The Difference Between Dysphoria and Negative Body Image

Note: This article discusses my personal experience of dysphoria. There is more than one way dysphoria can manifest, and not every trans person has the same feelings about their body as I do. Although this article has resonated with a large number of trans people, it is only one part of a very diverse tapestry of trans narratives.

You can also read a translation of this article en Español.

Most people understand body dysphoria as a dissonance between sense of self and body. But what does that mean? Is dysphoria the same as feeling uncomfortable after gaining weight? Is it the same as hating your big honking nose? Or is there a fundamental difference between dysphoria and other feelings of bodily discomfort?

I think about this quite often. Am I dysphoric about my hips, or do I just feel inadequate in a world where femaleness is defined as possessing childbearing hips? Am I dysphoric about my facial hair, or am I self-conscious because the rest of the world judges hairy women? When is discomfort over my body a result of testosterone poisoning, and when is it a desire to be more attractive? Is it possible to tell the two apart?

This is not a philosophical question. Insurance companies categorize trans medical care as “cosmetic” and use this as a justification to deny coverage of trans-specific procedures. Psychologists write off body dysphoria as a delusional manifestation of body dysmorphic disorder. Friends and family dismiss the extreme pain caused by dysphoria and tell us to “just accept who we are”.

The difference between dysphoria and negative self-image is important for us as people, as well. The mystique surrounding dysphoria holds us back from living fuller, happier lives. Dysphoria is a vaguely-defined and poorly understood phenomenon. Most descriptions of dysphoria are intuitive, personal, and vague. How can we understand ourselves without the language to describe specifics? How can we develop useful coping strategies with such a limited understanding of the inner workings of dysphoria? How can we explain to the cisgender population–who often have the final say in whether or not we get to live happy, full lives–what dysphoria is and is not, unless we dig deeper?

One trans medical treatment that’s misunderstood is facial feminization surgery (FFS for short). Some people think the desire for FFS is rooted in the pathology of mainstream beauty standards. They think trans women get FFS to look like supermodels. These people are completely wrong.

When Illusion is Reality

I’m going to be blunt: I am not attractive. Even under ideal conditions, my face isn’t pretty by conventional standards. It won’t win any beauty contests. It won’t appear on any magazine covers. Although estrogen halted the worst of my acne, I still have complexion problems. My skin is littered with deep acne scars. My pores are huge, and my skin color is splotchy. I have a large nose and small eyes. I’m not throwing a pity party; these are just the facts. Mainstream beauty standards are a scam as far as I’m concerned, but I can’t pretend to be immune to them, either.

My face is my primary source of discomfort. I can’t avoid it; I interact with my face every day when getting ready in the morning. And every day, my face looks different depending on how I feel. On bad days, I am overwhelmed with memories of my appearance pre-transition. My face looks hypermasculine to me, even though I regularly get read as a cis woman. This is clearly a problem with self-image. It doesn’t correlate to reality. It’s an emotional distortion. On good days, my face looks dramatically different. I stop seeing “the old boy” in the mirror, replaced with a face that feels right. It actually looks a lot like my face before I went through puberty the wrong way.

However, my face only feels right when I look at it straight on, in even lighting. Viewed directly from the front, without any shadows to reveal depth, my face registers as my own. It feels right. If I slowly turn my head, the dimensions of my face gradually stretch and become less and less recognizable. My face morphs into someone else’s. The effect is similar to perpsective-based optical illusions where a model or image appears to have a familiar form until you change your viewing angle:

A “chair” by Singaporean artist Matthew Ngui that loses coherence when viewed at different angles.

Felice Varini paints on architectural features to create “flat” images spread out in 3D space.

The feeling invoked when I look in the mirror is the same as when I view these illusions. They are confusing, disorienting, and unsettling. To me, these emotions are the defining characteristic of body dysphoria. Beauty has nothing to do with it: When Ngui’s chair breaks apart into several pieces, it no longer makes sense as an object. Parts that appear connected are, in reality, separate pieces. Half of the chair’s seat is actually a painting on the floor. The brain creates a spatial model of the chair, and then that model is violently torn to shreds when exposed to physical reality.

The viewer is upset: this was supposed to be a chair, and this is not what a chair is supposed to be at all! Varini’s painting appears distorted when the viewer steps away from the sweet spot, not because of any inherent quality to the painting, but because the brain has created an expectation of how it should appear. The viewer is disoriented when stepping away, as if space itself has warped.

Kokichi Sugihara creates mind-bending paper sculptures that appear to defy the laws of physics. The result is jarring because the brain expects different behavior from the objects it sees. The ball should roll down the slope, not up it! The brain wants to fit everything into a model that makes sense, but no such model exists.

