replied to isn’t available, but I can continue the discussion and answer your question.

        It is nice to see that someone knew exactly where it was going (previous person uses it/its/itself pronouns) that quickly (I use she/her by the way).

        It can take a while to unearth, and quite a bit of effort. Very much worth it, though that isn’t to say that it can’t get very hard at some points, especially when an assumption that one is making comes into question.

        CPTSD also seems to fit our experiences as well.

        Amplification techniques are techniques to deliberately cause dissociation, usually by amplifying that which is already there and controllably extending it, but also causing a form from scratch when one isn’t feeling that. Most amplification techniques can be turned around to be grounding techniques (techniques that fight dissociation), and vice versa. There is some risk. It does have some uses though. Very useful for trying to switch when one or both parties (person leaving control and/or person getting control) has no or little experience doing that, yanking someone out in an emergency (basically, causing the person currently in control of the body to dissociate out), getting through a particularly difficult moment by blunting it a bit and allowing one to get out of the moment before letting up on the dissociation and then processing it (note, this can sometimes cause more problems than it solves).

        Thank you for the compliment on the name.

        I wish you luck with your journey.

        On a side note, we have found that a very large fraction of trans people are plural/multiple or have been at one time (do note, we have found the same for a surprisingly large fraction of cis people, though it seems like a smaller fraction).

  6. Muíran Shíoraí says:

    The way my dissociative features manifest is (a) It is difficult to impossible for me to sleep during the night. The degree of anxiety is overwhelming. I now believe it is a degree of PTSD resulting from my father coming into our room and beating us. Imagine you are 5 or 6 years old, you are suddenly awakened by a slap across the face by a man’s hand then yanked by your night shirt collar out of bed and beaten with a strap, (b) I had an Aunt who was supposed to be caring for me. She would smack the shit out of me and like my Dad I would have no idea hy, her face wouldn’t be angry, it was calm, normal, like she was ironing clothes, She would lck me in a dark, stifling hot closet all day, no water or food. She would complain to my parents that didn’t behave and wouldn’t use the toilet. I tried telling my parents and the didn’t believe me. They punished me.

    There was more. As a teen I was a magnet fr abuse. As an adult I attract narcissitic personality types who act at first like what I’ve never had, a friend, a real friend that gets me. I’d never hear of gaslighting. Now it seems like gaslighting what is normal for most people and when you figure it out they tell you it your own fault for being so needy and trusting them like a fool.

    The weird thing is that now if someone hurts me, 6 months or year later I can think about what they id and feel nothing. I know that sounds great but the problem is that all emotional memories fade. Good or bad, it makes no difference. Given time the factual memory remains but the viseral, emotional impact of love and hate fade to nothing. I’ve only discovered this over the past year. I think it must be the only way I found to survive the terrible pain inside I’ve carry all my life.

    I can feel things in the here and now, but you know how for most people the more time that passes after they wake up, the harder it is to remember their dream. That’s what my emotions are like. I am so fucked up and I can’t see any way to a normal life.

  7. Graham says:

    Wow, I didn’t even think about this before. I certainly did feel robotic, disconnected from the outside world and my body. Like I was just a ghost watching people from an invisible glass room. Whenever I tried to have fun with people it felt like I was waisting my time, like sitting in my chair emotionless and looking out the window was something I was always supposed to do.
    Though I didn’t choose the path of medical transition to cope with my dysphoria, the symptoms have pretty much gone once I came to terms with my identity.
    Thank you so much for this article! It’s very important to recognize this aspect of dysphoria to figure out some ways to treat it more effectively.

  8. Pingback: Depersonalization | pennyhorse

  9. DWise says:

    First I’d like to say good job on your research. You’ve obviously considered a lot here. I can identify with all the dissociating symptoms, I never realised that was what it was called until recently.

    I had ADD and have had this happen to me all my life. I thought it was daydreaming or floating. I had migraines and it happened even more then.

    In my teen years I became anorexic for a while. I was slow to develop and decided it would be great to have it never happen. I had anxiety attacks and great depression as well.

    I remember speaking to my father when I was young about “floating” and he said, “yes, your mind can do neat things but it’s great to have you back”. And that’s how I always looked at everything I went through. It was a place or feeling I was in, but I can’t spend too long there because I’ve got to come back.

    No matter how floaty, how painful the migraine, how sad or isolated, how anxious, how nauseous, I had to come back. I had to make a choice. I had to ride it out. Sometimes I had to fight for it, but I keep coming back. Some times the floating is fun and safe and sometimes it it terifying.

    Every time I get sick, tired, anxious it can happen. But I come back to me. And I have a million things going on and it is not because I am transgender, because I’m not. I dissociate because that’s what my mind does for whatever reason.

    So when I read these blogs and posts I feel like people are forcing the narrative into their life. Like when you read the daily horoscope and you believe it because, well gosh you’re a Libra.

    I feel that there are a lot of people that dissociate and that doesn’t mean you are transgender any more than being a Libra means your going to get a job offer today. Your mind is an amazing thing and can do so many things to you. Its up to you how much you’re going to let it take you away. And it is up to you to say enough, time to come back.

  10. Lisa says:

    My 16 year old trans daughter just told me that she has had symptoms of depersonalization/derealization for a few years now. She revealed that she was female one year ago, and has had great difficulty with her own acceptance. Lots of self-loathing, despite a lot of family and community support, as well as HRT. Your article puts these experiences of hers into perspective for me. Thank you.

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