Trans Eating Disorder Care: Gender Dysphoria vs Body Dysmorphia
Transgender and non-binary clients experience a distinctive set of challenges when it comes to their mental health and well-being. Their experiences are marked by societal pressures, the complexities of gender dysphoria, and the added burden of conforming to conventional male and female body ideals. Recent research has revealed that transgender individuals are more likely to be diagnosed with an eating disorder (ED) relative to cisgender individuals. As a therapist, differentiating between gender dysphoria, body dysmorphia, or simply the societal pressures every human faces can be challenging, but it’s critical in delivering care.
Understanding Gender Dysphoria and Body Dysmorphia
Gender dysphoria and body dysmorphia are two distinct concepts that are sometimes confused and conflated. Gender dysphoria refers to the incongruence between one's gender identity and their assigned sex at birth. Although it is no longer classified as a disorder, it can imply the presence of discomfort, anxiety, or depression, and in a clinical setting, it is often a precursor for a person to seek gender affirming care, like hormone therapy or surgery.
On the other hand, body dysmorphia is an anxiety disorder where individuals obsess over a perceived flaw in their outer appearance. It is often accompanied by deep shame about their bodies and what they perceive as imperfections. Body dysmorphia can be accompanied with disordered eating, but not always.
Differentiating Between Body Dysmorphia and Gender Dysphoria
The key distinction between these two conditions lies in their response to changes made to the body. Body dysmorphia does not improve even when the physical body changes, making its treatment complex and requiring long-term therapy. In contrast, gender-affirming actions, such as hormone replacement therapy, gender affirming surgery, or changes in clothing, have been shown to alleviate gender dysphoria.
The Interplay of Gender Dysphoria and Body Dysmorphia
While gender dysphoria and body dysmorphia are separate concepts, they are often experienced simultaneously by transgender and non-binary individuals. The distress related to gender identity and body image can coexist, impacting aspects like size, shape, and control. These conditions inform each other but do not cause one another. Therefore, treating eating disorders in this context necessitates addressing both gender identity and body image concerns.
Supporting Transgender and Non-Binary Individuals with an Eating Disorder Therapist
As both an eating disorder specialist and a gender-affirming therapist, I frequently find myself at the intersection of treating clients dealing with both eating disorders and gender dysphoria. It is crucial to understand that a person experiencing gender dysphoria is not mentally ill; rather, they are dissatisfied with the gender assigned to them at birth. In contrast, a person with body dysmorphia has a disorder where they perceive their body or face as "ugly," "fat," or otherwise unattractive, despite medical or personal reassurances.
When addressing the treatment of transgender individuals with eating disorders, it is imperative to recognize the complexity of their experiences. All clients should be acknowledged and treated as complete, multi-dimensional individuals, rather than being reduced to a diagnosis. While the journey towards recovery may present challenges, it is a journey filled with hope, resilience, and the potential for empowerment.
