National Eating Disorders Association

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ED vs. Transgender Identity?

My girlfriend has said this several times and brought it up again. She wonders what the difference is between her anorexia and transgender identity. Why do we encourage those who suffer from body dysphoria (or trans) to change their body to match their mind, but tell those with ED that they are suffering from a mental illness?

It is an interesting question, that is for sure. I am doing research on it now. Does anyone have thoughts?

re: ED vs. Transgender Identity?

Anon25--well, this is a little eerie. Are you my girlfriend? Just kidding. I just had a pretty identical conversation with my girlfriend a few weeks ago. She has dealt with a lot of gender dysphoria in the past (including briefly identifying as trans) and I was in a serious relationship with an agender person before her, so I know this topic is seriously sensitive and has the potential to veer into dangerous transphobic territory if not treated delicately. It's kind of a scary question to pose and I'm glad you had the courage to do so.

The conversation I had with my girlfriend was part of a larger discussion in which we were kind of spiraling about a lot of topics related to our bodies and our gender identities/expressions/presentations/performance, but basically I had the same question--why is it a mental illness for me, a recovered bulimic, to desire to change my body so that I can bear living inside it, when I would never call it mental illness if someone is suffering from gender dyshporia?

Honestly we didn't come up with a great answer (granted I was just sobbing a lot so there wasn't a whole lot of space for answers, haha). I've been thinking about it for a few weeks and the only thing I can come up with is that changing our bodies through EDs almost always has negative consequences, whereas changing our bodies to feel more comfortable inside them from a gender standpoint almost always improves quality of life. This doesn't address the origin of the pain (ie: both situations involve feeling negative about your body and wanting to change that, so why is one a mental illness and not the other?), but I think it's an important contrast and perhaps this focus on the end result is appropriate?

I agree though that this is a tough question and one I've struggled with myself. Have you uncovered any other answers through your research? Thank you for posting about this, maybe (hopefully) other people will have thoughts too.

re: re: ED vs. Transgender Identity?

Ah!! Wouldn't that be awkward, to end up in the same chat forum? :) Though my girlfriend has actually looked at these posts before so I guess it really can happen, haha.

It's SUCH an interesting (and sensitive, I agree) topic to research. Obviously most of the articles I've found are dysphoria vs. dysmorphia. Some were angry posters (like my girlfriend, and perhaps you?) about why ED/dysmorphia is considered a mental illness and not dysphoria.

At first, I thought there were only two answers: either stop considering ED a mental illness, or return to the assumption that transgender IS a mental illness. Now, I'm not sure that has to be the conclusion. Like you said, ED has very negative consequences. I think that is the main argument. Everything I read said that dysphoria was seeing the reality and what is and is not there and knowing that it is not right. Dysmorphia is seeing something that is NOT there, not reality. So, trans individuals understand what the reality is and are uncomfortable with it. People with dysmorphia do not.

My girlfriend read these definitions and still says that she falls in the "dysphoric" category. She said she KNOWS that her body is supposed to look different. However, I still feel like she is dysmorphic, because she's unhappy with her size being too big, and she is not all. That to me says there is dysmorphia.

Others say that dysphoria can be healed by adding or taking away the parts, but dysmorphia cannot be cured, and can only be treated with therapy/medicine. I assume this is similar to the idea that if my girlfriend hits her "goal weight" through restricting, chances are she will just try to get lower, and lower, because it is more of an addiction than a true weight loss goal. I believe she has an issue because the process (restricting or purging) is unhealthy, weight loss doesn't necessarily have to be unhealthy. The method is the addicting part, in my opinion.

I think I have just been rambling...I don't know if any of this makes sense! Haha I'm just pleased to know that I'm not the only one pondering this.

re: ED vs. Transgender Identity?

Oh wow, that's so interesting—for some reason I never knew there was a difference between dysmorphia and dysphoria?! I actually think I've been using them interchangeably my entire life...which is clearly problematic, haha.

I agree the “conclusion” doesn't have to be so black and white. I think there's a lot of nuance here—reading your descriptions of dysphoria vs. dysmorphia, my first reaction was admittedly to take your girlfriend's camp because I think a lot of EDs are more complicated than just seeing a “fat” body when you look in the mirror but you're actually “thin.” Just speaking from personal experience, during my ED I never actually experienced dysmorphia—I didn't see fat where there wasn't fat, I just knew my body didn't look the way I wanted it to look (and actually there were times when it wasn't about my body at all and had way more to do with control/discipline/”deserving”/etc.). So I can understand your girlfriend's argument that her body is “supposed” to look different just because she feels like it should.

