Substance abuse is highly prevalent in the transgender population, and is known to be associated with psychosocial risk factors such as stigma, discrmination, and trauma (Glynn & van den Berg, 2017). Notably, trans people use cannabis at an elevated rate compared to the general population. The 2015 US Trans Survey found that 64% of trans people surveyed had ever used cannabis at least once, versus 47% of the population overall, and 25% reported having used cannabis in the past 30 days versus only 8% of the general population (James et al., 2016). Additionally, among those current users, 23% reported using cannabis every day or nearly every day.
The effects of cannabis use may be of particular concern to trans people due to the potential role of cannabis in triggering depersonalization/derealization symptoms or the onset of chronic depersonalization disorder. Trans people already face a highly elevated risk of depersonalization, a feeling of unreality or “no self”: 10-15% experience these symptoms chronically, compared to 1-2% of the wider population. This is especially pronounced among trans people with untreated gender dysphoria, as transitioning is associated with a reduction in these symptoms.
Chronic depersonalization in the general population has in some cases been observed to be triggered following an instance of substance use. Medford et al. (2003) presented a case series of 40 patients with depersonalization disorder whose condition first appeared after using illicit drugs. Of these patients, 50% reported an onset of symptoms following cannabis use, making it by far the most common substance identified as a trigger for chronic depersonalization. Additionally, another case series found six instances of depersonalization disorder occurring in adolescents after cannabis use (Hürlimann et al., 2012), and numerous similar cases of chronic depersonalization precipitated by cannabis have been reported in the literature (Szymanski, 1981; Keshavan & Lishman, 1986; Moran, 1986; Khalid-Khan & Volochniouk, 2016).
Cannabis is known to produce temporary dissociative effects during use, including depersonalization/derealization (van Heugten-Van der Kloet et al., 2015), and Madden & Einhorn (2018) have identified a number of factors that may put an individual at especially high risk of developing cannabis-induced chronic depersonalization. These include use of high-potency cannabis or frequent use of cannabis, using cannabis when suffering from severe stress, a history of transient depersonalization/derealization symptoms after cannabis use, a history of clinical anxiety or panic attacks, and a history of depersonalization/derealization symptoms outside the context of drug use.
Chronic depersonalization disorder is often a severely disabling condition and is frequently associated with major depression, anxiety, suicidality, and social and occupational impairments. Given our predisposition to developing depersonalization disorder, trans people – particularly those with additional risk factors – should be especially cautious when using cannabis. ■
