Dysmorphia vs Dysphoria Explained (Height, Gender & Beyond)

Dysmorphia vs dysphoria: What is the distinction between these two very similar disorders that both correspond to a dissatisfaction with an individual’s physical characteristics? This article will untangle the confusion to provide a clear overview of their differences, the influence of gender, height, and limbs on quality of life, and the potential treatment options available.

The Difference Between Dysmorphia and Dysphoria

There are a few primary characteristics of dysmorphia and dysphoria that can be used to distinguish them. Before exploring each term in detail, a brief overview will be provided for each.

Dysmorphia: A clinically-treated mental disorder whereby an individual obsesses over perceived flaws (often inconsistent with reality) of their physical image or a specific body part. It is typically treated with a combination of Cognitive Behavioral Therapy and medication.

Dysphoria: A dissatisfaction that is not classified as a mental disorder, often regarding gender, height, or limb characteristics, Treatment often involves group support, hormonal therapy, and possibly surgery (primarily sex reassignment surgery or leg lengthening surgery).

Understanding Dysmorphia and Dysphoria

To fully understand the nuances of each, the simplest way is to compare the technicalities contained within the formal and informal definitions of the words. While these two terms can clearly be distinguished from each other, they share many similarities and to complicate matters more, they are often experienced simultaneously.

Dysmorphia

According to Cambridge Dictionary, dysmorphia simply refers to an abnormality or deformation of a specific body part [1]. However the terminology is typically synonymous with Body Dysmorphic Disorder (BDD), which refers to a clinically-relevant mental health disorder in which an individual obsesses over their self-perceived flaws in their appearance [2]. In most cases, these flaws are exaggerated beyond reality, creating a compulsive critique and discontent of one’s body. 

Broadly speaking, body dysmorphia is applied to the obsession and anxiety over personal appearance, often with a hyper focus on particular bodily features such as hair, skin, muscle development, or facial features. Categorized as a mental health disorder, it is often associated with other clinical significant complications, such as obsessive-compulsive disorder (OCD) and eating disorders (for example: anorexia or bulimia).

Dysphoria

Dysphoria, on the other hand, may be a bit more ambiguous. Related to the word ‘euphoria’ (referring to happiness), dysphoria refers to a general dissatisfaction with something. An example is gender dysphoria, which is characterized by an individual with an incongruence between their assigned gender and the actual gender that they experience/express [3]. Another example is height dysphoria. Depending on the degree of discontent, an individual who wishes they were taller (or smaller) may experience height dysphoria. 

Gender dysphoria, body dysphoria (such as height dysphoria), and limb dysphoria are the most common types of dysphoria experienced. Although dysphoria may have serious health implications for the individual, it is merely classified as a diagnostic disorder, not a mental illness, creating ambiguity over the significance of the condition and appropriate treatment modalities [4].

Implications of Health and Quality of Life

Despite difficulties in quantifying and understanding the conversation surrounding dysmorphia vs dysphoria, both should be taken very seriously. In both cases, quality of life and mental health may be significantly impaired.

This article will explore common types of dysphoria with relevant comparisons to body dysmorphia (used interchangeably with BDD). Research and potential treatment options will be highlighted. However, this article is solely intended to be informative; it is recommended to talk with a medical professional regarding health concerns and treatment options available to you.

Gender Dysphoria

A very common type of dysphoria, gender dysphoria is intricately tied to other forms of dysphoria and dysmorphia. By experiencing distress over their assigned gender, individuals may experience BDD or height dysphoria due to the incongruence of their physical stature and expressed/experienced gender.

Gender dysphoria is often deeply connected to height dysphoria, because height is strongly related to gender stereotypes and physical characteristics. For example, an individual that experiences an incongruence with their assigned gender, may subsequently experience dysphoria with their height if it does not align with their experienced gender. This creates a positive feedback loop, in which gender dysphoria may increase the experience of height dysphoria, which consequently amplifies gender dysphoria. More on height dysphoria will be covered in the next section.

Diagnosis

Gender dysphoria involves the strong desire to be of another gender, which may result in the desire to change physical sex characteristics. However, it must be noted that not all transgender or gender diverse individuals will experience gender dysphoria [3]. 

The technical definition, as provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is “a marked incongruence between their experienced or expressed gender and the one they were assigned at birth” [5]. This turmoil contributes to the onset of other challenges, including interpersonal conflicts, depression, anxiety, and potentially suicidality. Therefore, psychiatric support and a professional, clinical diagnosis is recommended.

Impact

In one study, gender dysphoria in high school students was estimated to be between 1.2% and 2.7% of the population [6]. With documentation correlating gender dysphoria with increased rates of other psychiatric conditions including suicide, this prevalence warrants significant attention [7]. A larger survey in the United States found that 1.4 million individuals (0.4%) identify as transgender [5]. 