But I still think there's something in this distinction between the words. Part of me wonders (and I wouldn't recommend saying this to her, haha) whether your girlfriend and I are subconsciously trying to justify our EDs with a philosophical argument that isn't necessarily relevant? Like OK, this may seem super off-topic but remember when the Rachel Dolezal scandal happened and everyone was like “How is Rachel wanting to be a different race any different from Caitlyn Jenner transitioning, derp derp”? And it was so frustrating because you're spending all this energy trying to come up with logical arguments that will convince transphobic people why they're wrong, when really it's just as simple as race isn't the same as gender. I feel like it's possibly similar here...that although on the surface these two issues seem comparable, maybe they're actually not, for some reason I am unable to fully explain?? IDK!!!

And yes, I agree with that last paragraph about the process itself—this is what I keep coming back to, too. People I know who've gotten top surgery, for example, feel pretty instantly better in their skin. Definitely not so with the people I know who've struggled with EDs. I don't know anyone with an ED who lost the weight and then said, “Yes, great—NOW my body feels right!”

By all means, ramble away! I'm going to look into this more too. I'll let you know if I find anything else of interest!

I don't necessarily have

I don't necessarily have anything profound to add right this moment, but for some reason I really like

"But I still think there's something in this distinction between the words. Part of me wonders (and I wouldn't recommend saying this to her, haha) whether your girlfriend and I are subconsciously trying to justify our EDs with a philosophical argument that isn't necessarily relevant? Like OK, this may seem super off-topic but remember when the Rachel Dolezal scandal happened and everyone was like “How is Rachel wanting to be a different race any different from Caitlyn Jenner transitioning, derp derp”? And it was so frustrating because you're spending all this energy trying to come up with logical arguments that will convince transphobic people why they're wrong, when really it's just as simple as race isn't the same as gender. I feel like it's possibly similar here...that although on the surface these two issues seem comparable, maybe they're actually not, for some reason I am unable to fully explain?? IDK!!!"

They are just frickin' different!!!!!!!!

will continue to look into this, I hope you do the same. I think there's more to be discovered that goes even beyond the dysphoria vs. dysmorphia, especially when you begin thinking about the racial thing, and there's also an understudied (in my opinion) group out there that believes they should have been born without body parts etc. For example, someone who feels as if they should have been born without one leg will go to great lengths to have it removed, or if they feel they should have been blind will attempt to blind themselves. It's interesting.

re: I don't necessarily have

Haha! Good, I'm glad it resonated with you :)

Yes, definitely. Wow, I've actually never heard of that body part thing--that's fascinating. Kind of the opposite of a phantom limb, I guess?

Also I apologize for taking forever to respond--I moved across the country about a week ago so everything is chaos and I haven't had a chance to log on. Hope everything is going well with your girlfriend!

Big move!


What a move! I hope all of that went well (or continues to go well, as I'm sure you're still unpacking and whatnot). Things are as good as they can be, I guess. We had a very interesting couples session yesterday and she laid out several things that have been bothering her immensely about our relationship, and making her uncomfortable. Some of it caught me off-guard, and some of it I was expecting. It was very vulnerable and uncomfortable, but I hope that it will help us in the long run.

She was checked into a psych ward for not quite a week because she was having suicidal ideations (can't remember if I mentioned that already or not - don't feel like scrolling up!). She's back in treatment now, and seems to be much more receptive to the programming and what they have to offer her. That gives me hope.

I hope all is well on your end!

re: Big move!

Indeed!! I'm actually one of those people who is totally unpacked with stuff hanging on the walls within a few days of moving in, though, so fortunately all the at-home chaos was over pretty quickly (which is good because I'm now working remotely full-time). But the other transitions are ongoing, for sure. On top of all the usual instability that goes with a big change, I actually broke up with my girlfriend right before moving, so I'm kinda flailing right now.

I'm so glad to hear you're trying out couple's therapy and that you were both able to be vulnerable. Isn't it so surprising what can come out when you feel like you're in a safe space and a knowledgeable third party is there to add to/guide the conversation? I read your post in another thread (#creepin) and I'm sorry to hear that some stuff came out that made you uncomfortable. First of all I wanted to say don't beat yourself up--it's just impossible to know what might be triggering to someone who's dealing with an ED. For a few months this winter I was livid with my girlfriend pretty regularly for leaving socks on the floor. You'd think that would have nothing to do with my ED, but it was making me inexplicably anxious and became a trigger. My point is just that you never know, and all you can do is listen and do your best to adjust your behaviors when you're able to do so.

