Dysphoria Vs. Dysmorphia: What’s The Difference?
When discussing mental health, it's important to understand that "body dysmorphic disorder" refers to a specific condition, distinct from gender dysphoria, which involves an extreme concern with one's physical appearance, whereas gender dysphoria is a condition in which a person experiences significant distress due to a mismatch between their gender identity and the sex they were assigned at birth. The words “dysphoria” and “dysmorphia” may sound similar, but when it comes to gender dysphoria and body dysmorphia, they are two very different things. The following explains some of the differences between body dysmorphia and gender dysphoria and how they're addressed, as well as how to find support if you need it through means such as online therapy.
Body dysmorphia and gender dysphoria
A significant difference between body dysmorphic disorder and gender dysphoria is that body dysmorphic disorder (BDD) is a mental health condition, whereas gender dysphoria is not.
What is body dysmorphia or body dysmorphic disorder?
Body dysmorphic disorder, or BDD, is a mental health condition that's diagnosed under the category of Obsessive-Compulsive and Related Disorders in the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders).
Body dysmorphic disorder is a condition characterized by the following criteria:
- A preoccupation with one or more perceived flaws in one's physical appearance that are not observable or appear minimal to other people. This can be virtually any physical feature. The focus on appearance or body image can be very intense.
- A perception that a flaw is significant or very negative. A person with BDD may look in a mirror, see something small or unnoticeable about their appearance, and perceive it as a major flaw that’s embarrassing and shameful. For a person living with BDD, even looking in an ordinary mirror can seem like seeing a reflection in a funhouse mirror.
- Repetitive behaviors such as excessive grooming, checking one's appearance in the mirror frequently, skin picking, reassurance-seeking, or appearance-based comparison to others in response to the perceived flaw or concern.
- Clinically significant distress or difficulty functioning in work, school, social situations, or other basic life activities due to the perceived flaw or appearance-related concern.
BDD is diagnosed when symptoms are not better attributed to another diagnosis or condition. Having a blood relative with BDD or OCD can be a common contributing factor to developing the disorder. BDD can impact your life and ability to engage in activities, including work, school, and social activities, in serious ways. Someone with BDD might cancel important activities, plans, and experiences in daily life due to their symptoms, including their behaviors or distorted view of their appearance. Body dysmorphic disorder can be hard to live with, and it's common for people with body dysmorphia to experience feelings of anxiety, depression, and low self-esteem.
If you struggle with BDD or think that you might, you aren't alone, and the good news is that help is out there. Roughly 1 in 50 people are said to live with body dysmorphic disorder, and the age of onset tends to be at around 12-13 years of age. BDD is successfully treatable through forms of talk therapy such as cognitive-behavioral therapy (CBT). If BDD is impacting your life, or if you think that you might have BDD, it's important to reach out for help.
Body dysmorphia and eating disorders
Body dysmorphia and eating disorders aren’t the same things, but they do have some similarities. Each is a mental illness or psychological disorder that is related to feelings about or the perception of one’s body which can manifest as uncontrollable thoughts. Both tend to be associated with distressing and uncomfortable feelings about the body. Both frequently affect daily life. Another similarity is that people with body dysmorphia and eating disorders tend to have a preoccupation with body image and may experience a distorted body image. But while a person with an eating disorder typically is concerned with body size and shape, a person with body dysmorphia may be focused or anxious about a specific body part.
Eating disorders include anorexia nervosa, bulimia, binge eating disorder, and more. People with eating disorders can have co-existing body dysmorphia and vice versa. An eating disorder is a mental health disorder and can also be indirectly or directly linked to other mental disorders, such as anxiety or depression. If you or a loved one has an eating disorder, please reach out for help. Bulimia treatment, binge eating disorder treatment, and anorexia nervosa treatment can be very effective. If you require an anorexia nervosa treatment or treatment for any other eating disorder, please know that these treatments can help you live a healthy life, both physically and mentally.
What is gender dysphoria?
Gender dysphoria is a common experience among transgender people, although not every transgender person experiences gender dysphoria, and symptoms can be unique to personal experience. Many individuals who experience gender dysphoria suffer from significant emotional distress, as they may feel trapped in a body that does not align with their true gender identity.
The American Psychological Association (APA) defines gender dysphoria as "clinically significant distress or impairment related to a strong desire to be of another gender, which may include a desire to change primary and/or secondary sex characteristics" while noting again that not all transgender or gender diverse people experience dysphoria.
