Depersonalization in gender dysphoria

The Transgender Depersonalization Project

The Gender Analysis Transgender Depersonalization Project is our most significant original research program, working to elucidate the symptoms, causes, and treatments of depersonalization (feelings of unreality) in the context of gender dysphoria and medical transition. We’re currently working with trans people as well as medical professionals and specialists, drawing on emerging research in the fields of psychiatry, neurochemistry, and psychopharmacology to develop a better picture of the nature and treatment of depersonalization in the transgender population.

 

Articles

Many trans people who experience gender dysphoria also suffer from depersonalization disorder, a chronic syndrome of dissociative experiences such as feeling “unreal” and distanced from one’s self and one’s emotions. These symptoms have been shown to decline sharply following various steps of medical transition.

It is possible to experience gender dysphoria without realizing it, because certain mental and emotional symptoms of dysphoria other than discomfort with sexed anatomy may not seem at first to be symptoms of dysphoria at all.

A primer on the symptoms of depersonalization, its association with gender dysphoria, and the effect of transitioning on these symptoms.

If you’re accustomed to the mood dysregulation and dissociation that’s often present in untreated dysphoria, you might not realize this is even abnormal or that there are alternatives available. In making medical decisions such as whether to start hormones, you are deciding for or against this based on incomplete information – the potential improvements in mood, anxiety, and dissociation that you’d never become aware of without first actually trying hormones.

Trans people with chronic depersonalization describe a remarkably similar range of distinct experiences of changes in consciousness, perception, and emotion. While depersonalization is considered notoriously difficult to describe, many trans people have provided detailed descriptions and imagery that convey these symptoms vividly. 11 trans people offer their firsthand experiences, explaining in depth what feeling depersonalized is like for them.

Depersonalization in gender dysphoria is not a recent phenomenon. Transgender pioneers across the decades have described these dissociative dysphoric feelings: seeing life “only from a distance, or through glass”, experiencing “a detachment so involuntary that I often felt I really wasn’t there”, feeling “emotionally numb and going through the motions of being a human being without any real investment.”

After 5 years of HRT, I recently lost access to my hormones for a period of weeks. My depersonalization symptoms returned rapidly: a constant self-narration, feeling “robotic”, a loss of spontaneity, and experiencing the world as “flat noise”.

Lamotrigine (Lamictal), an anticonvulsant and mood stabilizer, has anti-dissociative effects and has been used successfully in the treatment of depersonalization disorder. There is a possible connection or common factor between depersonalization symptoms induced by NMDA antagonist dissociative drugs, lamotrigine’s inhibition of glutamate release, and estrogen’s modulation of NMDA. I tried replacing my hormones with lamotrigine for 11 days and had a moderate reduction in the depersonalization symptoms I’d normally experience, albeit with inconsistent results for derealization and occasional depersonalization attacks.

 

Topics

Those with gender dysphoria are at least 3 times as likely as the general population to experience clinical levels of depersonalization symptoms, and possibly up to 18 times as likely.

Depersonalization disorder has a severe impact on the lives of sufferers. They are more likely to be clinically depressed or anxious, even suicidal, with impairments in coping skills, academic achievements, employment, and overall social functioning.

The dissociative drug ketamine produces depersonalization and derealization symptoms by antagonizing the NMDA receptor, and this can be counteracted with the glutamate release inhibitor lamotrigine. Lamotrigine has been tested in the treatment of depersonalization disorder, and has found the most success when paired with an SSRI.

 

Transgender depersonalization in clinical practice

  • You and Your Gender Identity: A Guide to Discovery by Dara Hoffman-Fox, LPC (2017) [Amazon]

“Mental discomfort” has to do with the way your brain is “wired,” gender-wise. Conflict can arise when you experience a difference between your physical body and your “wiring,” as well the experience of being perceived by others as your assigned-sex-at-birth when your “wiring” is telling you otherwise.

“Mental discomfort” can be difficult for someone to pinpoint and describe. That’s because:

– It’s possible it has been there for so long that, to a certain extent, you have gotten used to it.

– You figure it must be the way you are supposed to be feeling and just need to live with it.

– You don’t know what else to attribute that feeling to.

In her article, “That Was Dysphoria? 8 Signs and Symptoms of Indirect Gender Dysphoria,” Zinnia Jones states (emphasis added by me):

“Some of us suffer the distress that stems from dysphoria, but without many clues that this is about gender. (Its) relation to our genders may be obvious only in retrospect.”

In other words, the actual frequency and intensity of your “mental discomfort” will more than likely be revealed after you begin to make changes that help to align your mind and body with your actual gender identity.

Here are ways some of my clients have described the experience of no longer experiencing “mental discomfort” after taking steps to be in harmony with their gender identity physically and socially:

– “I had no idea how much irritability/dissatisfaction/stress I was feeling on a regular basis until I…”

– “I didn’t know how depressed/anxious I actually was until I…”

– “‘I never knew how much I wasn’t ‘me’ until I…”

– “I never knew what ‘peace’ could feel like until I…”

– “I had no clue how cluttered my mind has been all of my life until I…”

– “Having to wear ‘guy clothes’ to work didn’t bother before (or at least I didn’t think it did) until I…”

– “Being addressed by my birth name used to be fine, but it definitely isn’t anymore now that I…”

– “I didn’t realize how disconnected I was from my body, myself, my life until I…”

Last updated: Feb 7, 2018


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