I also think what you said about your limits is very true--it's one thing to accept that the relationship may become a bit one-sided while your girlfriend is struggling with her recovery, but it's another to make a firm decision to soldier on for however long X amount of time that's going to take. No matter how much you love her, you still have needs of your own, and you have to answer to those because otherwise you'll just stop functioning as a human! It's totally understandable that you're thinking critically about how much you're realistically able to give. I get it--my ex and I both had a lot of mental health issues that impacted our relationship. There was a lot of other stuff going on too, but ultimately we weren't able to be the support systems the other person needed. I'm still working on accepting that.

All that said, I hope you'll continue having sessions like these that allow you to be open and vulnerable with each other. It's so important for connecting emotionally, especially when times are tough. And I'm so glad to hear she's receptive to treatment--honestly that's the #1 obstacle to overcome in recovery, so she's definitely on the right track.

Sorry to hear that :(

Hey #creep,

I'm sorry to hear that you're having a hard time with the breakup you've gone through. Those are never easy. I can't imagine doing that and THEN moving across the country. I feel for you :( I hope you have some people in your life to support you now, but...this weird message board is always available too.... I hate that feeling of having no support. And also, I'm jealous of your remote job. I've been looking for one and it's hard to find!

Adjusting behaviors...that is so hard. I've felt like I am just tossed to the side while she spirals. It's a very selfish feeling. I wish I was more selfless/secure. Today I mentioned that I wouldn't hate hearing that she finds me attractive every once in a while (HOW #DESPERATE DID THAT FEEL? Incredibly!). She came back with the fact that she's trying to not focus on physical compliments because it had been so triggering to her etc. which makes 100% sense...but it sucks for me when I feel insecure. However, maybe I can take this as a chance to re-learn how to feel attractive and what makes me attractive. There's some philosophical thought for ya.

As far as limits go, I am impressed that you recognized yours, even if it is really hard to deal with right now. I feel like so many people just let their limits fade away and end up falling apart. You clearly took a huge step in the right direction for your mental health (and probably hers too!). I hope that I have that kind of strength, if I need it.

The girlfriend is kind of in a crisis right now. An IDENTITY CRISIS. She says she has no idea who she is at all. What parts of her are shaped by ED? Who would she have been without ED? Who is she because of ED? She doesn't know if she should bother with grad school because what if that was her ED wanting to go into the social work field. Apparently she feels that describing her ED as "Ed" or another separate being has really fucked with her brain and she now doesn't know who she is. I've gone through a similar identity crisis when I started transitioning out of my strict religious upbringing this year (WiLd, I know) so I understand the terrifying feeling of uncertainty. But I am intrigued, have you experienced any kind of "identity crisis" in regards to your ED? If you know why? She's been dealing with hers for most of her life, so I think she just is at a point where she doesn't know where she ends and where the ED begins...or if they are even separate at all.

Sorry to hear that :(

Hahaha. Thank you for the words, I appreciate it! My family is actually here (the main reason I moved from downtown in a huge hip city to a pretty small town in the Midwest [*cringes*]) but I’m such an introvert that I’ve never been great at accepting support. It’s made me really self-reliant but also means I can get kind of lost when it gets really bad because I’m never 100% sure what kind of external support would even help me, if that makes sense. But I’m going to be getting back into therapy soon and I’m in the process of adopting an old dog which I’m ridiculously excited about, haha, so ~lil bb steps of self-care~

Yeah, the breakup was actually in the works for a while—we had been together a couple years and had moved in together the last year, which is when we started becoming super codependent in an unhealthy way (lol #lesbians). I’m glad it at least *sounds* like I’m being strong, haha. It’s ironic, my family keeps like stroking my cheeks (not literally but emotionally) with stuff like “you’re so brave” blah blah blah and I’m like, am I though? I don’t feel brave at all, I feel like this is a really difficult and traumatic thing I just did and I have no idea how to cope with it yet. Like I walked out of this relationship with someone I still love deeply and I just dropped the life I had spent four years building and suddenly I’m just gonna start living alone in a new city and hope I figure it out?! Wait, was this actually a terrible, self-destructive idea???!? Smh.

I’m trying to silence those thoughts because arriving here and living alone for the first time ever and having to like learn myself again is making me realize just how bad I had really gotten back there. I think if I had stayed I would have just atrophied completely. But accepting all this is a work in progress, for sure!

