dysphoria vs dysmorphia: the importance of distinction
In the competitive, materialistic, and vanity-centered society we live in, low self-esteem is becoming more and more of an issue in young people. We often hear rally cries for HAES and encourage people to accept and love their bodies. We preach about how our worth goes beyond the scale, beyond our muscles and gains, and others' opinions. While this is all fine and well, the awareness surrounding body image challenges and the efforts to promote self-acceptance overlook the complexity of body image.
If you were to ask any random person on the street if they have ever felt self-conscious about their appearances, chances are you will get a yes. Some experience it in the long term. Some experience it only when they wear ill-fitting pants. Nevertheless, we all experience self-doubt and uncertainty about our appearance.
Still, even though we all go through it in some form, it varies in presentation, degree, and meaning. Today we are discussing a more severe form of body discomfort: Body Dysmorphic Disorder. We will discuss how BDD is not the same as Gender Dysphoria, which is not a mental illness according to the DSM-V. Although the two experiences have their differences, there are also many overlaps in the emotional significance they carry.
Let us start by defining the two. Gender Dysphoria “describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.”1 This is often associated with transgender and non-binary individuals. Having Gender Dysphoria does not mean a person is mentally ill. Instead, it signifies that they feel discontent, disconnected, or misrepresented by the gender they were assigned at birth. However, there are harmful effects of this condition including depression, anxiety, and suicidal thoughts. So, while Gender Dysphoria is not a mental illness, it can be a factor/cause for such disorders. Furthermore, Gender Dysphoria is treatable with therapy, counseling, hormone therapy/blockers, and certain surgical procedures like subcutaneous mastectomy (commonly called “top surgery”). The effectiveness of these treatments depends on the individual, but research shows that treatment can provide relief and improvement in patients' daily lives.
To flip the conversation, Body Dysmorphic Disorder (BDD) is defined as a mental illness in which someone perceives an imaginary flaw about their body, is hyper-focused on it and reacts in a way that negatively affects their life. According to John Hopkins Medicine, “[they] may find that negative thoughts about [their] body are hard to control...spend hours each day worrying about how [they] look. [A person's] thinking can become so negative and persistent, [they] may think about suicide.” People with BDD can receive treatment via psychotherapy, medication, counseling, and CBT. While symptoms can greatly improve, there is no cure for BDD. Unlike Gender Dysphoria, BDD is rarely treated with surgery or hormonal therapy. Such is because people with this disorder perceive the flaw(s) for reasons unrelated to their actual body. There is no “correction” to be made, as the trademark of BDD is that the flaw is realistically and objectively unjustified. Rather than feeling disconnected or misrepresented by their body, people with BDD feel like their body is bad, flawed, or deformed because it looks that way to them. It is a very complex disorder that is hard to comprehend unless you have experienced it. I have had BDD for years and have received CBT. Despite my progress and continuing recovery, I still cannot find the words to explain my thoughts. The best I can manage is that my body just looks wrong. See? Not a Pulitzer Prize winner.
To be clear, I am not comparing the validity, severity, or emotional toll of BDD versus Gender Dysphoria. The key takeaway from the above definitions is to give you a good idea of their differences so that we as a community can understand and identify them better. To make the distinction between the two could be a matter of life-altering decisions. Since they each call for unique care and attention, misinterpreting BDD as Gender Dysphoria (and vice versa) could result in failed treatment, delayed support, and a biased care plan.
Here is an example to clarify what I mean. Person A is transgender and is experiencing Gender Dsymirphia. The doctor diagnoses this as BDD and, in turn, treats Person A with medication and CBT. Meanwhile, Person As identity is invalidated. Their mental health is at risk. They get medicated for a condition that they do not have. That is a crisis that deserves a whole blog post by itself. This situation is sadly commonplace due to the lack of education and awareness surrounding BDD and Gender Dysphoria. It all becomes even more complicated when you consider how many similarities the conditions do share. After all, transgender individuals can experience both Gender Dysphoria and BDD simultaneously. BDD in transgender individuals occurs due to the same factors and environments that cause the disorder in Cis individuals. According to the Center for Discovery, “transgender and non-binary folks not only experience the gendered and transphobic society that we live in...but they also are subject to the same diet culture messaging and societal pressures around what an “ideal” body is supposed to look like." These pressures connect with the development of BDD regardless of sexual identity or gender identity.
Overall, BDD and Gender Dysphoria are not a package in every case but can co-exist. What causes each condition depends on someones' environment, social status, genetics, upbringing, and so much more. They require different modes and forms of treatment, and misdiagnosis can cause physical and mental harm to already vulnerable populations. There is a great need for more in-depth education and awareness surrounding the intricacies of both conditions. Further, we cannot ignore another issue hiding in the shadows: willful ignorance. Prejudice in healthcare is widespread and takes many forms. From harmful therapies, medical gaslighting, refusal of care, and insurance denial, the LGBTQ+ community gets wronged by the system. Transgender individuals who suffer from Gender Dysphoria get frequently denied insurance covered for hormonal treatment or surgery. Insurance companies write it off as cosmetic instead of an effective treatment for a mentally debilitating issue. Members of the LGBQT+ community who suffer from BDD are less likely to even try seeking help. That is due to the abundant discrimination in the mental health and healthcare system. According to The Center for American Progress, “LGBTQ people face disturbing rates of health care discrimination—from harassment and humiliation by providers to being turned away by hospitals, pharmacists, and doctors.”
Thankfully, we have made progress in mending the problem. The Affordable Care Act (ACA), put in place by the Obama Administration, prohibited health care professionals, providers, and insurance companies from discriminating against LGBTQ+ people. Additionally, more policies and court rulings in recent years have paved the way to ensure safe and inclusive health care to LGBTQ+ people without the allowance of discrimination or harassment. Even better, more right-leaning states who chose not to pass state laws against discrimination are still required to follow ACA guidelines, as it is federal protection.
Politicians are not the only ones stepping up and facing the crisis head-on; we are too. You can join us in our fight for equal treatment and access to mental health care for the LGBTQ+ community. Learn more on how you can become a Community Advocate for LBGTQ+ Mental Health NOW. For more information or resources, check out our Get The Facts Page and Resources & Links Page. You can also contact us to write about your experience with BDD, Gender Dysphoria, or any topic related to the cause! Let Us Be The Change Together!
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