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For treating any disformity or disease, a correct estimation of the root of the problem is necessary. But how to do it when you get confused? What is the difference between dysmorphia vs dysphoria?
Dysmorphia vs Dysphoria
Gender dysphoria and body dysmorphia are two entirely different diagnostic criteria. But many times people tend to mix dysmorphia vs dysphoria with each other, which is why today we have come up with a comprehensive guide to distinguish between the two.
So, let’s get started with the distinction between Dysmorphia vs Dysphoria:
Body Dysmorphia
Body dysmorphic disorder or BDD for short is a mental health disorder that creates faulty and inaccurate body image about one’s body. It is a perceived flaw considered minor or maybe not even observable.
Some people even have delusional beliefs that make them think that the perceived flaw they see is an accurate perception.
Let’s look at an example to understand it better. This is adapted from the diagnostic and statistical manual-5 case book.
Story of Amy
Amy works in an office as an accountant, since thirteen she has been excessively preoccupied with her physical appearance, scarred skin thinning hair, a small chest, and a mole on her face that she thinks makes her nose look gigantic.
Other people would tell her she looked fine but she was convinced that she was ugly. She also believed that everyone in the office talked about her and made fun of her because of her appearance.
She spends 5-6 hours a day compulsively checking all of these areas of her body. And every time she passes a mirror or a window, she needed to adjust her hair to make it look fuller. To deal with her scarred skin, she used a razor blade to pick her skin to clear up the scars.
She consulted several dermatologists for face creams and peels, but nothing seemed to help. She also had two nose reduction cosmetic surgery but she felt like the doctors botched the jobs and didn’t know what they were doing.
Amy missed several weeks of work because she felt her co-workers created a hostile environment by making fun of her. She was given an ultimatum to report to work or be let go.
She filed a complaint against her boss for promoting harassment in the workplace. Amy didn’t date because she believed that men didn’t find her attractive.
She often thought that life was not worth living because she had nobody who could except her freak appearance. Family members tried to get her to see a psychiatrist but that only made her angry because they considered her ugliness a mental disorder.
Amy had been having some trouble sleeping for months and had some sleeping medications from her doctor.
After she was told she couldn’t come to work because of the complaint she filed she took all over her sleeping pills and sent her sister a text message saying that no one needed to worry about her anymore, her sister knowing Amy had been looking depressed and withdrawn called the police.
Amy was admitted to the hospital and treated for depression. So this is a pretty sad story about Amy but it is quite typical as to how this can look.
It doesn’t always result in a suicide attempt but approximately 80% of people with body dysmorphic disorder have time-to-time suicidal thoughts and 25% of those people attempt.
Symptoms: Dysmorphia vs Dysphoria
- People suffering from body dysmorphic disorder can feel emotions such as shame or disgust concerning a part or parts of their body and fixate on this.
- A preoccupation with one or more perceived defects or flaws in physical appearance that may be not even observable or even appear slight to others.
- You perform repetitive behaviours in response to distorted body image concerns. Some examples of this would be mirror checking, excessive grooming, comparing your appearance to others, or reassurance seeking.
- The preoccupation causes distress or impairment in social, occupational, or other aspects of functioning. The person may also adopt an unusual routine to avoid social contact that expresses the perceived flaw.
- The most common features about which people obsess include the face such as nose, wrinkles, acne, complexion and other blemishes, hair, skin, muscle size, tone, the breast size.
Body dysmorphia is strongly associated with obsessive-compulsive disorder1. It is an anxiety disorder characterized by obsessive thoughts that are carried out with compulsive actions that are unsettling to the individual.
It is also observed that gender dysphoria is seen a lot in autistic people. Gender dysphoria is often linked to other mental health complications, such as extreme feelings of anxiety (anxiety disorder) and depression.
Body dysmorphic disorder is estimated to effects up to 2.4% of the population. The condition usually starts in adolescence.
Body dysmorphia does not go away on its own, if untreated it may get worsen over time leading to low self-esteem, severe depression, anxiety disorder substance abuse2, and suicidal thought and behaviour.
These obsessive thoughts about appearance for hours interfere with basic life activities and make it impossible for the person to lead a normal daily life.
General Causes
The exact cause of body dysmorphia3 is unknown but like every other disorder, body dysmorphia may result from a combination of reasons. Such as environmental factors, especially if they involve negative societal expectations about the body or body image, low self-esteem, and also childhood trauma.
Genetics- Studies found that BDD is likely to run in families. Certain factors that may increase the risk of developing the condition include a family history of negative body image, perfectionism, negative life experiences like bullying or teasing, introversion, and media influence.
Treatment
The two main treatments for gender dysmorphia are anti-depressant medication and cognitive behavioural therapy or CBT.
1. Cognitive Behavioral Therapy
The goal of CBT treatment for body dysmorphia is to help people learn and practice concrete tools for physical exertion and in turn mental control over the perception and thoughts associated with the body dysmorphia.
The next stage of treatment is exposure therapy, which focuses on exposure to bodily sensations and situations that typically triggers the person.
The goal is to change the belief that body dysmorphia experienced and the ill perception of oneself are not true.
2. Selective Serotonin Reuptake Inhibitors
SSRI is an antidepressant. Fluoxetine is the most commonly suggested by mental health professionals and is the most research evidence to say that it works well for body dysmorphia. It can help to control negative thoughts and repetitive behaviours.
Gender Dysphoria
Story of Brian
Brian is born male or biologically defined as a male gender which is a gender that has been assigned to them at birth. But, growing up Brian realizes that they do not feel comfortable being recognized as male in society.