The gender a person identifies with may not be the same as their biological sex. Some people call one’s biological sex their “biological gender,” but gender is the identity, expression, or societal expectations, while sex is the label based on genitals and chromosomes at birth. For instance, a person whose biological sex was female at birth may identify as being of the male gender. A person who was “born male” may have been born with the male biological sex but their gender identity may not be male. What a person feels their true, individual gender is can be very unique and personal. Male and female aren’t the only genders people identify as, either. Some people may have non-binary gender identities, while others may have fluid gender identities.
Gender dysphoria is often an incredibly distressing* experience for a transgender person, as it can create an intense internal conflict between one's innate sense of gender identity and societal expectations and norms. Gender dysphoria can start in childhood and continue into adolescence and adulthood. It is often described as stemming from feelings of being trapped in the “wrong body,” although “wrong body” is not always the preferred term. It can be a sense of the biological sex of a person’s body not matching their gender identity, which can be a difficult reality to navigate and can cause unease, discomfort, social isolation, and other symptoms. Gender dysphoria is often linked to mental health complications, such as extreme feelings of anxiety (anxiety disorder) and depression. While gender dysphoria and body dysmorphia are not the same, people can experience both gender dysphoria and body dysmorphia.
This could mean asking people to use the pronouns that align with a person’s gender, a style of dress or apparel that makes someone feel more comfortable, a haircut, hormone therapy, facial hair (through hormone treatments, for instance), breast size (e.g. augmentation for trans women,), surgery, voice training, or something else. For example, a person whose biological sex is male may identify with the female gender and want to be addressed with female pronouns. One transgender person might want surgery and HRT (hormone replacement therapy), whereas another transgender person may want neither or only one of those things.
When a transgender person has support and can live as themselves, whether it does or does not involve things like medical transition, mental health outcomes are highly improved. Support from mental health professionals, medical professionals, family, friends, and the community at large. Additionally, the transgender community can be extremely important in supporting the mental health of transgender individuals.
*If you need immediate support and need someone to talk to, contact TrevorLifeline at 1-866-488-7386 or go to their website. Or use the Crisis Text Line to connect with a trained Crisis Counselor by texting HOME to 741741.
Find a therapist
If you're looking for someone to talk to, a counselor or therapist can help. There are several different ways to find a therapist online or near you. You can search the web, ask your doctor for a referral, contact your insurance company to see who they cover, or sign up for an online therapy platform like BetterHelp. BetterHelp is often more affordable than traditional in-person services without insurance, and all of the providers on the platform are licensed, mental health professionals. Adults can use BetterHelp to connect with a licensed therapist, and the platform TeenCounseling is available to serve teens from 13-19 years old with the consent of a parent or guardian.
A 2019 study found that internet-based cognitive behavioral therapy is effective for the treatment of BDD, while also increasing the availability of mental health services to these individuals. A recent 2021 study focusing on internet-based gender-affirming cognitive behavioral therapy for LGBTQIA+ youth and young adults found it to not only be effective for helping to treat the mental health challenges often experienced by those in the LGBTQIA+ community (such as depression and anxiety) but participants also “reported significantly reduced depression symptoms and improved stress appraisal and coping skills.” According to the researchers, “These findings suggest that digital technologies are a promising platform for the delivery of affirmative therapies for LGBTQA+ populations.”
Finding an LGBTQIA+ affirming provider who works with trans people as a demographic may be advantageous for those who need a safe space to talk about dysphoria and feelings related to gender and other similar concerns. Some therapists and counselors specialize in working with body image, body neutrality, body perception, body dysmorphia, body image distortions, eating disorder recovery, and obsessive-compulsive disorder, among other disorders. You deserve to find quality care that meets your needs and helps you live a happy life, so don't hesitate to start your search today.
Takeaway
Body dysmorphia, or body dysmorphic disorder, is characterized by the individual focusing excessively on a part or parts of their body that they perceive as flawed, often to the extent of interfering with their day-to-day life. Gender dysphoria, simply put, can be experienced when someone’s genitalia that they were born with does not match their gender identity. Both of these can be difficult to live with and work through, but it’s important to note that while body dysmorphia is a mental disorder, gender dysphoria is not. No matter who you are or what you are experiencing, you matter, your identity is yours to define and yours alone, and you deserve help and support when and where you need it. If you’re ready, you can take the first step to being treated by an experienced, empathetic, and knowledgeable online therapist.
