Overview

Hating parts of your own body is one of the most common experiences of adolescence, and it shows up in several clinical forms. Body dysmorphic disorder (BDD), eating disorders such as anorexia, and gender dysphoria all involve intense distress about the body, a drive to change it, and a belief that life will become bearable once the body is different. They can look very similar from the inside, especially to a teenager.

Many detransitioners describe realising, often years later, that what they had understood as gender dysphoria was tangled up with body dysmorphia, an eating disorder, or a more general hatred of a developing body. This page looks at how these conditions overlap, how they are told apart (and where that distinction breaks down), what the evidence on co-occurrence shows, and the uncomfortable conceptual question at the centre of it: why distress about sex characteristics is treated by changing the body, when distress in BDD and anorexia is not.

It sits alongside the pages on mental health, trauma, internalised misogyny and autism, which are often part of the same story.

Three conditions, one shared feeling

The textbook definitions are distinct, and it helps to set them side by side:

• Body dysmorphic disorder: a preoccupation with perceived defects in appearance that others see as minor or invisible, with repetitive behaviours such as mirror checking, comparing or camouflaging. It is classed with obsessive-compulsive and related disorders. A male-predominant form, muscle dysmorphia, centres on not being lean or muscular enough (MSD Manual).
• Anorexia nervosa: restriction of food to maintain a low body weight, driven by fear of weight gain and overvaluation of weight and shape.
• Gender dysphoria: distress about the mismatch between a person's sex and their felt or desired gender, typically including a strong wish to be rid of one's sex characteristics.
• Body integrity dysphoria (BID): an intense, persistent desire to become significantly physically disabled (for example, through amputation), with onset by early adolescence (ICD-11 6C21).

The diagnostic manuals try to keep these apart with exclusion rules. According to the DSM-5-TR criteria for BDD, if the only concern is body fat with abnormal eating, an eating disorder may be the better diagnosis; and if the only concern is the appearance of sex characteristics alongside a marked incongruence between experienced gender and sex, gender dysphoria "should be considered" (MSD Manual). In other words, the same feeling (hatred of a body part) gets a different label depending on which body part it is and what story the person tells about it.

Where the line blurs

The usual way of distinguishing gender dysphoria from BDD is perception. In BDD the person sees a defect that is not really there or is exaggerated; in gender dysphoria, it is argued, the person sees their body accurately but is distressed by what is there. One commenter on /r/detrans put the standard view clearly:

In BDD people will focus on a perceived flaw, and often have an extremely distorted perception of their body. People with gender dysphoria may perceive their body accurately, but feel distress at the sexual characteristics. —CarsonContinues

Others push back. A detransitioned woman pointed out that the "accurate perception" line does not hold up well under scrutiny, because gender dysphoria also involves a distorted meaning attached to normal features:

dysmorphia is actually defined in multiple sources as being overly concerned with perceived flaws that may or may not exist, and experiencing severe displeasure. gender dysphoria also presents a distorted self image around features that happen to be sex based. —rabbitrune, detrans female

This is the heart of the matter. A girl who sees her breasts accurately but experiences them as wrong, disgusting or "not mine" is not misperceiving their size, but she is assigning them a meaning (that they prove she is in the wrong body) that is itself a belief, not an observation. The same is true of an anorexic girl who correctly sees that her hips have widened but experiences that as a moral failure. The perception is accurate; the interpretation is not. That makes the dividing line between "dysmorphia" and "dysphoria" much thinner than the textbook tables suggest. The page on born in the wrong body looks at how that interpretation is supplied by culture rather than discovered.

Some detransitioners also point to variability as a clue. One male detransitioner, replying to someone whose chest distress had suddenly flared up, wrote:

Just hating something about your body is not dysphoria, it's not even rare at your age, it's a pretty common body dysmorphia. This also explains why the severity of your feelings changed. —Your_socks, detrans male

Anorexia as an escape from the sexed body

Long before gender identity was a widely available explanation, clinicians described anorexia in adolescent girls as, in part, a flight from puberty. The models of Hilde Bruch and Arthur Crisp linked anorexia to maturity fears: a regression to a prepubescent body as a way of avoiding the physical, sexual and social changes of becoming an adult. Maturity fears are associated with early onset, restrictive anorexia and poorer outcomes (Maturity fears in anorexia nervosa).

