#strife in some capacity most likely (going into web development as a woman as far as i need the public to be concerned)

[quitedisastrous]

life was so much easier three days ago when i was detaching myself from reality and spending all of my free time shiny hunting

[decodingellipses]

What It's Like to Be Transgender and Face Dysphoria and Body Dysmorphia at the Same Time

This piece is part of @allure's coverage of National Eating Disorder Awareness Week

As someone with a fluctuating self-image and a trans person who feels a simultaneous external demand and internal anxiety to continuously communicate my gender, I’ve never felt at peace with my appearance. Sometimes my desire to be seen can be confusing; I barely have a solid grasp on what I look like, especially to other people. How I feel about myself is nearly always about other people.

Understanding myself through the eyes of others provides a blueprint for me to have control over my self-image. In part, I'm hesitant to admit that maybe the feeling that control eludes me is what it means to have body dysmorphia and gender dysphoria concurrently. Maybe these things are in the driver’s seat more days than I am, and that is a reality I fear confronting.

The Origin Story of My Body Image Issues

Both of my parents grew up poor in Jakarta, Indonesia. With a desire to shift the trajectory of the future for them and their children, they found and worked well-paying jobs. They raised my siblings and me in Jakarta, but in contrast to their childhoods, we were financially well-off. To us, food was more than just food — it signified financial safety, a lack of scarcity and hunger. For my parents, my siblings and I were not just children, we were pockets in which they could invest assurance and safety; a second chance to witness childhoods without want.

My parents worried about us ever going hungry, and by eight years old, I was consuming cod-liver oil supplements daily and eating almost nonstop. Physically, I came to embody abundance because, from my parents’ perspective, I should have never gone hungry. But this physicality was also a symbol of shame, because from everyone else’s perspective, I was merely a fat kid. In my consumption of the safety my parents provided, I was losing some of my agency as societal fatphobia affected me. My complex relationship with my body began early; with every look in the mirror, I asked myself, "Am I to be thankful or remorseful for this body?"

Realizing I Had Body Dysmorphic Disorder

Contrary to what I was told by my environment, I felt indifferent about my body fat. It meant very little to me, though I disliked the way it shaped how people treated me. As a preteen, I don’t recall feeling embarrassed about being fat, but I think that’s one of the survival tactics you develop when you’re subject to harassment as a fatter kid in class and at family gatherings.

Though most of my childhood didn’t revolve around my weight, I recall feeling frustrated — even confused — when I had to look at photographs and footage of myself. In my head, I had a very clear image of what I looked like, and yet it was far from what I saw in pictures and videos of myself. Maybe my weight was part of that gap in perception, but it felt deeper and heavier than size. Body weight can change, and I feared that the dissonance between how I saw myself and how I actually appeared would never go away, even if the body weight did. I recognize this now as body dysmorphic disorder (BDD).

“The main component of BDD in a person is the primary feeling they are not who they are, having displeasure, and being unable to accept oneself physically,” says Emily S. Rosen, a licensed clinical social worker in New York City, trained in modern psychoanalysis and Gestalt psychotherapy. “Sometimes people see themselves differently than they are; like you see something in yourself that might not be there, but it feels like it’s there.”

To work through BDD, Rosen tells Allure, “I believe that if we had more compassion for ourselves, we would have more compassion for each other.”

I have yet to fully embrace that compassion for myself, but coming out as a trans woman and pursuing a medical transition at age 18 was a huge step for me in reclaiming my body. It was monumental for me to say, “No, I’m not a boy, I’m actually a girl,” because I felt like I was taking back my physical narrative. But I soon found that I was unprepared for the additional set of complexities and questions transitioning brought up.

Understanding Gender Dysphoria

Similar to BDD, gender dysphoria (GD) occurs when there is a disparity between one’s gender and the perception of their gender through societal constructs. Transitioning for me was a way to work with my BDD, but not because I was initially dysphoric about my gender. In college, I recognized my appearance less and less as testosterone gradually increased and affected my development, changing physical aspects such as bone structure, face shape, hairline, body hair, and more. I figured if testosterone drove me to perceive myself as masculine in a debilitating way, the only answer was to undo its effects by going on estrogen.

