If someone identifies as an amputee they are given psychological help

[gardenbird48]

and steered away from modifying their body. They are not immediately affirmed, applauded by their friends and sent for surgery. BDD is the same.
I am really struggling with the difference between this and gender dysphoria, can anyone, esp with a psychiatry background explain please?

Do you think trans people are making it all up?

Some of them. The vast majority of male transitioners appear to be AGP males or opportunistic MRAs. Interestingly, they are also often the loudest and most demanding trans people.

I have no doubt that there are some people who genuinely believe that they are not or should not be the sex of their body, people who have gender dysmorphia/dysphoria. I would consider most ROGD teens as temporary members of this group.

@Broomfondle great post definitely food for thought.

@BaronessBrighterThanYou

I must admit that I'm going to have trouble remembering which is a mental illness and which is not; the words are annoyingly similar!

Milotic's explanation suddenly made this make sense to me.

Dysmorphia is a mental illness - the feeling that there is something wrong with a healthy body (the 'morph' bit is to do with the shape of the body).

If someone thinks that there is something very wrong with their body, it is a normal reaction to feel distress, or dysphoria. So it would be wrong to classify this distress or dysphoria as a mental illness, since someone who genuinely has something wrong with their body would suffer similar distress. But presumably if someone became severely depressed, then it would be classified as an illness.

But I still don't understand this, because now I don't know what the difference is between dysphoria and depression.

@oldcrone depression is a similar set of chemicals in your brain. The difference to me seems to be in the trigger for it and the intensity of it.

Sort of like depression being a slow burner. Dysphoria being a quicker more intense rush.

I also have BDD. For me the key difference seems to be that people with gender dysphoria feel better after transitioning and surgery. However with BDD, surgery or other treatments or anything that increases the focus at all on the appearance makes it worse.

Interestingly one if the symptoms of BDD is researching obsessively "treatments" for perceived flaws. Again something that feeds the condition and increases anxiety.

Most anxiety disorders work like this. Increasing the focus on the anxiety or responding to obsessions related to the anxiety makes the anxiety worse and feeds the disorder.

I dint understand why gender dysphoria doesn't work in the same way. It perhaps it is less like other anxiety disorders including BDD than the name suggests.

Also with depression theres not necessarily a trigger. More a build up. Dysphoria and euphoria can be triggered out of no where.

Depression does not need an opposite. You have depression.

If you suffer with dysphoria you will also have euphoria. Both require balancing because both are equally as destructive and damaging in the long run.

You're better comparing depression to the body dysmorphia btw rather than the dysphoria.

Having suffered both dysphoria and depression I can only say that they are different and separate. One may influence the other, but they are independent of each other. At least they were in my case. I think the dysphoria did not make the depression worse (the depression predated the dysphoria), but recovery from depression helped me accept the cause of the dysphoria and helped me change the way I dealt with it, thus easing the dysphoria.

Agree with Jellyslice that its separate. I've never been clinically depressed or even experienced prolonged depression. Dysmorphia and identity issues are rife though.

@TheId

SonEtLumiere

Very easy. I do it all the time.

I do not tell my psychotic patients that yes I too can see the little green men or hear the voices they can but I do not deny that they can hear them and that it distresses them and they deserve kindness and care for that experience. I do not encourage them to call the police about hallucinations and the police do not attend if they do (ie they do not collude)

I do not tell my anorexic patients that yes they are fat and their dieting is justified but I acknowledge that they really feel they are fat and their fear of eating is real. They get therapy to help them identify why they have these beliefs. Weight watchers would not let them self identify as fat and join up.

I can't see the difference if I said to a gender dysphoric person that I accept they feel they are a woman and that this causes distress to them and that distress is real but I cannot agree that it is true or encourage them to campaign for access to women's spaces on that basis. I would instead encourage them to access therapy and talk about why they have those feelings and how to cope with them.

In general with delusional and overvalued ideas it is recognised that colluding with these is a very bad idea and prevents the person from recovering. Recovery is taken to be accepting that these thoughts are not based in reality and understanding the reason why they developed and addressing that instead.

