Dysphoria + Dysmorphia: The interplay between trans identity and dysmorphia

In this action-prompting article, Ella Pitt explores the relationship between trans communities and eating disorders, with a particular focus on the interplay between body dysmorphia and dysphoria. In tandem with their investigation, they also emphasise the need for better research into LGBTQ+ experiences of eating disorders.

It is not surprising to learn that LGBTQ+ people are more likely to develop eating disorders. A 2018 survey by the Trevor Project found that in America, LGBTQ+ teens were over eleven times more likely to develop an eating disorder than their non LGBTQ+ peers, and a staggering 54 percent of LGBTQ+ teens had already been diagnosed. Research by the charity Beat shows that these statistics are echoed within the United Kingdom.  According to a study of American college students, statistics for transgender people are particularly troubling. This group in particular reported much higher levels of eating disorder diagnoses and behaviours than their cisgender peers. 

It is important to consider the interplay between gender identity and mental health. Eating disorders and transgender identities regularly coexist in complex and interwoven ways, and cannot be divorced from each other.

“Transgender men, women and non-binary people are not typically afforded space within the narrow view of how an eating disorder sufferer looks.”

Despite the inflated prevalence of eating disorders among transgender people, they remain a vastly understudied group. Research is limited, and this lack of attention and awareness is in part due to outdated and inaccurate stereotypes of eating disorder sufferers. Transgender men, women and non-binary people are not typically afforded space within the narrow view of how an eating disorder sufferer looks. As a result, this in turn leaves little room to acknowledge the complex and multifaceted reasons for the prevalence of eating disorders in transgender people, or the varied nature of behaviours and symptoms that come with these illnesses.

Seeking help for an eating disorder can be complex for any sufferer. Feelings of denial, apathy and fear along with the limitations of poorly funded mental health services, mean that many people’s struggles remain undetected and untreated. A reluctance to seek out treatment options is intensified for transgender individuals that may have been traumatised by previous medical encounters and experienced transphobia in similar settings. This is a crucial limitation for transgender people for whom it may be imperative that treatment is specialised to address the risk factors associated with gender identity. 

This kind of specialised treatment is not widely available and the kind of support on offer varies enormously depending on presentation, age and postcode. Finding a professional that is understanding of what it means to be transgender and suffering with an eating disorder, that can then provide necessary care in response, is far from guaranteed. 

These limitations make it clear that the unique issues faced by transgender people must be explored fully to gain a more accurate picture of the demographics being affected by eating disorders. This involves considering societal attitudes towards transgender people and their effects. As a society we still subscribe to rigid and binary definitions of gender and these are consolidated by the systems we have in place, from education and work, to government and healthcare. These ingrained prejudices have a measurable impact on the ways that cisgender people react towards transgender bodies, creating conditions that increase the likelihood of eating disorders developing.

On an aesthetic level, typical ideas of what constitutes femininity and masculinity are still very much ingrained. Femininity is often associated with thinness and masculinity with the absence of curves and a muscular physique. For transgender people these harmful correlations can intensify negative body image. Individuals may resort to dangerous methods in order to influence their weight and shape, accelerating the development of eating disorders.

“The demand to conform to implied rules on body size and shape, imposed by a fatphobic society, is intensified for transgender people.”

The importance of appearance can be felt by all, however, our system of appearance-based judgment is escalated for the transgender community. The demand to conform to implied rules on body size and shape, imposed by a fatphobic society, is intensified for transgender people. Not only this, but perceived deviation from what is acceptable or desirable within society, can lead to more violent consequences. Whilst many eating disorder sufferers place an inflated importance on their bodily appearance, for transgender people this is reinforced by systemic and extreme examples of appearance-based intolerance. Not only does the amount of privilege awarded depend on thinness, it also frequently depends on the ability to ‘pass’ or meet a narrow description of how a certain gender should look. Transgender people are subjected to physical and emotional abuse at devastatingly high levels, ‘passing’ is not just desirous for many but is also frequently a prerequisite for staying safe. 

