Why Do Transgender People Hate Their Bodies?
Gender dysphoria is a symptom masquerading as a diagnosis
I did not believe in content warnings until I wrote this article. I figured that adults should be able to manage the simple act of reading a report of an academic paper without too much difficulty. But if you have apotemnophobia, you might want to skip this one, as it really is the stuff of nightmares.
Because many websites track what we read to make suggestions and drive our engagement, every now and again I will get an automated email recommending a new paper on gender that I had not heard anyone discuss so far. And so, the algorithm directed me to Erich Kasten’s case study about a patient diagnosed as suffering from both ‘body integrity dysphoria’ and gender dysphoria, published in the open-access journal Academia Mental Health and Well-Being in late October 2024.
Since at least the curious accident which Phineas Gage endured in 1848, psychiatry has made use of the individual case study. I wish it were true that academic journals were reliable sources which carried out due diligence on the case studies they publish. Since wishful thinking is not sufficient, I will have to prefix this article with the admission that the case study related by Kasten (2024) has not been independently verified by me.
The anonymous patient's story in this case study could be true. It could be a hoax intended to expose the deficiencies and credulity of academia on gender extremism. It could also be masochistic fan fiction. The contemporary gender Weltanschauung is such that any seriously deluded act seems plausible.
What is Gender Dysphoria, Anyway?
I had long been curious about the distinction between body dysmorphic disorder (BDD), body integrity disorder (BID), body integrity identity disorder (BIID), all referring to a preoccupation with self-perceived corporeal defects, and gender dysphoria. In the fifth edition revised text of the Diagnostic and Statistical Manual (DSM-5-TR) the American psychiatrist’s bible, Diagnostic Criteria F45.22 states that BDD would include:
“Repetitive behaviors (e.g., mirror checking, excessive grooming… reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.”
The degree of insight of the psychiatric patient diagnosed with BDD can vary:
“With good or fair insight: The individual recognises that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.”
Page 277 of the DSM-5-TR asserts: “Body dysmorphic disorder should not be diagnosed if the preoccupation is limited to discomfort with or a desire to be rid of one’s primary and/or secondary sex characteristics in an individual with gender dysphoria.”
However, the DSM-5-TR does not explain why the presence of gender dysphoria means that the patient cannot be diagnosed with BDD. It is almost as if a caveat was inserted to provide authority to the claim that people with gender dysphoria are not delusional if they insist that they really were ‘born in the wrong body.’ No-one is supposed to ask the obvious follow-up question: where is your right body, and who has it now?
What I had previously thought of as ‘body integrity disorder’ is now called ‘body integrity dysphoria’ in ICD-11 the International Classification of Diseases, 11th Revision, published by the World Health Organisation. It is defined as the “intense and persistent desire to become physically disabled in a significant way.” ICD-11 notes:
“The desire to become physically disabled results in harmful consequences, as manifested by either the preoccupation with the desire (including time spent pretending to be disabled) significantly interfering with productivity, with leisure activities, or with social functioning (e.g. person is unwilling to have a close relationship because it would make it difficult to pretend) or by attempts to actually become disabled having resulted in the person putting his or her health or life in significant jeopardy. The disturbance is not better accounted for by another mental, behavioural or neurodevelopmental disorder, by a Disease of the Nervous System or by another medical condition, or by Malingering.”
And just as with DSM-5-TR’s categorisation of body dysmorphic disorder, there is a special exception in the ICD-11 definition of body integrity dysphoria for “Gender incongruence of adolescence or adulthood”, without any explanation. It is just not the same, okay? It is not even defined as a subset of the BID category focused on sexual characteristics.
The changing of the word ‘disorder’ to ‘dysphoria’ or ‘incongruence’ is consistent with the desire to reduce stigma for certain elective treatments in the gender-affirming marketplace. For example, if someone wishes to have absurdly large breasts to enhance their career in the adult entertainment industry, we do not question their mental health or life goals; we take their credit card details.
Dysphoria just means ‘not coping,’ from the Greek words for ‘bearing badly.’ Physically removing the body part that we are not coping with removes the problem, in the same way that a guillotine is a proven effective remedy for headache. We do not need to figure out what caused the headache after that.
The Self-amputating Transgender Person
I have written previously about the possibility that the minority of surgeons who carry out radical experimental procedures on misinformed, physically healthy people do so because they enjoy the work, and because nobody stopped them. The case documented by Kasten (2024) added self-amputation to the list of treatments which progressive society no longer seems willing to question. Kasten noted:
“The urge for a disability may be so intense that those affected try to achieve a visual approximation of their desired body image (e.g., binding an undesired part of the body, using crutches, or a wheelchair). People with BID call these behaviors _pretending_. Dissatisfaction with the body can increase to the extent that they go to radical methods, such as freezing limb tissue in dry ice, triggering infection, or amputating by placing the limb on railway tracks.”
The male patient described in Kasten’s study was transgender and referred to using the ‘she’ pronoun in the published paper. This patient “was affected by BID and felt the need for amputation of both legs approximately 20 cm below the knees. No medical or psychotherapeutic therapies were sought; she was too embarrassed to express this need to a doctor or therapist.”
