Various forms of body dysphoria—including gender dysphoria, body integrity dysphoria, and body dysmorphic disorder—are deeply related to disruptions in the sense of self, particularly in how the brain integrates embodiment (the felt experience of the body) with identity (the conceptual sense of “who I am”).
These conditions involve mismatches between the subjective experience of the self (who I feel I am), and the perceived or physical body (how my body appears or feels). This mismatch implicates specific neural networks and regions that contribute to the construction of the embodied self. This can result in a personal struggle to come to terms with differences between perceived and experienced self.
When it comes to gender dysphoria it is no longer a private medical issue about dealing with personal problems of coping with one’s view of self. It has taken on a contentious political dimension that impacts not only the individual with the dysphoria, but also affects other people, especially women, and how the trans-lobby and weak politicians have changed policy and law.
Forms of Body Dysphoria & Neural Basis
1. Gender Dysphoria
- Experience: Incongruence between experienced gender identity and assigned sex at birth.
- Relation to Self: Affects the core narrative and embodied sense of self.
- Brain correlates:
- Insula: Disrupted interoceptive and emotional body awareness.
- mPFC: Involved in identity formation and gender representation.
- Structural/functional differences in brain regions associated with body perception (e.g., somatosensory cortex, anterior cingulate, hypothalamus).
- Evidence: fMRI studies show brain activity patterns in transgender individuals that more closely resemble their experienced gender than their assigned one, particularly in self-related tasks.
2. Body Integrity Dysphoria (BID)
- Experience: Desire to amputate a healthy limb because it feels “not part of the self.”
- Relation to Self: Distorted bodily self-awareness; a limb is disowned at the perceptual/identity level.
- Brain correlates:
- Right superior parietal lobule: Associated with body ownership and multisensory integration.
- Premotor cortex and insula: Integrate touch, position, and body schema.
- Evidence: Reduced connectivity in brain regions responsible for integrating bodily signals and constructing body ownership. The limb is intact, but not felt as “mine.”
3. Body Dysmorphic Disorder (BDD)
- Experience: Preoccupation with imagined or minor bodily flaws.
- Relation to Self: The aesthetic self becomes pathologically distorted—how one sees themselves is at odds with reality.
- Brain correlates:
- Orbitofrontal cortex: Overactive in self-monitoring and error detection.
- Amygdala and insula: Heightened emotional response to appearance-related stimuli.
- Occipitotemporal cortex: Altered visual processing of faces and bodies.
- Evidence: Functional imaging shows hyper-focus on details of the face/body, and difficulty integrating a coherent visual body image.
These forms of dysphoria reveal that the sense of self is not a monolithic entity—it’s layered and distributed:
| Level of Self | Description | Neural Substrate | Disrupted in… |
|---|---|---|---|
| Embodied self | The sense of owning a body, having a location and agency | Insula, parietal lobes, premotor cortex | BID, gender dysphoria |
| Narrative self | The autobiographical identity—who I am over time | mPFC, PCC, hippocampus | Gender dysphoria |
| Social/aesthetic self | How I appear to others or believe I do | OFC, visual cortex, amygdala | BDD |
Body dysphorias are expressions of fractured self-experience, often rooted in neurologically and psychologically measurable dissociations between aspects of the body and the self. They do not imply delusion or insanity, but rather a misalignment between brain-level representations of the body and one’s internal identity. They often involve core regions tied to self-perception, body ownership, emotion, and social identity.
Treatment
It is generally the case that clinical treatment of dysphorias aims to reduce or resolve the dysphoria itself—but how that is done varies greatly depending on the type of dysphoria, the individual’s needs, and evolving ethical standards.
The core goal across cases is to alleviate the suffering caused by the mismatch between self-experience and bodily or identity representations. However, how that’s achieved differs by condition and philosophical/clinical approach.
The general clinical strategy for dysphorias can be summaraised as:
- Primary aim: Reduce psychological distress and improve functioning
- Not necessarily: Restore a “normative” body or identity
- Often: Align external realities (body, environment) with internal experience when that is stable and persistent
Examples by Dysphoria Type
1. Gender Dysphoria
- Goal: Align body and social role with internal gender identity.
