Is it reasonable to use anorexia as comparison to GD?

[cheeseismydownfall]

I was talking to DH about the issue of gender dysphoria being treated using an affirmative approach. He isn't very familiar with the big picture, so I tried to explain it in terms of anorexia - if you were treating someone with anorexia you would of course be compassionate and recognise that their feelings of disgust associated with eating and their body are very real for them. But you wouldn't actually agree with them that their distress could be alleviated by losing weight. You would instead seek to treat the underlying cause (trauma, environmental, genetics etc). You wouldn't prescribe them gastric bypass no matter how desperately they wanted one.

DH kind of got my point, but felt really uncomfortable with making the analogy for reasons he couldn't explain - perhaps the sense of hijacking someone's illness for the purposes of proving my point - which I kind of get, it does feel almost exploitative somehow.

Is it a reasonable comparison to make? Or is it horribly insensitive for reasons that I'm not aware of?

I've seen it used as a comparison several times, including by someone who has suffered both. I think it's a really useful one actually because it's one people can immediately see the problem with affirming rather than treating.

It used to be considered like another body dysmorphia but is now not considered a mental health issue. It will be interesting to see with pushing back on relying on affirmation as a treatment to see whether it will again (in years to come) be recognized like a BDD again.

I think the comparisons for treatment are relevant. Surely surgery and hormones should be a last line of treatment. It has also been reported time and time again that GD seems to be the only condition that is self diagnosed the way it is. And that looking for causes or helping a person feel better about their own body can be considered conversion therapy.

It has become a minefield and I would hate to be a practitioner.

If you can find it (there was a share token on here) I’m pretty sure at least one of the detransitioners interviewed in the recent Times piece talked about how her parallel diagnosis of anorexia wasn’t explored when she was rushed through transition at the gender clinic

I have an eating disorder and I think it's a gross comparison.

Additionally, studies have shown that EDs have comorbid psychological presentations that aren't present in GID, which suggest that they are very different forms of illness.

e.g. pubmed.ncbi.nlm.nih.gov/23347389/

Many women have or have had eating disorders/body dysmorphia and do see a comparison.

There’s plenty of women have posted in FWR about their own struggles.

EDs have comorbid psychological presentations that aren't present in GID

My understanding that ASC is co-morbid in both conditions. I would imagine anxiety and depression too but I have definitely read about the ASC link with both conditions. A third of females referred to Tavistock have ASC I think and a lot of women with anorexia have autistic traits.

Given the very specific female presentation of high functioning ASC, which commonly becomes noticeable in adolescence and often when puberty is well underway, rather than pre or at the outset of puberty, I wouldn't surprise me at all.

Although in some cases they may be co-morbid, I don't personally think it is a great comparison because the reason why anorexia is taken so seriously is the very high death rate. Taking hormones isn't good for you but we don't have any evidence that it is nearly on a par with starving yourself.

(Many of these deaths may not APPEAR as death from anorexia. The death rate is calculated by just comparing the number of deaths in anorexics from all causes, to deaths in non-anorexics from all causes. Being seriously underweight makes you much more likely to get and to die from all sorts of illnesses)

Taking hormones isn't good for you but we don't have any evidence that it is nearly on a par with starving yourself.

Some women who transition, by their early 20s, are having mastectomies and hysterectomies. Serious surgeries that are irreversible and render them infertile.

That aside, I don't think you are using co-morbid in the correct way. It's not about death rate comparisons but where a diagnosis of one condition correlates highly with a diagnosis of another health condition - for e.g. diabetes and heart disease.

GID is not as dangerous as anorexia. Anorexia has the highest death rate of any mental health condition.

But I am amazed at that academic paper stating that there are no psychopathologies associated with GID. So no associated anxiety or depression? No increased suicidal ideation?

It took a lot of research (and feminist analysis) to understand the reasons for anorexia so I see parallels there too. It used to be just thought of as young girls taking slimming too far.

I got lost down a rabbit hole of articles comparing GD to BIIB - body integrity identity disorder recently - although not sure that's a good comparison? I think someone posted a thread on this recently. Parallels in that people who engaged with fellow suffers online (mostly people in their 40s who had never spoken to anyone in real life but now spent lots of time on forums) found their desire to have amputations increased. I can't find the article now but the writer was suggesting being able to connect with others moved them from feeling uncomfortable with their bodies (but it not being too much of a preoccupation) to something that took up a lot of their thoughts.

