Body image issues are often the most difficult aspect of eating disorder recovery to overcome. Dialogue around eating disorders and body image is usually centered around narratives of white, thin, able-bodied, heterosexual, and cisgender women. However, these conversations leave out the experiences of transgender and non-binary folks who often experience eating disorders and body image distress at disproportionately higher rates compared to their heterosexual, cisgender counterparts.
Transgender & Non-Binary Body Image Concerns
Most transgender individuals have a unique and complex relationship to their bodies. Transgender and non-binary folks not only experience the gendered and transphobic society that we live in, which is challenging in and of itself, but they also are subject to the same diet culture messaging and societal pressures around what an “ideal” body is supposed to look like. Some transgender and non-binary individuals experience an additional struggle in which their gender identity doesn’t align with their bodies.
Note: while not all transgender and non-binary individuals with eating disorders experience gender dysphoria, it is often hard to decipher whether or not one’s body image distress is related to gender dysphoria, body dysmorphia, or hesitancy and self-doubt fueled by societal expectations around body ideals and gender norms.
Gender Dysphoria and Body Dysmorphia, Explained
Body dysmorphia and gender dysphoria are two terms that are commonly, but incorrectly, conflated, undermining the reality of how powerful and difficult it can be to experience gender dysphoria and body dysmorphia.
Gender dysphoria is when there is a mismatch, or a sense of disconnect, between gender identity and one’s assigned sex at birth. No longer listed as a disorder in the DSM-V, gender dysphoria is considered a symptom that may cause discomfort, anxiety or depression, and can contribute to eating disorder behaviors and symptomatology. The false pathologization of gender dysphoria that often occurs is misplaced. The confusion is not in gender dysphoria itself but is the result of having trouble coping with dysphoric thoughts and feelings, due to experiences of transphobia, homophobia, oppression, bullying, victimization, and discrimination. Gender dysphoria is rooted in the issue and incongruence of identity, as opposed to shame. The dissonance between what feels internally true versus what is externally seen and perceived by others can create suffering and distress at the expense of one’s body. Although gender dysphoria is more pervasive than just with one part of your body, gender dysphoria can be eased by changing your body. For example, top surgery (a procedure to remove breast tissue) is known to help ameliorate chest dysphoria for those who were assigned female at birth but who don’t identify with having breasts.
Body dysmorphia is an anxiety disorder, currently listed in the DSM-V, that causes individuals suffering to worry about and have a preoccupation with a perceived flaw in their outer appearance. Individuals who experience body dysmorphia have a distorted view of themselves. Body dysmorphia is usually accompanied by deep shame about being in one’s body and of what their body looks like.
Differences Between Body Dysmorphia & Gender Dysphoria
Unlike gender dysphoria, body dysmorphia doesn’t respond to the changes we make to our bodies. Individuals with body dysmorphia and eating disorders, like Anorexia Nervosa, don’t actually feel better about their body when they use eating disorder behaviors, even if their body is physically transformed. Healing body dysmorphia is more than a physical process. It involves deep and long-term therapy, where one is encouraged to challenge their own thoughts. Whereas gender-affirming actions, like hormone replacement therapy or wearing different clothing, for example, have been shown to improve gender dysphoria.
The Link Between Gender Dysphoria and Body Dysmorphia
While we can conceptualize gender dysphoria and body dysmorphia as two different things, they are often not mutually exclusive. Transgender and non-binary folks may experience both simultaneously. Gender dysphoria and body dysmorphia are interconnected. While feelings of discomfort in one’s body is about gender, transgender and non-binary folks with eating disorders often simultaneously face distress about size, shape, and control. While body dysmorphia and gender dysphoria inform one another, they do not cause each other. Therefore, they both must be treated together, and eating disorder treatment for transgender and gender non-conforming folks cannot be considered outside the context of gender identity.
Jamie “OJ” Bushell (they/them) is in recovery from an eating disorder and is the co-founder of thirdwheelED.com, a blog and social media platform that documents eating disorder recovery through a queer lens. OJ writes about the intersectionality of eating disorders, trauma, sexuality and gender identity/expression. OJ uses their experience of seeking treatment for their eating disorder as a queer person to help raise awareness of the need for culturally responsive and affirming treatment and recovery support services for queer communities.
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