Starvation does, crudely, what puberty blockers do pharmacologically. Very low body fat shuts down oestrogen production, stops periods, flattens the chest and hips and keeps the body looking childlike and androgynous. Several detransitioned and desisted women (those who stopped identifying as trans without medically transitioning) describe using anorexia deliberately for exactly this purpose. One wrote that her goal was not thinness at all:

I was diagnosed with anorexia rather than gender dysphoria, based on how I looked (=skeletal), even though the reason why I was doing it was that I felt I needed to shut off my oestrogen production. I considered oestrogen something that shouldn't be in my body, and hated everything female about my body, and of course anorexia is a great way to deal with that—you end up looking like an androgynous 12-year-old, with barely any breasts or hips, no periods etc. —Ok_Bullfrog_8491, desisted female

The same commenter describes how the diagnosis she happened to receive changed everything. Because she was labelled anorexic, her doctors treated her distress as a danger to her life. Later, a gynaecologist who knew her history refused her testosterone. Her reflection was that "if the diagnosis had been gender dysphoria at the time, I'd have been affirmed" (Ok_Bullfrog_8491, desisted female). The underlying wish, to eradicate a female body, was the same either way; only the response differed.

For some, the order of events made it hard to tell which came first:

I didn't want an adult female body and all the adult female stuff that came with it (biological functions as well as female typed sexuality), so being anorexic via eating disorders and exercise addressed some of that. Viewing the androgynous body I developed as 'mine' was the next natural step… In many ways, my dream of going on HRT was so that I didn't have to expend energy trying to maintain a 'female anorexic body' I could just be a thin man via surgery —Luck_Unlucky, desisted

Fear of curves and female fat distribution

A recurring theme is horror at the specific way female bodies store fat. Breasts, hips and thighs are experienced not as sex characteristics but as evidence of being "fat" or lacking discipline. One desisted woman described the logic:

You might convince yourself that you're supposed to be a boy because you can't cope with your body not having zero fat (that is, you can't cope with a female fat distribution and hate that your hips and breasts show that you lack discipline and are still "fat"). —Ok_Bullfrog_8491, desisted female

Testosterone appears to offer what dieting cannot: a body that stays lean and flat without the constant effort of starvation. Some women describe recognising this only after desisting, noting that they had subconsciously connected maleness with being able to eat normally and stay thin. After stopping testosterone, the return of fat to the hips and thighs can itself become a source of anxiety, which is covered on the testosterone cessation page.

Control, regression and the wish to be protected

Underneath the eating disorder, many accounts describe something more basic than body shape: a need for control at a time when life felt out of control, and a wish to stay a child. One detransitioned woman, who grew up in poverty and abuse, wrote:

At some point I realized being small and skinny and youthful wasn't even about weight. Deep down I was wanting to regress because I felt like the more small and fragile I became, the more worthy I was of love and protection. —WisteriUHHH, detrans female

This connects body hatred to trauma and to sexualisation. Several women say that what they hated about their developing bodies was the attention it brought. A desisted woman explained that her chest felt "like having a target on my back regarding sexualisation" (cheerlessThinker1122, desisted female). Another said that her chest distress disappeared after trauma therapy, because it was the result of being groped, not of her breasts themselves (toobertpoondert, desisted female). See also internalised misogyny, which covers how a sexist culture can make the female body feel like a liability.

From pro-ana to "transition goals"

Several women who were online in the 2010s draw a direct line between pro-anorexia ("pro-ana") communities and the idealised androgynous, flat-chested bodies celebrated in some trans online spaces:

a lot of these girls obsess over having no curves and being lanky and flat chested. It's Tumblr pro-ana culture all over again but with a twist. —Outrageous_Proof_812, detrans female

One woman who had long been part of eating disorder communities online noticed "an influx of trans men or nonbinary people in those spaces" (ikyaaaa). Another suggested that the same distress simply finds a different outlet depending on what the culture offers: "Half of these people would be anorexic in 2005" (jackietea123, desisted female). This is a hypothesis, not a measured finding, but it parallels the concerns about social contagion and platform influence, and the historical observation that eating disorders themselves spread through peer groups and media.

Male experiences

Eating disorders and body dysmorphia are less often discussed among males, but they appear in male detransition accounts too, usually in the form of trying to stop or soften male puberty. A desisted man wrote that he "genuinely starved myself in order to try to get my body to be more feminine" (Aripotheosis, desisted male). Another, who identified as a woman for a time, described an ideal of being "small and skinny and smooth" that he now connects to never making peace with an adult body and to what happened at home while he was "becoming a man" (Irinescence, detrans male).