I do fail to see why being transgender is different but as I have said a lot upthread I accept that illness in general is a social construct and what we regard as illness that should be treated at any point is socially determined. If someone is happy being trans then they can carry on as far as I am concerned and don't need any treatment but that does not mean everyone has to agree with them about it.

This thread is interesting because people are trying to make parallels with other conditions, and I actually feel that is a valuable way of trying to work out what might really be happening with gender dysphoria.

So it seems in this post you're examining whether there are similarities to people who experience delusions and over-valued ideas, and you tend to feel that there are.

But there is a difference between the process of thinking, which might, in disordered patients, become delusional, and sense of identity isn't there? I think most people who state that they are trans are expressing at heart a gut feeling about who they are as a person, and that's different from a series of disordered thoughts isn't it?

And when you look at the studies on brain structure and function which show that trans peoples' brains tend to be more similar to brains of the sex they identify with rather than the sex that their body parts would say they have, that is meaningful isn't it? (And I am in no way being absolutist about this, there is no such binary as a 'male' brain and a 'female' brain, these are not separate circles on a Venn diagram to my mind, and any individual identifying in any particular way might have any variant on brain structure and function.....but yet there are trends in structure and functioning at a male/female population level)

health.clevelandclinic.org/research-on-the-transgender-brain-what-you-should-know/

www.sciencedaily.com/releases/2018/05/180524112351.htm

Given that it appears that there may be this biological underpinning to an individual's sense of gender, can they really be considered 'delusional' in the same way that that the patient who insists they see little green men sitting on the sofa next to you? (of course, when you know objectively there are none ;)

Refusing to believe gender identity exists is a strange way to phrase it. Do you think trans people are making it all up?

No but I don't think it is caused by being born in the wrong body and I don't think if you transition you actually change sex or that this means you were actually always the sex that you transitioned to. However, this seems to be what we are now expected to believe. If I believe this is possible for someone else then logically I have to either believe it is true for everyone or that it is, similar to anorexia, a mental health condition. Or am I missing something?

@suggestionsplease1 I think that is an interesting point but I think it is of limited use here as the "trans umbrella " is so wide that it now encompasses people who are trans for a wide variety of reasons.

@suggestionsplease1

I don't think what you have linked is as applicable to this as it seems.
But lets work on the understanding that there are femaley and maley kind of brains.
And let's look into the difference between gender and seeing little green men.
Seeing things that aren't there is a hallucination (assuming the little green men aren't there). Ascribing false ideas to something that is there can be a delusion (there is in fact a red car at the end of your road - but you believe this is a signal to the CIA that the chip in your brain is about to receive alien messages).
Say a male person had a femaley type brain - that could be correct, but the belief that this then means your sex/your body is wrong could be considered a delusion. Delusions are in a sense, beliefs. They're meanings
From what I've seen they aren't too different to a sense of identity. You can have delusions of guilt, delusions of grandeur etc. It's an entirely debatable point why some of these beliefs are considered acceptable and some considered pathological. We usually say delusions are false beliefs and so you come back to the question of what is true? Who knew trans rights debates could become so existential!

Can someone explain this to me please (genuinely)? If a Transperson believes they were born into the wrong body, how can they deny that there is a physical difference between male and female bodies?

And when you look at the studies on brain structure and function which show that trans peoples' brains tend to be more similar to brains of the sex they identify with rather than the sex that their body parts would say they have, that is meaningful isn't it? (And I am in no way being absolutist about this, there is no such binary as a 'male' brain and a 'female' brain, these are not separate circles on a Venn diagram to my mind, and any individual identifying in any particular way might have any variant on brain structure and function.....but yet there are trends in structure and functioning at a male/female population level)

So if there is overlap, then there is no such thing as a 'male' or 'female' brain (other than the fact that a male brain is found in a male body and a female brain is found in a female body). So trans people's brains can't be 'more similar to brains of the sex they identify with', because they are part of the category of the brains of the sex they are.