Also, they do not feel comfortable with their body and the gender roles which are assigned to them and feel that they are born in the wrong body. After consulting with their psychiatrist, they recognize that they are living with a condition called gender dysphoria.4
Gender dysphoria has its chapter in the Diagnostic and statistical manual-5 of mental disorders commonly known as the DSM-5.
It involves conflict between people’s physical or assigned gender and their gender identity. Let’s understand what the terms gender, assigned gender, and gender dysphoria are.
Gender is often described as the public and usually legally recognized lived role. Biological factors combined with social and psychological factors contribute to the person’s gender development.
Assigned gender refers to a person’s initial assignment of their biological gender as male or female gender at birth. It is based on anatomy and other visible sex characteristics.
Symptoms
Gender dysphoria is a term that refers to an individual’s discontentment with the gender assigned to them. People with gender dysphoria may feel very distressing and uncomfortable feelings about one’s biological sex.
This gender internal conflict affects people in different ways. Other symptoms can be changes in the way a person wants to express their gender identity through behaviour, choice of dress, and self-image.
They may also show signs of discomfort or distress, low self-esteem, becoming withdrawn or isolated, taking unnecessary risks, and neglecting themselves. Feeling to need to hide or be rid of the physical signs of your biological sex such as breasts or facial hair and genitals of your biological sex.
Some people may cross-dress, some may want to socially transition by changing their name and pronouns to something a person feels is more expressing of their gender identity while others may want to have a medical transition with sex change surgery or hormone replacement therapy.
Diagnosis Criteria
If a psychiatrist determines that a patient has at least two of the following characteristics for at least 6 months, they can diagnose the patient with gender dysphoria.
- There must be a marked incongruence between one’s experienced or expressed gender and primary or secondary sex characteristics.
- There must be a strong desire to be rid of one’s primary and or secondary sex characteristics.
- A strong desire for a primary or secondary sex characteristic of other genders.
- Or to be of other genders.
- Or to be treated as other gender or genders.
- Or a strong conviction that one has typical feelings and reactions of another gender.
Treatment Options
Treatment options for gender dysphoria include talk therapy, hormone therapy, puberty suppression, and gender reassignment surgery with the help of medical professionals.
For many children, these feelings do not continue into adolescence and adulthood while some children express feelings and behaviour relating to gender dysphoria at the age of 4 younger. Many may not express feelings or behaviours until puberty or much later.
However, in general, a child’s treatment typically involves a multidisciplinary team of healthcare professionals 5which may include a pediatrician, psychiatrist, mental health professional, and pediatric endocrinologist who specializes in hormone conditions in children and an advocate.
Treatment may focus primarily on affirming psychological support, understanding feelings and coping with distress, and providing children with a safe space to articulate their feelings.
It is important to know that gender dysphoria is not the same as gender nonconformity. Gender nonconformity is not in itself a mental disorder.
The sexual and gender identity disorder work group was concerned that removing gender dysphoria as a psychiatric diagnosis from the DSM-5 would jeopardize access to care.
Replacing the condition’s former name with gender disorder with gender dysphoria in the diagnostic label is more appropriate with clinical sexology and it also removes the connotation that someone is disordered.
Ultimately changes regarding gender dysphoria in the DSM-5 respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviour they experience without jeopardizing access to treatment options.
Transgender Community and Non-Binary Gender Identities
Transgender people or non-binary people generally experience dysphoria. Though not all people who experience gender dysphoria are transgender and not all trans people have gender dysphoria.
But a fair share of people experiencing gender dysphoria identifies as trans person.
Transgender is often defined as somebody who identifies as a gender other than the gender they were assigned at birth. Non-binary refers to people whose own gender cannot be explained by the binary genders male and female.
Every non-binary person conceptualizes their gender slightly differently. Some understand their gender to be a mix of male and female or between male and female or as something fluid or as something totally beyond the binary altogether and some don’t experience gender at all.
Transition for transgender people generally goes two ways. A person born as a female who transitions to male is referred to as FTM (female to male) or trans man, and trans women transitioning are referred to as MTF (male to a female)
Down mentioned are some people in the trans community and non-binary community that you can follow:
- Noah Finnce @NOAHFINNCE
- Yasmin Finney @yazdemand
- Elliot Page @TheElliotPage
Bottomline
By now, the concepts of dysmorphia vs dysphoria must be clear to you. If you know anybody who might be facing the same conditions, feel free to reach out to them and help them.
- Stein, Dan J. “Obsessive-compulsive disorder.” The Lancet 360.9330 (2002): 397-405. ↩︎
- Simon, Naomi M. “Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse.” Journal of Clinical Psychiatry 70.2 (2009): 10-14. ↩︎
- Vashi, Neelam A. “Obsession with perfection: Body dysmorphia.” Clinics in dermatology 34.6 (2016): 788-791. ↩︎
- Dhejne, Cecilia, et al. “Mental health and gender dysphoria: A review of the literature.” Gender Dysphoria and Gender Incongruence (2018): 56-69. ↩︎
- Bitter, Justin, et al. “Multidisciplinary teamwork is an important issue to healthcare professionals.” Team Performance Management: An International Journal 19.5/6 (2013): 263-278. ↩︎
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This article does an excellent job of breaking down the distinctions between dysmorphia and dysphoria. I also didn’t know much about these terms. It was great to read such an article that tackles such an important and often misunderstood topic.