For some males the dysmorphia was aimed directly at male features, and transition looked like the only escape:

Body dysmorphia. I hated all my obvious male features so much, and it didn't make sense to me why I hated them. In my mind, the only possible escape from these feelings was to become female… I liked all the physical changes from hrt, but I hated pretending to be a woman. —Your_socks, detrans male

That last point is important. He liked what the hormones did to his body but found that the gender part of the transition, actually living as a woman, never felt real. The problem was with the body, not with being a man. A desisted man who never transitioned described a similar pattern, which he called "gender dysmorphia": hating body hair, muscle and short haircuts, feeling disgust if anyone touched his facial hair. He came to understand it as rooted in trauma, and it eased only slowly over many years (Barzona, desisted male). The page on internalised misandry explores how shame about maleness can drive this kind of body hatred.

Chest distress: dysphoria, dysmorphia or something else?

Chest distress is the most common reason females seek mastectomy, and it is also where the overlap with general body image problems is most visible. Detransitioned and desisted women describe several different roots for what they once called "chest dysphoria":

• Sexual attention and assault. As above, some found that their distress was about being sexualised, and it faded with trauma work.
• Weight and breast size. Some say that weight loss or simply recognising that they disliked having large breasts changed everything. One wrote: "I lost a significant amount of weight and my chest dysphoria went away almost entirely" (g0ffie, desisted female). Another: "I wish I had just gotten a reduction cause I had big tits and I was just really uncomfortable with them to the point that I thought it was gender dysphoria" (dankepurple23, detrans female).
• Comparison and beauty standards. Some describe feeling that their bodies did not "qualify" as properly female because they did not match an ideal. One woman with BDD hated "all of the things that made me obviously female because they weren't enough to 'qualify'" (FoolOfASoup, detrans female).
• Context. One detransitioned woman noticed that "it wasn't until I was in public did I have dysphoria, but only for my chest" (simply-sage, detrans female), a sign that the distress may have been about other people's gaze rather than the body itself.

Each of these is a different problem with a different possible response, and none of them is resolved by declaring the person to be male. Several women who had mastectomies describe how the distress moved rather than disappeared. One said that after surgery, her "chest dysphoria currently makes me a suicidal hermit" and that it "complicated my relationship with my entire body worse than it was before" (bearspiracy, detrans female). The page on top surgery regret covers these experiences in more depth.

The "never enough" pattern

A defining feature of BDD is that fixing one "flaw" rarely brings peace: attention moves to the next one. Research on BDD patients who sought cosmetic procedures found that only around 2% of procedures reduced the severity of BDD over the long term, even though about 31% of people with BDD had sought them (Phillips & Crerand, Annals of Plastic Surgery). For this reason BDD is treated as a contraindication to some cosmetic surgery, such as rhinoplasty under American otolaryngology guidelines (Psychiatry Advisor).

Many detransitioners recognise this same pattern in their own transitions. One woman decided to detransition partly because she noticed it:

I was so sure that if only my voice was deeper, if only my hips were narrower, if only my legs were hairier, then it would be enough… Believing that I'll be happy if I cut my tits off is just as stupid as believing I'll be happy when I just lose another 10 pounds. It will never be enough. —imbibitionn, detrans female

Transition can also create body preoccupation where little existed before. One person who started testosterone at 15 described developing "severe, obsessive fixation on my face, body, tiny things like how 'masculine' my hands were", and said that when they raised this with their gender clinicians, it was brushed off as normal dysphoria and became evidence that transition was right. It later turned into an eating disorder, which improved only with therapy aimed specifically at eating and body image (deleted user). Another woman's eating disorder had been in remission for years and returned when she transitioned (FTMTXTtired, detrans female).

This raises a hard clinical problem: if the body-checking, comparison and constant moving of goalposts that characterise BDD are reinterpreted as gender dysphoria, the treatment offered (more body change) may feed the very cycle that keeps the person unwell.

Why change the body for one and not the others?

The most frequently raised question in these discussions is a philosophical one. Medicine generally does not resolve body-image distress by giving the person the body they want:

• People with anorexia who want to be thinner are not offered liposuction.
• People with BDD are generally steered away from cosmetic surgery and towards psychotherapy and medication.
• People with body integrity dysphoria who want a healthy limb amputated are, almost everywhere, refused.

Yet with gender dysphoria, the standard of care in many countries has been to change the body through hormones and surgery. A detransitioned woman put the comparison bluntly:

Body altering is not the solution for body dysmorphia. Therapy is. We don't give anorexics lipo to make them more comfortable in their bodies because they want to be skinny, so why should we give women double mastectomies because they want to be men? —kaleice, detrans female

The usual answer from supporters of transition is that gender dysphoria is different in kind: that it is rooted in a stable gender identity, that it does not respond to psychotherapy, and that bodily change brings lasting relief where cosmetic surgery for BDD does not. Each of these claims is contestable. Gender identity has no objective marker; the evidence that psychotherapy does not help comes from a period when exploratory therapy was rarely offered (see gender exploratory therapy); and systematic reviews have found the evidence for lasting benefit from medical transition in young people to be weak (Cass 2024). Detransitioners are, by definition, people for whom the body-changing route did not bring lasting relief.

