Depersonalization occurs when a person has experiences of being detached, feeling as if they are outside of their body, has experiences of being unreal, experiences a distorted sense of time, etc. According to the American Psychiatric Association (APA) depersonalization/derealization disorder is a dissociative disorder that consists of either feelings of depersonalization or derealization (thoughts that other things are not real), but the person’s reality testing remains intact. The symptoms the disorder cause significant distress or dysfunction, and the symptoms are not attributable to the effects of drug abuse, being on a medication (or an illicit drug), or a result of some other medical condition.
In addition, this disorder cannot be better explained by the presence of some other psychological/psychiatric disorder, such as another dissociative disorder, a psychotic disorder, a personality disorder, etc. Thus, according to the definition of a depersonalization/derealization disorder, any person who experiences depersonalization as a result of being under the influence of any drug does not have a depersonalization/derealization disorder. The dissociative effects that occur from drug use are typically diagnosed as the effects of being intoxicated, undergoing withdrawal from certain types of drugs, or side effects associated with using certain illicit drugs or medications.
Numerous drugs can produce sensations or feelings that one is outside of their body, being detached from oneself, being unreal, etc., which are symptoms of depersonalization; however, a dissociative disorder that is based on feelings of depersonalization cannot be diagnosed when someone is under the influence of drugs or alcohol.
The notion that people who use certain types of drugs, such as LSD or other hallucinogenic drugs, for long periods of time or in large amounts can later develop problems with psychosis still exists; however, according to the APA and empirical research studies, the research has long indicated that the effects of using hallucinogenic drugs are not associated with the later development of psychiatric disorders in the sense that use of hallucinogens causes someone to develop a psychotic disorder or dissociative disorder later. Instead, it appears that most individuals who use certain types of drugs like marijuana and hallucinogenic drugs and are later diagnosed with these types of mental health disorders more than likely had the disorder (either in its full manifestation or in a preclinical phase) before they began using the drugs, and the drugs may have exacerbated the symptoms of the disorder.
Cannabis Products (Marijuana) and Depersonalization
Cannabis (marijuana) is not technically classified as a hallucinogenic drug, although there is some inconsistency regarding its classification, and there are certainly numerous sources that do report that marijuana is a hallucinogen. The most authoritative sources, including the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM), the Substance Abuse and Mental Health Services Administration (SAMHSA), etc., do not classify marijuana or cannabis products as hallucinogens and do not place them in the same category as LSD, psilocybin, mescaline, etc., which are known hallucinogenic drugs. This is not to infer that the use of cannabis products cannot result in the experience of hallucinations or dissociative effects like depersonalization, but for most people and for classification purposes, cannabis is not considered to be a hallucinogen such that its primary effects result in hallucinations or dissociative effects.
The discrepancy results from the notion that a drug that can produce hallucinations in some individuals is not necessarily classified as a hallucinogenic drug. For instance, people under the influence of central nervous system depressant drugs like alcohol and benzodiazepines, and even under the influence of stimulant drugs like cocaine, may experience hallucinations, but these drugs are not classified as hallucinogens.
The actual personal experience associated with cannabis use can be quite variable, dose-dependent, and also dependent on the environmental circumstances under which the drug is used. In addition, the levels of the cannabinoids or psychoactive substances in cannabis products can vary between different types of cannabis products and even from different strains of marijuana. Certainly, using marijuana with high THC content would be more likely to produce perceptual effects like dissociation, but there is no guarantee that any person will experience depersonalization because of marijuana use.
There are reports of marijuana producing depersonalization in some individuals. Most often, this can occur when the person mixes marijuana with some other substance, such as alcohol, cocaine, an opioid drug, etc. The depersonalization that occurs as a result of marijuana use typically resolves rapidly once the effects of the drug wear off. It may or may not result in significant distress, depending on the circumstances and the individual’s emotional makeup. However, as stated above, there appear to be no lasting dissociative or psychotic effects that were not present prior to the use of marijuana in individuals who use the drug.
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The use of the terms hallucinogens and hallucinogenic drugs is clinically reserved for drugs that significantly alter perceptual experiences to the point of the person’s experience of reality being significantly distorted. The primary distortion of reality that occurs with hallucinogen use is the person’s perception of hearing or seeing things that really do not exist. Drugs classified as hallucinogenic drugs are considered to have this quality as their primary effect, and not as a secondary effect that occurs in some people who overdose on the drug or who may be having idiosyncratic reactions to the drug. As it turns out, using enough of many different types of substances can result in a significant distortion of reality even though the substances are not thought of as hallucinogenic drugs.