Are dysphoria and dysmorphia the same?
Dysphoria and dysmorphia are different concepts, but they are often confused with one another. Dysphoria, broadly speaking, refers to a mood characterized by discontent and agitation. It applies to several concepts in psychology and mental health, but one of its most frequent uses is to refer to gender dysphoria.
Gender dysphoria is a diagnosable mental health condition common in the transgender community. It refers to a feeling of intense discomfort a trans person experiences when looking at or considering their own body. To them, their body is incongruent and mismatched with what they feel their gender is. For example, a transgender individual who identifies as female but was assigned male at birth may experience significant dysphoria when considering the masculine features of their body. Their own gender is likely significantly more feminine leading to a distinct incongruity.
Dysmorphia, conversely, refers to a preoccupation with a perceived defect or flaw in one’s physical appearance. The preoccupation concerns a flaw that is either not noticeable or only slightly noticeable to others. When the preoccupation begins to interfere with daily life, it may result in a diagnosis of body dysmorphic disorder (BDD). Unlike gender dysphoria, BDD does not center on the distress caused by possessing features of a gender with which one does not identify.
Can you have dysphoria and dysmorphia at the same time?
Yes, dysphoria and dysmorphia are not mutually exclusive. Gender dysphoria describes the unpleasant discomfort of being within a body that does not align with the gender someone identifies as. Dysmorphia describes a preoccupation with a perceived deficit or flaw in one’s body. It is not directly related to gender.
Gender dysphoria is a diagnosable condition that is given when the discomfort of living within a body of the incorrect gender becomes distressing enough to interfere with daily life. Dysmorphia, or body dysmorphic disorder, is also a diagnosable condition when the distress becomes overwhelming enough to disrupt activities of everyday life. The conditions are not mutually exclusive, and it is possible to display symptoms of both. A licensed mental health professional can help distinguish between the two conditions and advise how each condition can be managed or treated.
What does body dysphoria look like?
Those with body dysphoria are so upset by the appearance of their body that it gets in the way of their daily life. It is important to note that the word “dysphoria” is often incorrectly used in this context. The correct term is body dysmorphia - also known as body dysmorphic disorder - which is often confused with another condition, gender dysphoria. Gender dysphoria occurs when a person experiences extreme distress because their body does not align with the gender they identify as.
Body dysmorphia is characterized by repetitive behaviors associated with one’s appearance. Common behaviors associated with body dysmorphia include:
- Excessive mirror checking.
- Camflouging (covering a perceived defect with makeup, clothing, etc).
- Skin picking.
- Excessive weight lifting or exercise.
- Excessive grooming.
The preoccupation with a perceived flaw causes a marked impairment in occupational, social, and academic areas of functioning. The average person who meets the criteria for body dysmorphic disorder tends to spend three to eight hours per day engaging in repetitive behaviors and thought processes related to their perceived flaw.
Why is it called gender dysphoria?
Gender dysphoria refers to a marked sense of distress when a person’s assigned gender does not align with their experienced or expressed gender. For example, a person who was assigned male at birth but who identifies as a woman may feel extreme discomfort and distress when confronted with the masculine features of their body.
It is important to note that biological sex and gender are distinct concepts. The terms are frequently used interchangeably in regular conversation but have very different meanings. A person’s sex is composed of biological traits - known as sex traits - that are reflected in their anatomy, physiology, genetics, and hormones. For example, nearly all humans have two sex chromosomes; males have an “XY” chromosome pair, and females have an “XX” chromosome pair. While it may seem like a biological definition of sex is straightforward, there are exceptions to the sex chromosome rule and many other “definitive” markers of sex.
Gender is even more complex. It is a sociocultural concept related to a person’s sex, but only because society has traditionally categorized men and women into separate roles, duties, and functions throughout history. A person’s sex is based on biology and has little to do with social or cultural factors, while gender is almost entirely shaped by society.
Consider gender roles as an example. The term “gender roles” refers to duties that were traditionally assigned to one gender over the other, such as women being responsible for domestic tasks and men being responsible for generating a household income. Although societal pressures have traditionally pushed for an alignment between sex and gender roles, modern society frequently debates gender roles as men and women defy previously-established norms.
While a person’s gender often aligns with their sex, that is not always the case. A person with many feminine traits may feel intrinsically masculine, and the reverse can also be true. In that case, the person’s biological sex traits represent a gender that does not align with their internal self. When that happens, intense distress can appear, leading to a potential diagnosis of gender dysphoria.