The comparison with body integrity dysphoria needs care. BID involves wanting to become disabled, which most people find far more alarming than wanting to look like the other sex, and comparing the two can feel insulting to trans-identified people. The point of the comparison is not that the conditions are the same, but that they share a structure: a persistent, early-onset sense that one's healthy body is wrong, and a belief that only surgery will fix it. Some people have both; one published case report describes a trans-identified male who also had BID and obtained amputation of both feet (case study, Academia Mental Health and Well-being). Medicine's general refusal to amputate healthy limbs on request rests on a principle (do not remove healthy, functioning tissue to treat a mental state) that gender medicine has set aside. Whether it was right to do so is exactly what is at stake. The pages on iatrogenic harm and informed consent discuss the ethics further.

A desisted woman who had once been in body-image communities summed up the shift she sees:

There is this drive to change something... and with the rise of gender ideology young peoples minds go there.... instead of just taking care of your body differently. —jackietea123, desisted female

Trans perspectives

Many trans-identified people strongly reject the idea that gender dysphoria is a form of body dysmorphia, and see the comparison as an attempt to delegitimise them. A trans-identified male on r/MtF wrote:

dysmorphia is experiencing your body as something it isn't. ie. seeing yourself as fat, when you're a healthy weight or under weight. dysphoria is the discomfort that comes from how your body actually is. both cause suffering. but being trans isnt a misperception of self. —Kind_Brief1012, trans woman (MTF)

At the same time, trans commenters often acknowledge that the two can coexist. One trans-identified female said dysphoria "isn't grounded in delusion" but that "a lot of trans people also struggle with body dysmorphia" (armadillotangerine, trans man (FTM)). Another noted that after top surgery, "some other dysphorias I had started getting stronger" (Aware-Rain9401, trans man (FTM)), which is close to the shifting-goalposts pattern detransitioners describe.

Some trans-identified people report that transitioning helped their eating disorder. One said that starting social transition "almost immediately relieved most of my body dysmorphia, and made it much easier to start ana recovery", because they realised they hated their body "not because i was fat, but because i wanted it to be male" (boobconsumer, trans man (FTM)). Research from Jon Arcelus's group, with more than 560 patients aged over 17 at a UK national gender service, found lower eating-disorder symptoms and body dissatisfaction among patients already taking cross-sex hormones than among those not yet on them (Medical Xpress 2018).

These accounts deserve to be taken seriously. They also show why careful assessment matters. The same reinterpretation ("I don't hate my body because it's fat, I hate it because it's female") is described by trans-identified people as a liberating discovery and by many detransitioners as the moment an eating disorder found a new disguise. The relief may be real in both cases; what differs is how long it lasts and what it costs. The cross-sectional design of the Arcelus study (comparing different people at one point in time, rather than following the same people) means it cannot show whether improvements persist, and it does not track people who later detransitioned.

What the evidence shows

Research consistently finds that eating disorders and body-image problems are more common among young people who identify as trans or non-binary, and among detransitioners, than in the general population. The figures vary widely depending on how symptoms are measured.

Some broader findings provide context. The Finnish adolescent gender service's early report found that "severe psychopathology preceding onset of gender dysphoria was common", with females markedly overrepresented (Kaltiala-Heino et al. 2015). A later Finnish register study found that psychiatric needs among gender-referred young people did not subside after medical transition (Ruuska et al. 2026). The Cass Review similarly highlighted the high rates of co-occurring mental health difficulties among referred young people (Cass 2024).

The evidence has clear limits:

• Direction of cause is unclear. Elevated eating-disorder rates are consistent with several explanations: gender distress causing disordered eating, eating disorders being misread as gender distress, or a shared underlying cause such as trauma, autism or a general vulnerability to body-focused distress. Cross-sectional studies cannot tell these apart.
• Screening tools are not diagnoses. High symptom rates on questionnaires overstate the number of people who would meet full diagnostic criteria.
• Detransitioners are hard to study. Clinic-based studies capture only those who return; Littman found that only 24% of respondents had told their clinicians they had detransitioned (Littman 2021). Studies of hormone users are rarely long enough to show who later stops.
• Online accounts are self-selected. The quotes on this page come from people who chose to discuss these experiences. They show what can happen and how people make sense of it, not how common it is.