Furthermore, clinical designations of the hallucinogenic drugs typically divide them into two basic categories: classic hallucinogens and dissociative hallucinogens. The classic hallucinogens, such as LSD, mescaline (peyote), and magic mushrooms (psilocybin), primarily produce hallucinations (most often visual hallucinations, although hallucinations in any sensory modality may occur as a result of taking these drugs). Dissociative hallucinogens can also produce hallucinations but very commonly produce dissociative effects as well, such as depersonalization or derealization. The major substances that are classified as dissociative hallucinogens include ketamine, phencyclidine (PCP), and DMT (N, N-Dimethyltryptamine).
Interestingly, some people may experience depersonalization if they use classic hallucinogens such as LSD, and other people may primarily experience hallucinations if they take ketamine. The classification of drugs is often based on the main effects that most people experience when they take the drug. For instance, most people who take central nervous system depressant drugs like a benzodiazepine will experience a reduction in anxiety; however, some people actually experience an increase in anxiety with the use of certain benzodiazepines. Thus, the majority of people who use a drug like LSD will experience visual hallucinations, and a few of them may experience depersonalization, whereas more individuals using a drug like ketamine will experience dissociative effects like depersonalization.
Other effects of hallucinogenic drugs include heightened perceptual experiences (e.g., sounds may seem more acute, colors brighter, etc.), significant distortions of time (most often, experienced as moving far more slowly), and a significant loss of reality testing. On this last note, individuals who are under the influence of these drugs are unable to make judgments or rational decisions, and they are often fully disconnected from reality, whereas a person with a depersonalization/derealization disorder often still understands who they are, where they are, etc.
The depersonalization or any other dissociative effects that occur as a result of using a dissociative hallucinogenic drug or even a classic hallucinogenic drug will typically wear off once the drug is metabolized and the individual is no longer experiencing their psychoactive effects.
There might be instances where individuals who use LSD or some other hallucinogenic drug experience what they believe to be “mind-expanding effects” of these drugs. For some individuals, the mind-expanding effects of the drug may be a sense of detachment from their own ego (often referred to as “ego death”), which is a very subjective philosophical notion that the person has expanded their consciousness. This may present itself in some cases as the person believing that they are detached from their own self and are now more aware and in tune with other aspects of reality. This is not a form of psychosis, and it is not a dissociative disorder, but some lay sources may consider this experience to be a form of depersonalization.
Interestingly, a person’s actual experience while under the influence of many hallucinogenic drugs such as LSD is often heavily influenced by the context in which the drug is taken. For example, “bad trips” more often occur in individuals who use LSD when they are stressed or emotionally upset (or expect to have a bad experience) than they do in individuals who are expecting to have a positive experience. Anyone experiencing depersonalization could conceivably also experience “a bad trip” and extreme emotional distress. However, most people who have bad trips do not appear to develop significant lasting psychological damage once the effects of the drugs wear off.
Individuals diagnosed with dissociative disorders often need to undergo comprehensive psychotherapy as there are no formal medications that can address these conditions. Medications may help with some of the reactive symptoms associated with these disorders, such as anxiety or depression. Individuals under the influence of drugs often need to be isolated or kept quiet if the effects of the drugs are disturbing to them, and time for the drug to metabolize in their system is the best form of treatment. The use of support, calming techniques, and reduction of environmental stimulation can be quite useful in people who have experienced severe distress.
Repeated bad trips on hallucinogenic drugs or having allergic reactions to these drugs should be a sign that the person should stop using the drugs; however, individuals who develop substance use disorders need professional intervention, such as involvement in therapy, peer support groups, etc. According to professional sources, such as APA, the risk factors for developing a depersonalization/derealization disorder include having some sort of interpersonal trauma (e.g., sexual or emotional abuse, particularly as a child), having immature defenses against stressful events, and having other personality variables, such as being disconnected or overly connected to others or events. The use of numerous types of drugs, including marijuana and hallucinogenic drugs, can exacerbate symptoms of a dissociative disorder like a depersonalization/derealization disorder, but they are not considered to be causal in nature.
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