Gender Identity Disorder Information

A Comparison of Gender Identity Disorder and Body Dysmorphic Disorder

Another psychological disorder that may be confused with Gender Identity Disorder, especially by a mental health caregiver not well-versed in gender problems, is Body Dysmorphic Disorder (BDD).

BDD occurs when a person become preoccupied with an imagined physical defect in their appearance, or a greatly exaggerated concern about a minor defect. This preoccupation must cause significant impairment in the individuals life, and they have to fret over it for at least an hour a day (under the clinical definition in the DSM-IV). Some other behaviors associated with BDD include:

  • Checking appearance in reflective surfaces frequently
  • Picking at their skin
  • Avoiding mirrors or reflective surfaces altogether
  • Repeated requests for reassurance that the defect is either REAL or is NOT real
  • Elaborate grooming "rituals."
  • Camoflauging some aspects of one's appearance with hats, one's hand, or makeup
  • Repeated touching of the perceived defect
  • Avoiding social situations where the "defect" may be seen by others
  • Anxiety and paranoia around other people

Most often BDD is an obsessive concern about one's face, hair, or smell. It usually begins to manifest during adolescence, becomes a chronic obsession, and leads to a great deal of internal unhappiness with one's self.

People with BDD fear ridicule in social situations, and may consult many different doctors - especially specialists like dermatologists and plastic surgeons. Many BDD sufferers will undergo risky and painful medical procedures in an attempt to irradicated the "defect" they believe exists. However, this often only makes the problem worse, or they start obsessing about some OTHER perceived defect they believe is in need of correction. BDD can often lead to social isoloation, uneccessary surgerical procedures, depression, and suicide.

BDD is often associated with other disorders like social phobias, Obsessive Compulsive Disorders (OCD), and delusions - in which case it is reclassified as a "Delusional Disorder." Delusions often take the form of Bromosis, which is an obsessive concern about body odor, or Parasitosis - a belief of fear that one is "infested" with parasites.

Mild dissatisfaction with one's appearance is NOT classified as BDD. 30-40% of Americans feel dissatisfied with their appearance, and intermittently have anxiety or depression over the dissatisfaction. BDD is chronic and much more intense.

BDD sufferers often don't want to undergo psychiatric treatment, because they firmly believe their "defect" has a physiological origin.

So far, you may be thinking that Gender Identity Disorder sounds pretty much like the same thing. But, again, one of the key differences is the fact that BDD responds to psychopharmacology, whereas GID does not. Treatment for BDD often involves the use of SSRI medications like Sertaline or Fluoxetine. Furthermore, psychotherpy is often successful in convincing the BDD sufferer that their perceptions are distorted. Those with GID are rarely convinced they are mistaken. GID (especially "transsexualism") also often manifests during early childhood, rather than during adolescence.

This comparison demonstrates why it is so VITAL that a person seek psychiatric care from a therapist well-versed in treating gender problems. A non-specialist may erroneously believe someone with GID is suffering from BDD. This could lead to the administration of drug therapies that are unnecessary and will be ineffective, and attempts to dissuade the person from seeking "surgical correction" for their problem. It is standard practice in treating BDD to convince sufferers that surgical procedures are not necessary, whereas those people properly diagnosed as "transsexual" under GID benefit greatly from surgical procedures.

Further confusing things is the possibility that a person with GID may also develop BDD as they obsess over those perceived "defects" on their body that contradict their gender identity. Again, this is why a trained gender specialist should treat a person suffering from Gender Identity Disorder - to avoid confusing the underlying problem with other or related psychological problems. Unless the underlying GID is addressed, the person will not "get better."

This is, incidently, why many psychotherapists specializing in gender problems insist on addressing the peripheral problems first. If the gender dysphoria wasn't actually present, but was a delusion caused by one or more of the other problems, correcting the peripheral problems FIRST would make the "delusional GID" dissipate as well. If the peripheral problems are conventionally treated, and the gender dysphoria persists, then a diagnosis of Gender Identity Disorder may be rendered. This can often feel frustrating to a GID patient who begins to feel his or her therapist is "gatekeeping" them from gender transition while treating peripheral problems and waiting to see if the GID subsides as well. Unfortuneately, some doctors WILL use treating peripheral problems as an excuse to keep the patient from beginning transition, sometimes because of a personal agenda or a misplaced "sense of morality." It is up to the patient, as a health care consumer, to decide whether or not to "fire" a therapist and seek help elsewhere.