Dysphoria causes the same dizzying confusion, because the brain expects the body to take up space differently. These hips should be wider. These shoulders should be narrower than the hips. When a situation calls attention to these inconsistencies, it’s like Ngui’s chair breaking apart, or Varini’s painting stretching out into space. The brain also expects the body to behave differently. To trans women who are dysphoric about their genitalia, an erection is as confusing as a ball rolling up a slope. It doesn’t make sense.

I use special techniques to alleviate these upsetting feelings. I wear black cardigans to minimize my shoulders. I layer shirts with long torsos over full-rise jeans, widening the appearance of my hips. When I masturbate, I usually cover myself in blankets and utilize guided visualization and deft hand maneuvers to make things feel right. I dodge mirrors, except for when I encounter those ideal viewing conditions and my real face shines through–then I stare at my reflection and burn the image into my mind. Using all these tricks and more, I can temporarily put Ngui’s chair back into a comprehensible form. I can line up Varini’s painting until it looks right again. I can make the ball roll down the slope. But they are all temporary solutions that require constant maintenance.

Trans medical procedures such as FFS offer a permanent, tangible solution to dysphoria. Instead of the illusion of a chair, you get an actual chair! The chair may not be as pretty as you had hoped, but damn it, at least it’s actually a chair! You can finally give your sore legs a rest without falling on your ass! And it’s a chair no matter what angle you view it from. Instead of a painting that disappears when you step away from it, you get a painting that looks the same from every angle. With SRS, the ball rolls down the slope like it’s supposed to. Everything works as expected, without thick blankets and mind tricks.

Surface Matters

Having described the essence of dysphoria, the question remains: What is the defining characteristic of an actual negative body image? We are just as prone to negative self-esteem as cisgender people–potentially moreso, as we are held to higher standards and start at a disadvantage.

Let’s return to Ngui’s chair. This time the chair’s paint is peeling off. One of its legs is cracked down the middle. The seat was severely water-damaged and is now rotting away. Regardless of all these defects, if the chair is just an illusion it will break apart when you look at it from the wrong angle. And if it’s a real chair, you can still sit down on it. The experience might be uncomfortable, but you can still rest your legs. Maybe you fantasize about sitting in a prettier chair, but at least you don’t have to gaze longingly at it from afar while using tricks to make yourself believe it’s really a chair.

Your slope doesn’t need fancy embellishments to make the ball roll downward like it’s supposed to. No amount of pretty trimmings will change the laws of physics. Regardless of how pretty your slope is, if the ball rolls against gravity it’s going to be disturbing.

My face would be a lot more attractive if I had perfectly smooth skin. But I would still need that perfect light and viewing angle to avoid dysphoria when looking at myself in the mirror. My face would look more feminine if I had a smaller philtrum (the space between the nose and upper lip). But it would still trigger dysphoria when viewed from the side. Conversely, if my brow line was reduced in prominence, and my nose didn’t stick out so far, my face would look the same from the side as it does in my ideal conditions.

All it would take to “fix” my face is to flatten it out a bit along one axis. I would look the same from the front, but that image would stop falling apart when I turn my head. The chair would stay a chair. After more than 18 years spent on my feet while tormented by the mirage of a chair, I’d be happy to sit in any old chair. I just want the real thing.

For a different take on dysphoria, check out Zinnia Jones’ article, “That was dysphoria?” 8 signs and symptoms of indirect gender dysphoria.

23 thoughts on “The Difference Between Dysphoria and Negative Body Image

  1. I just wanted to say thank you for writing this. I have had dysphoria my entire life and never knew how to even explain it to myself, never the less other people. I was told from a young age that I had negative body image, but I knew I didn’t. I knew I was a beautiful girl, but a beautiful girl doesn’t always mean happy. It didn’t fit, it wasn’t me. Reading this gives me hope and makes me feel that I’m not alone in this. I’d rather look like a mediocre looking man than the most beautiful woman in the world any day, because feeling like myself makes me feel the most beautiful.

  2. I am a trans ally, or try to be. Thank you so much for your post – those illusions are cool in their own right, but they’re an amazing tool for describing dysphoria. I’ve always taken it on faith that gender dysphoria is real, but I can now conceptualise far more vividly what the experience of dysphoria must be like.

    In the past, I’ve also wondered how I should justify believing that vanity plastic surgery is undersireable, while also supporting SRS. Much clearer now 🙂

    • Thanks for reading, and for the link! I’m glad my post is helping cis people understand dysphoria better as well. I should probably add a caveat that this is my personal experience of dysphoria, which isn’t necessarily the same for all trans people. Dysphoria is a complicated thing that may never have a single unifying model. But from discussions it seems my experience lines up with that of many other trans people.

