Abstract Aims This study aimed to investigate the differences in psychotic symptomatology, dissociative symptoms, alexithymia, and aberrant salience among three groups: non-cannabis users (NU), natural cannabis users (NC), and synthetic cannabinoid users (SCs). The study also explored the patterns of alexithymia and its associations with other psychopathological dimensions in these populations. Methods A total of 108 participants experiencing First Episode Psychosis (FEP) were recruited during psychiatric crisis presentations to emergency rooms in Italy and categorized into three groups (NU, NC, SCs; n = 36 each). Participants were initially assessed 48–72 h after inpatient admission following clinical stabilization. Psychopathological assessments were conducted using the Positive and Negative Syndrome Scale (PANSS), Dissociative Experiences Scale (DES-II),...