- Treatment may include:
- Psychotherapy: Supportive, exploratory, not reparative.
- Social transition: Changing name, pronouns, clothing.
- Medical transition: Hormone therapy, surgeries.
- Ethical approach: The dysphoria is treated by affirming the identity, not by attempting to “correct” it toward the assigned sex.
- Effectiveness: Transition (social and/or medical) often results in substantial reduction in dysphoria and improvement in quality of life, according to major clinical studies (e.g. WPATH guidelines).
2. Body Integrity Dysphoria (BID)
- Goal: This is highly controversial and medically complex.
- Typical treatments:
- Psychotherapy (often ineffective)
- Experimental use of VR, neurofeedback, or brain stimulation
- Surgical amputation: Ethically debated. A very small number of surgeons have performed amputations with informed consent, resulting in reduction of distress, but this is rare and medically contested.
- Clinical dilemma: When the sense of body ownership doesn’t respond to therapy, clinicians face the challenge of respecting autonomy while avoiding harm.
3. Body Dysmorphic Disorder (BDD)
- Goal: Correct distorted body image perception, not the body itself.
- Treatment:
- Cognitive Behavioral Therapy (CBT): Targets faulty beliefs and behaviors.
- SSRIs: Often effective, due to overlap with OCD-like patterns.
- Not recommended: Cosmetic surgery—can worsen symptoms since the dysphoria is about perceived flaw, not actual appearance.
| Dysphoria Type | Core Strategy | Example of Alignment |
|---|---|---|
| Gender Dysphoria | Affirm identity, adapt body/social role | Hormones, surgery, social support |
| BID | Unresolved; experimental | Rare surgical cases, neuromodulation |
| BDD | Challenge beliefs, reshape self-image | CBT + medication, avoid surgery |
While the goal is often phrased as “resolving dysphoria,” the ethics of treatment focus on minimizing suffering and supporting autonomy—not imposing a fixed or “normative” model of self or body.
In gender dysphoria, the most effective and ethical approach is to support self-identification and bring the body/social experience into alignment with the felt self. In BDD, the emphasis is on changing perception, not the body. In BID, treatment is still evolving because the condition challenges current medical norms of body integrity.
However, there are further controversies when it comes to treating gender dysphoria: the medical treatment of the young, and political consequences of affirmation and its impact on women.
Pushback Against Genger Affirmation and Self-ID
There has been increasing pushback in recent years against the affirmative model of care for gender dysphoria, in cases involving adolescents, and especially young children. This pushback isn’t uniform or universally accepted, but it’s shaping public policy, clinical guidelines, and ethical debate in many countries.
The gender-affirmative model holds that clinicians should respect and affirm a person’s stated gender identity, without pathologizing it, support social transition (e.g. name/pronoun change). When appropriate and desired, facilitate medical transition (e.g. puberty blockers, hormones, surgery). This model is based on the belief that:
“Gender diversity is a normal part of human variation, not a disorder to be corrected.”
But why isn’t that the case with other dysphorias? Why is gender dysphoria the special case? Aren’t other dysphorias also “a normal part of human variation, not a disorder to be corrected.” Would it be acceptable to start affirming BID by amputating limbs and carrying out other affirming surgeries?
Concerns About Medicalization in Minors
- Puberty blockers and cross-sex hormones carry irreversible effects on: Fertility, Sexual development, Bone density, Brain development (still under research).
- Surgical interventions (e.g. mastectomy or genital surgery) are irreversible and, if later regretted, cannot be undone.
Some critics argue that adolescents may not be developmentally capable of informed consent for such life-altering choices.
Example: Sweden, the UK, Norway, and Finland have revised their national guidelines to de-emphasize early medical interventions, particularly for youth, in favor of psychological exploration first.
Detransition and Regret
A small but visible population of individuals have detransitioned—returned to living as their birth-assigned gender. Some feel that medical transition was rushed or encouraged without adequate exploration of other factors (e.g., trauma, autism, internalized homophobia). While detransition rates are low overall, some critics argue that the lack of long-term follow-up studies makes it difficult to accurately assess regret.