Omg your entire second paragraph is literally like...echoes of conversations I’ve had in every serious relationship I’ve been in. If it helps at all I can totally confirm that your gf is not just lying to you with the trying not to focus on physical compliments thing—recovering from an ED requires completely rewiring the way your brain functions, so as crazy as it sounds, it is totally necessary to take kind of a blanket approach to anything involving physical appearance. One of my exes would always say stuff like “But you’re so beautiful,” and it would actually make me mad because it was so reductive. They never made much of an effort to understand my ED so maybe that’s why I had such a violent reaction to it, but my point is that even comments that on the surface should be helpful and affirming can end up being triggering or upsetting for someone who’s trying to recover, simply because of that focus on physical characteristics.

That said, OF COURSE it’s a horrible feeling for you!!! I totally know what you mean about feeling selfish, but you are NOT selfish for literally just...existing. Seriously, you’re a human who has needs, and this is a situation that demands you pretty much wrap those needs into a tidy lil box and tuck them away in a drawer for the foreseeable future, no end in clear sight. So much of supporting someone through any mental illness is just sacrifice sacrifice sacrifice—to be completely honest I’ve pretty much always been on the receiving end of that support, so I can’t even imagine how much it must suck to never have your partner tell you you’re sexy. On a similar note, do you ever read the website Autostraddle? Heather Hogan wrote an article a few months back called “We Will Have Sex Again, I Promise” or something like that—not about EDs in particular, but it tackles the impact of physical/mental health on her relationship with her partner, and it’s a beautiful/inspiring read if you’re in the mood to check it out. It might help some.

Finally, yes, 100%, an ED messes with your sense of identity. For about five years, I clung to mine because I was convinced it was the only thing that made me interesting. I was like, “What even am I without this all-consuming drive?” Because it totally takes over your head. It’s all you think about all day every day, so what else could possibly be the point of your life, existing on this planet? Honestly sometimes I miss my ED like an old friend and it’s for that reason—it gave me a sense of purpose that was just so clear-cut and easy to understand. There are even times now, four years into recovery, where I think about how nice it was to feel like I was better at most people than something. Sometimes I think about ED as a kind of parasite that comes in and invades your body/takes over your brain so you think you’re making decisions for yourself, but it’s actually the mental illness talking.

That’s pretty reductive and I’m not saying your gf is feeling those feelings exactly, but whenever I feel ED thoughts start to flare up, it usually has something to do with my sense of identity faltering. “She doesn’t know where she ends and where the ED begins”—yes, this. A lot of times recovering requires separating yourself from your ED and achieving this “revelation” that it’s not who you are, but it can be a really painful process because it makes you feel so alone and lost and confused.

Wow this got SO LONG


Re: Sorry to hear that :(

dropthemetaphor,Your post has been edited to fit within the Neda forum guidelines by removing any vulgar language.  We appreciate your use of our forums in order to support and cope with your feelings and frustrations.  Thank you!

It's been a minute...

Hey @dropthemetaphor,

I hope you are doing well. How has life been for you? I've disappeared for a long time. I hate that the NEDA website doesn't have the capability to notify when someone responds to your thread. Sheesh, it's 2017!

Things with my GF have been up and down. She left treatment a month or two ago and has been trying to do it on her own, with some help from her therapist. She's also started seeing a dietician who has experience with ED. I'm not sure how I feel about this, simply because she still wants to reach her goal weight (which I don't think is that healthy), but at least she wants to try to do it in a "healthier" way. However, she still gets overwhelmed and when she is stressed she doesn't eat or she purges what she does eat. Only time will tell.

I have found myself not asking about it as much, because I don't want to engage with it. I feel guilty about this! But I just want to have a "normal" relationship sometimes so I pretend that part of her doesn't exist sometimes. Her stressors and triggers remind me that it's still very present, though. She is at least considering a residential treatment after she graduates in May, so I am looking forward to that!

Update me on your life since your move, etc! I mean, only if you want to. #Consent


I'm a bit late to the convo I know, but you wrote this :

".. if my girlfriend hits her "goal weight" through restricting, chances are she will just try to get lower, and lower, because it is more of an addiction than a true weight loss goal."

This really is one of the core issues for people with entrenched EDs, it seems. The addictive part stops being about "being thin" and becomes more about "the process of becoming thin." If a person is addicted to the process itself, then as you said, they'll always need to adjust their goal weight lower.

Not to get all psychological, but when a person is addicted to the process, one probably needs to think about what sort of functions the process fulfills for them. Getting more to the heart of the matter, you know ?

Not that this is the cure or anything, because by this point there is the addictive thing at work too. But at least it can provide the person with some perspective on their behaviors I think.