  3. (tangent: have you encountered Julian Beever, the chalk pavement artist? Just like your chair – his chalk art looks 3D, but only from one angle)

  4. Hi I love your blog on this topic…you say it so well…I”m older FTM and struggle with how to explain disphoria…this is…perfect hits my /big bang theory Geek meter just right! smart and cute in one fell swoop!

  5. Oh wow, thank you. I hadn’t realised just how much I was failing to grasp dysphoria. Like Unquiet above, I never thought it didn’t exist or anything; I just didn’t know how to begin thinking about it or trying to understand it. Thank you for providing a metaphor that helps people who have never felt it understand it better.

  6. Thank you. This is the first description I’ve read that translates well (we’re just all so varied).

    I have a different but consistent experience with dysphoria. My palpable dysphoria preceded my understanding that the nature of my otherness was that I was a woman and not the man my body told everyone I was. It manifested as an increasing sense that the person in the mirror wasn’t really me. This disconnectedness led to growing disregard for my physical health. Despite being a person for whom weight maintenance is easy, I gained nearly 100 pounds in a few years.

    When I finally got a clue about myself, I tried the most basic makeup techniques for obscuring my more masculine features. I saw myself in the mirror for the first time. The sense of relief was overwhelming. Without really trying, I Iost 80 lbs in 4 months. There was no new willpower or goals, just a sense that this body was mine.

    I still experience dysphoria, but it is highly focal. Hormones have already helped a lot. GRS will address the glaring issue. I’ve gotten skilled at avoiding my profile and I’m learning to not see my brow bone when plucking my eyebrows.

  7. [self harm]

    Yes yes yes. This is how it is for me. Often, when I am made acutely aware of my penis, i have this intense urge to harm myself, to self-castrate and mutilate. I cannot conceptualize it as a penis or it becomes too much. It’s just too fucking awful and disgusting and I want it gone. People think dysphoria is “discomfort”…it’s much more than that. It’s self-destructive dissonance that your body doesn’t match who you are.

  8. Thank you so much.
    I am a trans boy (yes, boy, not man), and I am SO SICK of hearing (from my boyfriend especially) that ‘I look great’. NO I DO NOT. I am shorter than every cis female I see, who wears four inch heels because she feels disgusting as a five foot tall woman. I have repellent fat hips (liposuction hasn’t helped) and residual fat despite top surgery. I have grossly repellent close set squinty eyes, a huge crooked long wide nose, and fat lips. Even worse, I have the kind of ass that makes cis straight men yell comments at me that enrage me, and then make me realize that to me, cruel comments about brutalizing me as a woman have made me long to be a man, but they won’t let me be a man (and I pretty much have wanted to be a man since I have been conscious). I am so tired of hearing that I should ‘accept myself as beautiful’. I am butt-ugly and yet still wish to be a beautiful boy. Though I am a trans boy, I just wanted to let you know that trans women aren’t the only ones out there who hate the way they look because they don’t feel beautiful enough. As I am a gay trans boy, I want to be a pretty boy, which is something most straight trans men don’t understand. Love from your trans brother.

    • Hey, Justin. Just wanted you to know you’re not alone. I’m also ftm, I’m pansexual though and my degree of dominance/submisiveness and desired masculinity fluctuates regularily, but I’ve realised that when I want a more flamboyant gay look, I would be “feminizing” the only things I can really control right now like hair and makeup, and those being my most passable features in my control, without them people would (and have) mistake me for female instead of gay, and it’s dissapointing that I can’t fully express myself until I start hormones (to get more masculine features to ofset the feminine ones) without being misidentified. Although currently I’m being misidentified as a butch lesbian, which is almost more frustrating when I was at Toronto Pride where I expected to be respected as a trans man, and even wore a “trans” sticker and people were still calling me a dyke, and because I have never identified as lesbian or butch. I was a straight tomboy, then a gay boy, then bi then pan, so if I’m going to be identified as a girl either way, sometimes I wonder if I’d rather be identified as a pretty girl, which I was at one time, or a dyke which I never was nor did I ever identify with. Even within the trans community there are expectations about gender expression and I feel you there, but you’re not alone in that, and certainly not in being a gay trans guy. Sexual orientation is independant of gender identity, and trans people identify can (and do) identify with any of the orientations cis people do.