What you're saying is the equivalent of saying a tall woman has a 'male' height and a short man has a 'female' height.

@OldCrone

And when you look at the studies on brain structure and function which show that trans peoples' brains tend to be more similar to brains of the sex they identify with rather than the sex that their body parts would say they have, that is meaningful isn't it? (And I am in no way being absolutist about this, there is no such binary as a 'male' brain and a 'female' brain, these are not separate circles on a Venn diagram to my mind, and any individual identifying in any particular way might have any variant on brain structure and function.....but yet there are trends in structure and functioning at a male/female population level)

So if there is overlap, then there is no such thing as a 'male' or 'female' brain (other than the fact that a male brain is found in a male body and a female brain is found in a female body). So trans people's brains can't be 'more similar to brains of the sex they identify with', because they are part of the category of the brains of the sex they are.

What you're saying is the equivalent of saying a tall woman has a 'male' height and a short man has a 'female' height.

Not really because I think gender identity is a little more nuanced and complex than the single linear dimension of height which can be determined by a number alone!

And when you look at the studies on brain structure and function which show that trans peoples' brains tend to be more similar to brains of the sex they identify with rather than the sex that their body parts would say they have, that is meaningful isn't it?

So far as I'm aware, this isn't true, as a) there's no such thing as a typical female-pattern or male-pattern brain for trans-identified people's brains to be compared with and b) these studies don't tend to distinguish adequately between reported sexual orientation and actual sexual orientation.

HSTS males have brains in line with other homosexual males (in terms of comparison with heterosexual male brains); heterosexual trans males have brains resembling those of other heterosexual males. Quite difficult to tease this information out when the latter category are permitted to self-identify as lesbians, however.

Sex dysmorphia may be detectable in the same regions of the brain as other disorders of body-perception; this is not evidence of a "female brain" unless, of course, "disordered body perception" is part of your definition of "female".

I think gender identity is a little more nuanced and complex than the single linear dimension of height which can be determined by a number alone!

You already said that there is overlap between the attributes of male and female brains. So at what point does a 'male' brain become a 'female' brain, and not simply one which appears more similar to a typical female brain than a typical male brain?

And can you define exactly what you mean by 'gender identity'?

Psychiatrists recognise different kinds of false beliefs

An outright delusional idea is demonstrably false and often bizarre as encountered in psychotic mental illness and the solution is usually antipsychotic medication. I don't think a belief that you are transgender is that kind of idea

Overvalued ideas however are those that occur in eg anorexia and OCD where when heavily challenged the person will admit that their belief is odd, wouldn't be shared by others and is not evidence based, but it very strongly feels like that to them (a psychotic person makes no concessions they know they are right) eg anorexics don't deny their actual low weight they just think it has a different meaning.
Body dysmorphic disorder is this kind of disorder. It's not a psychosis as such. Psychotherapy is the mainstay of treating these kinds of conditions.

It may very well be the case that for psychotic ideas and for overvalued ideas there are some things about peoples brains that cause them to have those thoughts but still it doesn't make the thoughts true.

In all of these conditions kindness and compassion are needed for recovery but not collusion. In none of these conditions would anyone suggest going along with or facilitating the ideas and in fact if this does happen the person will not get better.

I honestly do find it hard not to see gender identity disorder/ gender dysphoria as subsets of body dysmorphic disorder with an overvalued belief that you have the wrong sex body. Plainly you do not because that is scientifically impossible but the feeling is very real and I expect distressing (although some say it's not distressing) and there will be reasons why a person has that belief. I would think the vast majority of them could be helped to feel differently if they wanted to.

Some late FtM transitions seem to be less about a sexual fetish and not dysphoria and many TRAs these days say that gender dysphoria is not a part of being trans and trans people don't need therapy. That is fine if they are happy then they are free to carry on living as they wish as long as it is harming no-one and believing what they wish but no therapy then no surgery I would say.

In fact you can live your life believing all kinds of very bizarre psychotic things and no one will force treatment on you if you don't want it and if you are causing no harm to yourself or anyone else. That is where the law draws the line.

