Depersonalization and agoraphobia associated with marijuana use.

This paper examines the role of uncontrolled depersonalization associated with marijuana use in the development of agoraphobia. Cases of six people are described, all of whom reported first experiencing depersonalization while using marijuana, and subsequently experiencing depersonalization while not using the drug. A fear of this 'uncontrolled' depersonalization resulted in considerable anticipatory anxiety and panic attacks. Patients ultimately presented for treatment of agoraphobia. A temporal relationship between marijuana use, uncontrolled depersonalization, panic attacks and agoraphobia does not imply causality. Comparison of these cases with other agoraphobia clinic patients provides tentative evidence for a difference between the two types of patients. There were no systematic patterns of stressors in the cases prior to the onset of symptoms. Data obtained before and after treatment indicated the cases were slightly more severe than clinic patients. Males and females were represented equally in the cases, whereas there was a higher incidence of females in the clinic patients. The cases' age of onset was younger than that of the clinic patients. Our standard cognitive-behavioural treatment programme required modification to account for the intensity of the fear of depersonalization in the cases.