  9. Thank you so much for this Amy, it’s helped me a lot in understanding my own experience and I’ll definitely keep this metaphor in mind when explaining it to others.
    I’m ftm and the parts of myself I feel dyshporia over vs negative body image have changed during my transition. I still feel dysphoria about my chest, genitals, periods, and voice. I used to feel major dysphoria about my face, height, lack of facial hair, arms, hips, and butt, but now those are less of an issue for me or have moved towards negative body image. My face has always been fairly androgynous, but I used to worry my eyelashes were too long, or that I was baby-faced which either made me look feminine or prepubescent, and many people agreed. Now I know that the right haircut can make a major difference, as well as my facial expressions, which are now usually more masculine or genderlessly ridiculous, and I like it that way 🙂 Height was an issue because I was always the tallest, but then all the guys hit that growthspurt in highschool at the same time I started transitioning and it made me suddenly feel very small compared to most of the cis-guys my age. Now I know cis-guys of varying heights and body-types and it’s made it more of a negative body image issue. Before I was able to make my face and voice more masculine, not having facial hair was a big issue, but now it doesn’t really matter, I just look forward to it when I can finally start HRT. My arms have always been slender and feminine as well as my hands and this caused major discomfort for me. I’ve always prefered t-shirts but I think this was part of what made me start wearing a hoodie almost 24/7, regardless of how hot it was. Now I’m comfortable with it, I’m better at binding so my chest seems flatter which has made my whole (clothed) body image more slender so my arms don’t seem so out of place, and although I get many people commenting on how soft, feminine, slender my hands are, for some reason it doesn’t bother me anymore and I’ll just say I have pianist’s fingers. Hips and butt were horrible my first year living as male, I was pulling the bottom of my hoodie down over them every 5 seconds and I would keep my head down and walk without confidence. Now it’s eased up and it’s more of an occasional annoyance. I’ve had a few girls mostly, including my ex-girlfriend talk about how much they like my butt and I’m just not sure how to react at this point. Currently I’m dealing with my belly fat as I’ve gained some weight there over the last year. It’s currently a dysphoria issue because my chest binder and tops are constantly getting caught between my belly and my chest which makes my breasts more prominent and it’s just physically uncomfortable, especially when it’s hot. I had a while at first where that weight was drawing my attention to all the other parts of my body that have the wrong weight distribution, which luckily testosterone fixes. I think my body issues will continue to develop, I’m much more comfortable with myself now than when I started this journey and I hope it continues in that direction. Right now it’s looking forward to the future with HRT and surgery that keeps me going, knowing it would be a waste to stop enjoying life now and only pity myself. I don’t want complete reliance on changing my body like that to be comfortable and proud of myself.

  10. Love this post. Hope it gets shared widely. (Going to forward to my mother, hoping it helps her understand.)

    I could feel it, but have had hard time articulating the experience of dysphoria. Much appreciation.

  11. The dysphoria we face is very real. Sometimes I would rather look like an “unattractive” or “average” male than have the slightly wider hips that I was born with. I would love to see myself in the mirror and identify with that person. Thanks for sharing your story. Maybe one day there will be such wonderful technology that we can just adjust the most subtle subtleties in the mirror — take an inch off here, add an inch there, shape the brow this way, ready to go! I fantasize about that day. Until then, I wear baggy clothes, try to keep my weight down so my hips don’t flare out, and do things to make peace with who we are. Because if we can’t change everything about our bodies, we can at least choose to move towards compassion.

  12. I really want to thank you. I’m not trans, but my closest friend is, also mtf. She deals with what she’s always described dysphoria, but the word doesn’t help me, a content ciswoman, understand. I’m so glad I can get a glimpse of what my dearest friend must be experiencing, and maybe I can better support her now that I understand better. Maybe now that I’ve finally found some source that educated me better on her struggle, I can work on taking my better end of the stick and giving her equal room on it.

    • I’m glad my article has helped you come to a greater understanding!

      Side note: A lot of trans people use different words to describe themselves, and it can be difficult to know what to use. For example, I am not an MtF, and don’t use that language to describe my experience. It’s generally the easiest to go with “trans woman” and “trans man” nowadays than MtF or FtM. It’s a good default for trans people you don’t know that well, that ruffles the least feathers. Thanks for reading!

  13. Thanks for this. It helps me to explain (even to myself) how my dysphoria about my wide hips, as a trans man, is not the same thing as a cis woman feeling “fat”. I have a supposedly ideal waist/hip ratio – for a woman – and it just looks very wrong and disproportionate to me when I see myself in a full-length mirror. Even when I lose weight the proportions stay the same and keep bothering me. I don’t see a curvy woman, I see a misshapen man, and it depresses me. I’ve recently started testosterone and hope the fat redistribution is going to help. Anyway, thanks for explaining it better than I could!

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