I have to admit, it's been awhile since I've read up on body dysmorphic disorders, so I'm not highly knowledgeable of it, but it typically comes with a high rate of comorbidity with other disorders, and typically, according to research, their attempts to modify their body does make things worse (I have no experience with people who have that disorder, so I don't know their attitudes regarding psychology and psychologists). Some psychs do consider gender dysphoria a body dysmorphic disorder, but they are of a minority of psychs and gender dysphoria does not follow the patterns of body dysmorphic disorder.
With gender dysphoria, it's not an issue with a particular area of your body, or body odor, or anything like that, but having an internal identity that does not match the sex of the body you was born with. Typically transsexuals show psychological improvement as they move along with their transition. And many transsexuals aren't particularly in broadcasting their lives to the world, or disclosing it to someone gathering data for a study, as they wish to simply get on with their lives. Of course many will take the time to explain, if you ask, and would rather you ask than make foolish assumptions, but we tend to not identify with the "trans" part unless it is relevant.
This is what the book actually says about it... well skipping all the introductory stuff, here's the controversy, here's side 1, here's side 2, etc.
"Various theories have been proposed to explain gender identity disorder (Carroll, 2007;
Gehring & Knudson, 2005; Doctor & Neff, 2001), but research to test these views has
been limited and generally weak. Many clinicians suspect that biological—perhaps
genetic or prenatal—factors play a key role in the disorder (Henningsson et al., 2005;
Bailey, 2003).
Consistent with a genetic explanation is evidence that the disorder sometimes runs
in families (Green, 2000). In addition, one biological study has received considerable at-
tention (Zhou et al., 1997, 1995). Dutch investigators autopsied the brains of six people
who had changed their sex from male to female. They found that a cluster of cells in the
hypothalamus called the bed nucleus of stria terminalis (BST) was only half as
large in these people as it was in a control group of “normal” men. Usually, a woman’s BST is much
smaller than a man’s, so in effect the men with gender identity disorder were found to
have a female-sized BST. Recent studies tell a similar story (Swaab, 2005). Scientists do
not know for certain what the BST does in humans, but they know that it helps regulate
sexual behavior in male rats. Although other interpretations are possible, it may be that
men who develop gender identity disorder have a key biological difference that leaves
them very uncomfortable with their assigned sex characteristics...
Types of Treatment for Gender Identity Disorder
Many people with gender
identity disorder receive psychotherapy (Affatati et al., 2004); however, controlled stud-
ies indicate that most adults with the disorder do not come to accept completely their
birth gender through psychological treatment (Carroll, 2007). Thus, a large number of
individuals seek to address their concerns and conflicts through biological interventions (see The Media Speaks
on the next page). For example, many adults with this disorder change their sexual characteristics by means of
hormone treatments (Andreasen & Black, 2006; Hepp et al., 2002). Physicians prescribe the female sex hormone
estrogen for male patients, causing breast development, loss of body and facial hair, and change in body fat distribution. Similar treatments with the male sex hormone testosterone are given to women with gender identity disorder.
Hormone therapy and psychotherapy enable many persons with this disorder to
lead a satisfactory existence in the gender role that they believe represents their true
identity. For others, however, this is not enough, and their dissatisfaction leads them to
undergo one of the most controversial practices in medicine:sex-change, or
sexual reassignment, surgery (Andreasen & Black, 2006; Hepp et al., 2002). This surgery
is preceded by one to two years of hormone therapy. The operation itself involves, for
men, amputation of the penis, creation of an artificial vagina, and face-changing plastic
surgery. For women, surgery may include bilateral mastectomy and hysterectomy. The
procedure for creating a functioning penis, called phalloplasty, is performed in some
cases, but it is not yet perfected (Doctor & Neff, 2001). Doctors have, however, devel-
oped a silicone prosthesis that gives the patient the appearance of having male genitals.
Studies in Europe suggest that 1 of every 30,000 men and 1 of every 100,000 women
seek sex-change surgery (Carroll, 2007; Bakker et al., 1993). In the United States, more
than 6,000 persons are estimated to have undergone this surgical procedure (Doctor &
Neff, 2001).
Clinicians have debated heatedly whether sexual reassignment is an appropriate
treatment for gender identity disorder. Some consider it a humane solution, perhaps
the most satisfying one to people with the pattern. Others argue that sexual reassign-
ment is a “drastic nonsolution” for a complex disorder. Either way, sexual reassignment
surgery appears to be on the increase (Olsson & Moller, 2003).
Research into the outcomes of gender reassign-
ment surgery points in favorable directions, although
generally most such research has significant meth-
odological flaws (Carroll, 2007). According to these
investigations, the majority of patients—both female
and male—state satisfaction with the outcome of
the surgery and report subsequent improvements in
the social, psychological, and occupational spheres
of their lives, particularly improvements in self-
satisfaction and interpersonal interactions (Michel
et al., 2002). Improvements in sexual functioning
after surgery, however, are often lacking (Schroder &
Carroll, 1999).
The rate of “poor” sexual reassignment out-
comes appears to be at least 8 percent (Carroll, 2007;
Abramowitz, 1986). Female-to-male patients con-
sistently show the most favorable psychosocial out-
comes. Those who display the autogynephilic type
of gender dysphoria (that is, those whose problems
seem to evolve from transvestic fetishism) are more
likely than those with the other types of gender dysphoria to regret sexual reassign-
ment surgery and to have poor outcomes. Finally, patients with serious pretreatment
psychological disturbances (for example, a personality disorder) are particularly likely
to regret the surgery and are more likely than others to later attempt suicide. All of this
argues for careful screening prior to proceeding on to this treatment approach and, of
course, for continued research to better understand both the patterns themselves and
the long-term impact of the surgical procedure.
Our gender is so basic to our sense of identity that it is hard for most of you to
imagine wanting to change it, much less to imagine the feelings of conflict and stress
experienced by those who question their assigned gender. Whether the underlying
cause is biological, psychological, or sociocultural, gender identity disorder is a dramatic
problem that often shakes the foundations of the sufferer’s existence."
I think somewhere around 474 it starts. And no, there is no way I'm going to try to fix the formatting of this.