Kasten’s research subject perceived their feet as “false meat.” The paper does not judge the patient, and verges on admiration: “Since the amputation, she feels free and enjoys the appearance of her own body and is proud of having successfully mastered this challenge... there was no therapy, nor was there any recommendation for or against the dry ice method she used to get rid of her feet.”
The paper continues: “Before the amputation, she constantly had to keep her need for the disability as a secret, which laid heavy on her, and the mental pressure caused by BID robbed her the joy in life. The mental pressure caused by the need for a disability made her completely desperate and reduced her concentration and working performance.”
Kasten’s paper includes a lengthy self-report by the patient studied, described as “exciting,” which is illuminating and worth quoting at length:
“From a young age, I have had a dislike of my body. I was born as a boy, and as child, I liked to play with “Transformer” toys, and I was fascinated by the way that they could change form. From about the age of 7 years, I was starting to feel that I would prefer to have been born as a girl. I had many more female friends than male, but I was still a stereotypical boy — playing sports and playing with toys for boys.”
“Just after starting secondary school, I remember getting teased by my friends for being infatuated with a girl in the year above me. In fact, I was not in love with her — I wanted to be her. Everything about her appealed to me — her clothes, her hair, etc. At this point, I really started to question my gender. I would go to bed at night hoping that I would be transformed into this girl, but there was something else that was bothering me.”
“At about the age of twelve, I watched the film “Robocop.” I was fascinated by the thought of losing an unwanted limb yet preserving function with a mechanical device… I then had a bit of an epiphany — what if I was a woman with no feet. This immediately felt right. Everything about this thought fitted with my ideal image for myself.”
“I cross-dressed in private for years and drew lots of pictures of how I saw my ideal self. I became increasingly frustrated with my feet and hated cutting my toenails… It was with the advent of the internet that I began to understand things a bit more. I suddenly found a community of trans friends, and I also started to find information about amputees.”
“In about 2007, I decided I could no longer carry on. I could control the gender issue to some degree by cross-dressing, but I couldn’t do anything about the feet situation (pretending didn’t work for me because I knew I was pretending) … I spent more and more time online in transgender forums, and eventually I discovered some BIID forums. Some of the members of these forums were clearly quite mentally unwell, but I did find a few people who seemed to have a genuine and deep need to change their bodies.”
“I cooled my feet with iced water and then managed to freeze them in dry ice. It took around 6 hours. I had guessed about a 50–50 chance of dying or achieving a successful outcome. I was so frustrated that these odds were acceptable. I stayed at home and went to bed with frozen feet. I don’t remember much after this, but I woke up in hospital… I underwent surgery and achieved bilateral below knee amputations. It was amazing… I was so much happier and also nobody had questioned my sanity! I was worried that I was going to be locked in a mental health facility, but no one noticed.”
“Then the problem struck. I was arrested by the police… they discovered that I had seen videos of an extreme pornographic nature and that I had arranged my own amputations. I was therefore investigated for possession of extreme pornography and insurance fraud… The benefit of being “discovered” is that I am now addressing my gender issues and have started feminizing hormone therapy. I am out to my friends as a transwoman.”
The court psychiatric report on the patient referred to possession of extreme pornographic “image/images portraying act likely to result in the serious injury to person’s private parts.” Let us recap that the DSM-5-TR and ICD-11 BID have categorically stated that the desire to remove body parts, sexual characteristics and gender dysphoria are unrelated. The psychiatric profession no longer stigmatises the most extreme manifestations of sadomasochism, let alone the everyday practice of sexual cruelty.
The patient in this case study went on to write about his wife: “It took her a while to understand (she did some research herself online which helped). She does see it as a “mental illness,” and I think the fact that all the psychiatrists and psychologists I have seen have said that I am otherwise sane has helped her.”
However, the patient’s wife is less understanding about the gender transition. As the patient reported: “She sees herself a bit as a “trans-widow” and that I have betrayed her. Unlike the BID, which previously I didn’t think she would understand or accept, I told her about my gender issues early in our relationship (over 20 years ago).”
“At that point I was a crossdresser and wanted to transition but was able to suppress this. I promised her that if we stayed together then I would never transition. She tolerated my exploration of femininity as long as I did it in private when she wasn’t around. As my gender feelings got stronger, it became difficult for me to suppress it. So, by beginning to express my feminine side she felt that I was breaking a promise to her.”
Conclusion
It was noted in paragraph 12.5 of the Cass Review that even social transition is not necessarily a neutral act; it should be considered an active intervention when carried out by the UK’s National Health Service. In the case study reported by Kasten (2024), we learned of a patient who reportedly began with cyborg fantasies of “Transformer” robots and experienced transgender identification in childhood, progressing through private cross-dressing to consuming criminalised online content and extreme acts of self-mutilation.
Kasten’s case study cites other examples of BID and gender dysphoria co-existing. It seems the gender industry supports the right to spiral into total madness under the all-powerful principle of bodily autonomy.
There is still a case for recognising gender borne badly as a symptom of serious dysfunction within an individual that needs significant help. That person might need protection from themselves, rather than affirmation. The DSM and ICD need a rethink where gender and corporeal self-hatred are concerned, at the very least.
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