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Dysphoria and Dysmorphia: Understanding Identity and Mental Illness

Austen Hartke5 Comments
 Photo by  MeganLynnette

Photo by MeganLynnette

The argument goes something like this:

"You wouldn't help an anorexic person starve themselves--you wouldn't support their false perception about their body, because it's harmful to them. Just because an anorexic person may believe they're too heavy doesn't mean it's true. They're not seeing reality for what it is. It's just the same for transgender people--just because they believe they're a different gender doesn't mean it's true, and supporting that false perception is harmful."

Well friends, it's come time to talk about this categorization of trans identities as mental illness, and about the comparison between gender identity and eating disorders. This comparison has been drawn recently in several articles following the interview with Bruce Jenner, and unfortunately it's based in a misunderstanding of psychological diagnoses. I'm not a mental health professional, but I've found that coming to understand two similar-sounding Greek words, dysphoria and dysmorphia, has helped me understand the difference between identity and mental illness. Confusing these two concepts can lead to bias against transgender folks, and to lack of compassion for people suffering with eating disorders, so let's dive in and get our facts straight!

First of all, how are eating disorders and transgender identities categorized by mental health professionals?

Eating disorders like anorexia and bulimia are part of a condition called "Body Dysmorphic Disorder." In short, Body Dysmorphic Disorder, or BDD, is a disorder in which your perception of your body does not align with reality. People with BDD are caught up in a cycle of obsessive thoughts about one or more parts of their body which they believe to be noticeably flawed--the word "dysmorphia" itself means "malformation." Eating disorders fall under the BDD umbrella. Someone with an eating disorder, then, perceives a part or parts of their body to be overweight, and the obsession over that fact pushes them into a disordered relationship with food.

Transgender people, on the other hand, are diagnosed by the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM V) with gender dysphoria. Gender dysphoria is not a disorder, and is now recognized not as a condition, but as a symptom. The word "dysphoria" means a sense of restlessness, anxiety, dissonance, or distress, and is the linguistic opposite of a sense of euphoria. Trans people experience this sense of distress when they contemplate the difference between the reality of their body, and the way they believe their body should be in order to align with their sense of self.

So, to sum up, body dysmorphia causes someone to believe their body is a certain way, while gender dysphoria is a sense that the body should be a different way. People with BDD are not able to see the difference between the way their body is and the way other people see their body; transgender folks are uncomfortably able to see the way their body really is, and the way that reality conflicts with their internal experience of their gender.

So how are body dysmorphia and gender dysphoria treated?

That's the interesting thing--one of the reasons gender dysphoria has been declassified as a disorder is because of the way treatment works. In the case of a mental disorder, psychotherapy and medication are generally shown to be helpful, and this is the case for body dysmorphia. People who suffer from eating disorders benefit greatly by cognative and behavior therapy, and by the use of anti-anxiety and depression medications, including selective serotonin reuptake inhibitors (SSRIs). People dealing with gender dysphoria, on the other hand, do not experience relief from the sense of dissonance when put on medication, and though therapy is often helpful, it does not cause the dysphoria to subside.

Surgical modification is another form of treatment which has been used in cases of both body dysmorphia and gender dysphoria. Despite recent rumors to the contrary, surgical intervention has been shown to be incredibly effective at relieving gender dysphoria. Once trans people experience their body as they believe it should be, the anxiety and depression surrounding their body and their perception in society decreases almost immediately, and only 1-4% of people experience any sense of regret regarding surgery. The same cannot be said of people suffering from body dysmorphia who attempt surgery. Physical modifications have been shown to be entirely unhelpful in cases of BDD because the obsessive thoughts will always target a new part of the body, and disordered eating and behavior patterns will continue

So how can we support transgender people who deal with gender dysphoria, as well as folks who struggle with body dysmorphia and eating disorders?

Well, we start by doing our research, and by listening to people who struggle with these issues. The truth is, support may look very different in these two scenarios, but the love you give is the same. If you have a friend or family member who struggles with an eating disorder, read up on what they're going through over at the National Eating Disorder Association, and talk with them about seeking clinical help. If you have a friend or family member who has come out to you as transgender and who deals with gender dysphoria, the best thing you can do is affirm their identity and use the correct name and pronouns. Body dysmorphia may last a lifetime, though it can be treated so that it no longer actively interferes with someone's life. Gender dysphoria, on the other hand, effectively disappears once a trans person is allowed to physically transition. 

In no way is recognizing someone's trans identity the same thing as encouraging someone's eating disorder--these issues are distinct, and carry their own solutions. Let's work together to keep this faulty argument from being used to demean trans folks, or to marginalize people suffering from BDD. Our friends and neighbors deserve better.