"I don't think you are using co-morbid in the correct way"

All I was saying is that some people have both. They may indeed be linked psychologically. But while gender dysphoria is certainly not trivial, at least on the basis of current knowledge it looks like anorexia is substantially more likely to actually kill you.

I think it's the treatment that's being put forward as a valid comparison, rather than the condition.

I think it's reasonable to be careful about making the comparison.

In many case, it's meant to be a loose comparison, I think. Someone says, well - we must accept someone's self-image, and you point out that in cases of illnesses like anorexia, we don't. So the point is, we can't make that general statement, it obviously is not always valid.

However, it's also possible that trans identity, or even gender dysmorphia, has some significant psychological or medical differences from anorexia, and the best approaches are quite different. So the comparison can probably only go so far unless you are discussing it from a knowledgable medical perspective.

I don’t think the comparison is way off the mark, particularly if you consider the current cohort of young women who, it is suggested, might have become dysphoric through social contagion.

However, like your husband, OP, I find myself uneasy making the comparison. I think it’s difficult to go against what, until recently, appeared to be medical consensus towards affirmation. Rather than comparison with anorexia, I tend to stick to quoting the astonishing number of professional bodies which admit the evidence base for transitioning is very poor indeed. Since that is definitively correct, I have no problem making the case. Whereas I don’t really know enough about anorexia to compare the two.

Definitely! Several of the young detransitioners at the Manchester event earlier on in the year, said they had gone from suffering from anorexia to identifying as trans, and that the feelings involved ( towards their bodies) were just the same.

Worryingly, the GIDs services had never once openly made any link, or even thought to consider this fact before affirming a trans identity.

In the past there was a more affirmative approach to anorexia. As a key component of anorexia is about having a sense of control, professionals advised family members not to interfere and let the women/girls make their own decisions about eating or they might make the underlying problems worse. This approach changed more recently because of the numbers of women suffering death or disability as a consequence. There have always been controversies about how much intervention is acceptable in treating eating disorders.

Isn't the real question though about whether the psychological or physiological mechanisms are in any way parallel, or similar, or related?

I think in some instances they may well be, particularly in these instances of young women who mainly seem focused on putting a lid on puberty. But I don't know that you could extrapolate that to other instances.

I think PP is right that it's an example used to question the affirmative approach, rather than a direct comparison of pathologies as such. It's a valid question, and questions of that nature are standard when exploring reasons behind ethical/medical approaches.
I also think it's important to drill down into who is being compared when looking at the disease process itself. I think 'GIDs' is too broad and it would be more useful to compare the aetiology of young trans identifying females with young females with eating disorders than anyone who is trans identifying of any age/sex.

A surgical solution to a mental illness/identity disorder is an anomaly in medicine/psychiatry and it's valid to ask why that is for GD and not anything else.

I think it should always be acknowledged though that AN is a particularly female affliction and a serious condition with a high mortality rate and there is no comparison between that and a middle aged man's wish to have a fetish validated which I know is not the entirety of the trans movement but has become a part of it.

He's "uncomfortable" with the analogy you're using in a private conversation but "doesn't know why"?

Maybe he's just uncomfortable because of the whole topic.

It's an incredibly apt comparison.

I think it's a useful analogy but only in a broad brush strokes kind of way to point out that affirming someone's desire to alter their body based on erroneous self perception isn't always a good idea. As someone who was very unwell for a long time with anorexia and bullemia I don't personally find the comparison offensive. However a trans man who posted on here a while back made, I think, a very interesting point, that with EDs and GD the direction of the discomfort is different. If you have an ED you often see your body as it isn't. You see yourself as fat and wish you were thin, even if you are already very underweight. With GD transpeople (or at least those who accept biolgy) see their body as it is. They see their body as female/male and want it to be the opposite. People with EDs see themselves as they are not and want to be as they are*. Transpeople see themselves as they are and want to be as they are not. That, according to the poster in question, is what distinguishes GD from other body dismorphic disorders.

• Obviously EDs are more nuanced than that and not every person with an ED will be underweight, but you get the jist.