Healing and recovery

What helped people who came to see their distress as body dysmorphia or an eating disorder? The accounts below describe personal experiences, not treatment recommendations. Anyone struggling with eating or body image should seek qualified help; the support directory lists gender-exploratory therapists and detransition support groups.

Treating the eating disorder or dysmorphia directly. Several people describe recovery coming from therapy aimed at body image and eating, rather than at gender. Detrans commenters recommend CBT for challenging distorted thoughts and dialectical behaviour therapy (DBT)-style distress tolerance for learning to sit with discomfort rather than acting on it immediately.

Body neutrality instead of body love. Many found that trying to love their bodies was too big a leap, and that simply accepting the body as a fact was more achievable:

If anything, it helped the most to realize that I didn't have to like my sex. My body just is what it is, and it doesn't matter if it isn't ideal or perfect. It's all I get. —autochoris, detrans

Another detransitioner described rejecting the idea that the body is "a project where I can change every part into a most optimal one" (anonymous1111199992, detrans). A detransitioned woman warned against swapping one fixation for another: "you do not want to substitute gender transition with a new plastic surgery fixation", and described starting with neutral self-talk and paying attention to how her body felt rather than how it looked (nolandnosea, detrans female).

Turning attention outward. Several people describe improvement coming not from working on the body but from looking at it less: getting a job, spending time outdoors, doing physical work or sport. One detransitioned woman said her distress faded when she stopped "staring at myself" and stopped obsessing over who she was (Pinkafoo, detrans female). Another grew out of her body dysmorphia and wish to be a man by 21, through camping and physical labour that "made me appreciate my body and feel connected to it", and through realising that "women are allowed to look and act however they want" (fridakahlosmonkey).

Focusing on health and function. For those recovering from anorexia, the motivation was often simply to be well enough to live. One woman who had restricted to a dangerously low weight wrote that recovery opened up a life of mountaineering, gymnastics and work: "There is SO much you can do when you are not obsessing over your body and food" (Cool_Incident_7272, detrans female).

Redefining what it means to be a woman or a man. Recovery for many involved letting go of narrow ideals of what a female or male body should look like, and accepting that a masculine woman or a slight, gentle man is still a woman or a man. See gender non-conformity without labels and healing and recovery.

Recovery is rarely linear. Several people describe body-image struggles that persist at a lower level for years, and detransition itself, with a body changed by hormones or surgery, can bring a new round of distress. Many find it easier to bear once it is understood as ordinary insecurity rather than proof of a hidden identity.

Related pages

• Mental health and gender identity
• Gender dysphoria
• Internalised misogyny
• Trauma
• Puberty blockers
• Mastectomy
• Healing and recovery
• Study archive and detransition videos

References

• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page.
• Jarvis, S. W. et al. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: retrospective cohort study. Archives of Disease in Childhood. study page, source.
• Kettula, K., Puustinen, N., Tynkkynen, L., Lempinen, L. & Tuisku, K. (2025). Gender Dysphoria and Detransitioning in Adults: An Analysis of Nine Patients from a Gender Identity Clinic from Finland. Archives of Sexual Behavior. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page, source.
• Ruuska, S.-M. et al. (2026). Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study. Acta Paediatrica. study page, source.
• Kerr, J. A., Paine, J., Thrower, E., Hoq, M., Mollica, C., Sawyer, S. M., Azzopardi, P. S. & Pang, K. C. (2024). Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care. Journal of Adolescent Health, 74(4), 850–853. source.
• A scoping review of research literature on eating and body image for transgender and nonbinary youth. source.
• Kaltiala-Heino, R., Sumia, M., Työläjärvi, M. & Lindberg, N. (2015). Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9:9. source.
• Arcelus, J. and colleagues (2018). Study of cross-sex hormone treatment and eating-disorder symptoms, European Eating Disorders Review, as reported in Hormone therapy may reduce eating disorder symptoms in transgender people. Medical Xpress.
• Crerand, C., Menard, W. & Phillips, K. Study of cosmetic procedures in body dysmorphic disorder, Annals of Plastic Surgery, as reported in Does cosmetic surgery help body dysmorphic disorder? EurekAlert.
• Body Dysmorphic Disorder: Ethical Questions and Surgical Contraindications. Psychiatry Advisor. source.
• Body Dysmorphic Disorder (BDD). MSD Manual Professional Edition (summarising DSM-5-TR criteria). source.
• World Health Organization. ICD-11 6C21 Body integrity dysphoria. source.
• Maturity fears in anorexia nervosa (review of the Bruch and Crisp models). Revista Mexicana de Trastornos Alimentarios. source.
• Case study about a patient suffering from body integrity dysphoria and gender dysphoria. Academia Mental Health and Well-being. source.