Behind Body Dissatisfaction, Discomfort, and Disordered Eating

Last week, I shared my story in "I Used to Feel Fat" about how my childhood discomfort with my body was immediately interpreted as weight-related distress, leading to years of dieting that never addressed the actual issue: gender dysphoria. That misinterpretation isn't uncommon. For many transgender and gender-diverse people, body-related distress gets filtered through cultural assumptions about weight, appearance, and "normal" body dissatisfaction—often delaying appropriate care and creating additional harm.

For healthcare providers, the challenge is real: How do you distinguish between gender dysphoria, body dysmorphia, especially when disordered eating is involved? How do you avoid gatekeeping transition care while still addressing genuine mental health concerns?

The stakes couldn't be higher. A Dutch study published in Clinical Child and Adolescent Psychology Review found that up to 47.7% of gender-incongruent youth referred to outpatient mental health care were at increased risk of an eating disorder, with 74.6% of those showing high eating disorder symptom scores. Meanwhile, recent Canadian research in the Journal of Eating Disorders analyzing over 24,000 high school students confirmed that transgender and gender diverse youth consistently report higher disordered eating scores compared to their cisgender peers.

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