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What is gender dysphoria?

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Many trans and non-binary individuals experience some level of gender dysphoria. Gender dysphoria causes significant distress and often leads to body dissatisfaction, which can then influence disordered eating and compensatory behaviors, such as excessive exercise. People who experience gender dysphoria may engage in these behaviors to try to change parts of their body to look more like their gender identity. These disordered eating behaviors can progress to a clinical eating disorder, like anorexia or bulimia.

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What is gender dysphoria?

Gender dysphoria refers to the psychological distress and impairment a person feels due to the incongruence between their sex assigned at birth (i.e., what gender their birth certificate says) and their actual gender identity (i.e., the gender they identify as). (1) 

Gender dysphoria is a formal diagnosis in the Diagnostic and Statistical Manual of Mental 

Disorders, Fifth Edition (DSM-5) which 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 affirming medical care.

People who experience gender dysphoria may have a desire to change their secondary and/or primary sex characteristics. But not all transgender individuals experience gender dysphoria—and that doesn’t make them any less trans. (2) Trans gender refers to when a person’s gender identity differs from the sex listed on their birth certificate.

In addition to psychological distress, gender dysphoria can also cause clinical depression and anxiety Rates of these psychiatric illnesses are higher than in their cis counterparts. (3) Cis gender refers to a person whose gender identity is the same as their assigned sex at birth.

Affirming treatment can reduce gender dysphoria 

Many trans and non-binary folks pursue various forms of gender affirmation to ease their gender dysphoria and validate their gender identities. These may include: (1)

  • Changing their pronouns and name
  • Changing gender markers on their license, passport, and more
  • Beginning hormone replacement therapy
  • Taking pubertal blockers
  • Masculine chest reconstruction (often called “top surgery”)
  • Breast augmentation
  • Facial feminization surgery

Everyone’s journey is different, and not everyone pursues or desires every aspect of gender affirmation available to them. Transitioning and receiving gender-affirming care is an extremely personal process, as only the person knows what may be best for them. Plus, many people find their path changes over time. Some people take hormones for several years. Others may opt for surgical affirmation and forgo hormone replacement therapy. None of these decisions makes a person more or less trans than someone else. 

A cisgender person can do many things to affirm someone’s gender, including: (4)

  • Using the correct pronouns and name
  • Saying “pronouns” instead of “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 

The link between gender dysphoria and eating disorders in gender expansive folks

It is a common misconception that cisgender heterosexual girls and women are the only ones who struggle with eating disorders. According to one study, trans students were 4.62 times more likely to have an eating disorder diagnosis than cishet women. This sample of trans students were also 2.46 times more likely to engage in compensatory behaviors, such as taking laxatives, vomiting, or exercising. Lastly, they were 2.05 times more likely to use diet pills. (5)

There may be many explanations for this connection. Those struggling with gender dysphoria often experience intense anxiety, stress, and discomfort related to their body image. Trans and non-binary people tend to have higher rates of body dissatisfaction than their cisgender counterparts. (6) As such, they may engage in disordered eating behaviors, such as: (7)

  • Cutting out entire food groups, such as fat or carbs
  • Severely restricting their eating
  • Skipping meals or eating small portions
  • Maintaining a rigid exercise routine
  • Exercising excessively or compulsively
  • Drinking excessive amounts of water

Gender expansive people may engage in these behaviors in an attempt to change parts of their body that they don’t like or that cause them significant distress. On the other hand, disordered eating may also help them accentuate gender-affirming characteristics. (6)

For example, trans men and transmasculine folks may try to make their hips smaller by restricting food intake or gain muscle by lifting excessively. Conversely, trans women and transfeminine individuals may restrict calories in order to become thinner and lose muscle mass. Of course, these ideals are based on harmful stereotypes related to gender. So many gender diverse people don’t subscribe to them, instead choosing to redefine gender and all its possibilities. However, 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.

All that said, not every trans person experiences gender dysphoria and not every person with gender dysphoria develops disordered eating behaviors or an eating disorder. Eating disorders are complex conditions, with numerous interacting causes and risk factors. Some trans and nonbinary people struggling with eating disorders may separate their condition from their physical body or gender dysphoria.

How does gender dysphoria differ from body dysmorphia disorder?

Body dysmorphic disorder (BDD) is a mental health condition in which a person is fixated on one or more perceived flaws in their appearance. Typically, these “defects” are extremely mild and unobservable to others. (2)

People experiencing body dysmorphia often engage in repetitive behaviors, such as skin picking, mirror checking, camouflaging, or seeking constant reassurance about the perceived flaw. They may also struggle with an extreme preoccupation related to comparing their physical appearance to that of others. Body dysmorphia does not have to be related to an eating disorder. For instance, someone with BDD may fixate on a birthmark or scar or the size of their nose. However, any body part can become the focus of a person’s preoccupation. (2)

Body dysmorphia is not the same thing as gender dysphoria, which is rooted in incongruent gender identity. Transphobic people and harmful medical providers may weaponize body dysmorphia against transgender and non-binary individuals by accusing them of experiencing disordered thought patterns causing them to want to change their physical appearance. But this is simply not true. Often, gender-affirming care can rectify a person’s gender dysphoria and even lead to gender euphoria. Conversely, if someone with body dysmorphic disorder got surgery or treatment to fix their perceived flaw, that wouldn’t resolve their condition. In fact, one study found that only 2% of surgical procedures reduced the symptom severity in those with BDD. (8) 

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. American Psychiatric Association. (2020). What is Gender Dysphoria?
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  3. Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry (Abingdon, England), 28(1), 44–57. https://doi.org/10.3109/09540261.2015.1115753
  4. Emerson College. (n.d.). Affirming Gender Identity. 
  5. Hammond, M. (n.d.). Exploring How Gender Identity Impacts Eating Disorders & Body Image.
  6. 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.
  7. National Eating Disorders Association. (n.d.). Warning Signs and Symptoms.
  8. Lifespan. (2010, August 11). Does cosmetic surgery help body dysmorphic disorder?. ScienceDaily

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