What's the opposite of body dysmorphia?
The opposite of body dysmorphia is secure body confidence. Many people feel insecure about at least one part of their body at some point in their lives, but if a person can manage that insecurity, apply coping skills, and restore confidence, they are unlikely to develop body dysmorphia.
Body image is a multidimensional construct that involves behavioral, perceptual, and cognitive components. Negative thoughts about one’s body are referred to as body dissatisfaction. If that dissatisfaction begins to interfere with daily life, body dysmorphia may develop. A person can stop or reverse the process by working to increase their self-esteem and instill a positive body image.
Can things trigger dysphoria?
Dysphoric symptoms may be worsened by things that are traditionally gendered or remind a person about their gender. For example, evidence suggests that being forced to use a restroom that aligns with a person’s biological sex rather than their gender can potentially produce feelings of distress. Other things that have the potential to induce distress include:
- Looking at a photo of oneself.
- Looking in a mirror.
- Sexual or intimate acts with another person.
- Pitch of voice.
- Being referred to as their sex rather than their chosen gender.
Is dysphoria a symptom?
Dysphoria is a symptom, not a diagnosable condition, but it is commonly used to refer to gender dysphoria, which is a condition but not a symptom. Dysphoria is a psychological term that describes a mood characterized by discontent, discomfort, and agitation. Today, dysphoria is most commonly associated with the term gender dysphoria. Gender dysphoria is a diagnosable mental health condition wherein dysphoric feelings are caused when a person’s internal feeling of gender is out of alignment with the gender assigned at birth.
Can you be diagnosed with dysphoria?
There is no diagnosis simply labeled “dysphoria,” and it is not possible to be diagnosed as dysphoric alone. Dysphoria is generally considered a symptom, referring to a mood characterized by agitation and discontent. However, dysphoria is sometimes used as a shorthand to refer to gender dysphoria, which is a diagnosable condition. When a person’s internal concept of gender does not align with the gender they were assigned at birth, severe distress may occur, which could warrant a diagnosis of gender dysphoria.
Dysphoria is also mentioned in the context of one other diagnosable condition, premenstrual dysphoric disorder (PMDD). PMDD is frequently referred to as a severe form of PMS and describes a constellation of symptoms that predictably occur about one to two weeks before the onset of menstruation.
What do I do if I have dysphoria?
The symptoms of gender dysphoria may feel overwhelming or beyond control, but evidence suggests that the severity of symptoms can be significantly reduced by seeking medical care. Treating gender dysphoria is generally a multi-disciplinary approach, and you can begin by speaking to a healthcare provider or mental health professional.
Managing the effects of dysphoria often begins by seeking therapy. Often, those seeking help from a mental health professional are looking for support during a lengthy and complex transition process. If you believe you are experiencing gender dysphoria, speaking with a therapist may be a viable and rewarding first step.
Is there a cure for dysphoria?
There is not a definitive cure for gender dysphoria, but there are several treatment options that have been shown to significantly reduce or eliminate the adverse effects associated with gender dysphoria. Generally, treatments begin with the least-invasive option and end at the most invasive, which is often cosmetic surgery designed to confirm a person’s gender.
Below are common treatments for gender dysphoria:
Psychotherapy. Therapy is not initiated with the goal of “curing” the person of gender dysphoria but rather to improve their overall quality of life and help them determine their goals regarding their dysphoria. Therapists often help people maintain their mental well-being throughout their transition process.
Hormone Replacement Therapy. Hormone replacement therapy, or HRT, introduces sex hormones that align with a person’s identified gender. Those assigned male at birth are typically prescribed a form of estrogen, which reduces masculine features of the body and increases feminine ones. In contrast, those assigned female at birth are typically prescribed a form of testosterone, which reduces feminine features and increases masculine ones.
Non-Genital Gender-Affirming Surgery. In non-genital affirming surgeries, the person receives surgery with the goal of reducing masculine or feminine traits not associated with the genitals. An example would be a mastectomy given to someone assigned female at birth who is transitioning towards more masculine features or breast implants for someone assigned male at birth who is transitioning towards more feminine features.
Genital Gender-Affirming Surgery. In genital gender-affirming surgeries, reproductive organs such as ovaries or testes are commonly removed, and the person may elect to have a penis or vagina constructed to bring their body in the closest possible alignment with their chosen gender.
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