Body dysmorphia and gender dysphoria can lead to depression, anxiety and even suicidal thoughts. People experience severe distress and problems with their life functioning in both situations. While often confused or compared, body dysmorphia and gender dysphoria are different. Gaining a better understanding of the differences can help people seek help and learn to cope with the impacts.

What Is Body Dysmorphia?

Body dysmorphia or body dysmorphic disorder (BDD) is a mental health disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) classifies BDD as an anxiety disorder. When someone has BDD, they repeatedly think about real or perceived imperfections in their body. They may spend hours each day experiencing intrusive and uncontrollable thoughts about their body and engaging in repetitive behaviors related to these thoughts. The preoccupation and behaviors cause much distress and interfere with their daily functioning. The distress may become so overwhelming that it leads to suicidal thoughts.

Symptoms of BDD

BDD symptoms listed in the DSM include:

• Feeling preoccupied with at least one perceived body imperfection that other people do not notice
• Engaging in repetitive behaviors (ex: checking, excessive grooming) or cognitive processes (ex: comparing to others)
• Feeling distressed or impaired functioning because of this preoccupation
• Symptoms consistent with an eating disorder, such as worry about body fat or weight, do not account for the preoccupation.

People who experience BDD may experience muscle dysmorphia and worry their body is too small or not muscular enough. Along with this, they may also worry about other body parts.

A BDD diagnosis includes specifiers related to insight:

• Good or fair insight
• Poor insight
• No insight or delusional beliefs

Living With BDD

People with BDD live with much distress, discomfort and impairment. Because of their distorted beliefs about their appearance, they typically have low self-esteem, feel unworthy and unlovable and fear people rejecting them. They typically have impaired social relationships. Because of their beliefs, someone with BDD may have few friends and avoid social situations and dating. 

When someone has BDD, they may become isolative with few social interactions. They often have depression and anxiety as well as BDD. Someone with BDD may think about suicide and even attempt it.

Someone who has BDD will engage in compulsive and repetitive behaviors for many hours. The behaviors help the person feel like they are working to check, change or hide their perceived imperfection. Behaviors might include

• Frequently checking their appearance in the mirror or avoiding mirrors
• Excessively grooming (ex: make-up, hair)
• Camouflaging defects with make-up, clothes or accessories
• Changing clothes repeatedly
• Seeking reassurance from others regarding appearance
• Picking at skin

BDD’s emotional, cognitive and behavioral components can interfere with school, work, household or other functions. A person with BDD may be less productive, drop out of school, stop working or fail to live up to other responsibilities. BDD can lead to someone frequently seeing doctors seeking treatment and advice regarding their perceived imperfections. Some people may even choose to have cosmetic surgery to alter or change their bodies.

Potential Causes

The cause of BDD is unknown. Some research suggests that when someone has developed BDD, they might have problems with how their neurotransmitters send and receive messages in the brain, similar to depression. There is a high correlation between someone having BDD and another mental health disorder such as depression or anxiety. 

Other risk factors can present in people with BDD:

• History of a traumatic or upsetting event
• History of emotional conflict with another 
• Low self-esteem
• People in their lives who have been critical or judgmental about their appearance
• Pressures from peers and society regarding appearance and beauty

What Is Gender Dysphoria?

Gender dysphoria (GD) refers to the distress or internal conflict someone feels when they psychologically identify with a gender other than the gender assigned to them at birth. For example, GD can occur when someone born with external male genitalia (assigned male at birth) identifies as a female. It can also happen when someone born with external female genitalia (assigned female at birth)  identifies internally as a male. 

People with GD live under tremendous pressure and distress because they desire to live in society as a gender that differs from their physical appearance. They may often take steps to live according to the gender with which they identify. They may dress as an alternate gender, seek medical treatment to alter their sexual characteristics or have surgery to change their sexual characteristics permanently.

Symptoms of Gender Dysphoria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines specific symptoms related to gender dysphoria. Regarding adults and adolescents, someone must experience an inconsistency between the gender they express and the gender assigned to them at birth for at least six months. They must present with at least two of the following characteristics:

• Inconsistency between expressed gender and sex characteristics
• Wants to get rid of or change sex characteristics
• Wants to have sex characteristics of another gender
• Strong need to become another gender
• Wants other people to treat them like another gender
• Believes they have emotions and behaviors consistent with another gender

The person must experience significant distress or impairment in functioning. 

The criteria differ for children. The DSM-5-TR defines that for a child to have gender dysphoria, someone must experience an inconsistency between the gender they express and the gender assigned at birth for at least six months. They must present with at least six of the following characteristics (at least one must be the first one):

• Wants to be another gender or declares they are another gender
• Likes to wear clothing typical to another gender 
• A tendency towards cross-gender roles during make-believe play
• Wants to play with toys stereotypically played with by another gender
• Prefers friends of another gender
• Rejection or refusal to play with toys, games, etc. that are typical to their assigned gender
• Dislikes their sexual anatomy
• Wants to have sex characteristics consistent with their experienced gender

The child must experience significant distress or impairment in functioning.

Living With Gender Dysphoria

People with gender dysphoria typically have powerful and intense emotions. They may experience anxiety and depression because of the complicated and conflicting experience of having sexual characteristics of one particular gender but identifying with a different gender. They may isolate themselves from others because they feel misunderstood and do not fit in anywhere. 

With gender dysphoria, a person may feel like some part of themselves is missing or not complete. They may feel very uncomfortable with their appearance and ashamed of their situation. This distress can lead to increased substance abuse and the development of an eating disorder. In more severe situations, a person with gender dysphoria may engage in self-harm, have suicidal thoughts or attempt suicide.

Recap: Dysmorphia vs. Dysphoria

Body dysmorphic disorder is an anxiety disorder in which someone believes they have an imperfection with their body or physical appearance. This belief may have no basis in reality. As with anxiety disorders, a preoccupation with this belief develops, and the person has difficulty controlling or stopping the thoughts. This preoccupation leads to repetitive behaviors and much emotional distress.

Gender dysphoria differs in that it is not an anxiety disorder. The person feels like they were born in the wrong body. Their assigned gender from birth does not match how they feel, express or identify their gender. As with BDD, gender dysphoria can lead to anxiety, depression and emotional turmoil.

Some people may simultaneously experience BDD and gender dysphoria. As gender identity relates to body image and physical appearance, someone may develop distorted views of their appearance. For example, someone with gender dysphoria may be preoccupied with the appearance of their breasts, hair or muscle tone. 

Finding Help

When someone has BDD or gender dysphoria, therapy can help treat their symptoms and improve their functioning. Research has shown cognitive behavioral therapy (CBT) is the preferred treatment for BDD. With CBT, the person can learn to restructure thoughts related to their perceived imperfections and decrease their compulsive or repetitive behaviors. With gender dysphoria, a therapist can help people process their negative thoughts and emotions, learn coping skills and find more clarity of mind. Ensuring they specialize in working with these issues is essential when seeking a therapist.

If you or someone you love is experiencing BDD or gender dysphoria, the Nobu app can provide resources and help. Nobu can offer support and assistance in learning how to cope with the symptoms of these conditions. You can access free mental health support, including learning coping skills, journaling prompts and goal setting. You can also connect to a mental health professional to help you during online therapy sessions. The app is available for download on the Apple Store and the Google Play Store.