The prevalence of individuals identifying as transgender is not an issue. However, there is an unfortunately profound connection between gender dysphoria and psychiatric conditions. Alarming studies found that 28% of the population with gender dysphoria reported problems with substance use, 48% with suicidal ideation, and 24% with at least one attempted suicide [5].

Due to the strong relationship between physical qualities and gender, diagnosing and treating the conditions of gender dysphoria must include a conversation on physical characteristics. A 2021 study concludes that height attainment may influence gender dysphoria in transgender and gender-diverse individuals, because height is strongly correlated with gender [8]. Both height dysphoria and BDD are commonly implicated with gender dysphoria for this reason, creating additional issues and complications.

Treatment

Although many treatment options are available, they may vary significantly from case to case. Further, some researchers conclude that the literature on risk factors and treatment is still unsettled [7]. The most common treatment modalities include interpersonal and professional support, psychotherapy, hormonal treatment, and surgery. 

For many individuals, particularly children, group therapy may be highly beneficial. When considering adolescents and adults, hormone therapy and psychotherapy become viable options to improve quality of life and lessen the burden of the discontentment experienced with gender dysphoria. Finally, surgery has reportedly been very successful in reducing levels of body dissatisfaction and gender dysphoria [9].

When comparing body dysmorphia vs dysphoria, there are many possible overlaps in treatments. However, BDD is often treated with medication such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT), whereas gender dysphoria is not. 

Height Dysphoria

As alluded to previously, dysphoria is also frequently experienced regarding height. Dissatisfaction with height can be easily attributed to BDD in addition to height dysphoria or height neurosis, however there is a technical differentiation that can be made. With BDD, a mental disorder, the dissatisfaction with height is expected to persist, regardless of treatment (for example, stature lengthening surgery) [10]. 

Alternatively, height dysphoria could be alleviated following a successful height altering surgery. Most commonly, this would be a limb lengthening procedure, although height reduction surgeries do occur as well.

Diagnosis

Diagnosing height dysphoria independent of body dysmorphic disorder can be very difficult. What is important to remember, is that dysphoria refers to a general dissatisfaction (lack of happiness), whereas BDD is a clinical disorder characterized by obsessive tendencies and anxiety over a specific body part. Many times, individuals that experience BDD perceive their body more critically than in reality.

While it is very possible for height to be associated with BDD, it is often expressed as a general dissatisfaction with height (dysphoria). Unfortunately, height is not the easiest physical quality to change. Unlike muscle definition or body composition, an alteration in height is beyond lifestyle modifications. Diagnosis is best performed by a professional.

Impact

Often underrecognized by those who do not experience height dysphoria, the prevalence of heightism in society is significant, particularly with social media trends in the digital world. Heightism, otherwise known as height shaming has run rampant in a world of positivity for years now. From TV shows mocking shorter people to reduced rates of corporate success among individuals that are shorter in stature, heightism that contributes to height dysphoria is inescapable for many.

In fact, there are numerous well documented disadvantages of being short. Although the disadvantages are often assumed to apply to men, women also tend to experience a higher quality of living when they are taller. Happiness, career opportunities, physical attractiveness, and even intelligence have all been correlated with height.

Treatment

Although treatment options for BBD are prevalent and well-documented, including the use of SSRIs and CBT, height dysphoria is much more difficult to address [2]. Short-term, temporary solutions such as improved posture and elevated shoes do not offer much promise.

However, effective and permanent solutions do exist in the form of leg lengthening surgeries. By receiving a leg lengthening surgery, a permanent increase in height can be obtained. In terms of attempting to mitigate or eliminate height dysphoria, this appears to be the most promising avenue available.

As with any procedure, there are risks and benefits that need to be carefully considered with leg lengthening surgery. Fortunately, as the technology improves, more resources continue to be made available to inform people of the potential benefits of leg lengthening surgery, the specific procedures involved, and the improvement of fixation devices.

Comparing dysmorphia vs dysphoria, the effectiveness of surgery may vary considerably. While leg lengthening surgery is considered to be highly effective for height dysphoria, the treatment of BDD is much more complicated [10]. Due to the psychological characteristics of BDD, there is a lower chance that surgery will effectively alleviate symptoms, due to underlying and adjacent physical and psychological issues. 

If it is suspected that an individual is experiencing BDD or a combination of height dysphoria and BDD, it is highly recommended that all treatment options are carefully considered with the help of a medical professional.

Limb Dysphoria

Lesser known and discussed, limb dysphoria is another categorization of dissatisfaction with one’s physical features, focusing on specific limbs. Whether limbs are deemed by the individual to be the wrong size (too long or too short, for example) or contain unique features that alter their appearance, the physical characteristics of limbs can have a profound impact on someone’s mental health.

Taking it a step further, there is actually a rare form of limb dysphoria called Body Integrity Identity Disorder (BIID) in which people desire amputation or paralysis on one or more healthy  limbs [11]. Unfortunately, little is understood about the psychological and neurological mechanisms underlying BIID, and thus, appropriate therapeutic interventions are not well defined.

