Understanding Body Dysmorphia vs. Gender Dysphoria for Trans-Affirming Care
To make nonbinary- and trans-affirming care interventions more suited to the folks they aim to serve, clinicians must understand unique differences for them, like body dysmorphia vs. gender dysphoria.
These two conditions look similar at face value, and a person can exhibit signs of both. But their root causes, behavioral or mental health profiles, and overall healing implications can differ in critical ways.
Here’s a brief guide about body dysmorphia vs. gender dysphoria and why understanding them matters for inclusive eating disorder treatment.
We Can’t Ignore That Trans Folks Are Struggling
First, we have to recognize that eating disorders among trans folks are extremely common. In fact, research shows that trans young adults are almost five times more likely to self-report eating disorder behaviors than their cisgender peers.
This is often due to complex layers of shame or stigma that intersect with the lived experience of being in a body that might not reflect their identity. Two significant body-related disorders we see among this population are body dysmorphia and gender dysphoria. Let’s define each one.
What Is Body Dysmorphia?
Body dysmorphic disorder (BDD) is a psychiatric diagnosis in the DSM-5, characterized by an all-consuming fixation with perceived flaws in one’s external appearance or body composition. Someone with BDD will often feel intense emotional distress if they see or think about certain body parts, even if those “defects” seem minimal or unnoticeable to others.
Body dysmorphia is usually accompanied by:
Intrusive thoughts
Repetitive actions such as body checking
Weight-control behaviors, like compulsive exercise or restrictive eating
Folks who suffer from body dysmorphia also frequently compare their bodies to others, whether on social media or offline, which can lead to social isolation and impair their ability to function.
It’s important to realize body dysmorphia is a cognitive distortion, which means that how someone with this condition views their appearance does not align with reality.
Still, the beliefs can be so ingrained that a person might take extreme, often harmful measures to change their body in an effort to alleviate distress. About 32 percent of folks who meet the criteria for BDD also have an eating disorder.
What Is Gender Dysphoria?
Gender-related gender dysphoria (GD) is also a psychiatric diagnosis in the DSM-5, but unlike BDD, this condition isn’t a misconception of reality. Instead, GD marks a lived incongruence between one’s gender expression or identity versus their assigned sex at birth.
This can result in a sense of disembodiment or intense discomfort with certain physical traits (voice, chest, genitals, body shape, etc.) that don’t match their internal experience.
That emotional distress can escalate even further if others misgender them in daily interactions, whether or not it’s deliberate. To minimize confusion, discrimination, or mistreatment associated with their appearance, and to present in a way that feels more comfortable, someone with GD might use drastic weight-control behaviors to alter their body.
The Journal of Eating Disorders shows a clear link between gender dysphoria and eating disorders in trans and nonbinary folks. But the research also indicates that affirmation in both social and healthcare spaces is extremely beneficial.
Healing outcomes can improve when clinicians use someone’s chosen name and pronouns, help them access certain medical services (hormone therapies, gender-affirming surgeries, etc.), and tailor treatment plans to align with their identity.
How These Disorders Compare and Contrast
Intense physiological discomfort and emotional distress are the main throughlines that connect body dysmorphia with gender dysphoria. And both are closely connected to eating disorders.
One cross-sectional study of over 1,100 trans and nonbinary volunteers found that 80 percent use restrictive eating habits to modify their sex characteristics or gender expression. These behaviors will turn into eating disorders for about 20 percent of trans and nonbinary folks, the research continues.
To spot the red flags, respond effectively, and nurture healing with treatment interventions tailored to one’s lived experience and specific needs, remember the core distinctions between body dysmorphia vs. gender dysphoria.
Nature of Distress: Body dysmorphia causes emotional distress from an obsession with perceived external flaws. gender dysphoria causes emotional distress from a misalignment between physical traits and internal gender expression.
Distortion vs. Identity: Body dysmorphia reflects a cognitive distortion that’s based on fixations and misconceptions. gender dysphoria reflects an authentic identity incongruence that’s rooted in a person’s legitimate lived experience.
Models of Care: Body dysmorphia is best treated with therapies that reframe intrusive thoughts and replace harmful behaviors with more beneficial coping mechanisms. gender dysphoria is best treated with identity-affirming care that centers the person’s gender expression and focuses on restoring embodiment.
Why It’s Important to Know the Difference
Understanding the nuances of body dysmorphia vs. gender dysphoria is about more than just knowing which term to use. The ability to differentiate between them in clinical settings can have real implications in both eating disorder treatment and healing outcomes.
Prevent a Misdiagnosis
Clinicians who are unfamiliar with gender dysphoria might overlook the emotional distress of identity incongruence and conflate it with body dysmorphia.
This potential misdiagnosis can make it hard for trans or nonbinary folks to trust their own lived experience. It can also lead to feelings of invalidation or a fear that they won’t be taken seriously in treatment.
Design Inclusive Care Plans
Once a clinician knows exactly what their patient is dealing with, it becomes easier to customize an affirming treatment model that aligns with how the person identifies and what they need to heal.
For example, being aware that hormone therapies could actually increase eating disorder symptoms in some trans folks can help clinicians avoid exacerbating harm.
Account for a History of Trauma
According to a recent survey, about 50 percent of trans adults face discrimination on a regular basis, and nearly 75 percent agree it worsens their mental health.
This experience can contribute to poor body image, low self-esteem, social isolation, or eating disorder behaviors. Whereas identity-affirming care helps combat the trauma and nurture resilience.
Everyone Deserves Identity-Affirming Care
Trans folks deserve to heal in spaces that feel safe and inclusive. We hope you, as a practitioner, will do the work to build your trans-affirming knowledge so you can provide supportive and effective care for clients who identify as such.
Find out how Project HEAL’s InformED Clinical Training Program can help you do exactly that.