Ideological vs Clinical Framing
Some argue that the affirmation-only approach is politicized and discourages neutral, exploratory psychotherapy. Concern exists that therapists feel pressure to affirm gender identity without deeper assessment of psychological complexity (e.g., co-occurring conditions like depression, trauma, or neurodivergence). Critics say this may foreclose developmental possibilities, especially in adolescents whose identities are still forming.
There is also a marked political aggression shown to detransitioners by the trans-ideology movement, that pressures people to transition in the first place then demonises those that regret it.
Rapid-Onset Gender Dysphoria (ROGD) [Highly Controversial]
Rapid-Onset Gender Dysphoria describes a phenomenon where adolescents, especially natal females, develop gender dysphoria suddenly, often in peer groups. Critics say it may reflect social contagion, trauma, or identity distress—not a stable transgender identity. This term is not officially recognized by most medical bodies (e.g. APA, WPATH), but it has driven political and clinical debate, especially around screening and gatekeeping.
Responses from Medical Institutions
Revisions in Guidelines:
- UK (NHS): Closed the Tavistock gender clinic in 2022, replacing it with regional centers emphasizing broader psychological assessment.
- Sweden/Finland/Norway: Moved toward psychotherapy-first models, allowing medical interventions only under strict criteria.
- WPATH (v8): Continues to support access to care but encourages individualized assessment and greater caution with youth.
Core tension:
How to balance autonomy and access vs safeguarding and caution, especially for young and vulnerable individuals.
| Issue | Debate |
|---|---|
| Consent | Can minors consent to irreversible treatment? Should parents/clinicians delay transition until adulthood? |
| Identity Formation | Is gender identity always innate and stable, or can it evolve through adolescence? |
| Gatekeeping vs Affirmation | Does caution protect or harm trans people? Does affirmation suppress legitimate clinical inquiry? |
| Regret and Responsibility | Who is responsible if someone regrets treatment? Should clinicians be held accountable for affirmative pathways? |
Women’s Spaces
There is a greater concern for the way trans-women in women’s spaces impact women that there is for the way trans-men impact men. Why?
Why do women historically have separate spaces and sports?
Women-only spaces arose from a need to protect privacy and bodily safety in a world where women were, and still are, at greater risk of sexual violence. They also ensure dignity and comfort during vulnerable acts like undressing, using the toilet, or seeking refuge (e.g., shelters), all of which are opportunities for male predators to take advantage of women. The safe spaces further acknowledge physical and social differences between men and women, including societal gendered power dynamics.
These spaces include: Bathrooms and locker rooms, Shelters for survivors of domestic or sexual violence, Prisons and inpatient facilities, Changing rooms and some female-only services (e.g., spas)
Women’s sports exist because biological males (on average *) have substantial physical advantages in speed, strength, endurance, and size due to male puberty and testosterone. Fairness and safety in athletic competition requires separation based on sex, not identity. Without this separation, women would be systematically outperformed in nearly all elite sports.
* It is the case that many women are stronger than many men. Comparing the bell curves of the distribution of stregth in men and women there will be some overlap. However, competetive sports do not pit strong women against weak men, they select for the strongest. And it has been shown over and over that trans-women that would be below average in a men’s competition tend to win easily when they compete against women.
The Religious Problem
Religious or cultural values may prohibit women from being seen by males while undressed. This is a particularly contencious point, politically, because there cross-overs of interests and political views.
The Trans-ideology lobby is typically ‘left-wing aggressive progressive’, and will demonise Christians for trying to impose their religiously motivated restrictions on how people live their lives. This has been the case when Christianity was explicitly homophobic, but even now, when homosexuality is accepted, or at least tolerated, in modern Christianity, the trans-lobby will be hightly critical of Christians that express their religious views on the matter.
However, the left has an odd tolerance for Islam, which has arisen out of Muslims initially being a minority in the West, and where the West has historically colonised what are seen of as ‘Muslim lands’. What they are keen to neglect is that ‘Muslim lands’ were aggressively colonised Christian and Jewish lands … but, one’s view of history is selective when current politics matters. (In a wider context, there is also the Red-green alliance that hangs over us, where both the far left and the far right of Islam are allied in opposition to democratic free market capitalist West.)
