Every day of my life since puberty I hated my body.
Gender Dysphoria Versus Body Dysmorphic Disorder (BDD)
I might not have thought much about Gender Dysphoria had I not come across a young woman in her twenties on a site called PsychForums. The title of her post was “Some days I feel insane.” She starts off by saying that her Body Dysmorphic Disorder became apparent from puberty, but her Gender Identity since birth. Body Dysmorphic Dysorder is an anxiety disorder about physical appearance and a distorted view of one’s body. Gender Dysphoria is an anxiety disorder about the mismatch between biological sex and gender identity. She swaps back and forth between genders, injecting herself with testosterone to become more masculine, since her body is normally thin. As a guy, her BDD centers around her small overall size and her face, neck, eyes, and midsection, which she perceives to be feminine.
When she takes estrogen to become more feminine, her Body Dysmorphic Disorder centers around her lean muscular shoulders, toned back, arms, and legs, and what she calls pectus excavatum, a slight dip in the chest causing her rib cage to flare out. She admits her pectus excavatum is very mild, but it is there and that is enough to upset her. At times she contemplates surgery to make her body more feminine, and surgery to make her body more masculine at other times. Her condition seems to be stable 60-70% of the time and then again she is anxious, stressed, depressed in regards to her appearance and gender. At these times she focuses on her perceived flaws, obsessing, searching the internet to see others with the same problem to try to make herself feel better.
Body Image, Not Just Women
I wanted to reach out to her, but she was no longer posting on the site. Perhaps I would tell her that though I am 80 and she is 26 and we are different genders, I understand what she is experiencing. Every day of my life since puberty I hated my body. I compensated by body building obsessively. Early on, I lost the chance at becoming an executive of a large company because I had to leave work at 5 p.m. each day to go to the YMCA and lift weights for three hours,. Including the commute and showering after workouts, that left little time other than preparing for and eating supper, then sleeping. Ironically, I would go out on a date and resent a girl for feeling my muscles. If I got into a relationship I felt a weird jealousy. It was as if she were being unfaithful to me. I was not the muscular man she was attracted to. I was slender and had less muscle than many girls . I longed to find a girl who would love me for who I was. But if I continued to body build, I would never be able to know. And if I stopped body building, I could not walk into a bar or dance and pick up a girl. The answer was a never-ending series of extremely short-time affairs. Too fat, too thin, too muscular, not enough muscle, too much hair, too little hair, too ugly, too masculine, too feminine. Thoughts pop into you mind like garish, uninvited guests. You mostly hear about body image problems with girls and women. But it can start with men early on.
Safety Seeking Behaviors
Body Dysmorphic Disorder and Gender Dysphoria are a life centered on safety-seeking behaviors of weight-loss and weight-gain diets, workouts, mirror viewing, and constantly comparing bodies. Weight lifting creates a shield my first psychoanalyst said. But not only is body building a safety-seeking behavior, it sets up a condition for conditional self-acceptance. You accept yourself when you look in the mirror and appear buff, but when the body building comes to an end, so does conditional self-acceptance.
Cognitive Therapy
Therapy for BDD and Gender Dysphoria had best include working on Unconditional Self- Acceptance. This means accepting yourself fat, skinny, ugly, old, masculine, feminine, as you are. Precondition sets you up for trouble. It is irrational not to accept yourself unconditionally. Why would you do otherwise? You are the decider. But we are not rational and it is not easy to accept ourselves unconditionally.
Metacognitive Therapy (MCT)
On its own, Cognitive Therapy (CT) is not sufficient. CT deals with problems. Metacognitive Therapy deals with process and patterns of thinking. MCT asserts that it isn’t what people think, but how. The MCT approach proposes that psychological disorder is linked to a specific style of thinking, involving recurrent, recyclic ideation in the form of worry and rumination and fixating attention on threat.
Moving Forward
In the Fall 2015 “Senior Advisor” Blue Cross Blue Shield Federal Employee Program newsletter tucked away quietly under “Pharmacy benefits”: “We provide prescription drug benefits for drugs used in the treatment of Gender Identity/Gender Dysphoria.”
Self-help books that help:
Total Self-Renewal through Attention Therapies and Open Focus (Sample Chapters) The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body
