Depersonalization in gender dysphoria

The Transgender Depersonalization Project

The Gender Analysis Transgender Depersonalization Project is our most significant research program, working to elucidate symptoms, causes, and treatments of depersonalization and 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 chronic depersonalization-derealization in the transgender population.

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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.

This is an earlier attempt to describe my experiences of depersonalization, how it manifested and estranged me from my own life, and the improvement I’ve seen after this remitted as a result of starting HRT.

Descriptions of transgender depersonalization experiences

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.”

The Matrix franchise, directed by two trans women, depicts the experience of transness and a life trapped in unreality using references and imagery of depersonalization and derealization.

The fourth Matrix film presents a more explicit depiction of gender dysphoria and focuses heavily on extreme trauma, apparent psychosis and severe dissociation with absorption and amnesia. Depersonalization and derealization in the matrix play a smaller role, while director Lana Wachowski’s distinctive cinematography and new look shows the evolution of her filmmaking approach and vision of the Matrix films throughout her transition.

Life impacts of chronic depersonalization

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.

Depersonalization triggers

Treating depersonalization-derealization disorder

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”.

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 shown the most success when paired with an SSRI.

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.

For as early as I can remember, I experienced severe and constant depersonalization, and this continued until age 23 when I began HRT. But even though transitioning has given me the ability to feel, I’m still working from a position of very little life experience in how to interpret and manage those emotions.

Misleading conflation of transgender depersonalization symptoms with “rapid onset gender dysphoria” pseudo-diagnosis

A deeply flawed study on an alleged new condition called “rapid onset gender dysphoria” cites one of my articles on depersonalization in gender dysphoria and mislabels it as “vague and nonspecific symptoms called signs of GD”. The study implicates my coverage of trans depersonalization as playing a causative role in the supposedly contagious spread of false gender dysphoria in cis people. This perspective completely neglects to account for published studies and observations of depersonalization symptoms among trans people.

The author of the rapid onset gender dysphoria study responds to my statements on her mislabeling of depersonalization symptoms with plenty of dodging and handwaving. Unfortunately for her, the article she cited as an example of “vague and nonspecific symptoms” had already been referenced in 2016 as “symptoms of mental discomfort” associated with gender dysphoria, in a book on gender identity development by Dara Hoffman-Fox, LPC.

I was interviewed by Evan Urquhart of Slate on the known connections between depersonalization disorder and gender dysphoria, and how the “rapid onset gender dysphoria” study misused my coverage of this condition and wrongly portrayed this coverage as playing a role in the spread of an unproven new disease.

“Harry Potter” author J. K. Rowling promotes Lisa Littman’s flawed work on “rapid onset gender dysphoria”, which weakly proposes a contagious social phenomenon based on a misuse of my articles about gender dysphoria and depersonalization.

The UK’s Christian Institute, citing Littman’s flawed “ROGD” study, lists my writing on depersonalization as a cause of socially contagious gender dysphoria in youth.

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: January 8, 2022

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