A few weeks after coming out, I scheduled an appointment with a psychotherapist to obtain my approval letters to undergo hormone replacement therapy (HRT), in which the testosterone in my blood would gradually be substituted with a prescribed dosage of testosterone blockers alongside estrogen. As an Internet kid, it wasn’t hard to surf the Web to prepare myself for the questions psychiatrists would ask me before determining whether or not HRT would be a good fit for me.

Shortly after I got my approval letters diagnosing me with gender identity disorder (GID), I met with Carolyn Wolf-Gould, a family physician who, since 2012, has worked at the Gender Wellness Center in Oneonta, New York, a facility that has worked with over 700 trans patients. During our first physical exam, she felt my throat for what was supposed to be an Adam’s apple. When she didn’t feel anything there, she said, with a promising grin, “Ah, you’re going to be just fine.” Before that moment, I’d never thought to have an opinion about my neck's appearance.

I believe she meant to assure me that an Adam’s apple, or lack thereof, was not something for me to be dysphoric about, but this moment taught me something bigger: There is a mold of what a woman should look like, and it was possible for me to fit that mold. Yes, it was comforting that nothaving an Adam’s apple was one less thing to worry about, but in that moment, I began second-guessing other aspects of my appearance.

After our appointment, I created a routine for myself. To avoid a five-o-clock shadow that I wasn’t even sure was an issue, I began color-correcting my face before applying makeup. I covered myself up with cardigans to assuage the fear that my shoulders were too masculine. I dressed in hyperfeminine clothing because I wanted to minimize the risk of being perceived as anything other a woman.

Because of BDD, I had always had a generally strange perception of myself. When I transitioned, I noted the pressures and expectations of presenting as a woman and eventually developed GD, which gave me an idea about exactly how I wanted to look. I went from wanting to just realistically recognize myself in the mirror to wanting to see myself as a woman, without a doubt.

The Compounding Effects of My Dysmorphia and Dysphoria

Because BDD and GD coexist, I need people in my life to understand the varying capacities of strife they cause me and how the two can compound the effects of each other on a day-to-day basis. Having gender dysphoria has forced me to be more in tune with myself, perhaps too much. When communicating my gender, I am hyper-aware of the way I present myself. Though I wish I didn’t have dysphoria, having some grasp on my appearance lessens the dysmorphia that blurs my perception of self. But on certain days my dysmorphia still gets the better of me, and when I see my reflection, I’m back to a place of confusion. At other times my dysphoria has a strong presence, and the effort to stand in my womanhood feels embarrassing and ineffective.

I don’t need doctors or therapists to validate that I am a girl who has a body, and that my body and gender are never going to be mutually exclusive, be it by my standards or someone else’s. “The number one misunderstanding of gender dysphoria is that it needs a pathological diagnosis of gender identity disorder, or GID, under the Diagnostic and Statistical Manual (DSM),” Wolf-Gould tells me. “The reality is that many trans people aren’t dysphoric and still need treatment. Then, how do they get cover[ed] in insurance? Thankfully, now there’s a new diagnosis: ‘gender incongruence,’ which means there’s a mismatch without any overlay of depression or upset-ness.”

I have no blueprint or calendar or meteorology report to predict the things that might impact my day. A few weeks ago, on my way home from school, it rained suddenly. On the sidewalk, I walked by a mother twirling her daughter in the rain. In between the patter of raindrops, I heard the clear joy in the girl’s laughter. I felt it ground me, reminding me of when I lived in Indonesia. I loved the way the beach swallowed my body whole. The ocean water was the only thing that understood my body's changes. I could stand still or swim, and know with full certainty that the water would still envelop every inch of me. I want to know how to live like that on land.

Ridding myself of dysmorphia and dysphoria seems unimaginable, and the shame of being truthful about my body image keeps me in silence. Daily, I am working on breaking that remorse, finding reflection not in images, but in stories.

*edits assisted by Rosemary Donahue and the team at @allure*