Do you think that you want to be thinner, or do you think you want to look more androgynous? This simple question would change my life and lead me to achieve lasting remission from my eating disorder.
My recovery was unlocked by an understanding of the difference between two distinct diagnoses: body dysmorphia and gender dysphoria. Both result in a person experiencing distress about how their body looks. The causes and treatment of that distress, however, are very different. Here, we’ll briefly define body dysmorphia and gender dysphoria and discuss how they are best treated.
Body Dysmorphia
Living with body dysmorphia is like seeing yourself in a funhouse mirror; no matter what your actual appearance is, you experience a warped version of it. Others won’t see the flaws you see when looking in the mirror.
Examples
- A person who is thin believes they are too large and need to lose weight
- A person who appears muscular perceives themselves as appearing too small or slight
Treatment
Changes to the body, like changes in weight or cosmetic procedures, typically have little to no effect on a person’s body dysmorphia. Instead, body dysmorphia requires psychological interventions aimed at helping a person address the cognitive distortions that cause them to perceive their body inaccurately.
Gender Dysphoria
Unlike body dysmorphia, living with gender dysphoria is not like standing in front of a fun house mirror. Rather, while you may perceive yourself more accurately, you still experience distress about your body’s incongruence with your gender identity.
Examples
- A person who is transmasculine looks in the mirror and sees that their body has breasts and full hips. This person is accurately perceiving what their body looks like, and is distressed by how their body’s shape does not affirm their gender identity.
- A trans woman looks in the mirror and sees an Adam’s apple. She is accurately perceiving this trait, but the Adam’s apple to her feels incongruent with her identity as a woman, and therefore causes distress.
Treatment
Unlike body dysmorphia, physical changes that affirm a person’s gender identity can help to significantly reduce or even resolve gender dysphoria.
These changes can include:
- Gender-affirming clothing, garments, and grooming
- Medical interventions like hormone replacement and surgeries.
Treating gender dysphoria typically involves a combination of gender-affirming care and psychological interventions aimed at reducing distress.
When it comes to eating disorder treatment
It is important to remember that a person with an eating disorder can also have gender dysphoria, body dysmorphia, both, or neither. When seeking eating disorder treatment as a trans or gender-expansive individual, it can be helpful to ask potential providers to explain how they address body dysmorphia and gender dysphoria in treatment. Their answer will help you gauge their ability to take a gender-affirming approach to eating disorder treatment.
References
American Psychiatric Association. (2022). Body dysmorphic disorder. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), 272-278.
American Psychiatric Association. (2022). Gender dysphoria. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), 513-521.
Amin, Lisha, M.Ed (2025).
Coelho, J. S., Suen, J., Clark, B. A., Marshall, S. K., Geller, J., & Lam, P.-Y. (2019). Eating disorder diagnoses and symptom presentation in transgender youth: A scoping review. Current Psychiatry Reports, 21(11). https://doi.org/10.1007/s11920-019-1097-x
Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender clients’ experiences of eating disorder treatment. Journal of LGBT Issues in Counseling, 10(3), 136–149.
McGregor, K., McKenna, J.L., Barrera, E.P., Williams, C.R., Hartman-Munick, S.M., & Guss, C.E. (2023). Disordered eating and considerations for the transgender community: A review of the literature and clinical guidance for assessment and treatment. Journal of Eating Disorders 11(1), 75. https://doi.org/10.1186/s40337-023-00793-0