It is no easier for feminist critics of Trans-ideology, because many of them are also of the left progressive, and have been part of the ‘left-wing aggressive progressive’ (with some justification) when criticisng men. Many of them too are reluctant to criticise Islam for fear of stoking the perceived ‘far-right’.
But, as it happens, the regressive Islamic ideology does discriminate against women in many ways, and sees both homosexuality and transgenderism as corruptions of the human spirit. The idea that homosexuals should be “thrown off high places” has been reified by ISIS and other factions of Islam; and it is not far below the surface of the sentiments of many Muslims in the West.
This is a bit of a dilemma for gender critical feminists, though some have become more outspoken about it, such as Kellie-Jay Keen aka Posie Parker.
The Self-ID Problem
A major problem has arisen with Self-ID laws or policies that allow individuals to declare their gender identity (e.g., as a woman) without medical, surgical, or legal requirements—in some cases, without even psychological assessment.
Allowing anyone to enter women’s spaces based on self-identification creates a loophole that bad-faith actors (biological males) could exploit. Examples are: changing rooms or shelters where women are undressed or sleeping; cases where biological males convicted of sexual crimes identify as women and request transfer to female prisons.
Critics emphasize: Not all trans women are predators, but all predators are opportunists—and policy matters more than intent.
Many women are uncomfortable undressing or using intimate spaces with someone biologically male, regardless of identity. Critics argue that compelled exposure to male-bodied individuals violates women’s bodily autonomy and consent.
Trans women who went through male puberty retain significant athletic advantages, even with hormone therapy. In several sports, trans women have outperformed female competitors and taken spots in competitions, podiums, or scholarships. Female athletes may feel unable to speak out for fear of being labeled transphobic, creating a climate of suppressed dissent.
Policy Landscape: A Global Variation
Different countries have taken different approaches:
- UK: Protects single-sex spaces under the Equality Act; debate ongoing over gender recognition reform.
- USA: Highly state-dependent; Title IX interpretations vary.
- Nordic countries: More cautious in extending self-ID to female-only spaces.
- Canada & Ireland: Self-ID laws with few restrictions; some public controversy followed.
Closing Thoughts
This issue doesn’t have easy answers, but thoughtful policy needs to:
- Respect the dignity of trans individuals, while
- Preserving hard-won protections for women, particularly in safety-critical spaces and competitive arenas.
This will likely involve nuanced distinctions—e.g., between informal public bathrooms, high-risk environments like prisons, and regulated domains like elite sports—rather than one-size-fits-all solutions. The public bathroom is probably the easiest to solve, with more single occupant rooms, rather than a room with cubicles. Prisons and sports need to be segragates spaces. Sports are always for elites – most men and women do not make it into elite sports.
That does mean that there are some social costs to being trans-gendered, beyond those experienced as a result of the dysphoria directly. There’s more focus from the trans-ideology movement on how sex-based space affect trans-women, when in reality the really vulnerable members of the trans community are trans-men (i.e. women). While sex-based spaces keep trans-women out of women’s spaces, must trans-men therefore use women’s spaces because they are women? What friction will ‘they ‘passing’ trans-men suffer when women are already opposing the presence of male looking trans-men.
To counter that concern we might wonder how a passing trans-man would fare if they continued to use men’s bathrooms – they should fare no worse than many men that appear to be effeminate, whether gay or straight. There is a unspoken rule in men’s bathrooms that you don’t make eye contact or interact with other men … glory holes aside.
There are other associations with gender dysphoria that blur the issue: political persuasion, sexual kink, drag, homosexuality, non-binary politics.
We don’t have this political fallout with other dysphorias, because they do not have a related political activism that makes use of them for other goals, and they don’t have difficult consequences for half the population, women.
The social contagion aspect of gender dysphoria conflated with political activism and the weaknesss of policy makers that respond too easily to fashion, has caused a lot of conflict.
This may take a long time to resolve. In the meantime it will probably be the case that harmless ‘passing’ trans-women and trans-men will continue to use the batchroom of their choice
Ramblings 