I think gender identity is a little more nuanced and complex than the single linear dimension of height which can be determined by a number alone!

A more detailed reply to this.

Suppose that there is some attribute of brains which is only ever found in female brains. By definition, this attribute, being exclusively female, will never be observed in male brains.

Now suppose that a man's brain is analysed, and he is found to have this attribute which it was thought was only ever present in women's brains. What this means is that the original assumption (that this attribute is exclusively found in female brains and never in male brains) was incorrect, and the attribute is actually found in both male and female brains, but is more commonly found in female brains. It doesn't mean that this man has a 'female' brain in his male body.

If there was a scietific test to determine whether a brain was male or female, it would actually prove that transgenderism doesn't exist in the sense of having a brain of the opposite sex to the body.

[quote Broomfondle]@suggestionsplease1

I don't think what you have linked is as applicable to this as it seems.
But lets work on the understanding that there are femaley and maley kind of brains.
And let's look into the difference between gender and seeing little green men.
Seeing things that aren't there is a hallucination (assuming the little green men aren't there). Ascribing false ideas to something that is there can be a delusion (there is in fact a red car at the end of your road - but you believe this is a signal to the CIA that the chip in your brain is about to receive alien messages).
Say a male person had a femaley type brain - that could be correct, but the belief that this then means your sex/your body is wrong could be considered a delusion. Delusions are in a sense, beliefs. They're meanings
From what I've seen they aren't too different to a sense of identity. You can have delusions of guilt, delusions of grandeur etc. It's an entirely debatable point why some of these beliefs are considered acceptable and some considered pathological. We usually say delusions are false beliefs and so you come back to the question of what is true? Who knew trans rights debates could become so existential![/quote]
I'm with you on your definitions of what a hallucination is and what a delusion is, and agree that your examples for both are fine... but I don't agree with your logic that being a male person (and I think we need to specify here a person with male genitalia as we're talking brain / body differences) and having a 'femaley' type brain should mean that you are delusional for feeling you are female rather than male.

Does it depend on the value that you place on visible genitalia? Because this person can visibly see their male genitalia does that inherently mean they are delusional for thinking they are female? Because I am sure we are all aware of the babies with botched circumscisions who were brought up as female but changed gender identity to male during adolescence or later. Are they delusional for feeling male?

If I may paraphrase Theld “I believe that their experiences are real and as individuals they should be respected, but the beliefs themselves (being separate from the person who holds them) are not representative of reality”
I totally agree. I won't be called a bigot because I refuse to believe something which is not grounded in reality. A bigot would wish these people ill. I don't. I just don't share their beliefs.

ALL identity is more nuanced. WHY is it that gender identity is seen as needing treating different than any other identity problem?

The mechanisms are the same. It is the external influences that causes the gender focussed identity problems IMO.

For example my ex. His "female" personality is no different than anyone else with Dissociative identity disorder. The reason his is female is because when his step dad abused him as a child, he told him he had a girls body. He told him he had female mannerisms etc. He made comments daily about him being born in the wrong body.

When he dissociated to escape this abuse, all of those things his step dad told him, that he wasnt old enough to understand arent true, are boxed off.

Those traits make up the "other". The one you keep secret. The one you're ashamed of and dont want anyone to know. Because you're a boy. you dont want anyone else to know you're really a girl. And you must be if the adults say so. My exs female personality is a manifestation of what an adult manipulated his brain into believing his was. His actual sense of self was never allowed to develop because he was always having to deal with this split.

When they DO start expressing this personality it feels very deep and personal because it is grown from incredibly deep trauma. It feels like you are finally sharing something unashamed with the world, and that part shouldnt be shamed. Of course it shouldnt. That 8 year old boy did not ask to be used and abused for an adults sick pleasure.

But at the same time you need the psychotherapy in order to express these parts healthily and manage the various chemical imbalances you'll cause and get addicted to.

And STILL is not an excuse to expect everyone else to change.

Proper use of psychotherapy enables you to deal with external triggers yourself.