Inflexible attitudes towards gender and outward appearance can be felt by non-binary people in specific ways. Non-binary gender, whilst being a fluid and changeable category that resists rule and regulation, is nevertheless understood by many to be a midpoint between male and female. This kind of thinking has produced a fixed definition of androgyny and what androgyny looks like. This runs hand in hand with an expectation for non-binary individuals to present themselves a certain way. For non-binary people it can feel as though thinness increases the chances of being validated and accepted as non-binary, even acting as a physical signal of gender. This can of course have devastating effects for those that feel a need to resort to extreme measures to achieve the ‘ideal’ body type associated with being non-binary.

These intense pressures are experienced by transgender people on both an individual and internal level. Gender dysphoria is defined as experiencing distress and incongruity between gender identity and sex assigned at birth. This is commonly experienced physically and/or socially. Dysmorphia on the other hand, which is more traditionally associated with eating disorders, is defined as an exaggerated fixation on a real or perceived physical flaw. It is important to recognise the differences between the two, and also the propensity for the two to coexist in transgender people. The relationship between dysmorphia and dysphoria may be closely intertwined, with gender dysphoria escalating the intensity of body dysmorphia and visa versa.

The relationship between dysphoria and dysmorphia is one factor which highlights the importance of increasing research into how Eating Disorders effect transgender people. Conversations surrounding the development of eating disorders tend to focus heavily on a preoccupation with body image and appearance-based self-criticism. In reality, for transgender people in particular, the development of eating disorders can be triggered by issues that seemingly have little to do with food, weight, or appearance.

Eating disorders have an extensive list of potential triggers, many of which transgender people experience regularly and continually. Lack of equality and acceptance for transgender people may not be as overt as it once was, but the vast majority of transgender people will be able to recount stories of judgement, alienation and hate. This, alongside the difficulty of coming to terms with being transgender and communicating that to others, can create the alienation and low self esteem that eating disorders thrive on.

For those struggling acutely with their gender identity and the way it is received by others, an eating disorder can act as a tool for self punishment. Eating disorder sufferers often describe the obsession with food and weight as feeling more manageable than addressing the source of their emotional pain, something which transgender people often experience disproportionately.

It is well established that trauma is often a contributing factor to the development of eating disorders. Transgender people are much more likely to face traumatic events, physical and emotional abuse. Even individuals that cannot describe their trauma as one or a series of isolated events, usually still face consistent micro-aggressions and othering. The constant reinforcement of being ‘different’ can create a feeling of chronic loneliness, further emphasising the isolating effects of suffering with an eating disorder. This further consolidates the need to continue fighting for inclusion and equality for transgender people in order to foster better mental health.

“Trans voices can be uplifted by honouring the need to address the ways that gender can influence eating disorder risk factors and manifestation.”

Whilst there is still room for investigation into the relationship between gender and eating disorders, listening to the experiences of those personally affected sheds an important light on the issue. Trans voices can be uplifted by honouring the need to address the ways that gender can influence eating disorder risk factors and manifestation. By using inclusive language that respects diversity in conversations about eating disorders and recognising the collective responsibility we have to educate ourselves and those within our social circles, we can change the way that current narratives disregard transgender people. The greater understanding there is of the contributing factors in the development and reinforcement of disordered eating in transgender people, the better the chances become for treatment options to address this link. 

Exploring the correlation between eating disorders and being transgender highlights how the interplay between gender dysphoria and body dysmorphia often creates pathways for self destruction to reign. On the other hand it also highlights how little established research exists on this phenomenon. For attempts to raise awareness about eating disorders to be truly successful, it is vital that we begin to prioritise inclusivity in education, in research and in treatment.

We must create accessible platforms for transgender people to speak about their experiences and include this group within eating disorder awareness campaigning. We must also advocate for medical students to receive a deeper level of education on transgender specific issues and demand funding for further investigation on this topic. Perhaps most importantly, it is time for society to listen actively to transgender eating disorder sufferers. Understanding and approach should be shaped by these voices as we strive to dismantle the prejudices, biases and incomprehension that currently pose such harmful limits.

Ella Pitt

edited by Serena Jones

For more from Ella, you can find their Instagram account here: @e_pitt_

Ella’s poetry instagram account is over at @whatsthetimepoetry

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