What is Gender Dysphoria?
Gender dysphoria is the psychological distress a person experiences when there is a difference between their assigned gender at birth, or the gender on their birth certificate, and their gender identity, or the gender they understand themselves to be (expressed gender). [1] It doesn’t necessarily have anything to do with someone’s sexual orientation or preferences.
In addition to psychological distress, gender dysphoria can also cause clinical depression and anxiety. Rates of these psychiatric conditions are higher in transgender and nonbinary populations than in cisgender individuals or those whose gender expression/identity is the same as their assigned sex at birth. Experiences of discrimination and minority stress may also contribute to higher rates of depression and anxiety in trans and nonbinary people. [2]
It’s important to note that not all transgender individuals experience gender dysphoria. “Transgender” simply refers to when a person identifies as a gender other than the sex assigned at birth, but they may not feel distressed over this incongruence.
Gender dysphoria is a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This has been a controversial topic because pathologizing gender dysphoria can be stigmatizing. On the other hand, the diagnosis has enabled many transgender and gender-diverse people to receive insurance coverage for affirming medical care (to change physical sex characteristics).
Affirming Treatment for Gender Dysphoria
People who experience gender dysphoria may have the desire to alter their primary and/or secondary sex characteristics. As such, many trans and nonbinary folks pursue various forms of gender affirmation to validate their gender identities. These may include: [1]
- Changing their pronouns
- Changing their name
- Changing gender markers on their license, passport, and other identification documents
- Beginning hormone replacement therapy
- Taking puberty blockers
- Masculine chest reconstruction (often called “top surgery”)
- Breast augmentation
- Facial feminization surgery
Many other forms of gender affirmation do not require legal or medical measures. They include:
- Gender-affirming hair cuts
- Gender-affirming clothing
- Binding, packing, or tucking
- Shaving or not shaving
- Laser hair removal
Everyone’s journey is different, and not everyone pursues or desires every aspect of gender affirmation listed above. Transitioning and receiving gender-affirming care is an extremely personal process, as only the individual knows what may be best for them.
Gender identity refers to one’s sense of their own gender, regardless of their assigned gender at birth.
Gender Affirmation and Transitioning
For many people, the path to gender affirmation changes over time.
Some people may use hormone replacement therapy (HRT) for several years and then be comfortable with stopping that treatment. Others may opt for surgical affirmation and forgo hormone replacement therapy altogether.
Often, other individuals are a big part of someone’s transition journey. Everyone from friends and family to caregivers and even strangers can help someone affirm their identity and avoid significant distress or impairment by: [3]
- Using someone’s established pronouns and name
- Asking for someone’s “pronouns” rather than “preferred pronouns”
- Using gender-neutral language
- Avoiding assumptions of pronouns or gender
- Avoiding gender stereotypes
- Correcting yourself if you misgender someone (without over-apologizing)
- Correcting others if they misgender someone
- Introducing yourself with your pronouns
- Using the language a trans person uses for themself
None of the decisions regarding someone’s transition are “right,” “wrong,” or make them any more or less transgender. They are simply different ways a person may seek to establish harmony between their outer appearance and inner identity.
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The Link Between Gender Dysphoria and Eating Disorders
It is commonly thought that cisgender, heterosexual (cishet) females are the only ones who struggle with eating disorders. This is simply not the truth.
Trans students are more than 4.5x more likely to have an eating disorder.
According to one study, trans students were 4.62 times more likely to have an eating disorder diagnosis than cishet females. This same study saw trans students as 2.46 times more likely to engage in compensatory behaviors, such as laxative abuse, self-induced vomiting, or over-exercising. Additionally, trans students were found 2.05 times more likely to use diet pills than their cishet counterparts. [4]
Other common disordered eating behaviors in trans and nonbinary communities include: [6]
- Fixating on concepts like body weight, body shape, food, and diet
- Becoming preoccupied with nutritional information
- Skipping meals or eating small portions
- Maintaining a rigid exercise routine or exercising excessively
- Experiencing binge eating episodes or feeling a loss of sense of control when eating
- Eating when not hungry
There are likely many explanations for these connections.
People with gender dysphoria often experience intense anxiety, stress, and discomfort related to their body image. Trans and non-binary people also tend to have higher rates of body dissatisfaction than their cisgender counterparts. [5]
Disordered Dating Behaviors and Gender Stereotypes
Some people experiencing body dysphoria may engage in disordered eating behaviors as an attempt to change parts of their body that cause them particular distress or to help them accentuate gender-affirming characteristics. [5]
For example, trans-men and transmasculine folks may try to make their hips smaller by restricting food intake or to gain muscle by lifting excessively. Conversely, trans-women and transfeminine individuals may restrict calories in order to become thinner and lose muscle mass.
These gendered body ideals are based on harmful stereotypes related to gender. And while many gender-diverse individuals don’t subscribe to them, instead choosing to redefine gender and all its possibilities, it’s important to acknowledge that external pressure from society is a very real influence on the development of eating disorders for trans and cis people alike.
Gender Dysphoria vs. Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is a mental health condition that involves a person’s fixation on one or more perceived flaws in their appearance. Typically, these “defects” represent tiny details and may even be unobservable to others.
People experiencing body dysmorphia often engage in repetitive behaviors related to their perceived flaw(s), such as:
- Skin picking
- Mirror checking
- Camouflaging aspects of their body
- Seeking constant reassurance about their appearance
- Being preoccupied with comparing their physical appearance to others
Body dysmorphia is an issue of focus and attention and does not have to be related to an eating disorder. For instance, someone with BDD may fixate on a birthmark, scar, or the size of their nose. Any body part can become the focus of a person’s preoccupation.
Body Dysmorphia vs. Gender Dysphoria
Body dysmorphia is also not the same thing as gender dysphoria. While BDD involves distress over the physical aspects of a person’s body, gender dysphoria refers to distress over one’s gender identity, which reaches far beyond the counters of the body.
Some people, including some in the medical community, may conflate the two conditions, which can lead to complications for someone seeking gender-affirming care. Others may more aggressively generalize that all transgender people are experiencing body dysmorphia as a way to shame them or suggest that their gender identity is the product of disordered thinking.
Yet, extending gender-affirming care to those who want or need it is important, as it can help those with gender dysphoria experience a greater sense of self-acceptance and inner peace.
If you’re experiencing body dysphoria, symptoms of an eating disorder, or both, the most important thing is to seek out treatment. By opening yourself up to self-care, you can start on a journey toward a healthier and happier life.
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Resources
- What is Gender Dysphoria? (2022). American Psychiatric Association. Accessed February 2023.
- Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1): 44–57.
- Affirming Gender Identity. Emerson College. Accessed February 2023.
- Hammond, M. Exploring How Gender Identity Impacts Eating Disorders & Body Image. The Lotus Collaborative Eating Disorder Recovery Center. Accessed February 2023.
- Milano, W., Ambrosio, P., Carizzone, F., De Biasio, V., Foggia, G., & Capasso, A. (2020). Gender Dysphoria, Eating Disorders and Body Image: An Overview. Endocrine, metabolic & immune disorders drug targets, 20(4): 518–524.
- Warning Signs and Symptoms. (2022). National Eating Disorders Association. Accessed February 2023.