However, limb dysphoria typically is associated with physical attractiveness. One important component of physical attractiveness is symmetry and body proportions. A significant amount of attention is given to body composition and muscle definition, but for many people, body proportions and ratios are just as important. In particular, Leg-to-Body (LTB) and “golden ratios” have been correlated with improved attractiveness, and consequently, advantages in the quality of life experienced.

Given the shared symptoms and characteristics of dysphoria (including gender, height, and limb dysphoria), recommended treatment options for limb dysphoria would be consistent with height dysphoria. Many cases of limb dysphoria relate to LTB ratios, giving merit to the potential benefits of leg lengthening surgery as a permanent solution.

Overview of Key Points

This article has attempted to clearly identify the nuances of dysmorphia vs dysphoria to compare and contrast these two conditions. A general summary of the key points are included below.

Classification

Dysmorphia refers to a clinically-treated mental disorder, most often referring to Body Dysmorphic Disorder (BDD). In this scenario, individuals obsess over perceived flaws, which may be grossly exaggerated or inconsistent with reality. Even with changes to the physical appearance, these intense feelings of dissatisfaction may persist, as the behavior is strongly associated with other psychiatric disorders such as OCD. 

Dysphoria is a general dissatisfaction (or unhappiness), often regarding physical characteristics. This does not share the same clinical classification as a mental disorder. The most common types of dysphoria are gender (an incongruence with expressed gender and assigned gender), height, and limbs.

Treatments Options

Regarding treatment options, it is recommended that dysmorphia is treated with a combination of Cognitive Behavioral Therapy (CBT) and medication, often in the form of Selective Serotonin Reuptake Inhibitors (SSRIs). These are common treatment modalities for clinical mental health disorders.

Alternatively, dysphoria follows the approach of group support (professional psychologists and personal relationships), hormonal therapy (particularly for gender dysphoria), and surgery if applicable. In the case of surgery, this most frequently involves leg lengthening surgery to help alleviate the symptoms of height and limb dysphoria, and in some cases, gender dysphoria.

Closing Thoughts

Dysmorphia and dysphoria are real and serious conditions. Fortunately, growing awareness, research, and development into the diagnosis and treatment opportunities will enable more people to live a happy and fulfilling life.

The most important takeaway is that it is strongly urged that anyone experiencing symptoms of dysmorphia or dysphoria, or anyone who is aware of someone else who may be experiencing symptoms, seeks out professional medical advice. Diagnoses and treatments are complex and require professional assistance to ensure the best outcomes for everyone.

Nevertheless, there are numerous resources to provide more insight into the unique challenges faced by people with dysphoria and/or dysmorphia, as well as some of the promising treatment opportunities to greatly enhance quality of life. For more information, the links and references included in this article are a great place to start if you are interested in learning more. 

References

[1] Dysmorphia. (2021). Cambridge Dictionary. Retrieved from https://dictionary.cambridge.org/dictionary/english/dysmorphia

[2] Body dysmorphic disorder. (2019, October 29). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/symptoms-causes/syc-20353938

[3] Turban, J. (2020, November). What is gender dysphoria? American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

[4] Gender dysphoria. (2020, May 28). National Health Service (NHS). Retrieved from  https://www.nhs.uk/conditions/gender-dysphoria/

[5] Garg G, Elshimy G, Marwaha R. Gender Dysphoria. [Updated 2021 Jul 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532313/

[6] Clark, T. C., Lucassen, M. F., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). The Journal of adolescent health: Official publication of the Society for Adolescent Medicine, 55(1), 93–99. https://doi.org/10.1016/j.jadohealth.2013.11.008

[7] Day, D. S., Saunders, J. J., & Matorin, A. (2019). Gender Dysphoria and Suicidal Ideation: Clinical Observations from a Psychiatric Emergency Service. Cureus, 11(11), e6132. https://doi.org/10.7759/cureus.6132

[8] Roberts, S. A., & Carswell, J. M. (2021). Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology, 9(6), 1679–1688. https://doi.org/10.1111/andr.13034

[9] van de Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., De Cuypere, G., Richter-Appelt, H., & Kreukels, B. (2017). Effects of Medical Interventions on Gender Dysphoria and Body Image: A Follow-Up Study. Psychosomatic medicine, 79(7), 815–823. https://doi.org/10.1097/PSY.0000000000000465

[10] Lee, R. C., Aulisio, M., & Liu, R. W. (2020). Exploring the Ethics of Stature Lengthening as Treatment for Height Dysphoria. Strategies in trauma and limb reconstruction, 15(3), 163–168. https://doi.org/10.5005/jp-journals-10080-1502

[11] Müller S. (2009). Body integrity identity disorder (BIID)–is the amputation of healthy limbs ethically justified?. The American journal of bioethics: AJOB, 9(1), 36–43. https://doi.org/10.1080/15265160802588194