The relationship between cannabis use and the psychological state of derealization (DR) is complex and requires careful consideration, especially for individuals who have previously experienced a dissociative episode. Derealization episodes are often accompanied by high anxiety and significant distress, leading to a feeling of being profoundly unsettled.
What Derealization Means
Derealization is a dissociative symptom where a person feels detached from their surroundings, perceiving the external world as unreal, distant, or dreamlike. The environment may appear foggy, visually distorted, or lack its normal vibrancy. This experience is a form of dissociation.
Derealization is not a loss of reality, as the person experiencing it knows that the perception is abnormal, which is a key difference from psychosis. Brief, temporary episodes of derealization are common, often occurring in moments of severe stress, panic attacks, or trauma. When these feelings become persistent or recurrent, causing significant distress or functional impairment, they may indicate an underlying condition or a dissociative disorder.
How Cannabis Can Initiate Dissociation
Cannabis, particularly strains high in delta-9-tetrahydrocannabinol (THC), can acutely trigger or mimic dissociative states like derealization. THC is the primary psychoactive compound in cannabis, and its effects on the central nervous system are responsible for altered perception. THC interacts with the brain’s endocannabinoid system, which regulates mood, memory, and cognition.
Acute cannabis intoxication can amplify anxiety and induce feelings of paranoia, which are precursors to a dissociative episode. The sudden, intense change in consciousness and sensory perception can overwhelm the brain, causing it to activate a protective mechanism that results in detachment. For some individuals, this drug-induced state may be the initial event that brings a latent vulnerability for derealization to the surface.
Evaluating the Risk of Using Cannabis After an Episode
Using cannabis after an episode of derealization carries a heightened risk of triggering a new or prolonged recurrence of the dissociative state. Once the brain has experienced a cannabis-induced DR episode, a process known as sensitization may occur, which lowers the threshold for a future recurrence. The brain establishes a pathway linking cannabis intoxication to the dissociative response.
Derealization is often a manifestation of an underlying anxiety or stress disorder, and using cannabis can exacerbate that core issue. While the drug may temporarily mask anxiety, the subsequent intoxication can lead to a panic response, which re-activates the learned dissociative coping mechanism. This pattern creates a vicious cycle, making the return of symptoms highly likely, especially for anxiety-prone individuals.
Key Factors That Influence Recurrence
Several specific factors determine the likelihood and severity of a derealization recurrence for those who choose to use cannabis despite the elevated risks. The ratio of THC to cannabidiol (CBD) is a major variable, as high-THC products are far more likely to induce anxiety and dissociation. CBD has anxiolytic properties and can mitigate some adverse psychoactive effects of THC, suggesting products with a high CBD-to-THC ratio (e.g., 10:1 or greater) carry less risk.
The total dosage and frequency of use also play a role, with lower doses and infrequent consumption being less likely to trigger an episode than high doses and daily use. Rapid delivery methods, such as smoking or vaping, result in a rapid spike of THC in the bloodstream and brain, posing a higher risk than slower methods like edibles. However, edibles can lead to unpredictable potency and a prolonged duration of effect, which introduces its own set of dangers. The environmental context and one’s current mental state are equally important, as using cannabis while already feeling stressed, anxious, or in an unfamiliar setting increases the chance of a dissociative reaction.
Alternative Approaches to Managing Anxiety
Since derealization often emerges as a coping mechanism for severe anxiety or stress, addressing the underlying emotional distress is a beneficial path forward. Seeking a professional psychological evaluation can help identify and treat any co-occurring anxiety disorders or trauma contributing to the dissociative symptoms. Cognitive Behavioral Therapy (CBT) is often recommended, as it teaches skills to challenge distorted thought patterns and manage the fear associated with the feeling of unreality.
Simple, non-pharmacological techniques can also provide immediate relief by “grounding” the person in the present moment. These include deep, mindful breathing exercises to calm the nervous system and sensory grounding techniques, such as focusing on five things you can see, four things you can touch, and so on. Lifestyle adjustments, like maintaining a consistent sleep schedule, engaging in regular physical activity, and practicing mindfulness, can collectively reduce overall stress levels and diminish the frequency of dissociative episodes.